JTCVS open最新文献

{"title":"Primary repair of common arterial trunk: A systematic meta-analysis of short- and long-term outcomes","authors":"Michela Cuomo MD ,&nbsp;Marco Moscarelli MD, PhD ,&nbsp;Francesco Pollari MD, PhD ,&nbsp;Oliver Dewald MD ,&nbsp;Guido Oppido MD ,&nbsp;Fabio Barili MD ,&nbsp;Alessandro Parolari MD ,&nbsp;Ariawan Purbojo MD ,&nbsp;Robert Anton Cesnjevar MD ,&nbsp;Italian Research Group on Outcome in Cardiac Surgery","doi":"10.1016/j.xjon.2025.05.012","DOIUrl":"10.1016/j.xjon.2025.05.012","url":null,"abstract":"<div><h3>Objectives</h3><div>Primary repair of the common arterial trunk is still burdened by high mortality rates. Because of the low incidence and complexity of common arterial trunk, evidence is limited to reports with small sample sizes, and issues such as the ideal surgical timing to address the primary repair are still debated. We performed a systematic review and meta-analysis to estimate the pooled mortality, morbidity, and reoperation rates after common arterial trunk primary repair.</div></div><div><h3>Methods</h3><div>PubMed, Google Scholar, Ovid-MEDLINE, and Ovid-EMBASE databases were searched to identify studies on common arterial trunk primary repair. Eligible studies reporting early mortality (primary outcome) after common arterial trunk primary repair were screened. Secondary outcomes were survival and reoperation on the right ventricle pulmonary artery conduit at the follow-up.</div></div><div><h3>Results</h3><div>Among 319 articles retrieved, 43 studies including 4844 patients met the inclusion criteria. Pooled early mortality was 11.23% (95% CI, 9.4-13.37). There was no difference in the early mortality rates between multicenter and single-center studies. The sub-analysis comparing the neonatal and non-neonatal repair groups showed a significantly lower mortality rate in the neonatal group (<em>P</em> &lt; .001). At the follow-up, the pooled mortality was 0.72% per year (95% CI, 0.51-0.93) and the reoperation rate on the right ventricle pulmonary artery conduit was 3.4% per year (95% CI, 2.24-4.57).</div></div><div><h3>Conclusions</h3><div>The early mortality rate after common arterial trunk primary repair is relatively high, and the reoperation rate per year on the right ventricle pulmonary artery conduit is a major problem. This meta-analysis supports the current tendency of performing primary repair during the neonatal period and can serve as a benchmark for future studies.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 182-195"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912823","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":"Improved outcomes with robotic-assisted laparoscopic paraesophageal hernia repairs compared with laparoscopic and transthoracic approaches: A single high-volume institution experience","authors":"Katelyn R. Ward MD ,&nbsp;Jenny Bui MD, MPH ,&nbsp;Irina Bondarenko MS ,&nbsp;Andrew Chang MD ,&nbsp;Kiran Lagisetty MD ,&nbsp;Jules Lin MD ,&nbsp;Chigozirim N. Ekeke MD ,&nbsp;David D. Odell MD, MMSc ,&nbsp;Rishindra M. Reddy MD, MBA","doi":"10.1016/j.xjon.2025.06.016","DOIUrl":"10.1016/j.xjon.2025.06.016","url":null,"abstract":"<div><h3>Objectives</h3><div>Laparoscopic (lap) paraesophageal hernia repair has excellent short-term outcomes but higher long-term recurrence rates compared with the transthoracic repair. We hypothesized that the robotic-assisted lap (robot) approach would have similarly good short-term outcomes as lap, but also lower recurrence rates.</div></div><div><h3>Methods</h3><div>A retrospective study of prospectively collected data was performed for paraesophageal hernia repairs at a single high-volume quaternary hospital from July 2018 to September 2022. Outcomes analyzed included 2-year postoperative radiographic recurrence (Rad), Society of Thoracic Surgeons-defined radiographic recurrence (STS-rad), symptomatic recurrence (Sx), and perioperative outcomes. Lap, robot, and transthoracic groups were compared using univariate, multivariate, and propensity score analysis.