JTCVS open最新文献

{"title":"The current landscape and challenges facing international medical graduates in cardiothoracic surgery training","authors":"Kelly A. McGovern MD , Anastasiia K. Tompkins BS , Louis F. Chai MD , Simran Randhawa MD , Vignesh Raman MD , Jessa Cintron BA , Gokcen Tugral-Gurk JD , Joseph Coselli MD , Michael Jaklitsch MD , David T. Cooke MD , Cherie P. Erkmen MD","doi":"10.1016/j.xjon.2024.12.016","DOIUrl":"10.1016/j.xjon.2024.12.016","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 527-533"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854716","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":"Graft patency of no-touch versus conventionally harvested saphenous vein conduits in coronary artery bypass grafting: A frequentist and Bayesian meta-analysis of randomized trials","authors":"Mimi X. Deng MD ,&nbsp;Zhenyu Li MSc ,&nbsp;Dominique Vervoort MD, MPH, CPH, MBA ,&nbsp;Rebecca N. Evan PhD ,&nbsp;Stephen E. Fremes MD, MSc","doi":"10.1016/j.xjon.2025.02.007","DOIUrl":"10.1016/j.xjon.2025.02.007","url":null,"abstract":"<div><h3>Background</h3><div>No-touch (NT) saphenous vein harvest is a technique that minimizes intimal injury and has been shown to improve patency. This study aimed to directly compare NT saphenous vein grafts (SVGs) to conventional skeletonized (CON) SVGs through a meta-analysis.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted for randomized controlled trials comparing the angiographic patency of NT-SVG and CON-SVG. The primary outcome was graft occlusion as a proportion of the total grafts assessed. Secondary outcomes were graft occlusion per patient, all-cause mortality, and leg wound complications. A random-effects model using a frequentist approach and Bayesian analysis were performed.</div></div><div><h3>Results</h3><div>A total of 235 studies were retrieved, of which 7 ultimately were chosen for analysis, with a total of 3334 randomized patients and 5798 SVGs. The pooled estimated age was 63.5 and 62.8 years for NT and CON, respectively, with approximately 14% of patients being women. The weighted mean angiographic follow-up was 11.6 months. Relative to CON-SVG, NT-SVG was associated with lower rates of graft occlusion per graft (relative risk [RR], 0.57; 95% confidence interval [CI], 0.46-0.72; <em>P</em> &lt; .001) and per patient (RR, 0.61; 95% CI, 0.46–0.79; <em>P</em> &lt; .001), comparable all-cause mortality (RR, 1.12; 95% CI, 0.56-2.25; <em>P</em> = .75), and a higher rate of leg wound complications (RR, 2.32; 95% CI, 1.78-3.02; <em>P</em> &lt; .001). Findings for occlusion per graft were consistent with Bayesian analysis (RR, 0.57; 95% credible interval, 0.41-0.79).</div></div><div><h3>Conclusions</h3><div>Compared to CON, NT confers significantly better patency and equivalent survival but poorer harvest site healing. The clinical benefit of NT remains uncertain, and further evidence is needed.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 185-205"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854722","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":"Is timing as critical for repair of dextro-transposition of the great arteries with ventricular septal defect without outflow tract obstruction?","authors":"Muhammad Faateh MBBS ,&nbsp;Spencer Hogue BS ,&nbsp;Amir Mehdizadeh-Shrifi MD ,&nbsp;Kevin Kulshrestha MD, MBE ,&nbsp;Md Monir Hossain PhD ,&nbsp;David G. Lehenbauer MD ,&nbsp;David L.S. Morales MD ,&nbsp;Awais Ashfaq MD","doi":"10.1016/j.xjon.2024.10.015","DOIUrl":"10.1016/j.xjon.2024.10.015","url":null,"abstract":"<div><h3>Objective</h3><div>We sought to explore the role of timing on outcomes of the arterial switch operation + ventricular septal defect closure.</div></div><div><h3>Methods</h3><div>Neonates undergoing the arterial switch operation + ventricular septal defect closure from the Pediatric Health Information System database (2004-2022) were identified. Patients with outflow tract obstruction were excluded. Baseline features and outcomes were compared by dividing the cohort by age at the arterial switch operation + ventricular septal defect closure: very early (0-7 days), early (8-14 days), late (15-21 days), and very late (&gt;21 days). A cut-point analysis was performed to identify if an age-cutoff predicted the composite outcome (in-hospital mortality/nonhome discharge/postoperative extracorporeal membrane oxygenation/delayed sternum closure/reoperation due to bleeding).