JTCVS open最新文献

{"title":"Biomechanical modeling of surgical techniques to repair isolated segmental P2 prolapse of the mitral valve","authors":"Gediminas Gaidulis PhD ,&nbsp;Kanika Kalra MD ,&nbsp;Muralidhar Padala PhD","doi":"10.1016/j.xjon.2025.03.011","DOIUrl":"10.1016/j.xjon.2025.03.011","url":null,"abstract":"<div><h3>Objective</h3><div>Prolapse of the P2 cusp of the mitral valve is a common valvular lesion that is amenable to surgical repair. Both resective and nonresective leaflet repair procedures are used, yielding good acute correction of the valve lesion, but with variable resulting valve kinematics and mechanics. In this study, we used a patient-specific computational model of isolated P2 prolapse without excess tissue to assess the mechanical and anatomical benefits of different surgical techniques.</div></div><div><h3>Methods</h3><div>Three-dimensional transesophageal echocardiogram of the mitral valve from a patient with segmental P2 prolapse was segmented and computationally modeled to serve as the disease model. Virtual repair was performed using neochordoplasty, triangular resection, and quadrangular resection. All techniques were accompanied by the addition of true-sized and downsized complete annuloplasty rings. Mitral valve closure was simulated for each repair, and the resulting systolic leaflet geometry, leaflet mobility, leaflet stresses, and chordal forces were computed.</div></div><div><h3>Results</h3><div>From complete loss of coaptation pre-repair, Coaptation length was restored to 5.8 mm with 2 neochordae, 5.9 mm with 4 neochordae, 2.8 mm with triangular resection, and 1.7 mm with quadrangular resection and a true-sized annuloplasty. Peak stress in the repaired P2 segment was initially 0.75 MPa, reduced to 0.47 MPa with 2 neochordae and 0.39 MPa with 4 neochordae, but increased to 0.79 MPa with triangular resection and 2.04 MPa with quadrangular resection. Smaller rings reduced these stresses and further increased coaptation length in all investigated repair scenarios, but with a positive effect of such downsizing being larger with neochordoplasty than resective techniques.</div></div><div><h3>Conclusions</h3><div>In the setting of isolated segmental P2 prolapse, preserving leaflet tissue with neochordae achieved largest leaflet coaptation with lowest leaflet stresses, whereas resective techniques restored smaller coaptation with less stress reduction.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 45-57"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320938","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":"Influences of age and obesity on heart transplant outcomes","authors":"Zach Rollins MD ,&nbsp;Ye In Christopher Kwon BA ,&nbsp;Graham Gardner MD ,&nbsp;Elizabeth Bashian MD ,&nbsp;Matthew Ambrosio MS ,&nbsp;Inna F. Tchoukina MD ,&nbsp;Keyur Shah MD ,&nbsp;Rahul Rajeev MD ,&nbsp;Josue Chery MD ,&nbsp;Vigneshwar Kasirajan MD ,&nbsp;Zubair A. Hashmi MD","doi":"10.1016/j.xjon.2025.02.022","DOIUrl":"10.1016/j.xjon.2025.02.022","url":null,"abstract":"<div><h3>Objective</h3><div>Obesity and older age have both been identified as risk factors for a worse long-term prognosis after heart transplantation. We sought to determine the 5-year outcomes for heart transplant patients with high-risk body mass index (BMI) &gt;30 (HRB), high-risk age &gt;70 years (HRA), or both (HRAB) as compared with recipients with normal risk (NR) in the modern era.</div></div><div><h3>Methods</h3><div>Records of isolated heart transplants in the United States from 2014 to 2023 were obtained for adults older than 18 years. BMI and age cut-off was identified on spline analysis. Survival curves were built for overall survival using a Kaplan-Meier method, with a log-rank test used to test for differences between groups. Risk adjusted Cox regression was performed on variables potentially influencing overall survival.