JTCVS open最新文献

{"title":"Influence of socioeconomic status on postoperative outcomes in acute type A aortic dissection repair","authors":"Benjamin Hambright BS ,&nbsp;Lamario Williams MD, PhD ,&nbsp;Rongbing Xie DrPH, MPH ,&nbsp;Sasha A. Still MD","doi":"10.1016/j.xjon.2025.01.013","DOIUrl":"10.1016/j.xjon.2025.01.013","url":null,"abstract":"<div><h3>Objective</h3><div>Type A aortic dissection repair is an emergency operation associated with both higher perioperative and postoperative risk. This study investigates the influence of socioeconomic status, as measured by the Distressed Communities Index (DCI), on patients who underwent acute aortic dissection repair and their postoperative outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 240 adult patients who underwent repair for acute Stanford Type A aortic dissection from 2009 to 2021. Patients were categorized into an at-risk group (DCI score ≥75) and a not-at-risk group (DCI score &lt;75) based on their zip code. We collected demographic, clinical, operative, and postoperative outcomes, analyzing data using descriptive statistics and multivariable logistic regression. Kaplan-Meier survival analysis assessed 5-year survival outcomes.</div></div><div><h3>Results</h3><div>At-risk patients were significantly younger (52 vs 59 years; <em>P</em> = .03) and more commonly African American (59.02% vs 26.5%; <em>P</em> &lt; .0001). Although chronic health condition rates were similar, at-risk patients showed trends toward higher rates of postoperative respiratory failure (27.1% vs 18.0%; <em>P</em> = .0926) and longer hospital stays (27.05% vs 15.25% for length of stay of 8-13 days; <em>P</em> = .065). However, rates of postoperative complications, including 30-day mortality and 5-year survival, were not significantly different between groups, and at-risk status did not significantly predict mortality (hazard ratio, 1.35; 95% CI, 0.65-2.79; <em>P</em> = .43).</div></div><div><h3>Conclusions</h3><div>Patients undergoing urgent surgery for acute Type A aortic dissection have similar postoperative outcomes, although at-risk patients may experience longer hospital stays and higher respiratory failure rates. Further study is necessary to understand the effect of DCI score on intermediate and long-term outcomes to mitigate social disparities and diminish modifiable risk factors.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 332-340"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentation, management, and clinical outcomes of acute type A dissection: Does sex matter?","authors":"Frederike Meccanici BSc ,&nbsp;Carlijn G.E. Thijssen MD, PhD ,&nbsp;Arjen L. Gökalp MD ,&nbsp;Marie H.E.J. van Wijngaarden MD ,&nbsp;Mark F.A. Bierhuizen MD ,&nbsp;Guy F. Custers MD ,&nbsp;Jort Evers BSc ,&nbsp;Jolien A. de Veld MD ,&nbsp;Maximiliaan L. Notenboom BSc ,&nbsp;Guillaume S.C. Geuzebroek MD, PhD ,&nbsp;Joost F.J. ter Woorst MD, PhD ,&nbsp;Jelena Sjatskig MD ,&nbsp;Robin H. Heijmen MD, PhD ,&nbsp;Mostafa M. Mokhles MD, PhD ,&nbsp;Roland R.J. van Kimmenade MD, PhD ,&nbsp;Jos A. Bekkers MD, PhD ,&nbsp;Johanna J.M. Takkenberg MD, PhD ,&nbsp;Jolien W. Roos-Hesselink MD, PhD","doi":"10.1016/j.xjon.2024.12.006","DOIUrl":"10.1016/j.xjon.2024.12.006","url":null,"abstract":"<div><h3>Background</h3><div>Male–female differences in clinical presentation, management, and outcomes of acute type A aortic dissection (AD-A) have been reported; however, robust data are scarce. This study examined those differences.</div></div><div><h3>Methods</h3><div>Consecutive adults diagnosed with AD-A between 2007 and 2017 in 4 referral centers were included retrospectively. Baseline data, operative characteristics, and mortality and morbidity during follow-up were collected using patient files, questionnaires, and referral information.