Annals of Thoracic Surgery最新文献

{"title":"Enhancing Graft Patency in Coronary Artery Bypass Grafting: Fluid Mechanics, Anastomotic Techniques, and Flow Dynamics","authors":"Yasunari Hayashi MD, Toshiaki Ito MD","doi":"10.1016/j.athoracsur.2025.01.032","DOIUrl":"10.1016/j.athoracsur.2025.01.032","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 5","pages":"Page 1133"},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Choice","authors":"","doi":"10.1016/S0003-4975(25)00022-0","DOIUrl":"10.1016/S0003-4975(25)00022-0","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 3","pages":"Page A8"},"PeriodicalIF":3.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Society Board","authors":"","doi":"10.1016/S0003-4975(25)00021-9","DOIUrl":"10.1016/S0003-4975(25)00021-9","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 3","pages":"Page A7"},"PeriodicalIF":3.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Memoriam: David Fullerton, STS Past President and Superb Cardiac Surgeon, Educator, Investigator, and Leader (1952-2024)","authors":"John Calhoon MD , Joe Cleveland MD , William Baumgartner MD","doi":"10.1016/j.athoracsur.2025.01.028","DOIUrl":"10.1016/j.athoracsur.2025.01.028","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 5","pages":"Pages 1126-1128"},"PeriodicalIF":3.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Future Is the Present, but Not Always the Past","authors":"Aaron Guo MD, Nahush Ashok Mokadam MD","doi":"10.1016/j.athoracsur.2025.02.001","DOIUrl":"10.1016/j.athoracsur.2025.02.001","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 4","pages":"Pages 916-917"},"PeriodicalIF":3.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Survival With Surgical Ablation of Atrial Fibrillation During Mitral Valve Surgery.","authors":"John B Eisenga, Kyle B McCullough, Jasjit K Banwait, Timothy J George, Kelley A Hutcheson, Robert L Smith, J Michael DiMaio, Justin M Schaffer","doi":"10.1016/j.athoracsur.2025.01.026","DOIUrl":"10.1016/j.athoracsur.2025.01.026","url":null,"abstract":"<p><strong>Background: </strong>Surgical ablation (SA) at the time of isolated mitral valve surgery (MVS) is recommended in patients with preexisting atrial fibrillation (AF). However, SA remains infrequently utilized during MVS with a poorly quantified impact on stroke and survival.</p><p><strong>Methods: </strong>Medicare claims (2008-2019) were queried to identify beneficiaries with preexisting AF undergoing MVS. All-cause mortality and the postoperative incidence of stroke/transient ischemic attack were evaluated as separate endpoints. Overlap propensity score weighting was used to risk-adjust for measured confounding variables. Analyses were repeated using surgeon frequency of SA as an instrumental variable to adjust for unmeasured confounding variables.</p><p><strong>Results: </strong>From 2008-2019, 41,795 Medicare beneficiaries with a preexisting diagnosis of AF underwent MVS. Surgeons were categorized, with 1326 infrequently (bottom quartile) performing SA (<30%; 10,364 beneficiaries) and 740 frequently (top quartile) performing SA (≥62%; 10,476 beneficiaries) during MVS. Beneficiaries undergoing MVS with SA (\"as-treated\" analysis) had a risk-adjusted median survival advantage of 0.56 (95% CI, 0.33-0.81) years (8.85 [95% CI, 8.64-9.04] vs 8.29 [95% CI, 8.11-8.47] years, P < .001 for risk-adjusted survival comparison) compared to those without. Beneficiaries undergoing MVS by frequent SA surgeons (\"surgeon-preference\" analysis) had a risk-adjusted median survival advantage of 0.35 (95% CI, 0.05-0.71) years (8.59 [95% CI, 8.40-8.85] vs 8.24 [95% CI, 7.97-8.40] years, P = .0015 for risk-adjusted survival comparison) compared to surgeons who infrequently performed SA.