Annals of Thoracic Surgery最新文献

{"title":"Outcomes in Children Who Undergo Postcardiotomy Extracorporeal Membrane Oxygenation: A Report From the STS-CHSD","authors":"Tanya Perry DO ,&nbsp;David S. Cooper MD, MPH ,&nbsp;Todd Sweberg MD, MBA ,&nbsp;Marshall L. Jacobs MD ,&nbsp;Jeffrey P. Jacobs MD ,&nbsp;Bin Huang PhD ,&nbsp;Chen Chen PhD ,&nbsp;Ravi R. Thiagarajan MD, MPH ,&nbsp;Marissa A. Brunetti MD ,&nbsp;Javier J. Lasa MD ,&nbsp;Eva W. Cheung MD ,&nbsp;S. Ram Kumar MD, PhD ,&nbsp;Iki Adachi MD ,&nbsp;Awais Ashfaq MD ,&nbsp;Katsuhide Maeda MD, PhD ,&nbsp;Farhan Zafar MBBS, MS ,&nbsp;David L.S. Morales MD","doi":"10.1016/j.athoracsur.2024.07.020","DOIUrl":"10.1016/j.athoracsur.2024.07.020","url":null,"abstract":"<div><h3>Background</h3><div>Children who undergo cardiac surgery may require postcardiotomy extracorporeal membrane oxygenation (ECMO). Although morbidities are considerable, our understanding of outcome determinants is limited. We evaluated associations between patient and perioperative factors with outcomes.</div></div><div><h3>Methods</h3><div>The Society of Thoracic Surgeons Congenital Heart Surgery Database was queried for patients aged &lt;18 years old who underwent postcardiotomy ECMO from January 2016 through June 2021. The primary outcome was survival to hospital discharge. The secondary outcome was survival without neurologic injury. Logistic regression for binary outcomes and competing risk analysis for survival were used to identify the most important predictors. Variables were selected by stepwise procedure using entry level <em>P</em> = .35. Those with <em>P</em> ≤ .1 were kept in the final model.</div></div><div><h3>Results</h3><div>Postcardiotomy ECMO was used to support 3181 patients during the same hospitalization as cardiac surgery: (A) intraoperative initiation of ECMO, n = 1206; (B) early postoperative (≤48 hours), n = 936; and (C) late postoperative (&gt;48 hours), n = 1039. The most common primary procedure of the index operation was the Norwood procedure. Of those with intraoperative ECMO, 57% survived to discharge vs 59% with early postoperative ECMO and 42% late postoperative ECMO (χ²₍₂₎ = 64, <em>P</em> &lt; .0001, V = 0.14). In all groups, postoperative septicemia, cardiac arrest, and new neurologic injury had the strongest association with mortality, whereas postoperative reintubation and unplanned noncardiac reoperation were associated with higher survival.</div></div><div><h3>Conclusions</h3><div>Multiple risk factors impact survival in children who undergo cardiac surgery and postcardiotomy ECMO. ECMO initiated &gt;48 hours after surgery is associated with the poorest outcomes. This is the first step in creating a predictive tool to educate clinicians and families regarding expectations in this high-risk population.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 413-422"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894820","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":"Regionalization of Thoracic Surgical Oncology Bears Fruit in Ontario","authors":"Marissa Guo MD,&nbsp;Peter J. Kneuertz MD, FACS","doi":"10.1016/j.athoracsur.2024.11.015","DOIUrl":"10.1016/j.athoracsur.2024.11.015","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 470-471"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755741","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":"Replacement of Chordae Tendineae With Expanded Polytetrafluoroethylene Sutures","authors":"Tirone E. David MD","doi":"10.1016/j.athoracsur.2024.12.001","DOIUrl":"10.1016/j.athoracsur.2024.12.001","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 259-262"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796530","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(24)01050-6","DOIUrl":"10.1016/S0003-4975(24)01050-6","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Page A4"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348593","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":"Neurocognitive Dysfunction After Short (<20 Minutes) Duration Hypothermic Circulatory Arrest","authors":"G. Chad Hughes MD ,&nbsp;Edward P. Chen MD ,&nbsp;Jeffrey N. Browndyke PhD ,&nbsp;Wilson Y. Szeto MD ,&nbsp;J. Michael