</div></div><div><h3>Results</h3><div>Between 2014 and 2023, there were 15,839 NR; 869 HRA; 8187 HRB; and 202 HRAB patients. There was a significant difference in overall survival by Kaplan-Meier evaluation between the 4 groups, with worse survival in the high-risk groups (<em>P</em> &lt; .001). The hazard ratio for mortality in the HRB, HRA, and HRAB groups was 1.21, 1.23, and 1.72, respectively (<em>P</em> &lt; .05). However, even recipients in the HRAB group had 5-year survival rates of 66.8%.</div></div><div><h3>Conclusions</h3><div>Overall survival is worse in recipients in the HRA, HRB, or HRAB groups than in recipients in the NR group but similar between patients with isolated BMI &gt;30 or age &gt;70 years. Patients with both increased BMI &gt;30 and age &gt;70 years had the worst overall survival. However, the 5-year survival even for HRAB suggests the value of transplantation even if patients are at high risk.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 253-263"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320955","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":"Should moderate tricuspid regurgitation be repaired at the time of mitral surgery? Results from a large registry-based study","authors":"Ali Hage MD, MPH ,&nbsp;Eugene H. Blackstone MD ,&nbsp;Tarek Malas MD, MPH ,&nbsp;Lars G. Svensson MD, PhD ,&nbsp;Ashley M. Lowry MS, MEd ,&nbsp;Annalisa Bernabei MD ,&nbsp;Kenneth McCurry MD ,&nbsp;Haytham Elgharably MD ,&nbsp;Marc Gillinov MD","doi":"10.1016/j.xjon.2025.03.025","DOIUrl":"10.1016/j.xjon.2025.03.025","url":null,"abstract":"<div><h3>Objectives</h3><div>To trace the temporal trajectory of unrepaired moderate tricuspid regurgitation (TR) after primary, isolated mitral valve repair (MVr) alone compared with none or mild TR, and to determine whether moderate TR is associated with worse survival.</div></div><div><h3>Methods</h3><div>Between January 1, 2000, and December 21, 2022, a total of 5467 consecutive patients (mean age, 58 ±12 years) with severe degenerative mitral regurgitation (MR) underwent MVr alone without concomitant TR repair. Of these, 3418 (63%) had no TR, 1652 (30%) had mild TR, and 397 (7%) had moderate TR. They were followed prospectively for a maximum duration of 24 years.</div></div><div><h3>Results</h3><div>Patients with preoperative moderate TR had an increased unadjusted risk of mortality (70% survival) at 14 years compared to patients with mild TR (81% survival) and those with no TR (85% survival), mostly related to a higher baseline risk profile. Patients who died during follow-up were more likely to have moderate TR compared to those who survived. Among patients with unaddressed moderate preoperative TR, the proportion with persistent moderate TR dropped to 19% (from 100%) immediately after MVr and then increased to 31% at 10 years. Degree of preoperative TR and postoperative MR were associated with moderate or greater TR during follow-up.</div></div><div><h3>Conclusions</h3><div>Patients with untreated preoperative moderate TR undergoing isolated MV surgery had incomplete resolution of their TR. The presence of moderate TR during follow-up was associated with increased mortality at long-term follow-up, mostly related to a higher baseline risk profile. MR perhaps should be treated before the development of moderate TR.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 72-84"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320941","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":"Transplantation of vascularized cardiac microtissue from human induced pluripotent stem cells improves impaired electrical conduction in a porcine myocardial injury model","authors":"Yuki Kuroda MD ,&nbsp;Jun Iida MD ,&nbsp;Kozue Murata PhD ,&nbsp;Yuki Hori MD ,&nbsp;Jumpei Kobiki MD ,&nbsp;Kenji Minatoya MD, PhD ,&nbsp;Hidetoshi Masumoto MD, PhD","doi":"10.1016/j.xjon.2025.03.006","DOIUrl":"10.1016/j.xjon.2025.03.006","url":null,"abstract":"<div><h3>Objective</h3><div>To demonstrate that the transplantation of human induced pluripotent stem cell (hiPSC)-derived vascularized cardiac microtissue (VCM) can improve conduction disturbances after myocardial injury (MI).