</div></div><div><h3>Results</h3><div>Among 207 cases (52 lap, 90 robot, and 65 transthoracic), robot was lower than lap (odds ratio [OR], 0.13-0.17; <em>P</em> &lt; .01) and similar to transthoracic (OR, 0.79-1.02; <em>P</em> &gt; .05) in univariate and multivariate analyses. STS-rad was similar between approaches across analyses, apart from robot being higher than transthoracic on propensity score analysis (OR, 1.83; <em>P</em> &lt; .01). Robotic Sx recurrence was lower in robot compared with lap across analyses (OR, 0.40-0.50; <em>P</em> &lt; .001). Median length of stay was 2 days for robot and lap, significantly shorter than transthoracic (median, 5 days; <em>P</em> &lt; .01). Fewer postoperative complications occurred in robot compared with transthoracic (OR, 0.19-0.21; <em>P</em> &lt; .01). Reoperation and endoscopic intervention were lower in robot compared with lap (OR, 0.09-0.12; <em>P</em> &lt; .01 and OR, 0.32-0.40; <em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Robotic paraesophageal hernia repairs had generally lower 2-year recurrence and reoperation than lap and shorter hospital stays and fewer immediate complications than transthoracic.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 255-265"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912925","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":"Posterior leaflet reconstruction in mitral valve repair: Does resect versus respect strategy matter?","authors":"Takuya Ogami MD ,&nbsp;Ethan Chetkof BS ,&nbsp;Johannes O. Bonatti MD ,&nbsp;Christopher Pantelis BS ,&nbsp;Stephen D. Waterford MD ,&nbsp;Francis D. Ferdinand MD ,&nbsp;Irsa S. Hasan MD ,&nbsp;Derek Serna-Gallegos MD ,&nbsp;David J. Kaczorowski MD ,&nbsp;Danny Chu MD ,&nbsp;Floyd W. Thoma BS ,&nbsp;Ibrahim Sultan MD","doi":"10.1016/j.xjon.2025.06.009","DOIUrl":"10.1016/j.xjon.2025.06.009","url":null,"abstract":"<div><h3>Objective</h3><div>Previous randomized controlled trials demonstrated comparable outcomes between posterior leaflet resections and neochord implantation in mitral valve (MV) repair. However, these studies were limited up to 1-year follow-up, and more recent evidence suggested that leaflet resections may offer superior long-term outcomes.</div></div><div><h3>Methods</h3><div>All patients who underwent MV repair with either resection or neochord implantation for posterior leaflet pathology between October 2011 and July 2024 were included. Propensity-score matching was used.</div></div><div><h3>Results</h3><div>A total of 457 patients underwent posterior leaflet reconstruction, with 334 (73.1%) requiring leaflet resection (resection group) and 123 (26.9%) receiving neochordae (neochord group). The median [interquartile range] follow-up for survival and reintervention was 5.93 [2.00, 9.09] and 5.48 [1.84, 9.02] years, respectively. Overall, the mean age was 63.9 years, and the mean ejection fraction was 58.9%. Robotic-assisted surgery was performed in 28.9% (n = 132). The 30-day mortality was 2.4% (n = 11). Propensity-score matching provided 119 patients in each group. Kaplan-Meier curves demonstrated similar survival at 5 years between these groups (93.1 ± 2.8% in the resection group and 89.6 ± 3.1% in the neochord group, <em>P</em> = .5). However, the neochord group had a greater cumulative incidence of reoperative MV surgery (8.0% vs 0.9% at 5 years in the resection group, <em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>Neochordae were implanted in 27.3% of patients undergoing MV repair. Neochord implantation was associated with a greater risk of MV reintervention in the long term. Careful patient selection and technical considerations are important when choosing the repair method.