</p><p><strong>Conclusions: </strong>In Medicare beneficiaries with preexisting AF, concomitant SA during MVS is associated with improved survival, as is undergoing surgery by a frequent SA surgeon. When analyzed based on surgeon preference for SA, the magnitude and time-dependent nature of the treatment effect of SA were substantially different compared to the \"as-treated\" analysis, suggesting that \"as-treated\" analyses may be subject to bias from unmeasured confounding variables.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ideal Timing of Coronary Artery Bypass Grafting After Non-ST-Segment Elevation Myocardial Infarction.","authors":"Anthony V Norman, Matthew P Weber, Mohamad El Moheb, Alexander M Wisniewski, Raymond J Strobel, Alan Speir, Michael Mazzeffi, Aarathi Manchikalapudi, Mark Joseph, Daniel Tang, Ramesh Singh, Mohammed Quader, Jared P Beller, Kenan Yount, Nicholas R Teman","doi":"10.1016/j.athoracsur.2025.01.024","DOIUrl":"10.1016/j.athoracsur.2025.01.024","url":null,"abstract":"<p><strong>Background: </strong>Patients with non-ST-segment elevation myocardial infarction (NSTEMI) benefit from revascularization, but guidelines are vague regarding optimal timing. This study aimed to identify the ideal timing of coronary artery bypass grafting (CABG) after NSTEMI.</p><p><strong>Methods: </strong>Study investigators examined patients with NSTEMI who underwent isolated CABG within 30 days of cardiac catheterization between July 2011 and July 2023 in a multicenter regional collaborative. Patients were stratified into 3 groups: ≤2 days, 3 to 7 days, and 8 to 30 days. Multivariable logistic regression analysis was performed to identify risk factors associated with mortality.</p><p><strong>Results: </strong>Study investigators identified 10,271 patients who underwent CABG: 3464 (34%) of these patients underwent CABG within ≤2 days, 5751 (56%) at 3 to 7 days, and 1056 (10%) at 8 to 30 days. The 3- to 7-day group had the lowest median The Society of Thoracic Surgeons predicted risk of mortality (1.36% vs 1.35% vs 2.09%; P < .001). The ≤2-day group more frequently presented with left main coronary artery disease (19% vs 16% vs 16%; P < .001) and cardiogenic shock (5.1% vs 1.8% vs 2%; P < .001). Mean cardiopulmonary bypass time was similar among the groups (97 minutes vs 97 minutes vs 97 minutes; P = .63). The 3- to 7-day group had the lowest operative mortality (3.2% vs 1.8% vs 4%; P < .001) and major morbidity (14% vs 11% vs 16%; P < .001). After risk-adjustment, the 3- to 7-day window was associated with decreased mortality compared with ≤2 days (odds ratio [OR], 0.56; 95% CI, 0.4-0.78; P < .001) and 8 to 30 days (OR, 0.51; 95% CI, 0.32-0.81; P < .001).</p><p><strong>Conclusions: </strong>CABG between 3 and 7 days after cardiac catheterization for NSTEMI was associated with the lowest risk of mortality. When possible, CABG within this window may afford better outcomes.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Valve Surgery for Patients With Infective Endocarditis: A Comparative Study","authors":"Connor Raikar BA ,&nbsp;Stanley Wolfe MD, MPH ,&nbsp;Luigi F. Lagazzi MD ,&nbsp;Ali Darehzereshki MD ,&nbsp;Nathan Kister MD ,&nbsp;Lawrence Wei MD ,&nbsp;Vinay Badhwar MD ,&nbsp;J. Hunter Mehaffey MD, MS","doi":"10.1016/j.athoracsur.2025.01.023","DOIUrl":"10.1016/j.athoracsur.2025.01.023","url":null,"abstract":"<div><h3>Background</h3><div>Patients with endocarditis frequently require valve surgical procedure, and despite the recent growth of minimally invasive cardiac surgery (MICS) for complex valve operations, consensus recommendations still suggest conventional sternotomy.</div></div><div><h3>Methods</h3><div>The institutional Adult Cardiac Surgery Database of The Society of Thoracic Surgeons (STS) evaluated all patients undergoing valve surgical procedure for endocarditis from July 2016 to March 2024. Patients were stratified by conventional sternotomy vs an MICS approach, including hemisternotomy, right thoracotomy, and robotic-assisted mitral, tricuspid, or aortic valve surgical procedure. Logistic regression assessed the risk-adjusted association with the primary outcomes of STS major morbidity or mortality and the MICS approach by accounting for all covariates in current STS risk models.