</div></div><div><h3>Results</h3><div>A total of 1005 patients were identified. The median age at repair was 6 days (interquartile range, 4-9). Repair was performed in the majority of study centers within the patient's first week of life. The distribution was very early in 652 patients (64.9%), early in 247 patients (24.6%), late in 72 patients (7.2%), and very late in 34 patients (3.4%). Late and very late groups had a greater proportion of preterm (6.3% vs 13.8% vs 23.2% vs 26.5%) and low-birthweight (5.8% vs 9% vs 21.9% vs 20%) patients (both <em>P</em> &lt; .05). In-hospital mortality was 3.1% and similar among groups (<em>P</em> &gt; .05). The identified cutoff was 8 days. In-hospital mortality was similar when comparing 0 to 8 days with more than 8 days groups (20 [2.8%] vs 11 [3.9%], <em>P</em> = .38). The more than 8 days group was more likely to develop the composite outcome (69 [24%] vs 125 [17.4%], <em>P</em> = .02), which remained significant in the multivariable analysis (adjusted odds ratio, 1.49; 95% CI, 1.02-2.15; <em>P</em> = .04). Hospitalization costs were significantly higher in the more than 8 days group ($240,742 vs $183,728, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>This analysis of more than 1000 neonates born with dextro-transposition of the great arteries + ventricular septal defect without outflow tract obstruction revealed that most patients undergo the arterial switch operation + ventricular septal defect closure within the first week of life and had acceptable major outcomes regardless of timing. Earlier arterial switch operation + ventricular septal defect closure may confer an advantage with regard to secondary outcomes and hospitalization costs.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 350-358"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854474","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":"Sex differences in patterns of cardiovascular referral in patients with Marfan, Ehlers-Danlos, and Loeys-Dietz syndromes","authors":"Christina Waldron BS,&nbsp;Afsheen Nasir MD,&nbsp;Kristina Wang BS,&nbsp;Alan Chou MD,&nbsp;Ely Erez MD,&nbsp;Prashanth Vallabhajosyula MD,&nbsp;Roland Assi MD, MMS","doi":"10.1016/j.xjon.2025.01.002","DOIUrl":"10.1016/j.xjon.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Diagnosis of Marfan (MFS), Ehlers-Danlos (EDS), and Loeys-Dietz (LDS) syndromes often warrants specialized evaluation for screening and surveillance of aortic disease. This study aims to characterize the rate of referral to cardiovascular medicine and cardiothoracic surgery in male and female patients diagnosed with MFS, EDS, or LDS.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of patients with genetic or clinical diagnoses of MFS, EDS, or LDS from electronic medical records in a large healthcare system between 2013 and 2022. We explored the referral pattern to cardiovascular medicine and cardiothoracic surgery based on connective tissue disease and sex.</div></div><div><h3>Results</h3><div>A total of 995 patients were identified (74% female), including 242 with MFS (41% female), 772 with EDS (87% female), and 31 with LDS (48% female). Referral rates to cardiovascular medicine and cardiothoracic surgery were 69% and 14%, respectively, with significantly higher rates for male patients compared to female patients (77% vs 66% [<em>P</em> = .001] and 33% vs 7.3% [<em>P</em> &lt; .001], respectively). Referral to cardiovascular medicine was 90% for MFS patients, 61% for EDS patients, and 94% for LDS patients, without a significant sex difference. Referral to cardiothoracic surgery for MFS, EDS, and LDS was 38%, 2.9%, and 48%, respectively. Among patients with aortic pathologies (n = 160), male patients had a higher rate of referral to cardiothoracic surgery compared to female patients (76% vs 58%; <em>P</em> = .016). There was no significant sex difference in maximum indexed aortic diameters.</div></div><div><h3>Conclusions</h3><div>Patients with MFS and LDS had high referral rates to cardiovascular medicine. Female patients with connective tissue diseases are less likely than male patients to be referred to cardiovascular medicine, particularly those with aortic pathologies.