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 94-103"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913180","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":"Management of the dissected aortic root in young patients: A propensity score-matched analysis of mechanical versus bioprosthetic aortic root replacement","authors":"Michael A. Catalano MD ,&nbsp;Omar Toubat MD, PhD ,&nbsp;Lauren Gillinov BS ,&nbsp;Kendall M. Lawrence MD ,&nbsp;Yu Zhao MS ,&nbsp;John J. Kelly MD ,&nbsp;Nicholas J. Goel MD ,&nbsp;Alexandra Sperry MD ,&nbsp;Wilson Y. Szeto MD ,&nbsp;Chase R. Brown MD ,&nbsp;Nimesh D. Desai MD, PhD","doi":"10.1016/j.xjon.2025.05.009","DOIUrl":"10.1016/j.xjon.2025.05.009","url":null,"abstract":"<div><h3>Objective</h3><div>Valve selection in acute type A aortic dissection (ATAAD) requiring aortic root replacement is challenging given the clinical acuity, unknown patient preferences, risk of surgical bleeding, and limited life expectancy. We sought to identify long-term outcomes of mechanical versus bioprosthetic aortic root replacement in young patients with ATAAD.</div></div><div><h3>Methods</h3><div>Retrospective review of our institution's database of ATAAD was conducted to identify patients aged 65 years and younger who underwent mechanical Bentall (mech-Bentall) or bioprosthetic Bentall (bio-Bentall) for ATAAD from 2002 to 2022. The primary end point was 10-year survival, which was compared in a propensity score-matched cohort and multivariable Cox proportional hazards model. A composite outcome of 10-year freedom from death, stroke, major bleeding, and valvular reintervention was assessed as a secondary end point.</div></div><div><h3>Results</h3><div>Of 1114 patients who underwent ATAAD repair, there were 79 mech-Bentalls and 67 bio-Bentalls in patients aged 65 years or younger. Patients undergoing mech-Bentall were younger, and they were less likely to undergo an extended arch operation; there was no difference in gender, race, comorbidities, or malperfusion on presentation. In a propensity score-matched analysis, mech-Bentall patients demonstrated a nonsignificant increase in 10-year mortality (<em>P</em> = .058) and demonstrated higher rates of the composite end point (<em>P</em> = .026). In a Cox proportional hazards model, mech-Bentall (hazard ratio, 1.892; <em>P</em> = .023) was independently associated with 10-year composite end point occurrence.</div></div><div><h3>Conclusions</h3><div>There is no survival advantage of mech-Bentall in ATAAD in young patients at 10 years, and it is associated with a significantly higher rate of morbid complications. When the aortic valve cannot be spared, bio-Bentall should be considered in ATAAD, even in young patients.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 22-33"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913237","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":"Bioprosthetic valve replacement for concomitant aortic and mitral positions","authors":"Hong Rae Kim MD, PhD ,&nbsp;Ha Eun Oh MD ,&nbsp;Ho Jin Kim MD, PhD ,&nbsp;Seon-Ok Kim MSc ,&nbsp;Ye-Jee Kim PhD ,&nbsp;Jung-Min Ahn MD, PhD ,&nbsp;Joon Bum Kim MD, PhD ,&nbsp;Dae-Hee Kim MD, PhD","doi":"10.1016/j.xjon.2025.04.013","DOIUrl":"10.1016/j.xjon.2025.04.013","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the clinical outcomes of double-valve replacement (DVR) using bovine pericardial and porcine bioprostheses, using a nationwide administrative claims database.</div></div><div><h3>Methods</h3><div>Adult patients (age ≥40 years) who underwent bioprosthetic DVR between 2003 and 2018 were identified from the Korean National Health Insurance Service database. The outcomes of interest were all-cause mortality, cardiac mortality, and valve-related events, including the incidences of reoperation, endocarditis, systemic thromboembolism, and major bleeding. Baseline adjustment was performed using propensity score matching. Time-related outcomes were evaluated using a competing risk analysis, with death considered a competing risk.