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Reply: Continental developments in African cardiothoracic surgery
JTCVS open Pub Date : 2025-02-01 DOI: 10.1016/j.xjon.2024.12.009
Victory B. Effiom MD , Anayo J. Michael MD , Fatma K. Ahmed MD , Achanga Bs. Anyinkeng MD , Jonas L. Ibekwe MD , Abdullah K. Alassiri MD , Victor O. Femi-Lawal MD , Eric E. Vinck MD
{"title":"Reply: Continental developments in African cardiothoracic surgery","authors":"Victory B. Effiom MD , Anayo J. Michael MD , Fatma K. Ahmed MD , Achanga Bs. Anyinkeng MD , Jonas L. Ibekwe MD , Abdullah K. Alassiri MD , Victor O. Femi-Lawal MD , Eric E. Vinck MD","doi":"10.1016/j.xjon.2024.12.009","DOIUrl":"10.1016/j.xjon.2024.12.009","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Page 387"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Routine use of jejunostomy tubes after esophagectomy: The good, the bad, and the ugly!
JTCVS open Pub Date : 2025-02-01 DOI: 10.1016/j.xjon.2024.09.032
Sadia Tasnim MD, MS , Siva Raja MD, PhD , Sadhvika Ramji MD , Rachel NeMoyer MD, MPH , Eugene H. Blackstone MD , Andrew J. Toth MS , John O. Barron MD , Daniel P. Raymond MD , Sudish C. Murthy MD, PhD , Monisha Sudarshan MD, MPH
{"title":"Routine use of jejunostomy tubes after esophagectomy: The good, the bad, and the ugly!","authors":"Sadia Tasnim MD, MS ,&nbsp;Siva Raja MD, PhD ,&nbsp;Sadhvika Ramji MD ,&nbsp;Rachel NeMoyer MD, MPH ,&nbsp;Eugene H. Blackstone MD ,&nbsp;Andrew J. Toth MS ,&nbsp;John O. Barron MD ,&nbsp;Daniel P. Raymond MD ,&nbsp;Sudish C. Murthy MD, PhD ,&nbsp;Monisha Sudarshan MD, MPH","doi":"10.1016/j.xjon.2024.09.032","DOIUrl":"10.1016/j.xjon.2024.09.032","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to assess adverse events, readmissions, and resource use associated with routine jejunostomy tube placement after esophagectomy.</div></div><div><h3>Methods</h3><div>From September 2018 to October 2021, 215 patients, with a median age of 65 years and a median body mass index of 27 kg/m<sup>2</sup>, underwent routine jejunostomy tube placement during esophagectomy. J-tube–related adverse events were collected from date of surgery to date of removal and categorized as (1) nonserious, resource-nonintensive (eg, skin irritations, discomfort); (2) nonserious, resource-intensive (eg, infection, clogged, and dislodged tubes); and (3) serious, resource-intensive (eg, bowel obstruction, volvulus, tube feed intolerance). Esophagectomy and jejunostomy tube–related readmissions and nutritional markers were also assessed during the jejunostomy tube indwelling time.</div></div><div><h3>Results</h3><div>Of the 215 patients, 177 experienced 459 events documented during 372 healthcare encounters. Nonserious adverse events occurred within 4 to 6 weeks after surgery with the peak at 3 to 4 weeks. Serious adverse events (4, 0.9%) were rare and occurred mostly in the acute postoperative period. Thirty-five patients (16%) were readmitted during their jejunostomy tube indwelling time, of whom 14 (7%) were readmitted due to jejunostomy tube–related issues. Jejunostomy tube–related events were not predictors for readmission. Nutritional status stabilized within 30 days of surgery.