</div></div><div><h3>Methods</h3><div>We prepared cell sheet-shaped VCM with hiPSC-derived cardiomyocytes and vascular cells using dynamic rocking culture. We induced MI via epicardial cryoablation in immunosuppressed crown minipigs (VCM and sham groups; n = 3) and transplanted the VCMs immediately after MI induction. The pigs underwent epicardial electroanatomical mapping immediately before and 1 week after MI induction.</div></div><div><h3>Results</h3><div>One week after MI induction, mean electrical potentials at the MI site decreased in both groups during sinus rhythm (from 11.05 to 1.74 mV in the VCM group and from 8.72 to 2.70 mV in the sham group, <em>P</em> = .048). The mean conduction velocity between the remote and MI sites was numerically higher in the VCM group compared with the Sham group (2.84 m/s vs 1.74 m/s). One of the 3 animals in the VCM group demonstrated 2 independent origins of excitation corresponding to the pacing sites when simultaneous pacing of the remote and MI sites was performed 1 week after MI induction. Histologic examination confirmed that the VCM had engrafted on the surface of the MI region. Furthermore, we confirmed that the myocardial tissue in the MI region remained more intact one week after injury in the VCM transplantation group compared to the sham group, suggesting that this contributed to the reduction of conduction disturbances.</div></div><div><h3>Conclusions</h3><div>The transplantation of VCM demonstrated a potential for improving conduction disturbances in MI.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 154-162"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321710","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":"Aortic arch uncrossing in neonates and young infants: A case series","authors":"Neil M. Venardos MD ,&nbsp;Arshid Mir MD ,&nbsp;Randall M. Schwartz MD ,&nbsp;Emilie D. Henry MD ,&nbsp;Harold M. Burkhart MD","doi":"10.1016/j.xjon.2025.04.011","DOIUrl":"10.1016/j.xjon.2025.04.011","url":null,"abstract":"<div><h3>Objectives</h3><div>Neonates diagnosed with a circumflex aortic arch and coarctation must undergo early repair. Complete surgical correction of this lesion involves an arch repair with an uncrossing procedure performed during the first few months of life. Little is known about outcomes in neonates undergoing surgery for this lesion. We reviewed our experience with the aortic uncrossing procedure in neonates and young infants.</div></div><div><h3>Methods</h3><div>A retrospective review of all patients undergoing aortic uncrossing at a single center between January 2015 and November 2024 was performed. Data reviewed included demographics, echocardiography, and cross-sectional imaging studies.</div></div><div><h3>Results</h3><div>Four neonates who underwent an aortic uncrossing procedure were identified. All had a right arch with a circumflex aorta descending in the left hemithorax. Age ranged from 7 to 46 days, and weight ranged from 2.8 to 4.5 kg. Aortic arch translocation and uncrossing were performed under circulatory arrest with antegrade cerebral perfusion. Two patients required patch augmentation of the anastomosis. Three out of 4 patients had left vocal cord dysfunction. The length of stay ranged from 29 to 89 days. One patient required a second cardiac operation unrelated to the original surgery. All 4 patients are doing well at follow-up (range, 5 months-9 years).</div></div><div><h3>Conclusions</h3><div>The aortic uncrossing procedure can safely be performed as part of a neonatal arch reconstruction with excellent results.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 308-311"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321011","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":"Minimally invasive coronary bypass grafting for treating multivessel coronary disease: A single-center prospective pilot study","authors":"Tong Ding MD, PhD,&nbsp;Yichen Gong MD,&nbsp;Yuanhao Fu MD,&nbsp;Zhongqi Cui MD,&nbsp;Song Wu MD,&nbsp;Wei Yang MD,&nbsp;Hang Yang MD,&nbsp;Hong Zhao MD,&nbsp;Haibo Feng MD,&nbsp;Huiping Zheng MD,&nbsp;Luyu Meng MD,&nbsp;Rui Guo MD,&nbsp;Huijin Han BS,&nbsp;Yunpeng Ling MD","doi":"10.1016/j.xjon.2025.03.030","DOIUrl":"10.1016/j.xjon.2025.03.030","url":null,"abstract":"<div><h3>Objectives</h3><div>The study sought to explore the characteristics and outcomes of patients undergoing clinically indicated minimally invasive cardiac surgery—coronary artery bypass grafting (MICS-CABG) and off-pump coronary artery bypass for MICS-CABG eligible multivessel disease, to inform the design of a confirmatory comparative effectiveness trial.