</div></div><div><h3>Results</h3><div>Among the 889 patients who met the inclusion criteria, 608 (68.3%) received a bovine pericardial valve and the other 281 (31.6%) received a porcine valve. After matching 195 pairs of patients, there were no significant differences in cardiovascular mortality, all-cause mortality, thromboembolism, or major bleeding between the bovine and porcine groups; however, patients with porcine valves had a higher risk of reoperation (adjusted hazard ratio, 2.08; 95% confidence interval, 1.10-3.94) in competing risk analyses. An adjusted subgroup analysis showed that patients without diabetes and a lower Charlson Comorbidity Index who received a porcine valve had a higher risk of reoperation.</div></div><div><h3>Conclusions</h3><div>This nationwide cohort study on DVR revealed that the choice of bioprosthetic valve type was not associated with the risk of cardiovascular mortality. However, the use of porcine prostheses was significantly associated with a higher risk of reoperation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 61-74"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913233","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":"The complex and hazardous course for heterotaxy-associated congenital heart disease","authors":"Anna Olds MD, MS ,&nbsp;James M. Meza MD, MS ,&nbsp;Nithya Rajeev BS ,&nbsp;Mike Kim BS ,&nbsp;Luke M. Wiggins MD ,&nbsp;Winfield J. Wells MD ,&nbsp;Vaughn A. Starnes MD ,&nbsp;John David Cleveland MD","doi":"10.1016/j.xjon.2025.06.018","DOIUrl":"10.1016/j.xjon.2025.06.018","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with heterotaxy-associated congenital heart disease often require multiple operations, which may have a cumulative effect on their outcomes. This study aimed to define the cardiac surgical course in a large cohort and identify longitudinal risk factors for death/transplant.</div></div><div><h3>Methods</h3><div>All patients with heterotaxy-associated congenital heart disease who underwent cardiac surgery at one institution from 2005 to 2022 were retrospectively reviewed. Demographics, anatomy, and operative course were summarized. Parametric risk hazard analysis for death/transplant was performed. Operations were analyzed as time-varying covariates.</div></div><div><h3>Results</h3><div>Of 217 patients included, left isomerism occurred in 89 (41%), 139 (64%) were right ventricle dominant, and 43 (20%) had biventricular dominance. Total anomalous pulmonary venous return occurred in 100 patients (46%): 40 (40%) supracardiac, 34 (34%) intracardiac, 18 (18%) infracardiac, 7 (7%) mixed, and 19 (19%) obstructed. Ultimately, 102 patients (47%) reached the Fontan and 29 patients (13%) reached biventricular circulation. Transplant-free survivals at 1, 5, and 10 years were 79.4% ± 3%, 71.0% ± 3%, 63.9% ± 3%, respectively. Multivariable parametric analysis resolved 2 phases of risk for death/transplant. First-phase predictors included coarctation (parameter estimate 0.91 ± 0.55, <em>P = .</em>04) and time-varying total anomalous pulmonary venous return repair + pulmonary blood flow control (parameter estimate 1.64 ± 0.37, <em>P &lt; .</em>001). Second-phase predictors included tricuspid atresia (parameter estimate 2.17 ± 0.59, <em>P &lt; .</em>001), time-varying Fontan revision (parameter estimate 3.48 ± 0.51, <em>P &lt; .</em>001), and time-varying atrioventricular valve repair/replacement (3.55 ± 0.54, <em>P &lt; .</em>001). Reaching the Glenn reduced the risk of death/transplant (parameter estimate −1.85 ± 0.54, <em>P &lt; .</em>001).</div></div><div><h3>Conclusions</h3><div>Operative management of heterotaxy-associated congenital heart disease is high risk, especially when total anomalous pulmonary venous return repair with pulmonary blood flow control is required. Risk after infancy is primarily determined by need for the Fontan or atrioventricular valve reintervention.