JTCVS open最新文献

{"title":"Trends in utilization, timing, and outcomes of thoracic endovascular repair for type B aortic dissection in the United States","authors":"Troy Coaston BS ,&nbsp;Oh Jin Kwon MD ,&nbsp;Amulya Vadlakonda BS ,&nbsp;Jeffrey Balian ,&nbsp;Nam Yong Cho BS ,&nbsp;Saad Mallick MD ,&nbsp;Christian de Virgilio MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.xjon.2024.07.016","DOIUrl":"10.1016/j.xjon.2024.07.016","url":null,"abstract":"<div><h3>Background</h3><div>Aortic dissection is the most common acute aortic syndrome in the United States. Type B aortic dissection (TBAD) can be managed medically, through open surgical repair, or with thoracic endovascular repair (TEVAR). The present study sought to assess contemporary trends in the use and timing of TEVAR.</div></div><div><h3>Methods</h3><div>Adult nonelective TBAD admissions were identified in the 2010 to 2020 Nationwide Readmissions Database. Patients were categorized as medical management (Medical Management), TEVAR at initial hospitalization (Early), or TEVAR during readmission (Delayed). Multivariable models were developed to assess associations with clinical outcomes and resource utilization.</div></div><div><h3>Results</h3><div>Of 85,753 patients, 8.7% underwent TEVAR at index hospitalization (Early). From 2010 to 2020, the proportion undergoing TEVAR decreased significantly (from 11.3% to 9.6%; nptrend &lt; .001), while the proportion of TEVAR at a subsequent hospitalization increased (from 13.0% to 21.6%; nptrend &lt; .001). Compared to Medical Management, the Early group was younger (median. 63 [interquartile range (IQR), 52-74] years vs 69 [IQR, 57-81] years), and more frequently privately insured (27.7% vs 17.5%; <em>P</em> &lt; .001). Following adjustment, the Early group had a reduced odds of mortality (adjusted odds ratio [aOR], 0.56; 95% confidence interval [CI], 0.48-0.66) and increased hospitalization costs (β = +$50,000; 95% CI, $48,000-$53,000). Among 4267 TEVAR patients with available procedure timing data, 15.7% were categorized as Delayed. The Early and Delayed groups did not differ in terms of demographics. The Delayed group had a decreased likelihood of major adverse events (aOR, 0.50; 95% CI, 0.39-0.64); however, this did not affect 90-day cumulative hospitalization costs (β = +$2700; 95% CI, -$5000-$11,000, ref: Early).</div></div><div><h3>Conclusions</h3><div>This study suggests changes to TBAD management in both treatment modality and TEVAR timing. Focused analysis on the timing and long-term costs of TEVAR are needed to optimize care delivery.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 35-44"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553617","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":"Autonomous Fontan pump: Computational feasibility study","authors":"Mark D. Rodefeld MD ,&nbsp;Timothy Conover PhD ,&nbsp;Richard Figliola PhD ,&nbsp;Mike Neary MS ,&nbsp;Guruprasad Giridharan PhD ,&nbsp;Artem Ivashchenko MEng ,&nbsp;Edward M. Bennett PhD","doi":"10.1016/j.xjon.2024.07.003","DOIUrl":"10.1016/j.xjon.2024.07.003","url":null,"abstract":"<div><h3>Objective</h3><div>After Fontan palliation, patients with single-ventricle physiology are committed to chronic circulatory inefficiency for the duration of their lives. This is due in large part to the lack of a subpulmonary ventricle. A low-pressure rise cavopulmonary assist device can address the subpulmonary deficit and offset the Fontan paradox. We investigated the feasibility of a Fontan pump that is self-powered by tapping reserve pressure energy in the systemic arterial circulation.</div></div><div><h3>Methods</h3><div>A double-inlet, double-outlet rotary pump was designed to augment Fontan flow through the total cavopulmonary connection. Pump power is supplied by a systemic arterial shunt and radial turbine, with a closed-loop shunt return to the common atrium (Q_P:Q_S 1:1). Computational fluid dynamic analysis and lumped parameter modeling of pump impact on the Fontan circulation was performed.</div></div><div><h3>Results</h3><div>Findings indicate that a pump that can augment all 4 limbs of total cavopulmonary connection flow (superior vena cava/inferior vena cava inflow; left pulmonary artery/right pulmonary artery outflow) using a systemic arterial shunt powered turbine at a predicted cavopulmonary pressure rise of +2.5 mm Hg. Systemic shunt flow is 1.43 lumped parameter model, 22% cardiac output. Systemic venous pressure is reduced by 1.4 mm Hg with improved ventricular preload and cardiac output.