Annals of Thoracic Surgery最新文献

{"title":"Coronary Artery Bypass Grafting With Mitral Annuloplasty or Replacement for Ischemic Mitral Regurgitation in Medicare Beneficiaries.","authors":"Timothy J George, John J Squiers, J Michael DiMaio, Jasjit K Banwait, Paul A Grayburn, Michael J Mack, Justin M Schaffer","doi":"10.1016/j.athoracsur.2025.01.021","DOIUrl":"10.1016/j.athoracsur.2025.01.021","url":null,"abstract":"<p><strong>Background: </strong>Retrospective studies of patients with ischemic mitral regurgitation (iMR) undergoing coronary artery bypass grafting (CABG) with concomitant mitral valve surgery frequently report improved survival with mitral valve repair/annuloplasty (MVr) over replacement (MVR). However, the only randomized controlled trial found no survival difference.</p><p><strong>Methods: </strong>Medicare claims data were queried to identify beneficiaries with iMR undergoing CABG/MVr or CABG/MVR. Kaplan-Meier estimates of survival after CABG/MVr and CABG/MVR were generated, and 20-year restricted mean survival times (RMSTs) were compared. Then, surgeons were stratified by their rate of CABG/MVr into groups with a demonstrated preference for MVr (PA) or MVR (PR). Outcomes were reanalyzed by surgeon preference. Overlap propensity score weighting was used for risk adjustment in all analyses.</p><p><strong>Results: </strong>Among 10,471 beneficiaries with iMR, 6457 (61.7%) underwent CABG/MVr and 4014 (38.3%) underwent CABG/MVR. Risk-adjusted RMSTs were 6.02 years (95% CI, 5.77-6.26 years) after CABG/MVr and 5.57 years (95% CI, 5.33-5.81 years) after CABG/MVR (difference, 5.4 months; 95% CI, 1.2-9.4 months; P = .01). Among 1118 surgeons, 223 were PA surgeons (performed 2191 operations; 89.5% MVr rate) and 235 were PR surgeons (performed 1930 operations; 23.0% MVr rate). Risk-adjusted RMSTs were 5.76 years (95% CI, 5.36-6.15 years) vs 5.77 years (95% CI, 5.40-6.14 years) among beneficiaries undergoing surgery by PA surgeons and PR surgeons, respectively (difference, 0.1 years; 95% CI, -6.6 to 6.6 months, P = .964).</p><p><strong>Conclusions: </strong>In Medicare beneficiaries with iMR undergoing CABG/mitral valve surgery, CABG/MVr was associated with improved survival, even after risk adjustment for measured confounders. This may be due to unmeasured confounding variables affecting the decision to perform MVr or MVR, such as valvular pathology and/or severity of regurgitation. After endeavoring to account for unmeasured confounders using surgeon preference as an instrumental variable, surgeons who preferred CABG/MVr or CABG/MVR achieved similar long-term survival for their patients.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392367","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":"Shipwrecks and Surgery: Lessons in Leadership, Followership, and Ethos","authors":"Thomas E. MacGillivray MD","doi":"10.1016/j.athoracsur.2025.01.022","DOIUrl":"10.1016/j.athoracsur.2025.01.022","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 5","pages":"Pages 934-940"},"PeriodicalIF":3.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392371","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":"Patient Selection for Surgery vs Surveillance in Moderately Dilated Ascending Aorta: Insights From Treatment in Thoracic Aortic Aneurysm: Surgery versus Surveillance (TITAN:SvS), an International Prospective Trial.","authors":"Adham Makarem, Jehangir J Appoo, Munir Boodhwani, Ming Hao Guo, Sarah Brownlee, Philippe Demers, Himanshu J Patel, G Chad Hughes, Francois Dagenais, Michael W A Chu, Maral Ouzounian, Juan B Grau, John Bozinovski, Zlatko Pozeg, Elaine Tseng, Rony Atoui, Arminder S Jassar","doi":"10.1016/j.athoracsur.2025.01.020","DOIUrl":"10.1016/j.athoracsur.2025.01.020","url":null,"abstract":"<p><strong>Background: </strong>Guidelines for treating ascending thoracic aortic aneurysms (ATAA) are largely based on single-center studies. To understand factors influencing patient selection for surgery vs surveillance, patient and aneurysm characteristics were compared for patients in the randomized and registry arms of a large prospective, multicenter, multinational trial.