JTCVS open最新文献

{"title":"Potential advantage of magnetic resonance imaging in detecting thoracic wall infiltration in pleural mesothelioma: A retrospective single-center analysis","authors":"Isabel Barreto MD ,&nbsp;Sabine Franckenberg MD ,&nbsp;Thomas Frauenfelder MD ,&nbsp;Isabelle Opitz MD ,&nbsp;Olivia Lauk MD","doi":"10.1016/j.xjon.2024.10.012","DOIUrl":"10.1016/j.xjon.2024.10.012","url":null,"abstract":"<div><h3>Objectives</h3><div>Thoracic wall infiltration in pleural mesothelioma determines the extent of resection and can be an important prognostic factor. Currently, standardized imaging for restaging after neoadjuvant systemic therapy comprises contrast-enhanced computed tomography or positron emission tomography. Additional thoracic magnetic resonance imaging could better discriminate chest wall infiltration preoperatively and increase staging accuracy. For this reason, the added benefit of magnetic resonance imaging was evaluated at our center.</div></div><div><h3>Methods</h3><div>A retrospective analysis of the extended imaging protocol was performed from July 2018 to March 2024, including a descriptive analysis for the patient's sex, age, tobacco consumption, asbestos exposure, histological subtype, TNM stage, Modified Response Evaluation Criteria for Solid Tumors in solid tumors, and number of neoadjuvant therapy cycles. Preoperative restaging included routine imaging and magnetic resonance imaging. After histological diagnosis of pleural mesothelioma, neoadjuvant therapy was conducted, followed by intended macroscopic complete resection, with intraoperative biopsies of suspicious chest wall lesions. Computed tomography and magnetic resonance imaging results were compared with intraoperative biopsies.</div></div><div><h3>Results</h3><div>Twenty-six patients (mean age, 65.50 years, 11.50% female) with operable pleural mesothelioma were included. Of the 11 patients with histologically proven chest wall infiltration, 10 (90.91%) had a cT-stage 3 or greater and 4 (36.36%) underwent surgery that resulted in an R2 resection. Thoracic magnetic resonance imaging showed a high sensitivity (90.91%) for the detection of chest wall infiltration, especially when compared with the computed tomography scan (9.09%).</div></div><div><h3>Conclusions</h3><div>With the adjunctive use of magnetic resonance imaging, we demonstrated a higher sensitivity for detection of chest wall infiltration compared with conventional imaging before surgery. This may improve patient selection for surgery. Nevertheless, larger studies are required to confirm these results.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 318-325"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465192","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}

{"title":"Pediatric cardiac surgical site infections: A single-center quality improvement initiative","authors":"Nhat Chau HBSc ,&nbsp;Crystal Tran HBSc, CCRP ,&nbsp;Megan Clarke MN, RN, CIC ,&nbsp;Jennifer Kilburn MN, RN ,&nbsp;Cecilia St. George-Hyslop MEd, RN, CNCCPC ,&nbsp;Diana Young RN ,&nbsp;Sandra L. Merklinger MN-NP, PhD ,&nbsp;Erica Mosolanczki MN-NP ,&nbsp;Vivian Trinder MN-NP ,&nbsp;Jill O'Hare MN-NP ,&nbsp;Karen Clarke RN ,&nbsp;Kate McCormick MScN, RN ,&nbsp;Rachel D. Vanderlaan MD, PhD, FRCSC","doi":"10.1016/j.xjon.2024.08.013","DOIUrl":"10.1016/j.xjon.2024.08.013","url":null,"abstract":"<div><h3>Objective</h3><div>Pediatric cardiac surgery site infections (SSI) represent significant morbidity. Our institution reported elevated SSI rates of 3.48 per 100 cases over a 5-year period above target rates of 2.5 per 100 cases. Therefore, as a quality improvement initiative, we implemented interventions with the goal of decreasing SSI rates by 30%.</div></div><div><h3>Methods</h3><div>Pediatric cardiovascular surgery patients (January 2021 to August 2023) who had SSI within 30 days of index operation were included (n = 1514) based on the National Healthcare Safety Network definition. Descriptive statistics were used to compare our preintervention cohort (pre-IV) (January 2021 to April 2022; n = 753) and postintervention cohort (post-IV) (May 2022 to August 2023; n = 761).