Annals of Thoracic Surgery最新文献

{"title":"The Association of Chylothorax With Aggressiveness of Lymph Node Management During Pulmonary Resection.","authors":"Devanish N Kamtam, Mark F Berry, Nicole Lin, Ntemena Kapula, Jake J Kim, Bailey Wallen, Mina Satoyoshi, Irmina A Elliott, Brandon A Guenthart, Douglas Z Liou, Natalie S Lui, Leah M Backhus, Joseph B Shrager","doi":"10.1016/j.athoracsur.2025.01.019","DOIUrl":"10.1016/j.athoracsur.2025.01.019","url":null,"abstract":"<p><strong>Background: </strong>Chylothorax is a morbid and costly complication that can originate in lymph node resection beds. We hypothesized a close association between the occurrence of chylothorax and the extent and aggressiveness of lymph node dissection.</p><p><strong>Methods: </strong>We conducted a nested case-control study of 1728 non-small cell lung cancer patients who underwent resection at our institution between January 2005 and July 2023. Cases were defined as patients who developed chylothorax. Each case was matched with 3 control patients who did not develop chylothorax, based on year of diagnosis, clinical N descriptor, presence of granulomatous lymph nodes, extent of resection, and tumor laterality. Using conditional logistic regression, we estimated risk ratios with 95% CIs to examine the association between the occurrence of chylothorax and several measures of the extent of lymph node resection.</p><p><strong>Results: </strong>The incidence of chylothorax was 33 of 1728 (1.9%). In the matched groups, patients with chylothorax had higher rates of complete lymphadenectomy (82% vs 65%, P = .059) and systematic lymph node dissection as defined by International Association for the Study of Lung Cancer, European Society of Medical Oncology, and European Society of Thoracic Surgeons (85% vs 52%, P = .002). Station 2 was resected significantly more often in the chylothorax group (48.5% vs 29%, P = .04). The chylothorax group had a longer median in-hospital stay (7 vs 4 days, P = .003) and higher rates of reoperation (18% vs 1.0%, P = .006) and readmission (18% vs 5%, P = .03).</p><p><strong>Conclusions: </strong>In matched groups, chylothorax is associated with several measures of more aggressive lymph node management and results in substantial postoperative morbidity. This finding provides additional support for more selective lymph node management approaches when resecting smaller, less solid, and less 18-fluorodeoxyglucose-avid tumors.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081080","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 Myocardial Hibernation and Scar on Benefits From CABG in Ischemic Left Ventricular Dysfunction.","authors":"Shuyang Song, Xu Han, Xinghong Ma, Xiaodi Wang, Chaowu Yan, Lei Wang, Wei Fang","doi":"10.1016/j.athoracsur.2025.01.011","DOIUrl":"10.1016/j.athoracsur.2025.01.011","url":null,"abstract":"<p><strong>Background: </strong>The significance of evaluating myocardial viability in making decisions regarding coronary artery bypass grafting (CABG) for patients with ischemic left ventricular dysfunction (ILVD) remains controversial. This study aimed to examine the impact of integrated assessment of hibernating myocardium and scars on the survival benefit associated with CABG in patients with ILVD.</p><p><strong>Methods: </strong>Consecutive patients with ILVD who underwent fluorine-18 fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance imaging with late gadolinium enhancement viability testing from January 2015 and April 2018 were retrospectively enrolled. The primary end point was all-cause death. The secondary end point was a composite of cardiovascular death, cardiovascular hospitalization, heart transplantation, revascularization, insertion of an implantable cardioverter-defibrillator, or nonfatal stroke. Cox models calculated hazard ratios (HRs) and CIs for CABG vs medical therapy alone for subgroups with different levels of hibernation and scars.</p><p><strong>Results: </strong>During a median follow-up of 71.5 months in 507 patients, 98 patients reached the primary end point and 194 reached the secondary end point. After adjustment, CABG was associated with lower risks of all-cause mortality (HR, 0.249; 95% CI, 0.154-0.428; P<.001) and lower incidences of secondary outcomes (HR, 0.457; 95% CI, 0.318-0.658; P<.001) compared with medical treatment alone in the population. Across all 4 subgroups classified by the optimal cutoff value (10% hibernation and 26% scar), CABG was associated with favorable outcomes regardless of the hibernation and scar level.</p><p><strong>Conclusions: </strong>The extent and severity of hibernating myocardium and scars appear not to influence the effects of CABG in patients with ILVD.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080959","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":"Paravalvular Leak After Transcatheter Aortic Valve Implantation: Results From 3600 Patients.","authors":"Nav Warraich, James A Brown, Eishan Ashwat, Dustin Kliner, Derek Serna-Gallegos, Catalin Toma, David West, Amber Makani, Yisi Wang, Ibrahim Sultan","doi":"10.1016/j.athoracsur.2025.01.012","DOIUrl":"10.1016/j.athoracsur.2025.01.012","url":null,"abstract":"<p><strong>Background: </strong>Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. Mild PVL remains prevalent after TAVI, and its impact on long-term survival is unclear. This study aimed to examine the incidence, impact on survival, and progression of PVL.