</div></div><div><h3>Methods</h3><div>Over 30 months, 245 MICS-CABG and 158 off-pump coronary artery bypass participants were enrolled. Health-related quality-of-life was assessed using the 36-Item Short-Form Health Survey and Seattle Angina Questionnaire. The primary end point was the score on the physical component summary and mental component summary subscale of the 36-Item Short-Form Health Survey (on which scores range from 0 to 100, with higher scores indicating better health status).</div></div><div><h3>Results</h3><div>The score on the Physical Component Summary-United States subscale of the 36-Item Short-Form Health Survey increased to a greater extent with MICS-CABG than with off-pump coronary artery bypass at both 7 and 30 days (<em>P</em> = .002 and <em>P</em> = .001, respectively), as well as Physical Component Summary-Hong Kong subscale (MICS-CABG and off-pump coronary artery bypass: <em>P</em> = .002 and <em>P</em> &lt; .001, respectively). The mental component summary subscale of the 36-Item Short-Form Health Survey in either the United States or Hong Kong and all 5 domains of Seattle Angina Questionnaire score were similar between the 2 groups throughout the follow-up period.</div></div><div><h3>Conclusions</h3><div>MICS-CABG, an emerging modality for treating multivessel coronary disease, yields an improved 7- and 30-day physical function than off-pump coronary artery bypass. Moreover, both strategies resulted in similar significant relief from angina over 12 months. A randomized controlled trial is warranted to compare the efficacy of these 2 revascularization strategies. (Prospective Cohort Study on Minimal Invasive Coronary Surgery: NCT04267835).</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 96-119"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320867","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":"Improving outcomes of right ventricular outflow tract reconstruction during the Ross operation: Homograft decellularization and surgical technique","authors":"Ana Beatriz Brenner Affonso da Costa Réa MD ,&nbsp;Francisco Diniz Affonso da Costa MD, PhD ,&nbsp;Eduardo Leal Adam MD, PhD ,&nbsp;Claudinei Colatusso MD ,&nbsp;Carolina Limongi Oliveira MD ,&nbsp;Miguel Morita Fernandes da Silva MD, PhD","doi":"10.1016/j.xjon.2025.01.020","DOIUrl":"10.1016/j.xjon.2025.01.020","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the influence of decellularization and surgical technique in the cumulative incidence of homograft dysfunction and reinterventions after the Ross Operation.</div></div><div><h3>Methods</h3><div>From 1995 to 2024, 414 patients underwent a Ross operation using cryopreserved (n = 161, median follow-up = 20.4 years) or decellularized homografts (n = 253, median follow-up = 9.1 years). Thirty-nine patients receiving decellularized homografts had a proximal conical extension of the homograft with decellularized human pericardium. Homograft dysfunction was defined as a peak gradient ≥40 mm Hg or pulmonary insufficiency moderate or greater.</div></div><div><h3>Results</h3><div>The cumulative incidence of any dysfunction at 15 years was similar among the 2 groups (decellularized = 12.4%, vs cryopreserved = 11.2%). However, serial echocardiographic measurements revealed that peak gradients were lower in the decellularized homografts (β = −2.99, <em>P</em> &lt; .001). Age and homograft size were risk factors for homograft stenosis in cryopreserved homografts, but only age was associated with this event in the decellularized cohort. The cumulative incidence of reoperations at 15 years was lower in the decellularized group (1.2% vs 6.8%). Conical extension improved hemodynamic performance of decellularized homografts even further and was associated with lower late peak gradients (β = −6.37 and β = −7.44, in relation to direct anastomosis and anterior hood, respectively).