DiMaio MD ,&nbsp;William T. Brinkman MD ,&nbsp;Jeffrey G. Gaca MD ,&nbsp;James A. Blumenthal PhD ,&nbsp;Jorn A. Karhausen MD ,&nbsp;Michael L. James MD ,&nbsp;David Yanez PhD ,&nbsp;Yi-Ju Li PhD ,&nbsp;Joseph P. Mathew MD, MHS","doi":"10.1016/j.athoracsur.2024.09.015","DOIUrl":"10.1016/j.athoracsur.2024.09.015","url":null,"abstract":"<div><h3>Background</h3><div>It has long been held that the safe duration of hypothermic circulatory arrest (HCA) is at least 25 to 30 minutes. However, this belief is based primarily on clinical outcomes research and has not been systematically investigated using more sensitive brain imaging and neurocognitive assessments.</div></div><div><h3>Methods</h3><div>This exploratory substudy of the randomized Cognitive Effects of Body Temperature During Hypothermic Circulatory Arrest (GOT ICE) trial, which compared outcomes for deep vs moderate hypothermia during aortic arch surgery, investigated the frequency of neurocognitive and structural and functional magnetic resonance imaging (MRI) deficits with HCA of short (&lt;20 minutes) duration. Neurocognitive deficit was defined as ≥1 SD decline in ≥1 of 5 cognitive domains on neurocognitive testing.</div></div><div><h3>Results</h3><div>Of 228 GOT ICE participants with complete 4-week cognitive data, 74.6% (n = 170 of 228) had HCA durations &lt;20 minutes, including 59 patients randomized to deep hypothermia (&lt;20.0 °C), 55 patients randomized to low-moderate (20.1-24.0 °C) hypothermia, and 56 randomized to high-moderate (24.1-28.0 °C) hypothermia. Of these participants, cognitive deficit was detected 4 weeks postoperatively in ∼40% of patients in all 3 groups (deep hypothermia, 22 of 59 [37.3%]; low-moderate hypothermia, 23 of 55 [41.8%]; and high-moderate hypothermia, 24 of 56 [42.9%]). Furthermore, in a subset of patients with complete MRI data (n = 43), baseline to 4-week postoperative right frontal lobe functional connectivity change was inversely associated with HCA duration (range, 8-17 minutes; <em>P</em> for familywise error rate &lt; .01).</div></div><div><h3>Conclusions</h3><div>Even short durations of HCA result in cognitive deficits in ∼40% of patients, independent of systemic hypothermia temperature. HCA duration was inversely associated with frontal lobe functional MRI connectivity, a finding suggesting that this brain region may be preferentially sensitive to HCA. Surgeons should be aware that even short durations of HCA may not provide complete neuroprotection after aortic arch surgery.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 343-350"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331876","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":"Tophaceous Gout Presenting as a Fluorodeoxyglucose-Avid Anterior Mediastinal Mass","authors":"Matthew Aizpuru MD ,&nbsp;Casey M. Briggs MD ,&nbsp;Rafael E. Jimenez MD, MHA ,&nbsp;Chi Wan Koo MD ,&nbsp;Trenton R. Foster MD ,&nbsp;Sahar A. Saddoughi MD, PhD","doi":"10.1016/j.athoracsur.2024.09.024","DOIUrl":"10.1016/j.athoracsur.2024.09.024","url":null,"abstract":"<div><div>In this case report, we describe an unusual presentation of gout, manifesting as a fluorodeoxyglucose-avid anterior mediastinal mass mimicking a malignant neoplasm on positron emission tomography/computed tomography. The unusual observation of tophaceous gout in the anterior mediastinum is of relevance to chest physicians and surgeons as well as to radiologists and pathologists evaluating patients with lesions in the mediastinum.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 472-475"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373520","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":"Lifetime Management for Aortic Stenosis: Strategy and Decision-Making in the Current Era","authors":"Shmuel Chen MD, PhD ,&nbsp;Andrei Pop MD ,&nbsp;Lakshmi Prasad Dasi PhD ,&nbsp;Isaac George MD","doi":"10.1016/j.athoracsur.2024.05.047","DOIUrl":"10.1016/j.athoracsur.2024.05.047","url":null,"abstract":"<div><div>Aortic stenosis, the most common valvular disease in the Western world, has traditionally been treated with surgical aortic valve replacement (SAVR) but is increasingly treated by transcatheter aortic valve replacement (TAVR). Whereas patients older than 65 years are preferably treated with bioprosthetic tissue valves, there is considerable uncertainty in the choice between TAVR and SAVR. We present various considerations for optimizing the lifelong management of patients receiving bioprosthetic valves (SAVR or TAVR). To maximize life expectancy and to minimize cumulative lifetime risk, we suggest decision-making individualized for patient anatomy and overall (current and future) risk.