</div></div><div><h3>Conclusions</h3><div>Serious adverse events after routine jejunostomy tube placement postesophagectomy are rare and occur mostly in the immediate postoperative period. Nonserious adverse events are more common and can be resource-intensive, providing an opportunity for improvement. Readmissions for jejunostomy tube complications are low. Nutritional status is appropriately maintained with supplemental jejunostomy tube feeding postesophagectomy. These findings suggest that routine jejunostomy tube placement at the time of esophagectomy can be a reasonable management strategy as part of a delayed feeding algorithm.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 276-287"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Research productivity among applicants who matched into an integrated thoracic surgery residency program: A bibliographic review
JTCVS open Pub Date : 2025-02-01 DOI: 10.1016/j.xjon.2024.11.017
Nika Samadzadeh Tabrizi MD , Michelle Shen BS , Alexander D. Shapeton MD , Isha Doshi MD , Junyi Liu BS , Thomas Fabian MD , Patrick Chan MD
{"title":"Research productivity among applicants who matched into an integrated thoracic surgery residency program: A bibliographic review","authors":"Nika Samadzadeh Tabrizi MD ,&nbsp;Michelle Shen BS ,&nbsp;Alexander D. Shapeton MD ,&nbsp;Isha Doshi MD ,&nbsp;Junyi Liu BS ,&nbsp;Thomas Fabian MD ,&nbsp;Patrick Chan MD","doi":"10.1016/j.xjon.2024.11.017","DOIUrl":"10.1016/j.xjon.2024.11.017","url":null,"abstract":"<div><h3>Background</h3><div>Research productivity is an important factor in candidate selection by integrated thoracic surgery residency programs, and thus tracking the research output of applicants who match into an integrated program is necessary. This study sought to examine the research productivity of matched integrated applicants prior to residency and to assess demographic, bibliographic, and institutional variables associated with continued research productivity during residency.</div></div><div><h3>Methods</h3><div>Bibliographic records of applicants who matched into an integrated thoracic surgery residency program from 2015 to 2022 were reviewed manually (eg, PubMed/MEDLINE, Scopus, Google Scholar, ResearchGate) to identify studies published up to January 2024. Publications were stratified by publication type and first authorship relative to the applicants’ match year. Individuals were analyzed by demographics, medical school ranking, and affiliated residency program research infrastructure.</div></div><div><h3>Results</h3><div>A total of 300 matched integrated applicants were identified. Among applicants who matched into an integrated program, the number of total (<em>P</em> = .001) and first-authorship (<em>P</em> = .006) publications prior to residency increased significantly from 2015 to 2022. Over the same period, the rates of total (<em>P</em> = .2) and first-authorship (<em>P</em> = .3) publications during residency remained relatively unchanged. Matched integrated applicants with a higher number of total and first-authorship publications prior to residency had higher rates of total publications (1.17; 95% confidence interval [CI], 1.09-1.25; <em>P</em> &lt; .001) and first-authorship publications (1.19; 95% CI, 1.13-1.26; <em>P</em> &lt; .001) publications during residency.</div></div><div><h3>Conclusions</h3><div>Research productivity among applicants who matched into an integrated thoracic surgery residency program from 2015 to 2022 has increased and is a strong predictor of sustained scholarly output during residency.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 369-378"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tricuspid valve replacement with bioprostheses: Which type fits best?