</div></div><div><h3>Conclusions</h3><div>It may be possible to tap reserve pressure energy in the systemic circulation to improve Fontan circulatory efficiency. Further studies are warranted to optimize, fabricate, and test pump designs for hydraulic performance and hemocompatibility. Potential benefits of an autonomous Fontan pump include durable physiologic shift toward biventricular health, freedom from external power, autoregulating function and exercise responsiveness, and improved quality and duration of life.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 257-266"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141693539","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":"Out of the ice age: Preservation of cardiac allografts with a reusable 10 °C cooler","authors":"John M. Trahanas MD ,&nbsp;Timothy Harris MD ,&nbsp;Mark Petrovic MS ,&nbsp;Anthony Dreher MPA ,&nbsp;Chetan Pasrija MD ,&nbsp;Stephen A. DeVries PA-C ,&nbsp;Swaroop Bommareddi MD ,&nbsp;Brian Lima MD ,&nbsp;Chen Chia Wang BSc ,&nbsp;Michael Cortelli BS ,&nbsp;Avery Fortier BSc ,&nbsp;Kaitlyn Tracy MD ,&nbsp;Elizabeth Simonds BA ,&nbsp;Clifton D. Keck ,&nbsp;Shelley R. Scholl RN ,&nbsp;Hasan Siddiqi MD ,&nbsp;Kelly Schlendorf MD ,&nbsp;Matthew Bacchetta MD ,&nbsp;Ashish S. Shah MD","doi":"10.1016/j.xjon.2024.08.005","DOIUrl":"10.1016/j.xjon.2024.08.005","url":null,"abstract":"<div><h3>Objective</h3><div>Static cold storage with ice has been the mainstay of cardiac donor preservation. Early preclinical data suggest that allograft preservation at 10 °C may be beneficial. We tested this hypothesis by using a static 10 °C storage device to preserve and transport cardiac allografts.</div></div><div><h3>Methods</h3><div>In total, 52 allografts were recovered between July 2023 and March 2024 and transported using a 10 °C storage cooler. Results were compared to a 3:1 propensity match of allografts transported on ice. Patients were excluded for the following reasons: dual viscera transplant, previous heart transplant, complex congenital heart disease, or allograft injury during procurement.</div></div><div><h3>Results</h3><div>Among the 10 °C cooler cohort, median total ischemic time was 222 minutes at 10 °C versus 193 minutes on ice (<em>P</em> &lt; .0001). Intraoperative change in lactate was statistically lower at 10 °C (3.6 vs 5.1 mmol/L, <em>P</em> = .0016). Cardiac index score was greater in 10 °C cooler hearts at 24 (3.2 vs 3.0, <em>P</em> = .016) and 72 hours (3.3 vs 2.9, <em>P</em> = .037), despite similar vasoactive inotrope scores. There was no difference in severe primary graft dysfunction (1.9 vs 2.6%, <em>P</em> &gt; .99). 10 °C hearts demonstrated less change in lactate but no difference in vasoactive inotrope scores or cardiac index. In hearts with extended ischemic time, delta lactate was lower in 10 °C cooler hearts. There was no statistical difference in outcomes for donor hearts &gt;40 years old.</div></div><div><h3>Conclusions</h3><div>This is an early experience of static preservation in a 10 °C cooler. Postoperative allograft function was excellent, and lactate profiles lower in those allografts with extended ischemic times. Static cold storage targeting 10 °C may offer an inexpensive method for extended heart preservation. Further investigation is needed to assess long-term outcomes of 10 °C storage.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 197-209"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553450","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":"Preliminary outcomes of quantitative flow ratio-guided coronary bypass grafting in primary valve surgery: A propensity score weighted analysis","authors":"Jiaxi Zhu MD ,&nbsp;Yunpeng Zhu MD ,&nbsp;Wei Zhang PhD ,&nbsp;Zhe Wang MD ,&nbsp;Xiaofeng Ye MD, PhD ,&nbsp;Mi Zhou MD ,&nbsp;Haiqing Li MD ,&nbsp;Jiapei Qiu MD ,&nbsp;Hong Xu MD ,&nbsp;Yanjun Sun MD ,&nbsp;Lei Kang RN ,&nbsp;Shengxian Tu PhD ,&nbsp;Qiang Zhao MD, PhD","doi":"10.1016/j.xjon.2024.06.008","DOIUrl":"10.1016/j.xjon.2024.06.008","url":null,"abstract":"<div><h3>Objectives</h3><div>The guidelines recommend fractional flow reserve-guided coronary artery bypass grafting (CABG) during primary valve surgery without evidence. Quantitative flow ratio (QFR) is a novel coronary angiography (CAG)-based fractional flow reserve measurement. We aimed to compare the early clinical outcomes between QFR-guided and CAG-guided CABG in these patients.