</div></div><div><h3>Results</h3><div>The study included 889 patients (37.5% female). Females were significantly older at presentation (median, 67.0 [interquartile range [IQR], 59.0-75.0] years vs 61.0 [IQR, 53.0-69.0] years; <em>P</em> &lt; .001) and more often had cardiovascular comorbidities. Severe hypotension, tamponade, and nausea were more frequently observed in females. Short-term mortality was 18.5% in females and 21.2% in males (<em>P</em> = .362). No significant differences in treatment between males and females were observed. After surgery, the median follow-up was 6.2 years (IQR, 3.5-9.2 years). Overall 10-year survival was 50.1% (95% confidence interval [CI], 43.6%-57.6%) in females and 62.8% (95% CI, 58.1%-67.9%) in males (<em>P</em> = .009), although this difference was not significant after multivariable correction. Compared to the matched general population, survival was lower than expected in females and comparable to expected in males. The long-term reintervention rate in surgically treated survivors was comparable between males and females (2.1%/patient-year). Male- and female-specific risk factors for long term mortality were identified.</div></div><div><h3>Conclusions</h3><div>These findings highlight a distinct clinical profile at presentation with AD-A between males and females, while treatment approach and short-term mortality were comparable. The relatively poor long-term survival in females and male-/female-specific risk stratification warrant further investigation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 47-57"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentator Discussion: Impact of left ventricular rehabilitation on surgical outcomes in patients with borderline left heart hypoplasia","authors":"","doi":"10.1016/j.xjon.2024.10.020","DOIUrl":"10.1016/j.xjon.2024.10.020","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 374-375"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital readmission after heart valve surgery in the United Kingdom","authors":"Jeremy Chan MD,&nbsp;Pradeep Narayan MD,&nbsp;Tim Dong BSc,&nbsp;Daniel P. Fudulu MD, PhD,&nbsp;Gianni D. Angelini MD,&nbsp;CVD-COVID-UK/COVID-IMPACT Consortium","doi":"10.1016/j.xjon.2025.02.001","DOIUrl":"10.1016/j.xjon.2025.02.001","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate hospital readmission rates in the United Kingdom within the first 12 months following heart valve surgery.</div></div><div><h3>Methods</h3><div>All patients who underwent heart valve surgery between January 2013 and April 2023 were included in the study. Readmission to any National Health Service hospital within 12 months after discharge was captured. Trends in readmission, primary and secondary diagnoses, and related procedures were evaluated.</div></div><div><h3>Results</h3><div>A total of 44,467 patients (median age, 69.3 years; 61% male) were included, of whom 44.6%, 23.15%, and 11.95% experienced 1, 2, and 3 readmissions, respectively, within 12 months of discharge following the index procedure. The overall 30-day and 12-month readmission rates were 12.9% and 44.6%, respectively, with a total of 42,151 readmissions. The median time from discharge to readmission was 61 days (interquartile range, 14-168 days). The overall 12-month readmission rate remained consistently above 40% throughout the study period, with a slight drop in 2020 during the COVID-19 pandemic. Cardiovascular-related readmissions accounted for 10,318 (24.5%) of the total readmissions. Arrhythmia was the most common primary diagnosis (37.6%; atrial fibrillation/flutter in 82.4% of the cases), followed by heart failure (16.1%) and valve-related dysfunction (15.2%). Surgical valve procedure-related readmissions accounted for 24.9% of the total, with chest pain of noncardiac origin (41.0%), respiratory tract infections (16.0%), and pleural effusions (10.0%).</div></div><div><h3>Conclusions</h3><div>Nearly one-half of the patients required at least 1 readmission within 12 months of heart valve surgery, placing significant strain on the healthcare system. Cardiovascular- and procedure-related causes accounted for one-half of all readmissions.