JTCVS open Pub Date : 2025-02-01 DOI: 10.1016/j.xjon.2024.11.003
Uberto Bortolotti MD
{"title":"Tricuspid valve replacement with bioprostheses: Which type fits best?","authors":"Uberto Bortolotti MD","doi":"10.1016/j.xjon.2024.11.003","DOIUrl":"10.1016/j.xjon.2024.11.003","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Page 109"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association of dysautonomia with refractory ventricular tachyarrhythmia in patients requiring thoracoscopic surgical cardiac sympathetic denervation
JTCVS open Pub Date : 2025-02-01 DOI: 10.1016/j.xjon.2024.11.020
Andrei Gurau MD, MHS, MS , Dianela Perdomo BS , Hamza Khan MD , Kelsey Melinosky MD , Anna Chudnovets MD , Jacob Blum BA , Mahmoud Kutmah BA , Victor Yang BA , Albert Leng BA , Arjun Menta BS, BBA , Xiyu Zhao BS , Suguru Yamauchi MD, PhD , Kristen Rodgers BS , Kathryn Ecoff BS , Errol Bush MD , Andreas S. Barth MD, PhD , Malcolm Brock MD , Frank Bosmans PharmD, PhD , Jinny S. Ha MD
{"title":"Association of dysautonomia with refractory ventricular tachyarrhythmia in patients requiring thoracoscopic surgical cardiac sympathetic denervation","authors":"Andrei Gurau MD, MHS, MS ,&nbsp;Dianela Perdomo BS ,&nbsp;Hamza Khan MD ,&nbsp;Kelsey Melinosky MD ,&nbsp;Anna Chudnovets MD ,&nbsp;Jacob Blum BA ,&nbsp;Mahmoud Kutmah BA ,&nbsp;Victor Yang BA ,&nbsp;Albert Leng BA ,&nbsp;Arjun Menta BS, BBA ,&nbsp;Xiyu Zhao BS ,&nbsp;Suguru Yamauchi MD, PhD ,&nbsp;Kristen Rodgers BS ,&nbsp;Kathryn Ecoff BS ,&nbsp;Errol Bush MD ,&nbsp;Andreas S. Barth MD, PhD ,&nbsp;Malcolm Brock MD ,&nbsp;Frank Bosmans PharmD, PhD ,&nbsp;Jinny S. Ha MD","doi":"10.1016/j.xjon.2024.11.020","DOIUrl":"10.1016/j.xjon.2024.11.020","url":null,"abstract":"<div><h3>Objective</h3><div>Although cardiac sympathetic denervation (CSD) effectively manages refractory ventricular tachyarrhythmias (RVTs) in long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia, the link between dysautonomia and RVT from broader etiologies is understudied. We hypothesized that dysautonomia is linked to RVT regardless of etiology in patients requiring CSD. We aimed to determine whether these patients have a high burden of dysautonomia symptoms using the Composite Autonomic Symptom Score-31 (COMPASS-31).</div></div><div><h3>Methods</h3><div>COMPASS-31 surveys were administered to 37 patients with RVT who underwent CSD and 37 matched healthy controls. COMPASS-31 scores were compared using Mann-Whitney <em>U</em> tests. Comparisons were made between patients with and without structural heart disease, and multivariable regression identified predictors for COMPASS-31 scores and CSD response.</div></div><div><h3>Results</h3><div>Common operative indications were idiopathic ventricular arrhythmias (49%) and arrhythmogenic right ventricular cardiomyopathy (30%). Patients with RVT had significantly greater COMPASS-31 scores (median 25.3) compared with control patients (median 8.6, <em>P</em> &lt; .001), with greater scores in the gastrointestinal, secretomotor, orthostasis, pupillomotor, and vasomotor domains. Sensitivity analysis confirmed these findings, showing significantly greater COMPASS-31 scores in cases versus controls (estimate: 14.5; 95% confidence interval, 9.2-19.8, <em>P</em> &lt; .001). No differences were found between patients with and without structural heart disease, and no predictors for COMPASS-31 score were identified. One year post-CSD, 78.4% of patients remained free of implantable cardioverter-defibrillator shocks.</div></div><div><h3>Conclusions</h3><div>Dysautonomia symptoms are significantly associated with RVT requiring CSD, regardless of underlying etiology. This association, in the context of CSD efficacy in RVT across structural and nonstructural etiologies, highlights autonomic dysfunction as a common pathophysiologic link warranting further investigation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 120-127"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Temporal trends in the utilization, costs, and outcomes of concomitant left atrial appendage closure across a statewide collaborative
JTCVS open Pub Date : 2025-02-01 DOI: 10.1016/j.xjon.2024.10.030