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 296-307"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blurring of the Lines for Better Outcomes","authors":"Russell Seth Martins MD,&nbsp;Faiz Y. Bhora MD, FACS","doi":"10.1016/j.athoracsur.2024.10.018","DOIUrl":"10.1016/j.athoracsur.2024.10.018","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Page 491"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631897","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":"Metrics for Benchmarking Lung Cancer Surgery Quality: Not Waiting for Godot!","authors":"Sora Ely MD ,&nbsp;Raymond U. Osarogiagbon MBBS","doi":"10.1016/j.athoracsur.2024.10.016","DOIUrl":"10.1016/j.athoracsur.2024.10.016","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 253-256"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559347","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":"Commission on Cancer Standards for Lymph Node Sampling and Oncologic Outcomes After Lung Resection","authors":"Benjamin J. Resio MD ,&nbsp;Kay See Tan PhD ,&nbsp;Matthew Skovgard MD ,&nbsp;Joe Dycoco MS ,&nbsp;Prasad S. Adusumilli MD ,&nbsp;Manjit S. Bains MD ,&nbsp;Matthew J. Bott MD ,&nbsp;Robert J. Downey MD ,&nbsp;Katherine D. Gray MD ,&nbsp;James Huang MD ,&nbsp;Daniela Molena MD ,&nbsp;Bernard J. Park MD ,&nbsp;Valerie W. Rusch MD ,&nbsp;Smita Sihag MD ,&nbsp;Gaetano Rocco MD ,&nbsp;David R. Jones MD ,&nbsp;James M. Isbell MD","doi":"10.1016/j.athoracsur.2024.09.009","DOIUrl":"10.1016/j.athoracsur.2024.09.009","url":null,"abstract":"<div><h3>Background</h3><div>The newest Commission on Cancer standards recommend sampling 3 mediastinal and 1 hilar lymph node stations, 3 (N2) 1 (N1), for lung cancer resections. However, the relationship between the Commission on Cancer standards and outcomes has not been thoroughly investigated.</div></div><div><h3>Methods</h3><div>A prospective institutional database was queried for clinical stage I-III lung resections before the implementation of the new standards. The relationship between the 3 (N2) 1 (N1) standard (“guideline concordant”) and outcomes (upstaging, complications, receipt of adjuvant therapy, locoregional/distant recurrence, and survival) was assessed with multivariable models and stratified by stage.</div></div><div><h3>Results</h3><div>Of 9289 pulmonary resections, 3048 (33%) were guideline concordant and 6241 (67%) were not. Compared with nonconcordant, those that were guideline concordant had higher rates of nodal upstaging (21% vs 13%; odds ratio [OR], 1.32 [95% CI, 1.14-1.51]; <em>P</em> &lt; .001) and in-hospital complications (34% vs 27%; OR, 1.17 [95% CI, 1.05-1.30]; <em>P</em> = .004) but similar adjuvant systemic therapy administration (19% vs 13%; OR, 1.09 [95% CI, 0.95-1.24]; <em>P</em> = .2; 98% chemotherapy). Locoregional and distant recurrences were not significantly improved with guideline concordance across clinical stage I, II, and III subsets. Overall survival was similar in clinical stages I and II, but improved survival was observed for guideline concordant clinical stage III patients (hazard ratio, 0.85 [95% CI, 0.74-0.97]; <em>P</em> = .02).</div></div><div><h3>Conclusions</h3><div>Sampling 3 (N2) 1 (N1) was associated with increased upstaging and complications but not with decreased recurrence or mortality in clinical stage I or II patients. Survival was improved for concordant, clinical stage III patients. Further study is indicated to determine the ideal lymph node sampling strategy across heterogeneous lung cancer patients.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 308-315"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300167","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}