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 239-255"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of major cardiac operations are not improved for black patients at black-serving institutions","authors":"Nikhil L. Chervu MD, MS,&nbsp;Saad Mallick MD,&nbsp;Amulya Vadlakonda BS,&nbsp;Sara Sakowitz MS, MPH,&nbsp;Ifigenia Oxyzolou,&nbsp;Troy Coaston BS,&nbsp;Peyman Benharash MD","doi":"10.1016/j.xjon.2024.11.021","DOIUrl":"10.1016/j.xjon.2024.11.021","url":null,"abstract":"<div><h3>Objective</h3><div>Although provider–patient racial concordance has been associated with improved outcomes among patients of Black race, it is unclear if increased representation at the institutional level is associated with the same benefits.</div></div><div><h3>Methods</h3><div>Adults undergoing coronary artery bypass grafting and valve operations were tabulated from the 2016-2020 National Inpatient Sample. Black-serving quartiles were generated using the annual proportion of Black patients admitted for all diagnoses. The primary end point was in-hospital mortality with Society of Thoracic Surgeons–defined major complications, postoperative length of stay, and costs as secondary outcomes. Mixed regression models were used to ascertain the association between Black-serving quartile designation and outcomes of interest; an interaction term was used to evaluate the incremental association of race and Black-serving quartiles.</div></div><div><h3>Results</h3><div>Of an estimated 1,203,120 patients, 7.2% were Black. After adjustment, highest Black-serving quartile hospitals demonstrated higher odds of mortality (adjusted odds ratio, 1.18, 95% CI, 1.06-1.30) and major complications (adjusted odds ratio, 1.19, 95% CI, 1.11-1.28) compared with lowest Black-serving quartile hospitals. Notably, Black patients had significantly higher mortality compared with non-Black patients at highest Black-serving quartile institutions (3.3%, 95% CI, 3.0-3.7 vs 2.6, 95% CI, 2.4-2.8), but not at the lowest (3.1%, 95% CI, 1.8-4.4 vs 2.2, 95% CI, 2.1-2.4). Black patients exhibited a stepwise increase in risk of major complication rates, postoperative length of stay, and costs with higher Black-serving quartiles.</div></div><div><h3>Conclusions</h3><div>Highest Black-serving quartile hospitals had worse clinical outcomes overall compared with those in the lowest Black-serving quartile. Unfortunately, Black patients had additional increased mortality, complications, postoperative length of stay, and costs at high Black-serving quartile institutions, highlighting the compounding effects of patient and hospital-level racial disparities.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 321-331"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of pulmonary hypertension and right ventricular function on outcomes of isolated tricuspid valve surgery","authors":"Salah E. Altarabsheh MD ,&nbsp;Juan A. Crestanello MD ,&nbsp;Nishant Saran MD ,&nbsp;Richard C. Daly MD ,&nbsp;Joseph A. Dearani MD ,&nbsp;Kevin L. Greason MD ,&nbsp;John M. Stulak MD ,&nbsp;Austin Todd MS ,&nbsp;Phillip G. Rowse MD ,&nbsp;Arman Arghami MD ,&nbsp;Gabor Bagameri MD ,&nbsp;Mauricio A. Villavicencio MD ,&nbsp;Hartzell V. Schaff MD ,&nbsp;Vidhu Anand MBBS","doi":"10.1016/j.xjon.2025.01.009","DOIUrl":"10.1016/j.xjon.2025.01.009","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the impact of pulmonary hypertension and right ventricular dysfunction on outcomes of isolated tricuspid valve surgery.