Yas Sanaiha MD , Bob Kiaii MD, FRCRC, FACS , Jack C. Sun MD , Michael Madani MD , Tom C. Nguyen MD , Richard J. Shemin MD , Peyman Benharash MD , University of California Cardiac Surgery Consortium
{"title":"Temporal trends in the utilization, costs, and outcomes of concomitant left atrial appendage closure across a statewide collaborative","authors":"Yas Sanaiha MD ,&nbsp;Bob Kiaii MD, FRCRC, FACS ,&nbsp;Jack C. Sun MD ,&nbsp;Michael Madani MD ,&nbsp;Tom C. Nguyen MD ,&nbsp;Richard J. Shemin MD ,&nbsp;Peyman Benharash MD ,&nbsp;University of California Cardiac Surgery Consortium","doi":"10.1016/j.xjon.2024.10.030","DOIUrl":"10.1016/j.xjon.2024.10.030","url":null,"abstract":"<div><h3>Objective</h3><div>With the rising incidence of atrial fibrillation, left atrial appendage closure (LAAC) at the time of cardiac surgery remains an important adjunct. The present study characterized trends, associated resource utilization, and potential disparities in the use of left atrial appendage exclusion.</div></div><div><h3>Methods</h3><div>Using a Society of Thoracic Surgeons regional academic collaborative database, we queried all adult patients undergoing coronary and valve procedures with concomitant LAAC between 2015 and 2021. Trends in LAAC, as well as the technique for closure, were evaluated. Multilevel hierarchical logistic modeling was applied to delineate factors associated with LAAC, accounting for patient and operative characteristics. Generalized linear models were developed to perform risk-adjusted incremental cost analysis.</div></div><div><h3>Results</h3><div>Of the 8699 patients who met the study criteria, 1377 underwent left atrial appendage closure. Over the study period, the annual rate of LAAC increased from 16.7% to 30.8% (<em>P</em> &lt; .001). LAAC patients were older, but less commonly insulin-dependent diabetics or on dialysis. Female sex, redo, and urgent operative status had lower risk-adjusted odds of LAAC. Although LAAC was associated with longer bypass time, there was no significant association with 30-day mortality or 30-day readmission. LAAC was associated with an incremental increase in adjusted costs by $10,602 (95% confidence interval, $4078-$17,126).</div></div><div><h3>Conclusions</h3><div>Rates of LAAC are increasing but less common among female patients, as well as those requiring urgent/emergent interventions. LAAC did not significantly impact short-term mortality. Our results suggest that LAAC may be a high-value intervention among patient populations that have the greatest potential to derive its benefits.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 176-189"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Type A intramural hematoma over 21 years: A single center's experience
JTCVS open Pub Date : 2025-02-01 DOI: 10.1016/j.xjon.2024.09.033
Jennifer Lynn Kim MD , Michael Baiocchi PhD , Matthew Leipzig BS , Matthew Duda MD , Edgar Aranda-Michel MD, PhD , Emily Tognozzi MS , Kelly Higa MD, PhD , Yuanjia Zhu MD, PhD , John Ward MacArthur MD , Y. Joseph Woo MD , Michael P. Fischbein MD, PhD
{"title":"Type A intramural hematoma over 21 years: A single center's experience","authors":"Jennifer Lynn Kim MD ,&nbsp;Michael Baiocchi PhD ,&nbsp;Matthew Leipzig BS ,&nbsp;Matthew Duda MD ,&nbsp;Edgar Aranda-Michel MD, PhD ,&nbsp;Emily Tognozzi MS ,&nbsp;Kelly Higa MD, PhD ,&nbsp;Yuanjia Zhu MD, PhD ,&nbsp;John Ward MacArthur MD ,&nbsp;Y. Joseph Woo MD ,&nbsp;Michael P. Fischbein MD, PhD","doi":"10.1016/j.xjon.2024.09.033","DOIUrl":"10.1016/j.xjon.2024.09.033","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the differences in short- and mid-term outcomes for intramural hematoma in the type A distribution (TAIMH) and acute type A aortic dissection (ATAAD) patients treated at a single institution between 2000 and 2020 to provide insight into whether an emergent surgical treatment strategy for TAIMH is an acceptable treatment option.</div></div><div><h3>Methods</h3><div>Between January 2000 and December 2020, a total of 903 patients were treated for acute aortic syndrome at Stanford Hospital. Baseline characteristics, operative details, short-term postoperative outcomes, mid-term survival, and reoperation rates were examined for this cohort. Cardinality matching was used to control for baseline characteristics and presentation symptoms. Fine balance matching was used to control for cannulation strategy.