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 1-15"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854329","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":"Role of a multidisciplinary team approach in the management of chronic thromboembolic pulmonary hypertension","authors":"Benjamin Yang MD ,&nbsp;Anthony Zaki MD ,&nbsp;Nicholas Oh MD ,&nbsp;Juan Umana-Pizano MD ,&nbsp;Ihab Haddadin MD ,&nbsp;Alice Goyanes MD ,&nbsp;Nicholas Smedira MD, MBA ,&nbsp;Haytham Elgharably MD ,&nbsp;Michael Zhen-Yu Tong MD, MBA ,&nbsp;Gustavo A. Heresi MD, MS","doi":"10.1016/j.xjon.2024.12.011","DOIUrl":"10.1016/j.xjon.2024.12.011","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic thromboembolic pulmonary hypertension (CTEPH) is an under-recognized complication of pulmonary embolism that, if left untreated, leads to heart failure. This study aimed to characterize the role of a multidisciplinary team in the management of CTEPH.</div></div><div><h3>Methods</h3><div>Starting in 2011, a multidisciplinary team was assembled to systematically evaluate and manage all CTEPH patients based on hemodynamic profile, extent of thromboembolic disease burden, and comorbidities. From 1997 to 2021, 306 patients underwent pulmonary thromboendarterectomy for CTEPH. The cohort was divided into an early era prior to 2011 (62 cases) and a recent era from 20,211 to 2021 (244 cases).</div></div><div><h3>Results</h3><div>Baseline demographic and hemodynamic profiles were similar in the 2 eras, with a mean age of 53 ± 14 years, mean pulmonary artery pressure of 44.9 ± 11.2 mm Hg, and mean pulmonary vascular resistance of 7.4 ± 3.9 Wood units. Early era patients had more severe right ventricular dysfunction (49.1% vs 25.0%; <em>P</em> &lt; .001). Recent era patients underwent more concomitant tricuspid valve repairs (22% vs 2.9%; <em>P</em> &lt; .001) despite similar tricuspid regurgitation severity. Following surgery, recent era patients had lower in-hospital mortality (2.9% vs 12%) with less morbidity, including less prolonged ventilation (32% vs 59%), less need for dialysis (1.6% vs 21%), and shorter hospital length of stay (16 days vs 21 days). The difference in survival was sustained long-term (88% vs 70% at 6 years).</div></div><div><h3>Conclusions</h3><div>Outcomes after pulmonary thromboendarterectomy improved since the establishment of the multidisciplinary team—most notably, more complete resolution of pulmonary hypertension and improved overall survival. A team-based approach for selection and perioperative management of these complex patients can be associated with improved early outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 147-155"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854577","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 gender differences on optimal oxygen delivery thresholds to prevent acute kidney injury in cardiac surgeries with cardiopulmonary bypass","authors":"Tomoya Oshita CE ,&nbsp;Arudo Hiraoka MD, PhD ,&nbsp;Kosuke Nakajima CE ,&nbsp;Ryosuke Muraki CE ,&nbsp;Masahisa Arimichi CE ,&nbsp;Genta Chikazawa MD, PhD ,&nbsp;Hidenori Yoshitaka MD, PhD","doi":"10.1016/j.xjon.2025.01.001","DOIUrl":"10.1016/j.xjon.2025.01.001","url":null,"abstract":"<div><h3>Background</h3><div>The nadir oxygen delivery index (DO₂i) during cardiopulmonary bypass (CPB) is reportedly associated with acute kidney injury (AKI) in patients undergoing cardiac surgery. However, there are few reports on the relationship between patient sex and the nadir DO₂i threshold to prevent AKI. The aim of this study was to seek and evaluate the optimal DO₂i threshold differences between males and females to avoid AKI during on-pump cardiac surgery.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed a total of 430 patients who underwent cardiac surgery between March 2017 and February 2023. A receiver operating characteristic analysis and univariable and multivariable regression analyses were performed to evaluate the association between perioperative variables, including the nadir DO₂i and incidence of AKI, in males and females.</div></div><div><h3>Results</h3><div>The nadir DO₂i was significantly lower (median, 294 [interquartile range (IQR), 272-317] mL/min/m² versus 277 [IQR, 262-295] mL/min/m²; <em>P</em> &lt; .001) and cumulative time below the DO₂i of 270 mL/min/m² was longer (0.3 [IQR, 0-4.2] minutes vs 3.0 [IQR, 0-11.7] minutes; <em>P</em> &lt; .001) in the female patients. However, the incidence rate of AKI was similar in males and females (15.2% [n = 39/256] vs 16.7% [n = 29/174]; <em>P</em> = .68). The best cut-off values of nadir DO₂i for AKI were &lt;301 mL/min/m² (sensitivity, 82.1%; specificity, 39.5%) in males and &lt;273 mL/min/m² (sensitivity, 69.0%; specificity, 61.4%) in females.</div></div><div><h3>Conclusions</h3><div>The optimal DO₂i to prevent AKI during cardiac surgery differs between males and females. Therefore, CPB management should be adjusted by sex based on the different cut-off values of nadir DO₂i.