</div></div><div><h3>Methods</h3><div>From 2004 to 2022, 298 patients (age 71.0 ± years, 59.4% female) underwent isolated tricuspid valve surgery. Pulmonary hypertension was defined as right ventricular systolic pressure ≥50 mm Hg, and right ventricular dysfunction as right ventricular fractional area change &lt;32% on preoperative transthoracic echocardiogram. Patients were stratified into 4 groups: group I: No pulmonary hypertension or right ventricular dysfunction (n = 199), group II: pulmonary hypertension without right ventricular dysfunction (n = 45), group III: right ventricular dysfunction without pulmonary hypertension (n = 43), and group IV: pulmonary hypertension and right ventricular dysfunction (n = 11). Uni- and multivariable analyses were performed to evaluate association of pulmonary hypertension and right ventricular function with outcomes.</div></div><div><h3>Results</h3><div>Tricuspid valve replacement was performed in 218 (73.2%) and repair in 80 (26.8%) patients. Operative mortality was 4.7%, similar for reoperations (5.2%) and primary procedures (4.5%) (<em>P</em> = .907). Median follow-up was 5.4 (interquartile range, 2.3-12.5) years, survival was 74.4%, 48.4%, 39.8%, and 67.3% in groups I-IV, respectively (<em>P</em> &lt; .0001). Multivariable analysis identified pulmonary hypertension (hazard ratio, 2.9; 1.83-4.62, <em>P</em> &lt; .001) and right ventricular dysfunction (hazard ratio, 2.83; 1.76-4.56, <em>P</em> &lt; .001) as independent predictors of greater long-term all-cause mortality, in addition to older age (<em>P</em> &lt; .001) and severe chronic lung disease (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Among patients who underwent isolated tricuspid valve surgery, presence of pulmonary hypertension or right ventricular dysfunction at baseline is linked to greater long-term mortality.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 115-126"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of a degradable thin film to modulate perfusion to post-autotransplantation airways in rats","authors":"Aravind Krishnan MD ,&nbsp;Mahdi Forouharshad PhD ,&nbsp;Elbert Heng MD ,&nbsp;Alyssa Garrison MS ,&nbsp;Daniel Alnasir BSE ,&nbsp;Shubham Patil BS ,&nbsp;Arman Farazdaghi BS ,&nbsp;Moeed Fawad MS ,&nbsp;Stefan Elde MD ,&nbsp;Brandon A. Guenthart MD ,&nbsp;Laura M. Ensign PhD ,&nbsp;Y Joseph Woo MD ,&nbsp;Kunal S. Parikh PhD ,&nbsp;John W. MacArthur MD","doi":"10.1016/j.xjon.2025.01.008","DOIUrl":"10.1016/j.xjon.2025.01.008","url":null,"abstract":"<div><h3>Objective</h3><div>Recipients of lung transplants experience the lowest long-term survival among all solid-organ transplant recipients. Airway complications contribute significantly to morbidity and mortality post-lung transplant and may be driven by airway devascularization inherent to procurement and implantation of the lungs. We studied application of biodegradable, nanofiber-based thin films to devascularized autotransplanted airways to mitigate airway ischemia.</div></div><div><h3>Methods</h3><div>We used a rat tracheal autotransplantation model that replicates airway ischemia. Rats were divided into an operated control group (n = 18) and a treatment group (n = 12) receiving an electrospun film composed of randomly aligned polydioxanone (PDO) nanofibers applied to the circumferential surface of the transplanted trachea. Airway perfusion was assessed via laser speckle contrast analysis at 0, 3, and 10 days. Differences in perfusion units were calculated between the nontransplanted and transplanted segments of the trachea. Multimodal analysis of angiogenesis in tracheal autografts included immunoassay profiling for proangiogenic cytokines, histologic injury grading, and speckle angiography.</div></div><div><h3>Results</h3><div>Qualitative and quantitative perfusion differences were demonstrated at days 0, 3, and 10. Nanofiber-based, PDO thin films significantly improved perfusion in the transplanted segment of trachea (<em>P</em> &lt; .05). Histologic injury scoring was significantly worse in the operated controls compared with the treatment group (<em>P</em> &lt; .01). Immunoassays demonstrated increased expression of vascular cell adhesion molecule 1 in the treatment group (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Application of a nanofiber-based, PDO thin film induced a local tissue response that improved perfusion and histologic injury scoring of the transplanted airway in an autotransplant model of airway devascularization. Immune multiplexing suggests local inflammatory responses may drive angiogenesis.