</div></div><div><h3>Results</h3><div>Of 741 patients undergoing valve surgical procedure for endocarditis, the median age was 37 years, 582 (78.5%) had a substance use disorder, 210 (28.3%) underwent redo sternotomies, and 166 (22.4%) had redo valve operations. MICS was associated with a higher repair rate for mitral valves (76.3% vs 48%; <em>P</em> &lt; .0001) but a lower rate for tricuspid valve (22.5% vs 44.1%; <em>P</em> &lt; .0001), with no difference for aortic valves (8.3% vs 7.4%; <em>P</em> = .372). Before risk adjustment, MICS was associated with longer cross-clamp times (99 minutes vs 86 minutes; <em>P</em> = 0.019) but a lower incidence of STS major morbidity or mortality (15.4% vs 27.8%; <em>P</em> = 0.019). After robust risk adjustment, age (odds ratio [OR], 1.1; <em>P</em> = 0.008), lung disease (OR, 2.2; <em>P</em> = 0.010), preoperative creatinine (OR, 1.3; <em>P</em> = 0.016), and valve repair vs replacement (OR, 0.17; <em>P</em> = 0.002), but not MICS (OR, 1.2; <em>P</em> = 0.807), were independently associated with STS major morbidity and mortality.</div></div><div><h3>Conclusions</h3><div>MICS valve surgical procedure for endocarditis appears both safe and effective, with repair rates and risk-adjusted outcomes similar to those of open surgical procedure.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 5","pages":"Pages 1020-1026"},"PeriodicalIF":3.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Result of a Multicenter Study on the Physician-Modified Fenestrated and Branched Endovascular Grafts for Thoracoabdominal Aneurysms.","authors":"Guangmin Yang, Yepeng Zhang, Haiya Ni, Leiyang Zhang, Ping Wang, Xiaoqiang Li, Ming Zhang, Min Zhou","doi":"10.1016/j.athoracsur.2025.01.025","DOIUrl":"10.1016/j.athoracsur.2025.01.025","url":null,"abstract":"<p><strong>Background: </strong>Physician-modified fenestrated and branched endografts (PMEGs) have emerged as an endovascular solution for managing thoracoabdominal aortic aneurysms (TAAAs) in the past decade. This study evaluated the outcomes and experience of 3 high-volume centers.</p><p><strong>Methods: </strong>Patient data from 3 academic centers in China, spanning from 2017 and 2021, were retrospectively collected and analyzed. Early outcomes were assessed through perioperative morbidity and mortality. Follow-up outcomes included survival, freedom from reintervention, and patency of target vessels.</p><p><strong>Results: </strong>PMEG procedures were performed in 186 patients (156 men; mean age, 68.4 ± 13.4 years) with TAAAs. Fenestrations or branches were used to incorporate 618 target vessels. Postoperative all-cause mortality was 6.5%, with aneurysm-related deaths accounting for 1.6%. Morbidity included acute kidney injury (5.9%), stroke (1.1%), myocardial infarction (2.7%), and limb ischemia, respiratory failure, and bowel ischemia requiring resection (each 1.6%). Transient spinal cord injury developed in 1 patient. With a mean follow-up of 3.4 ± 1.3 years, survival rates were 96% at 1 year and 94% 3 years. The secondary patency rates of target vessels at 1 and 3 years were 99% and 98%, and freedom from reintervention was 95% and 91%, respectively.</p><p><strong>Conclusions: </strong>Fenestrated and branched endovascular aneurysm repair with PMEGs appears to be a safe and effective treatment for complex aortic aneurysms. Although early and midterm outcomes are promising and comparable to those of custom-made devices, further follow-up is essential to confirm long-term efficacy.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conduit Selection in CABG surgery: Mounting RIMA Evidence is Challenging our Beliefs.","authors":"Austin Browne, André Lamy","doi":"10.1016/j.athoracsur.2025.01.027","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.027","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}