</p><p><strong>Methods: </strong>TITAN:SvS (Treatment in Thoracic Aortic aNeurysm: Surgery versus Surveillance) is a large prospective multicenter study of patients with ATAA between 5.0 and 5.4 cm, randomizing patients 1:1 to initial surgery vs surveillance. Nonrandomized patients are enrolled into a registry where results of operative or surveillance strategy can be monitored prospectively. Between 2018 and 2023, 615 patients were enrolled at 22 sites in the United States and Canada. Demographic and aneurysm characteristics were compared between randomized and registry arms.</p><p><strong>Results: </strong>Compared with randomized and operative registry groups, patients in the surveillance registry were older with more comorbidities. No significant differences were observed in maximal ascending aortic diameter (5.1 cm [interquartile range, 5.0-5.2 cm] vs 5.1 cm [interquartile range, 4.9-5.2 cm] P = .2) or other aneurysm characteristics. Despite similar numbers of enrolling centers in the United States (n = 11) and Canada (n = 12), Canadian patients were more likely to be randomized (58% vs 7%, P < .01) and less likely to be enrolled in the operative (9% vs 42%, P < .01) or surveillance registry (34% vs 51%).</p><p><strong>Conclusions: </strong>Enrollment data for TITAN:SvS suggest that patient and geographic characteristics, rather than aortic size, influence decision-making regarding the initial treatment strategy for ATAAs. These findings highlight the need for caution when generalizing outcomes from operative registries, because sicker patients may be excluded.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384022","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":"Impact of Margin Distance on Locoregional Recurrence and Survival After Thoracoscopic Segmentectomy","authors":"Lin Huang MD, PhD ,&nbsp;René Horsleben Petersen MD, PhD","doi":"10.1016/j.athoracsur.2024.07.012","DOIUrl":"10.1016/j.athoracsur.2024.07.012","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to identify the impact of margin distance on locoregional recurrence (LRR) and survival outcomes after thoracoscopic segmentectomy for non-small cell lung cancer.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from prospectively collected consecutive thoracoscopic segmentectomies in a single center from January 2008 to February 2023. The restricted cubic spline of the adjusted Cox regression model for LRR displayed the breakpoint of margin distance. The Kaplan-Meier estimator with log-rank test evaluated the overall survival between the 2 groups stratified by the breakpoint, and the Aalen-Johansen estimator with the Gray test assessed the LRR-free survival and lung cancer-specific survival in the competing model.</div></div><div><h3>Results</h3><div>The study included 155 patients. LRR was observed in 22 patients (14.2%), with a median time to LRR of 17.1 months (interquartile range, 6.3-26.3 months). Margin distance was found to be a predictor for LRR (hazard ratio, 0.92; <em>P</em> = .033). The identified breakpoint for margin distance in this cohort was 19.8 mm. Compared with this cutoff, a margin distance of 15 mm increased the risk of LRR by 65%, whereas 25 mm decreased the risk to LRR with 31%. A segmentectomy with a margin distance ≥20 mm resulted in significant improvements in overall survival (<em>P</em> = .020), lung cancer-specific survival (<em>P</em> = .010), and LRR-free survival (<em>P</em> &lt; .001) compared with cases with a margin distance of &lt;20 mm.</div></div><div><h3>Conclusions</h3><div>Margin distance ≥20 mm decreased LRR and improved survival outcomes for thoracoscopic segmentectomy in this study.