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 510-520"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveying surgeon practices and perspectives on extent of intraoperative nodal evaluation in non–small cell lung cancer","authors":"Lyndon C. Walsh BA ,&nbsp;Alessandro Brunelli MD ,&nbsp;Biniam Kidane MD, MSc ,&nbsp;Jazmin Eckhaus MBBS ,&nbsp;Pierre Olivier Fiset MD, PhD ,&nbsp;Jonathan D. Spicer MD, PhD ,&nbsp;Mara B. Antonoff MD","doi":"10.1016/j.xjon.2025.01.010","DOIUrl":"10.1016/j.xjon.2025.01.010","url":null,"abstract":"<div><h3>Objective</h3><div>The National Comprehensive Cancer Network and Commission on Cancer guidelines encourage surgeons to obtain tissue from 1 or more N1 and 3 N2 nodal stations during resection for non–small cell lung cancer. We aimed to characterize surgeons’ familiarity with and adherence to recommended guidelines and to elucidate factors influencing surgical practices globally.</div></div><div><h3>Methods</h3><div>A questionnaire was designed to assess surgeon behaviors regarding intraoperative nodal assessment decisions during lung cancer resection. Survey items included demographics, case-based scenarios, self-perceived behaviors regarding nodal decision-making, and knowledge-based questions regarding nodal assessment guidelines. The survey was distributed to the General Thoracic Surgical Club, European Society of Thoracic Surgeons, Canadian Association of Thoracic Surgeons, and Australian &amp; New Zealand Society of Cardiac &amp; Thoracic Surgeons.</div></div><div><h3>Results</h3><div>Altogether, 236 of 2396 surgeons (9.8%) from 46 countries responded. The majority were men (192/236) and general thoracic surgeons (204/236). Participants were subcategorized into North America (n = 96), Europe (n = 96), and All Other (n = 44). The importance of 4 variables that impact lymph node excision varied by region: length of procedure (<em>P</em> = .04), patient age (<em>P</em> = .0004), patient frailty (<em>P</em> = .0034), and institutional guidelines (<em>P</em> = .01). Surgeons stated that in patients who received neoadjuvant treatment, most would opt for a full lymphadenectomy. A total of 80.5% (n = 190) claimed familiarity with guidelines, yet only 56.4% (n = 133) could identify the guidelines.</div></div><div><h3>Conclusions</h3><div>The variables driving intraoperative decision-making for nodal dissection vary by region. Moreover, surgeons tend to overstate their knowledge of existing guidelines. To optimize cancer care around the world, education needs to be provided uniformly to drive positive patient outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 376-382"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathologic upstaging and survival outcomes for patients undergoing segmentectomy versus lobectomy in clinical stage T1cN0M0 non–small cell lung cancer","authors":"Ryan C. Jacobs MD, MS,&nbsp;Erik E. Rabin MD,&nbsp;Charles D. Logan MD,&nbsp;Sandeep N. Bharadwaj MD,&nbsp;Hee Chul Yang MD,&nbsp;Raheem D. Bell MD,&nbsp;Emily J. Cerier MD,&nbsp;Chitaru Kurihara MD,&nbsp;Kalvin C. Lung MD,&nbsp;Diego M. Avella Patino MD,&nbsp;Samuel S. Kim MD,&nbsp;Ankit Bharat MBBS","doi":"10.1016/j.xjon.2025.01.014","DOIUrl":"10.1016/j.xjon.2025.01.014","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the impact of the extent of surgical resection on overall survival in patients with clinical T1cN0M0 (cT1cN0M0) non–small cell lung cancer (NSCLC), with and without pathologic nodal upstaging (pN1+).