</p><p><strong>Methods: </strong>This was a retrospective, single-institution cohort study of TAVIs between November 2012 and January 2023. Patients were stratified by 30-day PVL severity: none to trace, mild, and moderate to severe. Multivariable logistic regression was performed to identify risk factors associated with increasing PVL severity. Kaplan-Meier survival estimation and Cox proportional hazards regression were performed.</p><p><strong>Results: </strong>A total of 3600 patients underwent TAVI. Of these, 2719 (75.5%) had none to trace PVL, 808 (22.5%) had mild PVL, and 73 (2.0%) had moderate to severe PVL at 30 days. On multivariable logistic regression, later years of valve implantation (2017-2023) were protective against PVL progression. Kaplan-Meier estimates of the 3 groups were significantly different (P < .001) with the moderate to severe group having reduced survival. On Cox regression, moderate to severe PVL was associated with increased mortality (hazard ratio, 1.80; 95% Cl, 1.31-2.46; P < .001), whereas mild PVL was not (hazard ratio, 1.01; 95% CI, 0.89-1.15; P = .88) compared with none to trace PVL. For Kaplan-Meier estimates comparing the none to trace and mild PVL groups alone, landmark analysis showed reduced survival in the mild PVL group after 2 years (P = .03); however, this late reduction in survival in the mild PVL group did not persist on multivariable analysis (P = .14).</p><p><strong>Conclusions: </strong>After TAVI, moderate to severe PVL is associated with reduced survival compared with none to trace PVL. Mild PVL may result in a delayed survival reduction.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081079","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":"Outcomes After Tracheostomy in Patients Undergoing Congenital Heart Surgery.","authors":"Jessica B Briscoe, Alyssia Venna, Rittal Mehta, In Hye Park, Yuliya Domnina, Hannah Greenlick-Michals, Manan Desai, Aybala Tongut, Can Yerebakan, Yves d'Udekem","doi":"10.1016/j.athoracsur.2025.01.015","DOIUrl":"10.1016/j.athoracsur.2025.01.015","url":null,"abstract":"<p><strong>Background: </strong>Early tracheostomy improves outcomes in the adult population, but there is little evidence of benefit in the pediatric population. We investigated hospital and late survival of tracheostomy placement in patients who also underwent congenital cardiac surgery.</p><p><strong>Methods: </strong>A single-center review of 65 consecutive patients who underwent tracheostomy placement and cardiac surgery in a pediatric hospital between 2011 and 2022 was performed. Multivariable logistic regression analysis was performed to assess predictors of mortality, and a Kaplan-Meier estimate was performed to evaluate mortality.</p><p><strong>Results: </strong>Final analysis included 62 patients. Median birth weight and age at tracheostomy admission was 2.7 (interquartile range [IQR], 2-3) kg and 175 (IQR, 107-266) days, respectively. Patients failed extubation a median of 3 (IQR, 1-4) times. Duration of ventilation before tracheostomy was 85 (IQR, 49-106) days. Thirty-nine patients (63%) were discharged from the hospital. Thirty-eight patients (61%) died overall, of which 21 (55%) died in hospital. Median survival was 328 (IQR, 94-1711) days. Independent predictors of mortality were longer length of stay (odds ratio [OR], 4.66; 95% CI, 1.6-13.8; P < .01), tracheomalacia (OR, 0.31; 95% CI, 0.1-0.93; P = .04), sepsis (OR 3.4; 95% CI, 1.18-10; P = .02), pneumonia before or after tracheostomy (OR, 3.3; 95% CI, 1.1-10.2; P = .04), and acute kidney injury requiring dialysis (OR, 8; 95% CI, 1.96-54.5; P = .01).</p><p><strong>Conclusions: </strong>With 61% mortality after tracheostomy in patients undergoing cardiac surgery in a pediatric hospital, one can wonder whether this practice improves survival in these patients. Families should be warned that, in the sickest patients, tracheostomy may only offer increased survival for a limited time.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076457","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 Atretic Aortic Valve on Systemic Ventricular Function After the Norwood Procedure.","authors":"Stefan Fetcu, Thibault Schaeffer, Frank Klawonn, Christoph Röhlig, Jonas Palm, Takuya Osawa, Carolin Niedermaier, Paul Philipp Heinisch, Nicole Piber, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono","doi":"10.1016/j.athoracsur.2025.01.014","DOIUrl":"10.1016/j.athoracsur.2025.01.014","url":null,"abstract":"<p><strong>Background: </strong>Aortic atresia (AA) is considered a risk for the Norwood procedure. This study aimed to compare the longitudinal ventricular function (VF) and atrioventricular valve (AVV) regurgitation in patients with AA and aortic stenosis (AS).</p><p><strong>Methods: </strong>Using serial echocardiographic images in patients undergoing the neonatal Norwood procedure between 2001 and 2020, systemic VF assessed by ejection fraction and the degree of AVV regurgitation were compared between the patients with AA and AS.