</div></div><div><h3>Conclusions</h3><div>This study represent the longest follow-up with decellularized homografts during the Ross Operation. Decellularized homografts were associated with slower progression of late gradients and lower cumulative incidence of reoperations up to 15 years of follow-up. Conical extension with decellularized human pericardium may further improve their early and late hemodynamic performance.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 25-38"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321019","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 pretransplant extracorporeal membrane oxygen support duration on lung transplant outcomes: United Network for Organ Sharing analysis","authors":"Harpreet Singh Grewal MD ,&nbsp;Luke Benvenuto MD ,&nbsp;Kemarut Laothamatas MD ,&nbsp;Angela Dimango MD ,&nbsp;Hilary Robbins MD ,&nbsp;Lori Shah MD ,&nbsp;Gabriela Magda MD ,&nbsp;Ritesh Shreenidhi MS ,&nbsp;Sneha Dahiya MS ,&nbsp;Joseph Costa DHSc, PA-C ,&nbsp;Bryan Stanifer MD, MPH ,&nbsp;Joshua Sonett MD ,&nbsp;Frank D'Ovidio MD, PhD ,&nbsp;Philippe Lemaitre MD, PhD ,&nbsp;Selim Arcasoy MD, MPH","doi":"10.1016/j.xjon.2025.03.012","DOIUrl":"10.1016/j.xjon.2025.03.012","url":null,"abstract":"<div><h3>Objective</h3><div>The use of pretransplant extracorporeal membrane oxygenation (ECMO) continues to increase. In the most recent Scientific Registry for Transplant Recipients, 11% of listed candidates for lung transplantation were on ECMO. We evaluated the impact of the duration of ECMO bridge to transplantation on posttransplant outcomes using United Network for Organ Sharing data.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study from January 1, 2015, to December 31, 2019, to include pre−COVID-19 pandemic data. Patients were grouped into quartiles on the basis of duration of ECMO support (&lt;4, 4-8, 9-17, and &gt;17 days). The primary outcome was survival at 1 year after transplantation. Secondary outcomes included length of stay from transplant to discharge, 1-month survival, 6-month survival.</div></div><div><h3>Results</h3><div>In total, 489 patients were analyzed. Median age decreased over the quartiles (quartile 1 age 55 vs quartile 4 age 37; <em>P</em> &lt; .001). The proportion of patients who were ambulatory on ECMO support increased over the quartiles (quartile 1 was 23.85% vs quartile 4 was 63.87%; <em>P</em> &lt; .001). Survival at 1 year was not different among the quartiles after adjusting for lung allocation score, body mass index, gender, ambulatory status, type of lung transplant, and creatinine. Six-month survival was reduced in the patients on prolonged ECMO support (quartiles 3 and 4). Ambulatory status, creatinine, and body mass index were significant contributors to survival at 1 year in the adjusted analysis.</div></div><div><h3>Conclusions</h3><div>Duration of pretransplant ECMO bridge to transplantation appears to impact 6-month survival in patients who were on ECMO for 9 days or longer, but duration of ECMO support does not appear to negatively impact postlung transplant survival during the first year or length of stay from transplant to discharge.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 466-473"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321417","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":"Association between timing of angiotensin II administration and outcomes in vasoplegia after cardiac surgery","authors":"Travis J. Miles MD ,&nbsp;Michael T. Guinn MD, PhD ,&nbsp;Orlando R. Suero MD ,&nbsp;Todd K. Rosengart MD ,&nbsp;Marc R. Moon MD ,&nbsp;Joseph S. Coselli MD ,&nbsp;Ravi K. Ghanta MD ,&nbsp;Subhasis Chatterjee MD","doi":"10.1016/j.xjon.2025.04.014","DOIUrl":"10.1016/j.xjon.2025.04.014","url":null,"abstract":"<div><h3>Objective</h3><div>Vasoplegic shock after cardiopulmonary bypass (CPB) is a highly morbid condition. The novel vasopressor angiotensin II is increasingly being used for catecholamine-resistant vasoplegia. Although early intervention with adjunctive therapies such as methylene blue can improve outcomes of vasoplegia, the optimal timing for escalation with angiotensin II is unknown.