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 316-324"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789818","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":"Gradients After Valve-Sparing Root Replacement of Bicuspid Aortic Valve—A Unique Phenomenon","authors":"Marek J. Jasinski MD, PhD (Professor),&nbsp;Kinga Kosiorowska MD,&nbsp;Rafal Nowicki MD","doi":"10.1016/j.athoracsur.2024.09.028","DOIUrl":"10.1016/j.athoracsur.2024.09.028","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 492-493"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373517","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":"Tailoring BITA Configuration Strategies in Coronary Artery Bypass Grafting","authors":"David Glineur MD, PhD,&nbsp;Sigrid Sandner MD, MS","doi":"10.1016/j.athoracsur.2024.10.017","DOIUrl":"10.1016/j.athoracsur.2024.10.017","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 360-361"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559349","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":"Concomitant Surgical Ablation in Paroxysmal vs Persistent Atrial Fibrillation During Mitral Surgery","authors":"Ali Darehzereshki MD ,&nbsp;J. Hunter Mehaffey MD MSc ,&nbsp;J.W. Awori Hayanga MD, MPH ,&nbsp;Dhaval Chauhan MD ,&nbsp;Christopher Mascio MD ,&nbsp;J. Scott Rankin MD ,&nbsp;Lawrence Wei MD ,&nbsp;Vinay Badhwar MD","doi":"10.1016/j.athoracsur.2024.06.020","DOIUrl":"10.1016/j.athoracsur.2024.06.020","url":null,"abstract":"<div><h3>Background</h3><div>Despite prospective randomized evidence supporting concomitant treatment of atrial fibrillation (AF) during mitral valve (MV) surgery, variation in surgical management of AF remains. We assessed longitudinal outcomes after surgical treatment of persistent or paroxysmal AF during MV surgery in Medicare beneficiaries.</div></div><div><h3>Methods</h3><div>All Medicare beneficiaries with a diagnosis of AF undergoing MV surgery (2018-2020) were evaluated. Patients were stratified by no AF treatment, left atrial appendage obliteration (LAAO) alone, or surgical ablation and LAAO (SA+LAAO). Doubly robust risk adjustment and subgroup analysis by persistent or paroxysmal AF were performed.</div></div><div><h3>Results</h3><div>A total of 7517 patients with preoperative AF underwent MV surgery (32.1% no AF treatment, 23.1% LAAO alone, 44.7% SA+LAAO). After doubly robust risk adjustment, AF treatment with SA+LAAO or LAAO alone were associated with lower 3-year readmission for stroke or bleeding. However, SA+LAAO was associated with reduced 3-year mortality and readmission for AF or heart failure compared with no AF treatment or LAAO alone. Compared with no AF treatment or LAAO alone, SA+LAAO was associated with lower composite end point of stroke (hazard ratio, 0.75) or death (hazard ratio, 0.83) at 3 years. Subgroup analysis identified similar longitudinal benefits of SA+LAAO in patients with persistent or paroxysmal AF.</div></div><div><h3>Conclusions</h3><div>In Medicare beneficiaries with AF undergoing MV surgery, SA+LAAO was associated with improved longitudinal outcomes compared with LAAO alone or no AF treatment in patients with paroxysmal or persistent AF. These contemporary real-world data further clarify the benefit of SA+LAAO during MV surgery across all types of AF.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 389-397"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535926","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":"Long-term Outcome After Repair of Transposition of the Great Arteries With Aortic Arch Obstruction","authors":"Kei Kobayashi MD, PhD ,&nbsp;Luciana Da Fonseca Da Silva MD ,&nbsp;Bari Murtuza MD ,&nbsp;Mario Castro-Medina MD ,&nbsp;Melita Viegas MD ,&nbsp;Jose Da Silva MD ,&nbsp;Carlos E. Diaz Castrillon MD ,&nbsp;Victor Morell MD","doi":"10.1016/j.athoracsur.2024.07.009","DOIUrl":"10.1016/j.athoracsur.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><div>This study compares the long-term outcomes of patients after repair of transposition of the great arteries (TGA) with and without aortic arch obstruction (AAO).</div></div><div><h3>Methods</h3><div>This is a single-institution, retrospective study between October 2004 and February 2023. Patients who underwent arterial switch operation and aortic arch repair (ASO-AAR group) with patch augmentation were compared with those without AAO (ASO group). The primary end point was survival; freedom from reintervention was a secondary end point.