</div></div><div><h3>Results</h3><div>In the post-IV cohort, we found a significant decrease in total SSI (1.97 SSIs per 100 cases [15 out of 761]) versus pre-IV (3.85 SSIs per 100 cases [29 out of 753]), demonstrating a 48% reduction (<em>P</em> = .029). In our post-IV cohort, there was a significant reduction in superficial SSIs (pre-IV, 3.19 SSIs per 100 cases [24 out of 753] vs post-IV, 1.58 SSIs out of 100 cases [12 out of 761]; <em>P</em> = .04). Wounds presenting at 1 to 3 weeks were also reduced in our post-IV cohort (pre-IV, 2.66 SSIs per100 cases [20 out of 753] vs post-IV, 0.66 SSIs per 100 cases [5 out of 761]; <em>P</em> = .002). A significant reduction in SSIs in nonneonates was also noted (pre-IV, 2.79 SSIs per 100 cases [21 out of 753] vs post-IV, 0.92 SSIs per 100 cases [7 out of 761]; <em>P</em> = .007). Additionally, there was a significant reduction in SSIs associated with the Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery Congenital Heart Surgery 1 mortality category (<em>P</em> = .033) and the number of readmissions in the post-IV cohort (<em>P</em> = .042).</div></div><div><h3>Conclusions</h3><div>A new surgical site dressing and multidisciplinary surveillance plan effectively reduced the overall burden of SSI rates at our institution. Future studies will address risk factors in specific subpopulations to further reduce SSIs at our institution.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 438-447"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959772","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}

{"title":"Randomized study of temporary diaphragm pacing for enhanced recovery after surgery in cardiac surgery patients at risk of prolonged mechanical ventilation","authors":"Jessica R. Hungate MD ,&nbsp;Raymond P. Onders MD ,&nbsp;Mohammad El Diasty MD, PhD ,&nbsp;Yasir Abu-Omar MD, DPhil ,&nbsp;Rakesh C. Arora MD, PhD ,&nbsp;Cristian Baeza MD ,&nbsp;Yakov Elgudin MD, PhD ,&nbsp;Kelsey Gray MD ,&nbsp;Alan Markowitz MD ,&nbsp;Marc Pelletier MD ,&nbsp;Igo B. Ribeiro MD ,&nbsp;Pablo Ruda Vega MD ,&nbsp;Gregory D. Rushing MD ,&nbsp;Joseph F. Sabik III MD","doi":"10.1016/j.xjon.2024.09.031","DOIUrl":"10.1016/j.xjon.2024.09.031","url":null,"abstract":"<div><h3>Objective</h3><div>Prolonged mechanical ventilation after cardiac surgery significantly increases morbidity and mortality. The aim of this study is to establish the role of diaphragmatic pacing to decrease mechanical ventilation burden in high-risk patients undergoing cardiac surgery.</div></div><div><h3>Methods</h3><div>This is a prospective, randomized trial of temporary diaphragmatic pacing electrode use in patients undergoing cardiac surgery (NCT04899856). Prognostic enrichment strategy was used to identify patients at higher risk of prolonged mechanical ventilation by having inclusion criteria of prior open cardiac surgery, left ventricular ejection fraction less than 30%, history of stroke, intra-aortic balloon pump, or history of chronic obstructive pulmonary disease. Two electrodes were placed in each hemidiaphragm intraoperatively. On arrival to the intensive care unit, patients were randomized to immediate diaphragmatic pacing or standard of care.</div></div><div><h3>Results</h3><div>Forty patients received implants, with 19 in the treatment group and 21 in the standard of care group. Only 1 patient in the treatment group was on mechanical ventilation at 24 hours versus 4 patients in the standard of care group, resulting in a relative risk reduction of 71% being on mechanical ventilation at 24 hours postoperatively. Predictive enrichment strategy was used to identify patients most likely to respond to therapy of diaphragmatic pacing. In this analysis, median time on mechanical ventilation was 17.7 hours (interquartile range, 8.3-23.4) for the 15 patients in the standard of care group and 9.4 hours (interquartile range, 7.14-12.5) for the 13 patients in the treatment group, for an improvement of 8 hours with diaphragm pacing (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Temporary diaphragmatic pacing improved weaning from mechanical ventilation by 8 hours with a significant reduction of prolonged mechanical ventilation. Multicenter randomized trials confirming diaphragmatic pacing as an Enhanced Recovery After Surgery tool to decrease mechanical ventilation may reduce length of stay, postoperative infections, and additive costs.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 76-84"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959776","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}