</div></div><div><h3>Methods</h3><div>This observational study screened all 2081 patients admitted to our institution for elective primary mitral and/or aortic valve surgery from January 2017 to September 2020. Of them, all 188 patients with comorbid coronary artery lesions (visual estimated stenosis ≥50%) were included. Sixty-nine patients with QFR analysis received bypasses only for lesions with QFR ≤0.80 (QFR-guided group). The remaining 119 patients without QFR analysis received bypasses for all stenosis ≥50% (CAG-guided group). Propensity overlap weighting was used to neutralize the intergroup imbalance. The primary end point was major adverse cardiovascular events.</div></div><div><h3>Results</h3><div>After propensity score weighting, the baseline characteristics were comparable. Concomitant coronary artery bypass grafting was performed 58.1% versus 100% in the QFR-guided and CAG-guided groups, respectively. The mean number of grafts was significantly lower in QFR-guided group than in the CAG-guided group (0.9 ± 0.7 vs 1.6 ± 0.5 [<em>P</em> &lt; .001]). The weighted 30-day incidence of major adverse cardiovascular events was numerically lower in the QFR-guided group than in the CAG-guided group, but not statistically significant (6.3% vs 11.8% [<em>P</em> = .429]). After a median follow-up of 31.6 months, the weighted risk of major adverse cardiovascular events and mortality were significantly lower in the QFR-guided group than in the CAG-guided group (major adverse cardiovascular events: hazard ratio, 0.45; 95% CI, 0.24-0.84; <em>P</em> = .012; mortality: hazard ratio, 0.38; 95% CI, 0.16-0.93; <em>P</em> = .029).</div></div><div><h3>Conclusions</h3><div>Compared with CAG-guided coronary artery bypass grafting, QFR-guided CABG is associated with less grafting and better clinical outcome in primary valve surgery with comorbid coronary artery disease. To confirm this finding, the Quantitative Flow Ratio Guided Revascularization Strategy for Patients Undergoing Primary Valve Surgery With Comorbid Coronary Artery Disease trial (NCT03977129) is ongoing.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 90-108"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553534","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":"Genetics of aortic aneurysm disease: 10 key points for the practitioner","authors":"John A. Elefteriades MD, PhD (hon),&nbsp;Mohammad A. Zafar MD,&nbsp;Bulat A. Ziganshin MD, PhD","doi":"10.1016/j.xjon.2024.07.014","DOIUrl":"10.1016/j.xjon.2024.07.014","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 58-63"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841288","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":"Outcomes of pediatric heart transplantation in children with selected genetic syndromes","authors":"Sarah Wilkens MD, MPH ,&nbsp;Jaimin Trivedi MBBS, MPH ,&nbsp;Deborah Kozik MD ,&nbsp;Andrea Nicole Lambert MD, MSCI ,&nbsp;Bahaaldin Alsoufi MD","doi":"10.1016/j.xjon.2024.05.016","DOIUrl":"10.1016/j.xjon.2024.05.016","url":null,"abstract":"<div><h3>Objective</h3><div>Genetic syndromes (GSs) are often linked to congenital heart disease (CHD) and cardiomyopathy (CM). The effect of GSs on survival following pediatric heart transplant (HT) has not been well described. We aimed to compare outcomes following HT between children with a GS and those without a GS.</div></div><div><h3>Methods</h3><div>The United Network for Organ Sharing (UNOS) transplantation database was merged with the Pediatric Health Information System (PHIS) administrative database to identify children with GS who underwent HT between 2009 and 2019. Characteristics and outcomes were compared between children with a GS (GS group) and those without a GS (no GS group).</div></div><div><h3>Results</h3><div>GSs were present in 225 of 2429 HT recipients (9%). The most common GSs were DiGeorge syndrome (n = 28), muscular dystrophy (n = 27), Down syndrome (n = 26), and Turner syndrome (n = 14). The incidence of CHD was higher in the GS group compared to the no GS group (54% vs 38%; <em>P</em> &lt; .1); however, patient demographics, hemodynamics, renal and hepatic dysfunction, and requirements for dialysis, mechanical ventilation, extracorporeal membrane oxygenation, and mechanical circulatory support were not different between the 2 groups. Time on the waitlist was not significantly different between the GS and no GS groups (55 days vs 53 days; <em>P</em> = .4). There also was no between-group difference in the incidence of post-transplantation complications, including dialysis (8% vs 5%; <em>P</em> = .38), stroke (3% vs 4%; <em>P</em> = .34), primary graft dysfunction (2% vs 2%; <em>P</em> = .75), need for pacemaker (1% vs 1%; <em>P</em> = .84) and rejection (3.4% vs 3.4%; <em>P</em> = .96). Survival at 10 years post-HT was 75% for the no GS group and 72% for the GS group (<em>P</em> = .59). The survival curves also did not differ between patients with CM and those with CHD.