</p><p><strong>Results: </strong>A total of 335 consecutive patients were included, consisting of 273 with hypoplastic left heart syndrome and 62 with its variants. AA was observed in 146 patients (43.6%) and AS in 189 (56.4%). Longitudinal VF and AVV regurgitation were evaluated using a total of 4687 echocardiograms. Preoperatively, VF was better in AA patients than in AS patients (P = .01). After the Norwood procedure, VF was initially (1-30 days) worse in patients with AA than in those with AS (P < .01). However, after that (31 days to stage 2 palliation), it improved in the AA group but remained worse than in the AS group (P < .01). After stage 2 palliation, VF was reduced in the AA group compared to the AS group, especially between 31 to 90 days postoperatively (P < .01). The degree of AVV regurgitation after the Norwood procedure (P < .01) as well as after stage 2 palliation (P < .01), was worse in AA patients, compared with AS patients.</p><p><strong>Conclusions: </strong>After the Norwood procedure, patients with AA demonstrated inferior systemic VF as well as worse AVV function throughout the palliation period before Fontan completion.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076455","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":"Emerging Implications of Elevated Lipoprotein(a) Levels in Coronary Artery Bypass Graft Surgery: A Narrative Review.","authors":"Shubh K Patel, Miriam S Badross, Nitish K Dhingra, Michael Moroney, Jack H Casey, Syed M Ali Hassan, Tayyab S Khan, David A Hess, Marlys L Koschinsky, Hwee Teoh, Subodh Verma","doi":"10.1016/j.athoracsur.2025.01.013","DOIUrl":"10.1016/j.athoracsur.2025.01.013","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery bypass grafting (CABG) remains a cornerstone in the management of coronary artery disease (CAD). In nonurgent surgical revascularization cases, preoperative optimization of modifiable risk factors can improve outcomes. There is increasing interest in the relationship between lipoprotein(a) levels and the risk for ischemic cardiovascular disease, particularly how CABG outcomes are in turn affected. This review highlights the role of lipoprotein(a) in the pathogenesis of CAD and CABG outcomes and discusses future directions for its optimal management in the perioperative period.</p><p><strong>Methods: </strong>The PubMed/MEDLINE database was reviewed until March 2024 to capture publications that evaluated and/or described the relationship between lipoprotein(a) and CABG surgery or CAD outcomes.</p><p><strong>Results: </strong>The available literature supports lipoprotein(a) as a causal and independent risk factor for the pathogenesis of CAD. Elevated lipoprotein(a) levels are associated with an increased risk of adverse post-CABG outcomes, including graft occlusion incidence and major adverse cardiovascular events. Genetic variations influencing lipoprotein(a) levels play a role in disease progression and surgical outcomes. Several therapies aimed at reducing lipoprotein(a) levels, currently in phase III clinical trials, show promise for improving the prognosis after CABG.</p><p><strong>Conclusions: </strong>Among individuals undergoing surgical revascularization for CAD, lipoprotein(a) levels may help define risk and inform best practices for perioperative management. We advocate for the routine measurement of lipoprotein(a) in all patients undergoing CABG. Emerging lipoprotein(a)-lowering agents show promise for secondary prevention of cardiac events, although dedicated analyses in cardiac surgical subcohorts will be important to evaluate their role in improving CABG outcomes.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076454","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 Emerging Influence of Artificial Intelligence on Traditional Medical Textbooks.","authors":"Joseph A Dearani, Constantine Mavroudis","doi":"10.1016/j.athoracsur.2025.01.018","DOIUrl":"10.1016/j.athoracsur.2025.01.018","url":null,"abstract":"<p><p>This review provides a comprehensive exploration of how artificial intelligence (AI) is reshaping medical education and the role of traditional textbooks. The historical context underscores the evolution of medical knowledge bridging past advances with current AI-driven innovations, highlighting the indispensable role of both printed and electronic medical textbooks. The strengths and limitations of traditional and digital textbooks are considered. The potential for AI to enhance medical education through real-time updates, personalized learning, and advanced visual aids is particularly compelling. This perspective is critical for practitioners and educators who are navigating the integration of AI in their fields.