{"title":"Surgical management of giant cell arteritis of the proximal aorta","authors":"Motahar Hosseini MD ,&nbsp;Alberto Pochettino MD ,&nbsp;Joseph A. Dearani MD ,&nbsp;Alejandra Castro-Varela MD ,&nbsp;Hartzell V. Schaff MD ,&nbsp;Katherine S. King MS ,&nbsp;Richard C. Daly MD ,&nbsp;Kevin L. Greason MD ,&nbsp;Juan A. Crestanello MD ,&nbsp;Gabor Bagameri MD ,&nbsp;Nishant Saran MBBS","doi":"10.1016/j.xjon.2024.08.017","DOIUrl":"10.1016/j.xjon.2024.08.017","url":null,"abstract":"<div><h3>Objective</h3><div>Giant cell arteritis (GCA) may present as proximal aortic pathology requiring surgical intervention. We present our experience with surgical management of GCA in patients presenting with proximal aortic disease.</div></div><div><h3>Methods</h3><div>From January 1993 to May 2020, 184 adult patients were diagnosed with GCA on histopathology after undergoing cardiac surgery. Survival was estimated with Kaplan-Meier method. Reoperation rates were estimated with cumulative incidence accounting for competing risks of death.</div></div><div><h3>Results</h3><div>The most common indication for surgery was ascending aortic aneurysm (n = 179, 97.3%). Stroke occurred in 6 (3.3%), pneumonia in 8 (4.4%), and dialysis in 3 (1.6%) patients. Multivariable analysis found advanced age (hazard ratio [HR], 1.054; 95% confidence interval [CI], 1.026-1.082, <em>P</em> &lt; .001), recent heart failure (HR, 1.890; 95% CI, 1.016-3.516, <em>P</em> = .04), peripheral vascular disease (HR, 2.229; 95% CI, 1.458-3.624, <em>P</em> &lt; .001), and cerebrovascular disease (HR, 1.762; 95% CI, 1.035-3.000, <em>P</em> = .03) as predictors of late mortality. Median follow-up was 13.7 years, and 30-day mortality was 1.5%. Nineteen patients underwent 24 aortic reinterventions including aortic arch reconstruction (n = 4), descending thoracic aorta aneurysm repair (n = 8), thoracoabdominal aortic aneurysm repair (n = 11), and pseudoaneurysm repair (n = 1). Rate of reintervention on the aorta was 3.9% (95% CI, 1.9%-8.1%), 7.1% (95% CI, 4.1%-12.3%), 12.8% (95% CI, 8.3%-19.6%), and 12.8% (95% CI, 8.3%-19.6%) at 1, 5, 10, and 15 years, respectively.</div></div><div><h3>Conclusions</h3><div>Surgery in patients with GCA can be performed with acceptable early and late outcomes. Advancing age, heart failure, peripheral vascular disease, and cerebrovascular disease are risk factors for worse survival. Postoperative surveillance is important as need for aortic reintervention is not uncommon.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 123-131"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959865","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}

{"title":"Combined simulation and ex vivo assessment of free-edge length in bicuspidization repair for congenital aortic valve disease","authors":"Perry S. Choi MD ,&nbsp;Amit Sharir BS ,&nbsp;Yoshikazu Ono MD ,&nbsp;Masafumi Shibata MD ,&nbsp;Alexander D. Kaiser PhD ,&nbsp;Yellappa Palagani PhD ,&nbsp;Alison L. Marsden PhD ,&nbsp;Michael R. Ma MD","doi":"10.1016/j.xjon.2024.09.008","DOIUrl":"10.1016/j.xjon.2024.09.008","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to investigate the effect of free-edge length on valve performance in bicuspidization repair of congenitally diseased aortic valves.</div></div><div><h3>Methods</h3><div>In addition to a constructed unicuspid aortic valve disease model, 3 representative groups—free-edge length to aortic diameter ratio 1.2, 1.57, and 1.8—were replicated in explanted porcine aortic roots (n = 3) by adjusting native free-edge length with bovine pericardium. Each group was run on a validated ex vivo univentricular system under physiological parameters for 20 cycles. All groups were tested within the same aortic root to minimize inter-root differences. Outcomes included transvalvular gradient, regurgitation fraction, and orifice area. Linear mixed effects model and pairwise comparisons were used to compare outcomes across groups.</div></div><div><h3>Results</h3><div>The diseased control group had a mean transvalvular gradient of 28.3 ± 5.5 mm Hg, regurgitation fraction of 29.6% ± 8.0%, and orifice area of 1.03 ± 0.15 cm². In ex vivo analysis, all repair groups had improved regurgitation and transvalvular gradient compared with the diseased control group (<em>P</em> &lt; .001). Free-edge length to aortic diameter of 1.8 had the highest amount of regurgitation among the repair groups (<em>P</em> &lt; .001) and 1.57 the least (<em>P</em> &lt; .001). Free-edge length to aortic diameter of 1.57 also exhibited the lowest mean gradient (<em>P</em> &lt; .001) and the largest orifice area (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Free-edge length to aortic diameter ratio significantly impacts valve function in bicuspidization repair of congenitally diseased aortic valves. As the ratio departs from 1.57 in either direction, effective orifice area decreases and both transvalvular gradient and regurgitation fraction increase.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 395-404"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959869","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}