</div></div><div><h3>Conclusions</h3><div>Children with certain GSs and end-stage heart failure can be expected to have similar post-transplantation outcomes to those without a GS. Although early and late post-transplantation care is individualized to each patient, the presence of a GS should not influence the decision to list for HT.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 279-287"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553455","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":"Type B aortic dissection in Marfan patients after the David procedure: Insights from patient-specific simulation","authors":"","doi":"10.1016/j.xjon.2024.04.017","DOIUrl":"10.1016/j.xjon.2024.04.017","url":null,"abstract":"<div><h3>Objective</h3><div>An elevated risk of acute type B aortic dissection exists in patients with Marfan syndrome after the David procedure. This study explores hemodynamic changes in the descending aorta postsurgery.</div></div><div><h3>Methods</h3><div>A single-center retrospective review identified 5 patients with Marfan syndrome who experienced acute type B aortic dissection within 6 years after the David procedure, alongside 5 matched patients with Marfan syndrome without dissection more than 6 years postsurgery. Baseline and postoperative computed tomography and magnetic resonance scans were analyzed for aortic geometry reconstruction. Computational fluid dynamic simulations evaluated preoperative and postoperative hemodynamics.</div></div><div><h3>Results</h3><div>Patients with acute type B aortic dissection showed lower blood flow velocities, increased vortices, and altered velocity profiles in the proximal descending aorta compared with controls. Preoperatively, median time-averaged wall shear stress in the descending aorta was lower in patients with acute type B aortic dissection (control: 1.76 [1.50-2.83] Pa, dissection: 1.16 [1.06-1.30] Pa, <em>P</em> = .047). Postsurgery, neither group had significant time-averaged wall shear stress changes (dissection: <em>P</em> = .69, control: <em>P</em> = .53). Localized analysis revealed surgery-induced time-averaged wall shear stress increases near the subclavian artery in the dissection group (range, +0.30 to +1.05 Pa, each comparison, <em>P</em> &lt; .05). No such changes were observed in controls. Oscillatory shear index and relative residence time were higher in patients with acute type B aortic dissection before and after surgery versus controls.</div></div><div><h3>Conclusions</h3><div>Hemodynamics likely play a role in post–David procedure acute type B aortic dissection. Further investigation into aortic geometry, hemodynamics, and postoperative acute type B aortic dissection is vital for enhancing outcomes and refining surgical strategies in patients with Marfan syndrome.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 1-16"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141041481","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":"Lobectomy versus segmentectomy in patients with T1N2 non–small cell lung cancer: An analysis of the National Cancer Database","authors":"Yoshiko Iwai MS ,&nbsp;Panagiotis Tasoudis MD ,&nbsp;Chris B. Agala PhD ,&nbsp;Audrey L. Khoury MD, MPH ,&nbsp;Danielle N. O'Hara Garcia MD ,&nbsp;Jason M. Long MD, MPH","doi":"10.1016/j.xjon.2024.08.003","DOIUrl":"10.1016/j.xjon.2024.08.003","url":null,"abstract":"<div><h3>Objective</h3><div>To assess survival outcomes for patients with stage IIIA (T1N2M0) non–small cell lung cancer (NSCLC) using the National Cancer Database (NCDB).</div></div><div><h3>Methods</h3><div>Patients with T1N2M0 NSCLC undergoing lobectomy or segmentectomy were identified in the NCDB from 2004 to 2019. Patient characteristics were compared using χ² and Fisher exact tests. Overall survival was evaluated using the Kaplan-Meier method and the Cox proportional hazard analysis adjusting for type of resection, age, sex, and margin positivity, Charlson comorbidity index, number of lymph nodes examined, number of positive lymph nodes, and tumor size.