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 196-206"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912822","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":"Corrigendum to Surgical resection of diffuse pulmonary arteriovenous malformations (PAVMs) [JTCVS Open Volume 23, February 2025, Pages 309-317]","authors":"Aden R. Falk ,&nbsp;Lindsay J. Nitsche BS ,&nbsp;Colleen E. Bontrager BA ,&nbsp;Sarah Bond PA-C ,&nbsp;Lauren A. Beslow MD, MSCE ,&nbsp;Alexandra J. Borst MD ,&nbsp;Jennifer Pogoriler MD, PhD ,&nbsp;Paul J. Devlin MD ,&nbsp;Elizabeth Goldmuntz MD ,&nbsp;Sunil Singhal MD ,&nbsp;Scott O. Trerotola MD ,&nbsp;Stephanie M. Fuller MD, MS","doi":"10.1016/j.xjon.2025.06.001","DOIUrl":"10.1016/j.xjon.2025.06.001","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Page 242"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912924","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":"A guide for the type A aortic dissection consultation and surgical planning: Key points for cardiac surgery trainees","authors":"Ryaan El-Andari MD,&nbsp;Michael C. Moon MD","doi":"10.1016/j.xjon.2025.04.020","DOIUrl":"10.1016/j.xjon.2025.04.020","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 151-159"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913301","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":"The 10 commandments of cardiac surgery training","authors":"Francesco Cabrucci MD ,&nbsp;Beatrice Bacchi MD ,&nbsp;Andrea Amabile MD","doi":"10.1016/j.xjon.2025.04.021","DOIUrl":"10.1016/j.xjon.2025.04.021","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 147-150"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913302","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":"Applying expertise: Extrapleural pneumonectomy and extended pleurectomy decortication in the management of Masaoka-Koga stage IV thymoma","authors":"Karishma Chandarana MBBS, MRCS,&nbsp;Marinos Koulouroudias BMedSci, MBBS, MRCS, MRes,&nbsp;Helen Weaver BSc, MBChB, FRCS(CTh),&nbsp;Apostolos Nakas MD, MRCS","doi":"10.1016/j.xjon.2025.04.010","DOIUrl":"10.1016/j.xjon.2025.04.010","url":null,"abstract":"<div><h3>Objectives</h3><div>The European Society of Medical Oncology supports the use of surgery with adjuvant radiotherapy in resectable Masaoka-Koga Stage IV thymomas. We explore the role of extended pleurectomy decortication (EPD) and extrapleural pneumonectomy (EPP) in the management of patients with Masaoka-Koga stage IV thymic tumors with pleural involvement from our single-center experience.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of patients who had undergone extended resections over a 10-year period for Masaoka-Koga stage IV thymomas at our thoracic unit in the United Kingdom. Data was gathered from patient records and electronic databases.</div></div><div><h3>Results</h3><div>Ten patients were included in our series; 90% with primary thymoma and 10% with metastatic recurrence. In total, 80% of patients had EPD and 20% EPP; 60% had pericardium resected and 50% the ipsilateral hemidiaphragm. Length of stay was 2 to 21 days (median, 7 days). There was no in-hospital or 90-day mortality. Histology subtypes were variable: World Health Organization type AB (20%), B1 (10%), B2 (50%), and B3 (20%). A total of 60% of patients had R1 resection. All patients had adjuvant therapy. In total, 70% of patients had disease recurrence with an average disease-free interval of 44 months (range, 8 months to 10 years). Five-year survival was 90% with an overall survival of 60%.</div></div><div><h3>Conclusions</h3><div>This series supports the use of extended resections in selected patients with Masaoka-Koga stage IV thymoma as part of multimodality treatment. EPP and EPD are not part of routine thoracic surgery practice in the United Kingdom. We suggest these cases are referred to dedicated centers with required expertise.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 279-287"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912926","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}