</div></div><div><h3>Results</h3><div>A total of 187 TAIMH patients were treated surgically and 27 were managed medically. The ATAAD arm included 642 patients who underwent surgery and 47 who were managed nonoperatively. ATAAD operative patients were more commonly male and younger compared to the TAIMH operative patients; however, other baseline medical history was similar in the 2 arms. ATAAD patients presented with higher rates of malperfusion and aortic regurgitation. Cross-clamp and cardiopulmonary bypass times were longer in the ATAAD arm, and these patients underwent more root replacements. Short-term postoperative outcomes were similar in the 2 arms, and there was no significant difference in unadjusted long-term survival and freedom from reoperation. With cardinality matching for preoperative history and presentation symptoms, mid-term survival was better for TAIMH patients. With fine balance matching for cannulation strategy, there was no significant difference between the groups in mid-term survival or stroke.</div></div><div><h3>Conclusions</h3><div>In conclusion, a surgical management strategy for acute TAIMH results in excellent postoperative outcomes and supports an aggressive emergent operative strategy in aortic centers of excellence.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 1-18"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Phrenic nerve infiltration: A good practice to combine pulmonary expansion and pain control in patients with high risk of prolonged air leak
JTCVS open Pub Date : 2025-02-01 DOI: 10.1016/j.xjon.2024.10.026
Beatrice Trabalza Marinucci MD , Antonio D'Andrilli MD , Cecilia Menna MD , Silvia Fiorelli MD, PhD , Alessandra Siciliani MD , Claudio Andreetti MD , Anna Maria Ciccone MD , Giulio Maurizi MD , Camilla Vanni MD , Matteo Tiracorrendo MD , Domenico Massullo MD , Erino Angelo Rendina MD , Mohsen Ibrahim MD
{"title":"Phrenic nerve infiltration: A good practice to combine pulmonary expansion and pain control in patients with high risk of prolonged air leak","authors":"Beatrice Trabalza Marinucci MD ,&nbsp;Antonio D'Andrilli MD ,&nbsp;Cecilia Menna MD ,&nbsp;Silvia Fiorelli MD, PhD ,&nbsp;Alessandra Siciliani MD ,&nbsp;Claudio Andreetti MD ,&nbsp;Anna Maria Ciccone MD ,&nbsp;Giulio Maurizi MD ,&nbsp;Camilla Vanni MD ,&nbsp;Matteo Tiracorrendo MD ,&nbsp;Domenico Massullo MD ,&nbsp;Erino Angelo Rendina MD ,&nbsp;Mohsen Ibrahim MD","doi":"10.1016/j.xjon.2024.10.026","DOIUrl":"10.1016/j.xjon.2024.10.026","url":null,"abstract":"<div><h3>Objective</h3><div>Prolonged air leak due to residual air space after lung resection is a main challenge. To date, few surgical options have been described to prevent this complication. The aim of this study is to investigate the safety and the efficacy of intraoperative phrenic nerve infiltration with long-acting anesthetics in producing transient hemidiaphragm paralysis in patients at high risk for prolonged air leak, thus improving pulmonary expansion after surgery and reducing air leaks, while controlling postoperative pain.</div></div><div><h3>Methods</h3><div>Between January 2021 and 2023, 65 consecutive patients at risk for prolonged air leak (defined in accordance with “2019 Society of Thoracic Surgery score criteria of prolonged air leak”) who underwent lung resection (lobectomy or anatomic segmentectomy) for malignancy were prospectively included in the study. They were randomly (1:2 ratio) assigned to receive (group A, 22 patients) intraoperative phrenic nerve infiltration with ropivacaine 10 mg/mL in the peri-neurotic fat on the pericardium or not to receive intraoperative phrenic nerve infiltration (group B, 43 patients). Five patients in group B were excluded because they did not undergo anatomic resection. Data on pulmonary reexpansion, prolonged air leaks, pain at 24 and 72 hours postsurgery, referred shoulder pain, length of hospital stay, and length of chest tube permanence were collected and compared.