{"title":"Surgery versus surveillance for ascending aortic aneurysms in elderly patients","authors":"Veronica F. Chan BSc ,&nbsp;Ming Hao Guo MD, MSc ,&nbsp;Thais Coutinho MD ,&nbsp;Aryan Ahmadvand BSc ,&nbsp;Mahdi Zeghal BSc ,&nbsp;Adam Mussani BSc ,&nbsp;Talal Al-Atassi MD, MPH ,&nbsp;Roy Masters MD ,&nbsp;David Glineur MD, PhD ,&nbsp;Munir Boodhwani MD, MSc","doi":"10.1016/j.xjon.2024.08.021","DOIUrl":"10.1016/j.xjon.2024.08.021","url":null,"abstract":"<div><h3>Background</h3><div>Whether elderly patients with aortic root or ascending aortic aneurysm (ATAA) would benefit from the new surgical size threshold of 5.0 cm is unknown. This study aimed to evaluate the natural history of ATAA in elderly patients and to compare long-term outcomes of those who underwent initial surveillance versus surgery.</div></div><div><h3>Methods</h3><div>Patients age ≥75 years with an ATAA ≥40 mm were categorized into 2 groups: initial surgery and initial surveillance. The primary outcome was all-cause mortality; Kaplan-Meier curves were plotted for survival. A multivariable Cox proportional hazard regression model was used to identify independent predictors of long-term mortality.</div></div><div><h3>Results</h3><div>The study series comprised 300 patients, including 58 who underwent initial surgery and 242 who received surveillance between July 2010 and September 2022. In the surveillance cohort, the mean aneurysm growth rate was 0.10 cm/year. Comparing surveillance to surgery, at 8 years there was no difference in survival (mean, 77.8 ± 3.4% vs 71.8 ± 9.6%; <em>P</em> = .65). For 116 patients with an initial aneurysm diameter ≥5.0 cm, there was no difference in survival between the 2 groups at 8 years (76.5 ± 7.0% vs 68.4 ± 11.3%; <em>P</em> = .20). Larger body surface area (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.09-1.90; <em>P</em> = .01) and history of smoking (HR, 2.25; 95% CI, 1.27-3.98; <em>P</em> = .01) were identified as predictors of long-term mortality.</div></div><div><h3>Conclusions</h3><div>In our series of elderly patients with ATAA, there was no difference in 8-year survival between initial surveillance and surgical management, with a high competing risk of nonaortic mortality. Surveillance may be a reasonable alternative to surgery for selected older adults with ATAA &lt;5.5 cm.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 132-143"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959949","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}

{"title":"Healthcare economic burden of unresolved slipping rib syndrome","authors":"Adam J. Hansen MD,&nbsp;J.W.Awori Hayanga MD, MPH,&nbsp;Alper Toker MD,&nbsp;Vinay Badhwar MD","doi":"10.1016/j.xjon.2024.09.022","DOIUrl":"10.1016/j.xjon.2024.09.022","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the healthcare costs associated with unresolved slipping rib syndrome (SRS).</div></div><div><h3>Methods</h3><div>Data pertaining to patients who underwent operative repair for SRS at our academic institution were analyzed retrospectively. Duration of symptoms, previous management efforts, number of healthcare provider consultations, imaging studies, adjunctive surgical and pain management procedures performed to treat the symptoms, and prior unsuccessful SRS operations were catalogued. US Medicare billing standards were used to average costs for provider visits and overall cost of surgical and interventional pain management procedures. Analgesic medication costs were determined using generic pricing.