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 271-279"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854583","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":"Midterm outcomes of thoracic endovascular aortic repair versus optimal medical therapy for uncomplicated acute type B dissection","authors":"Kevin G. Hu BS ,&nbsp;Wei-Guo Ma MD ,&nbsp;Stevan Pupovac MD ,&nbsp;Irbaz Hameed MD ,&nbsp;Soraya Fereydooni MD ,&nbsp;Eric S. Li MD ,&nbsp;Haleigh Larson MD ,&nbsp;Mohammad Zafar MBBS ,&nbsp;Britt Tonnessen MD ,&nbsp;Jonathan Cardella MD ,&nbsp;Eduard Aboian MD ,&nbsp;Raul Guzman MD ,&nbsp;Cassius Ochoa Chaar MD ,&nbsp;David Strosberg MD ,&nbsp;Matthew Williams MD ,&nbsp;Naiem Nassiri MD ,&nbsp;Roland Assi MD ,&nbsp;Prashanth Vallabhajosyula MD, MS","doi":"10.1016/j.xjon.2024.12.013","DOIUrl":"10.1016/j.xjon.2024.12.013","url":null,"abstract":"<div><h3>Objective</h3><div>We sought to compare the early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) versus optimal medical therapy (OMT) for uncomplicated acute type B aortic dissection.</div></div><div><h3>Methods</h3><div>Data were analyzed for 200 consecutive patients with uncomplicated acute type B aortic dissection from February 1992 to July 2022, including 147 with initial OMT and 53 undergoing TEVAR at index hospitalization. Baseline, intraoperative, and postoperative data, survival, and (re)intervention were compared between the two strategies.</div></div><div><h3>Results</h3><div>In-hospital/30-day mortality was 7.5% (15/200) for the entire series, which was significantly lower in the TEVAR group compared with the OMT group (0 vs 10.2% [15/147]; <em>P</em> = .013). Thirty-day rates were 5.7% (3/53) for reintervention after TEVAR and 15.6% (23/147) for intervention after OMT (<em>P</em> = .064). Death within 30 days of (re)intervention was 0 (n = 0) in the TEVAR group and 18.4% (n = 14) in the OMT group (<em>P</em> = .063). There were no significant differences in the incidences of stroke, paraplegia, acute kidney injury, sepsis, or malperfusion syndrome after initial treatment. Kaplan–Meier survival in the TEVAR group was 92.3% (95% CI, 80.7-97.0) at 1 year and 3 years, significantly higher than in the OMT group (80.3% [95% CI, 72.8-85.8] and 71.4% [95% CI, 63.4-78.0]; <em>P</em> = .012). In patients aged 65 years or more, TEVAR also achieved a significantly higher survival, which was 93.7% (95% CI, 77.5-98.3 vs 69.7% [95% CI, 58.0-78.7]) at 1 year and 93.7% (95% CI, 77.3-98.3] vs 60.5% [95% CI, 48.7-70.5]) at 3 years (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>In this single-institution experience, upfront TEVAR performed at index hospitalization for uncomplicated acute type B aortic dissection was associated with improved survival at early and midterm follow-up.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 67-76"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854675","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":"Delays in phases of care from identification to treatment of suspicious lung nodules","authors":"Nihar Rama BS ,&nbsp;Rachel Nordgren PhD ,&nbsp;Aliya N. Husain MD ,&nbsp;Aditya Juloori MD ,&nbsp;Christine M. Bestvina MD ,&nbsp;Rajat Thawani MD ,&nbsp;Marina Garassino MD ,&nbsp;Septimiu Murgu MD ,&nbsp;Ajay Wagh MD, MS ,&nbsp;D. Kyle Hogarth MD ,&nbsp;Carrie Barth MS ,&nbsp;Darren Bryan MD ,&nbsp;Mark K. Ferguson MD ,&nbsp;Jessica Donington MD ,&nbsp;Maria Lucia Madariaga MD","doi":"10.1016/j.xjon.2025.01.006","DOIUrl":"10.1016/j.xjon.2025.01.006","url":null,"abstract":"<div><h3>Objectives</h3><div>Shorter time to lung cancer diagnosis and treatment is associated with improved outcomes. We analyzed the time spent from nodule identification to treatment to identify targets for improving the timeliness of suspicious lung nodule care in a diverse patient population.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of patients with suspicious lung nodules (suspected clinical stage I/II primary lung cancer) at a single academic medical center (2020-2022). Patients with suspected stage III/IV or nonprimary lung cancers were excluded. Multivariable Cox regressions were performed to assess factors associated with timeliness of care.