</div></div><div><h3>Results</h3><div>We identified 176 patients, 31 in the ASO-AAR group and 145 in the ASO group. The median follow-up period was 10.3 years. There were no differences between the ASO-AAR group and the ASO group in early deaths (3.2% vs 0.7%) and late deaths (3.2% vs 2.8%), or 15-year survival rates (92.6% vs 96.2%). Surgical and catheter-based reinterventions were higher in the ASO-AAR group, involving the pulmonary arteries (41.9% vs 4.8%, <em>P</em> &lt; .001), aortic arch (16.1% vs 0.7%, <em>P</em> &lt; .001), and residual ventricular septal defects (11.4% vs 0%, <em>P</em> = .05). The ASO-AAR group showed a higher prevalence of double-outlet right ventricle TGA-type (61.3% vs 4.1%, <em>P</em> &lt; .001) and a lower aortopulmonary index (0.67 vs 1.01, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Patients undergoing surgical repair of TGA and AAO achieved excellent survival rates, comparable to patients with simple transposition. A higher rate of surgical and catheter-based reinterventions was observed in patients with arch obstruction and/or a low aortopulmonary index. AAR with patch augmentation proved to be an effective surgical technique with a low incidence of aortic reinterventions.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 406-412"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762441","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":"Aortic Valve Neocuspidization: An Additional Asset in the Lifetime Management of Aortic Valve Diseases","authors":"Andrea Amabile MD,&nbsp;Markus Krane MD,&nbsp;Danny Chu MD","doi":"10.1016/j.athoracsur.2024.09.045","DOIUrl":"10.1016/j.athoracsur.2024.09.045","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 491-492"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480069","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":"Intersection of Race, Rurality, and Income in Defining Access to Minimally Invasive Lung Surgery","authors":"J.W. Awori Hayanga MD ,&nbsp;Xun Luo MD ,&nbsp;Islam Hasasna MS ,&nbsp;Paul Rothenberg MD ,&nbsp;Shalini Reddy MD ,&nbsp;J. Hunter Mehaffey MD ,&nbsp;Jason Lamb MD ,&nbsp;Vinay Badhwar MD ,&nbsp;Alper Toker MD","doi":"10.1016/j.athoracsur.2024.03.040","DOIUrl":"10.1016/j.athoracsur.2024.03.040","url":null,"abstract":"<div><h3>Background</h3><div>Race is a potent influencer of health care access. Geography and income may exert equal or greater influence on patient outcomes. We sought to define the intersection of race, rurality, and income and their influence on access to minimally invasive lung surgery in Medicare beneficiaries.</div></div><div><h3>Methods</h3><div>Centers for Medicare and Medicaid Services data were used to evaluate patients with lung cancer who underwent right upper lobectomy<span><span>, by open, robotic-assisted thoracic surgery (RATS), or video-assisted thoracic surgery (VATS) between 2018 and 2020. </span>International Classification of Diseases<span><span>, 10th Edition, was used to define diagnoses and procedures. We excluded sublobar, segmental, wedge, bronchoplasty, or reoperative patients with nonmalignant or </span>metastatic disease<span><span> or a history of neoadjuvant chemotherapy. Risk adjustment was performed using inverse probability of treatment weighting (IPTW) propensity scores with generalized linear models and Cox </span>proportional hazards models.</span></span></span></div></div><div><h3>Results</h3><div>The cohort comprised 13,404 patients, 4291 open (32.1%), 4317 RATS (32.2%), and 4796 VATS (35.8%). Black/urban patients had significantly higher RATS and VATS rates (<em>P</em> &lt; .001), longer long-term survival (<em>P</em> = .007), fewer open resections (<em>P</em> &lt; .001), and lower overall mortality (<em>P</em> = .007). Low-income Black/urban patients had higher RATS (<em>P</em> = .002), VATS (<em>P</em> &lt; .001), longer long-term survival (<em>P</em> = .005), fewer open resections (<em>P</em> &lt; .001), and lower overall mortality compared with rural White patients (<em>P</em> = .005).</div></div><div><h3>Conclusions</h3><div>Rural White populations living close to the federal poverty line may suffer a burden of disparity traditionally observed among poor Black people. This suggests a need for health policies that extend services to impoverished, rural areas to mitigate social determinants of health.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 325-332"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756994","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}