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076459","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 Annular Enlargement: Y-Incision Rationale, Technique, and Outcomes.","authors":"Sarah A Chen, Chi Chi Do-Nguyen, Marc Titsworth, Bo Yang","doi":"10.1016/j.athoracsur.2025.01.016","DOIUrl":"10.1016/j.athoracsur.2025.01.016","url":null,"abstract":"<p><strong>Background: </strong>Trials comparing transcatheter aortic valve replacement and surgical aortic valve replacement (SAVR) have shown that in patients with annuli <26 mm, SAVR had negative hemodynamic and clinical outcomes. Recently, studies revealed that the effective orifice diameter of surgical prosthetic valves is 5-7 mm smaller than the labeled valve size. To improve outcomes of SAVR, the Y-incision aortic annular enlargement (AAE) enlarges the surgical aortic annulus to accommodate a prosthetic valve 3-4 sizes larger with an effective orifice area that matches the patient's native annulus. This review discusses when and how the Y-incision AAE should be performed.</p><p><strong>Methods: </strong>OVID MEDLINE, OVID Embase, and Cochrane Library were searched with terms that included \"Y-incision aortic annular enlargement,\" \"valve sizes,\" and \"long-term survival.\" The search included publications after 2020. The reference lists of included studies were reviewed to retrieve additional studies.</p><p><strong>Results: </strong>In patients with matched native annular sizes, AAE significantly improved midterm survival without increasing perioperative complications. Patients treated with a larger valve had notably better long-term survival and small valve sizes were significant risk factors for operative and long-term mortality. Compared with patients treated with a Nicks or Manougian procedure, the hemodynamics in patients treated with Y-incision AAE were significantly better.</p><p><strong>Conclusions: </strong>Y-incision AAE could be routinely considered for patients with a normal annulus (17-25 mm) undergoing SAVR.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076431","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 Society of Thoracic Surgeons General Thoracic Surgery Database: 2024 Update on Outcomes and Research.","authors":"Christopher W Towe, Elbert Y Kuo, Andrew Feczko, Biniam Kidane, Onkar V Khullar, Christopher W Seder, Paul H Schipper, James M Donahue, Elizabeth A David, Leigh Ann Jones, Robert Habib, Zouheir ElHalabi, Lisa M Brown","doi":"10.1016/j.athoracsur.2025.01.010","DOIUrl":"10.1016/j.athoracsur.2025.01.010","url":null,"abstract":"<p><p>The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) remains the largest and most comprehensive audited thoracic surgical database in the world. As the STS GTSD grows to nearly 1 million cases, the pulmonary resection for cancer and esophagectomy short-term risk models have been refined to provide participants with benchmarked performance reports to facilitate quality improvement efforts. New for 2025 will be the development of long-term risk models and the online release of both short- and long-term risk calculators. A voluntary module to collect neoadjuvant targeted and immunotherapy data has been created and accepted by participants and is rapidly accruing data. STS GTSD participant public reporting has increased 50% over the last 2 years after the application of the U.S. News & World Report 3% transparency credit. All GTSD data analyses are now performed internally by the STS Research and Analytic Center, resulting in multiple publications through the Access & Publication, Task Force on Funded Research and Participant User File mechanisms. Future initiatives include the incorporation of patient-reported outcomes into the STS GTSD, revision of the data collection form to incorporate variables associated with long-term outcomes, and focused efforts to increase the value of STS GTSD participation. This report delineates volume trends, recent initiatives, and the prolific research output emanating from the STS GTSD, reflecting a year of substantial progress and academic productivity.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069368","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":"Bioprosthetic Valve Fracture for Transcatheter Aortic Valve-in-Valve Replacement: A Systematic Literature Review.","authors":"Trevor C Chopko, Jonathan N Afoke, Fazal W Khan, Phillip G Rowse","doi":"10.1016/j.athoracsur.2025.01.009","DOIUrl":"10.1016/j.athoracsur.2025.01.009","url":null,"abstract":"<p><p>Transcatheter aortic valve-in-valve replacement presents a viable, minimally invasive approach to replacing degraded bioprosthetic surgical valves. The major drawback of this technique is poor hemodynamics in the form of patient-prosthesis mismatch and high transvalvular gradients. This is commonly attributable to the reduced valvular diameter from the transcatheter heart valve fixed inside the degraded bioprosthesis. Maximizing this diameter by bioprosthetic valve fracture occurs through a noncompliant, high-pressure balloon to splay the degraded valve outward. Despite its novelty, this has demonstrated improved hemodynamic outcomes and optimal valvular expansion with slightly increased operative risk. In this review, we highlight the technique of bioprosthetic valve fracture, types of suitable balloons and valves, timing in relation to valve-in-valve implantation, safety and efficacy, implications, and future directions.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069366","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}