</div></div><div><h3>Results</h3><div>Between February 2019 and January 2024, a total of 435 consecutive patients spent a median of 36 months searching for a diagnosis and symptom relief prior to evaluation at our institution. The median number of physicians consulted was 6 (range, 0-75). The total cost of physician visits was $2,990,434 USD. The median number of imaging studies was 5 (range, 0-55), at a total cost of $965,949. Cholecystectomy was performed in 47 patients (11%), at a cost of $716,750. Previous SRS surgery had been attempted 150 times at various institutions and accounted for $4,500,000 (estimated $30,000 per operation in billing). Intercostal nerve block, ablation, and spinal cord stimulator placement had been performed in 30%, 15%, and 5% of the patients, respectively, at a total cost of $963,821. The median number of analgesic medications used per patient was 1 (mean, 1.3; range, 0-5); the total medication cost was $1,111,860. The total preoperative healthcare cost in our series was $12,445,173, for an average of $28,610 per patient.</div></div><div><h3>Conclusions</h3><div>SRS remains poorly understood. Symptoms can be severe and debilitating, and patients frequently consume significant healthcare resources. With recognition and definitive surgical management, SRS may be addressed successfully. Prompt treatment has the potential for significant healthcare savings.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 485-490"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960022","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}

{"title":"Heart transplant survival and the use of donors with intracranial bleeding: United Network for Organ Sharing Registry propensity-score matched analysis","authors":"J. Sam Meyer MSc ,&nbsp;Nancy Sweitzer MD ,&nbsp;Dan Aravot MD ,&nbsp;Carmelo A. Milano MD, MHS ,&nbsp;Yaron D. Barac MD, PhD","doi":"10.1016/j.xjon.2024.09.028","DOIUrl":"10.1016/j.xjon.2024.09.028","url":null,"abstract":"<div><h3>Objective</h3><div>The transplantation of hearts from donors who experienced intracranial bleeding (ICB) has been associated with inferior long-term survival in both single-center analyses and, more recently, with the United Network for Ogan Sharing Registry. The purpose of this study was to further explore this relationship through propensity score matching in recipients receiving donor hearts from ICB and non-ICB donors in a large national registry.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort analysis of the United Network for Organ Sharing Registry Organ Procurement and Transplantation Network between 2006 and 2018 for adult candidates wait-listed for isolated heart transplantation. Recipients were stratified into 2 groups: ICB and non-ICB donors. Propensity score matching was performed to estimate causal effects by using observational data. Kaplan-Meier analysis was used to estimate survival posttransplant. Cox proportional hazards modeling was used to evaluate the independent effect of ICB as a cause of death.</div></div><div><h3>Results</h3><div>A total of 25,315 candidates met inclusion criteria. ICB heart donors (n = 5529) were older (median age, 42 vs 27 years; <em>P</em> &lt; .001), less likely men (54.5% vs 75.2%; <em>P</em> &lt; .001), and more often had a history of smoking (20.1% vs 11.7%; <em>P</em> &lt; .001), and hypertension (34.2% vs 9.5%; <em>P</em> &lt; .001). Before matching there was a significant difference in long-term posttransplant survival; for example, the non-ICB (60.7% [interquartile range, 59.5%-61.9%] vs 56.8% (interquartile range, 54.7%-59.0%]; <em>P</em> &lt; .0001). However, when analyzing the propensity-score matched groups for outcomes, no difference was found between the cohorts both in terms of long-term survival as well as in rates of rejection.</div></div><div><h3>Conclusions</h3><div>In the largest propensity score matching analysis of heart transplants from donors who had experienced ICB, we found similar survival and rejection rates in heart transplant recipients.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 306-317"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960030","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}

{"title":"A posterior pericardial chest tube is associated with reduced incidence of postoperative atrial fibrillation after cardiac surgery: A propensity score–matched study","authors":"Luis Gisli Rabelo BS ,&nbsp;Igor Zindovic MD, PhD ,&nbsp;Daniel Oudin Astrom PhD ,&nbsp;Egill Gauti Thorsteinsson BS ,&nbsp;Johan Sjogren MD, PhD ,&nbsp;Kristjana Lind Olafsdottir BS ,&nbsp;Matthildur Maria Magnusdottir BS ,&nbsp;Anders Jeppsson MD, PhD ,&nbsp;Tomas Gudbjartsson MD, PhD","doi":"10.1016/j.xjon.2024.09.003","DOIUrl":"10.1016/j.xjon.2024.