</div></div><div><h3>Results</h3><div>Hemidiaphragm elevation (<em>P</em> = .006) and pulmonary expansion (<em>P</em> = .000) were significantly higher in group A. Patients in group A showed lower pain at 24 and 72 hours compared with group B (<em>P</em> = .004). Shoulder pain (0.001) and prolonged air leak (0.000) were higher in group B. Length of chest tube was longer in group B. No difference in hospital stay length was observed.</div></div><div><h3>Conclusions</h3><div>This is the first study to investigate 2 combined effects of phrenic nerve anesthetic infiltration (hemidiaphragm elevation and pain control), with potential enhancement of a patient's recovery after surgery. Intraoperative phrenic nerve infiltration in patients with a risk for prolonged air leak appears to be a safe and effective clinical practice to improve pulmonary expansion in this set of patients, reducing postoperative air leak. This result is associated with an additional improvement in pain control, especially for shoulder pain.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 349-357"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The impact of extent of nodal involvement on stage IIIA (N2) non−small cell lung cancer outcomes
JTCVS open Pub Date : 2025-02-01 DOI: 10.1016/j.xjon.2024.11.018
Lye-Yeng Wong MD , Lillian L. Tsai MD , Hao He PhD , Irmina A. Elliott MD , Mark F. Berry MD
{"title":"The impact of extent of nodal involvement on stage IIIA (N2) non−small cell lung cancer outcomes","authors":"Lye-Yeng Wong MD ,&nbsp;Lillian L. Tsai MD ,&nbsp;Hao He PhD ,&nbsp;Irmina A. Elliott MD ,&nbsp;Mark F. Berry MD","doi":"10.1016/j.xjon.2024.11.018","DOIUrl":"10.1016/j.xjon.2024.11.018","url":null,"abstract":"<div><h3>Objective</h3><div>Stage IIIA (N2) non−small cell lung cancer (NSCLC) treatment can depend on the extent of nodal involvement, with surgery considered for limited disease and definitive chemoradiation preferred for bulky or multi-station disease. Evidence to support management is limited. This study evaluated the impact of the extent of stage IIIA (N2) nodal involvement on outcomes after surgery.</div></div><div><h3>Methods</h3><div>Patients who underwent surgical resection of T1-2N2M0 NSCLC in the Surveillance, Epidemiology, and End Results database from 2004 to 2019 were stratified as having limited (1 positive node) versus more extensive (&gt;1 positive node) nodal disease, and survival was evaluated with Kaplan-Meier and Cox analyses.</div></div><div><h3>Results</h3><div>Of the 6933 patients identified surgical patients, 2129 (30.7%) had limited nodal disease whereas 4804 (69.3%) had more extensive nodal involvement. The limited nodal group had greater 5-year overall survival than the more extensive node group (39.3% vs 30.3%, <em>P</em> &lt; .001), and more extensive nodal involvement (hazard ratio, 1.26; <em>P</em> &lt; .001) was independently associated with worse survival in Cox analysis. Surgical patients had a greater 5-year overall survival than 1644 comparable N2 patients with extensive nodal involvement who received definitive chemoradiation (30.9% vs 18.9%, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Increasing nodal involvement is associated with worse survival for patients with stage IIIA (N2) NSCLC but select patients with more extensive nodal disease may still benefit from surgery compared to chemoradiation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 256-265"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Distal anastomotic new entry tears and aortic remodeling following type A dissection repair: A systematic review
JTCVS open Pub Date : 2025-02-01 DOI: 10.1016/j.xjon.2024.11.004
Ryaan El-Andari MD , Nicholas M. Fialka MD , Abdullah Alshehri MD , Ali Fatehi Hassanabad MD, PhD , Sabin J. Bozso MD, PhD , Michael C. Moon MD
{"title":"Distal anastomotic new entry tears and aortic remodeling following type A dissection repair: A systematic review","authors":"Ryaan El-Andari MD ,&nbsp;Nicholas M. Fialka MD ,&nbsp;Abdullah Alshehri MD ,&nbsp;Ali Fatehi Hassanabad MD, PhD ,&nbsp;Sabin J. Bozso MD, PhD ,&nbsp;Michael C. Moon MD","doi":"10.1016/j.xjon.2024.11.004","DOIUrl":"10.1016/j.xjon.2024.11.004","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 89-100"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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