</div></div><div><h3>Results</h3><div>Of 157 patients, 59% were female, 53% were Black, and mean age was 70 ± 8.6 years. Nodules were identified incidentally (52%) or via screening (48%). Treatment was surgery in 52% and stereotactic body radiotherapy in 44%, and 10.2% were benign. Median (interquartile range) times from referral to diagnosis and from referral to treatment were 34 (22-56) days and 65 (44-84) days, respectively. Consultation to biopsy (20 [12-34] days) and diagnosis to treatment (28 [8-43] days) were the longest phases of care. Longer time from referral to diagnosis was associated with Black race and widowed status, whereas longer time from referral to treatment was associated with female gender, widowed status, frailty, body mass index greater than 18.5, Eastern Cooperative Oncology Group performance status less than 2, bronchoscopic biopsy, and treatment with stereotactic body radiotherapy.</div></div><div><h3>Conclusions</h3><div>Increased time spent in suspicious lung nodule care is associated with demographic, social, and clinical factors. The longest phases are time from consultation to biopsy and from diagnosis to treatment. Improving multidisciplinary care coordination for vulnerable patient populations could improve the timeliness of suspicious lung nodule care.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 451-471"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854868","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":"Young lung cancer patients undergoing surgery: Comparison of clinicopathological characteristics and outcomes in patients aged ≤50 years versus >50 years","authors":"Rachel T. Leo BA,&nbsp;Evert A. Sugarbaker BS,&nbsp;Miles McAllister BA,&nbsp;Anupama Singh MD,&nbsp;Rafael R. Barcelos MD,&nbsp;Ali Basil Ali MD,&nbsp;Raphael Bueno MD,&nbsp;Michael T. Jaklitsch MD,&nbsp;Paula Ugalde Figueroa MD,&nbsp;Scott J. Swanson MD","doi":"10.1016/j.xjon.2024.12.008","DOIUrl":"10.1016/j.xjon.2024.12.008","url":null,"abstract":"<div><h3>Objective</h3><div>We investigated clinicopathologic characteristics, overall survival (OS), and locoregional recurrence-free survival of young surgical patients with non–small cell lung cancer.</div></div><div><h3>Methods</h3><div>Retrospective review of an institutional database of patients aged 50 years or younger undergoing resection for non–small cell lung cancer between January 1995 and March 2022. A control group of patients older than age 50 years was selected by stratified random sampling. Relevant characteristics were compared with Wilcoxon rank sum,χ,² and Fisher exact tests. Propensity-score weighting was used to control for confounders. OS and locoregional recurrence-free survival were analyzed with Kaplan-Meier and Cox proportional hazards regression.</div></div><div><h3>Results</h3><div>We identified 196 patients aged 50 years or younger and 232 patients older than age 50 years. Median age was 46 years (interquartile range, 43-49 years) in the younger group and 69 years (interquartile range, 63-74 years) in the older group. Younger patients were more often women, non-White, and with fewer comorbidities. They more often presented with symptoms, stage III or IV disease, and more often received neoadjuvant therapy. In unweighted analysis, younger patients showed superior OS (log-rank <em>P</em> &lt; .0001). After propensity score weighting for procedure type, histologic type, Charlson Comorbidity Index, and smoking status, there was no significant difference in OS at 5 years between younger and older groups (70.62% vs 72.99%; weighted log-rank <em>P</em> = .084). Younger patients showed superior OS (weighted log-rank <em>P</em> = .0006) and locoregional recurrence-free survival (weighted log-rank <em>P</em> = .017) for clinical stage I, but not any other stage. lymphovascular invasion was an independent risk factor for worsened OS and locoregional recurrence-free survival across ages.</div></div><div><h3>Conclusions</h3><div>Recognizing lung cancer as a differential diagnosis for patients aged 50 years or younger is crucial because this group shows superior outcomes for stage I disease. Lymphovascular invasion is an independent prognostic risk factor across age groups.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 409-422"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854480","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":"Optimal treatment for nonsevere coronary artery disease in valve surgeries: Concurrent coronary artery bypass grafting or postoperative medical therapy?","authors":"Li Ding MD, PhD","doi":"10.1016/j.xjon.2025.01.011","DOIUrl":"10.1016/j.xjon.2025.01.011","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 256-263"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854579","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}