</div></div><div><h3>Results</h3><div>In total, 2883 patients with T1N2 NSCLC undergoing segmentectomy or lobectomy were identified. The majority (96.5%) of patients received lobectomy and 100 (3.5%) patients received segmentectomy. Patients undergoing segmentectomy were older (<em>P</em> = .001) and had tumors in the lower lobe of the lung (<em>P</em> = .001) versus patients undergoing lobectomy. Fewer patients who received segmentectomy underwent radiation (<em>P</em> = .015) and neoadjuvant chemotherapy (<em>P</em> = .041). Fewer patients undergoing segmentectomy had &gt;10 lymph nodes examined and &gt;5 positive nodes compared with patients receiving lobectomy (both <em>P</em> &lt; .001). Although 30-day readmission rates were similar (<em>P</em> = .27), 30-day mortality was lower in the segmentectomy cohort (<em>P</em> = .047). There was a significantly lower risk of death among patients undergoing lobectomy versus segmentectomy (hazard ratio, 0.96; 95% confidence interval, 0.94-0.98; <em>P</em> = .001).</div></div><div><h3>Conclusions</h3><div>In this NCDB analysis, lobectomy was more commonly performed for T1N2 NSCLC compared with segmentectomy. Lobectomy offered a significant survival advantage over segmentectomy, even when adjusting for risk factors. Thus, these findings suggest that lobectomy may be a superior resection of choice for patients with T1N2 disease.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 304-312"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553337","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":"Durability of porcine and pericardial prostheses in tricuspid valve replacement","authors":"Brittany A. Zwischenberger MD, MHSc ,&nbsp;Carmelo Milano MD ,&nbsp;John Haney MD ,&nbsp;Jeffrey G. Gaca MD ,&nbsp;Jacob Schroder MD ,&nbsp;Keith Carr BS ,&nbsp;Donald D. Glower MD","doi":"10.1016/j.xjon.2024.06.017","DOIUrl":"10.1016/j.xjon.2024.06.017","url":null,"abstract":"<div><h3>Objective</h3><div>Biologic valves dominate tricuspid valve replacement, yet data on different valve types are lacking. We compare the survival and durability of porcine and pericardial tricuspid prostheses.</div></div><div><h3>Methods</h3><div>A retrospective review of consecutive patients undergoing tricuspid valve replacement with porcine (N = 542) or pericardial (N = 144) prostheses between 1975 and 2022 was performed using a prospectively maintained institutional database. Concurrent procedures were included. Cox proportional hazards and logistic regression were performed.</div></div><div><h3>Results</h3><div>Patients who received the porcine prosthesis, compared with pericardial, were younger (56 ± 17 years vs 63 ± 15 years) and more likely to present urgently (55% porcine, 44% pericardial); however, there were no differences in redo status or concomitant operations. Ten-year survival was not significantly different between the porcine and pericardial groups (35% ± 3% vs 28% ± 4%, respectively, <em>P</em> = .2). The 10-year cumulative incidence of structural valve deterioration (porcine 9% ± 2%, pericardial 11% ± 3%, <em>P</em> = .8), reoperation for structural valve deterioration (porcine 5% ± 1%, pericardial 4% ± 2%, <em>P</em> = .06), and severe regurgitation (porcine 4% ± 1%, pericardial 5% ± 2%, <em>P</em> = .7) were not significantly different between groups. The failure mode was similar, with no difference in severe stenosis (porcine 32/47 [68%], pericardial 11/16 [69%], <em>P</em> = .9) or severe regurgitation (porcine 18/47 [38%], pericardial 7/16 [44%], <em>P</em> = .7). On regression analysis, valve type was not associated with survival (<em>P</em> = .6). Valve type was not associated with structural valve deterioration (<em>P</em> = .1) or reoperation for structural valve deterioration (<em>P</em> = .9).</div></div><div><h3>Conclusions</h3><div>In our series, there were no differences in survival or durability between porcine and pericardial valves. In most patients undergoing tricuspid valve replacement, the choice of porcine versus pericardial prosthesis is unlikely to affect clinical outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 78-87"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553533","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":"Should we wait until the morning?","authors":"","doi":"10.1016/j.xjon.2024.06.002","DOIUrl":"10.1016/j.xjon.2024.06.002","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Page 372"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141396183","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}