</div></div><div><h3>Methods</h3><div>The National Cancer Database (NCDB) was queried to identify patients with cT1cN0M0 NSCLC who underwent lobectomy or segmentectomy without receiving neoadjuvant therapy between 2010 and 2021. Bivariate analyses were performed to compare demographic and clinical characteristics across surgical groups. Propensity score matching was used to compare outcomes of segmentectomy versus lobectomy. Cox proportional hazard models and Kaplan-Meier survival estimates were used to assess the association of overall survival on the interaction between extent of resection and pathologic nodal upstaging.</div></div><div><h3>Results</h3><div>A total of 22,945 patients were analyzed, including 21,875 (95.3%) who underwent lobectomy and 1070 (4.7%) who underwent segmentectomy. Pathologic nodal upstaging to pN1+ occurred in 14.5% of lobectomy cases and in 6.6% of segmentectomy cases. Propensity score–matched analysis revealed that patients undergoing segmentectomy had comparable overall survival to those undergoing lobectomy (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.86-1.16), and those undergoing segmentectomy with pN1+ had comparable overall survival to those undergoing lobectomy with pN1+ (HR, 1.04; 95% CI, 0.65-1.66).</div></div><div><h3>Conclusions</h3><div>In patients with cT1cN0M0 NSCLC, overall survival outcomes are similar between segmentectomy recipients and lobectomy recipients, including those incidentally found to have pN1+, suggesting a potential role of lobe-preserving approaches. Additionally, completion lobectomy may not offer a survival benefit in cT1cN0M0 patients incidentally discovered to have pathologic N1 nodes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 394-408"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac donation after circulatory death in adult congenital heart disease: Early national experiences and outcomes","authors":"Alex M. Wisniewski MD, MSc,&nbsp;Matthew P. Weber MD, MS,&nbsp;Abhinav Kareddy BS,&nbsp;Nicholas R. Teman MD,&nbsp;Jared P. Beller MD,&nbsp;Leora T. Yarboro MD","doi":"10.1016/j.xjon.2024.12.014","DOIUrl":"10.1016/j.xjon.2024.12.014","url":null,"abstract":"<div><h3>Objective</h3><div>Cardiac donation after circulatory death has increased in utilization with results comparable to donation after brain death in adult patients undergoing heart transplantation. However, its use in adult congenital heart disease (ACHD) is not well studied. We aimed to characterize outcomes of cardiac donation after circulatory death in an ACHD population.</div></div><div><h3>Methods</h3><div>Utilizing the United Network for Organ Sharing database, patients with ACHD who underwent heart transplantation between January 2020 and January 2024 were identified. Those with any prior heart transplant or undergoing multiorgan transplant were excluded. Kaplan-Meier survival analysis and Cox regression were used for group survival comparisons.</div></div><div><h3>Results</h3><div>A total of 420 adult patients with congenital heart disease undergoing heart transplant met inclusion criteria with 36 patients receiving donation after circulatory death grafts. Circulatory death grafts were from a similar median distance (273 vs 222 miles) but had longer ischemic times (4.7 vs 3.8 hours) and higher use of ex situ perfusion devices (66.7% vs 5.7%; <em>P</em> &lt; .001). Kaplan-Meier analysis demonstrated significantly worse 90-day survival after transplant in the donation after circulatory death group (log-rank <em>P</em> = .039) but no difference on landmark analysis for survivors after 90 days (log-rank <em>P</em> = .43).</div></div><div><h3>Conclusions</h3><div>Early results of circulatory death grafts compared with brain death grafts in adult patients with congenital heart disease undergoing heart transplantation have demonstrated worse early survival but similar midterm survival following 90 days. Attention should be placed on improving outcomes during the perioperative period to effectively utilize this potential expanded donor pool in ACHD.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 311-320"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}