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery that is associated with other adverse outcomes. Recent studies have shown that drainage of pericardial effusion by a posterior pericardial incision reduces the incidence of POAF. An alternative approach is a chest tube placed posteriorly in the pericardium. We evaluated whether the use of a posterior pericardial drain was associated with reduced risk of POAF in patients undergoing coronary artery bypass graft (CABG) and/or aortic valve replacement (AVR).</div></div><div><h3>Methods</h3><div>This observational study included 2535 patients who underwent CABG (n = 1997), AVR (n = 293), or combined CABG and AVR (n = 245) in Iceland from 2002 to 2020. From our study population, 553 (22%) received a 20-Fr posterior pericardial chest tube in addition to standard mediastinal and left pleural drains. The incidence of POAF in patients with and without a posterior pericardial drain was compared before and after 1:1 propensity score matching.</div></div><div><h3>Results</h3><div>Of 2535 patients, 1100 were included in the matched cohort. The incidence of POAF was lower in patients receiving posterior pericardial chest tube drainage compared with the control group, both before (34% vs 43%, <em>P</em> &lt; .001) and after (33% vs 43%, <em>P</em> = .002) matching. In a multivariable analysis, posterior pericardial chest tube drainage was independently associated with a reduced risk for POAF (adjusted odds ratio 0.67; 95% confidence interval, 0.52-0.88; <em>P</em> = .003).</div></div><div><h3>Conclusions</h3><div>This observational study suggested that posterior pericardial chest tube drainage is associated with a significant reduction of POAF after routine CABG and/or AVR procedures. The results are hypothesis-generating and must be confirmed in prospective randomized trials.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 244-254"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960087","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}

{"title":"Noniatrogenic hypoglycemia: A universal marker for poor outcomes","authors":"Hannah Rando MD, MPH,&nbsp;Matthew Acton MD,&nbsp;Ifeanyi Chinedozi MD,&nbsp;Zachary Darby MD,&nbsp;Jin Kook Kang MD,&nbsp;Glenn Whitman MD","doi":"10.1016/j.xjon.2024.05.005","DOIUrl":"10.1016/j.xjon.2024.05.005","url":null,"abstract":"<div><h3>Objective</h3><div>Previous retrospective studies have established a relationship between postoperative hypoglycemia and adverse outcomes after cardiac surgery, but none have accounted for the cause of hypoglycemia.</div></div><div><h3>Methods</h3><div>A retrospective review was performed of patients who underwent cardiac surgery at a single institution between 2016 and 2021. Patients were categorized as hypoglycemic if they had 1 or more postoperative blood glucose measurement less than 70 mg/dL and normoglycemic otherwise. Hypoglycemia was subcategorized as noniatrogenic (underlying liver failure, adrenal insufficiency, sepsis, or shock) or iatrogenic (insulin infusion continued while nil per os or infusion protocol violated) via manual chart review. Baseline characteristics were compared between groups using Pearson χ², analysis of variance, and Kruskal-Wallis testing, and outcomes were compared using multivariable logistic regression.</div></div><div><h3>Results</h3><div>In total, 5373 patients and 183,346 glucose measurements were included. Hypoglycemia occurred in 5% (267) of patients, of whom 63% (169) were iatrogenic and 37% (98) were noniatrogenic. In a multivariate analysis adjusting for age, sex, case urgency, pre-existing diabetes, and bypass time, both iatrogenic and noniatrogenic hypoglycemia were associated with greater odds of renal failure, prolonged ventilation, and prolonged intensive care unit length of stay relative to normoglycemia, but the magnitude was substantially lower in iatrogenic hypoglycemia. Patients with noniatrogenic hypoglycemia had 68.6 times greater odds of mortality relative to patients who were normoglycemic (odds ratio, 68.6; confidence interval, 39.5-119), but patients with iatrogenic hypoglycemia had no increased odds of mortality (odds ratio, 1.45; confidence interval, 0.77-2.73).</div></div><div><h3>Conclusions</h3><div>When excluding patients with conditions known to cause hypoglycemia from the analysis, the morbidity and mortality of iatrogenic hypoglycemia from tight postoperative glycemic control is dramatically attenuated.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 323-331"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141140079","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}