</div></div><div><h3>Methods</h3><div>Pharmacologic data were extracted from electronic health records for patients who underwent surgery with CPB during 2017-2022. Patients were identified who received angiotensin II intraoperatively or postoperatively (ie, early or late). Multivariable logistic regression was used to determine the risk-adjusted effects of earlier angiotensin II administration on postoperative major adverse events: mortality and major morbidity.</div></div><div><h3>Results</h3><div>Seventy (1.4%) patients received angiotensin II for vasoplegia. The median [interquartile range] vasopressor dose at time of angiotensin II initiation was 0.33 [0.26-0.48] norepinephrine equivalents. Vasoplegia requiring treatment with angiotensin II was associated with substantial mortality (42.9% vs 3.3%, <em>P</em> &lt; .001) and major morbidity (81.4% vs 20.3%, <em>P</em> &lt; .001). The 51.4% of patients who began receiving angiotensin II intraoperatively had less major morbidity (94.1% vs 69.4%, <em>P</em> = .019) and a trend toward lower mortality (30.6% vs 55.9%, <em>P</em> = .057) than patients who received it postoperatively. In multivariable logistic regression, intraoperative initiation was an independent predictor of fewer major adverse events (odds ratio, 0.037; 95% confidence interval, 0.004-0.393).</div></div><div><h3>Conclusions</h3><div>Morbidity and mortality rates are high in patients given angiotensin II for vasoplegia. Initiating this medication intraoperatively may improve outcomes, underscoring the importance of early intervention for patients at risk for vasoplegia after CPB.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 280-293"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of prolonged support on surgically implanted microaxial left ventricular assist devices for refractory cardiogenic shock","authors":"Iris Feng BS ,&nbsp;Gabriel Dardik BS ,&nbsp;Yuji Kaku MD ,&nbsp;Yanling Zhao MS, MPH ,&nbsp;Henry del Carmen BBA ,&nbsp;John DePaolo MD, PhD ,&nbsp;Marisa Cevasco MD, MPH ,&nbsp;Mauer Biscotti MD ,&nbsp;Joyce W. Wald DO ,&nbsp;Justin A. Fried MD ,&nbsp;Koji Takeda MD, PhD","doi":"10.1016/j.xjon.2025.03.023","DOIUrl":"10.1016/j.xjon.2025.03.023","url":null,"abstract":"<div><h3>Objective</h3><div>The US Food and Drug Administration approved the use of Impella 5.5 (Abiomed) for mechanical circulatory support for up to 14 days, but many patients require longer duration of support. This study sought to compare outcomes of standard versus prolonged Impella 5.5 support.</div></div><div><h3>Methods</h3><div>A retrospective review of 257 patients implanted with the Impella 5.5 device between 2020 and 2024 for cardiogenic shock at 2 high-volume institutions was conducted. Patients were stratified by standard (≤14 days) (n = 143) versus prolonged (&gt;14 days) (n = 114) device support.</div></div><div><h3>Results</h3><div>At baseline, the etiology of shock was more likely to be acute decompensated heart failure (74.6% vs 52.4%; <em>P</em> &lt; .001) in patients requiring prolonged support. Duration of device support ranged from 1 to 133 days with median being 25.0 days (interquartile range [IQR], 19.0-36.0 days) and 7.0 days (IQR, 5.0-11.0 days) in prolonged and standard cohorts, respectively. Bridge to decision (42.1% vs 29.4%; <em>P</em> = .046) and ultimate destination of transplant (36.8% vs 15.8%; <em>P</em> &lt; .001) were more common in the prolonged cohort. Incidence of stroke (10.5% vs 8.4%; <em>P</em> = .712), bleeding requiring surgical exploration (7.0% vs 4.9%; <em>P</em> = .650), and in-hospital mortality (23.0% vs 30.1%; <em>P</em> = .262) were similar between groups, although surgical site infection was more common in the prolonged cohort (11.4% vs 3.5%; <em>P</em> = .026). Cumulative incidence analysis showed stroke was rare beyond 30 days of device duration. In patients who survived to device explant, 60-day survival after explant was equivalent between groups (91.8% vs 88.8%; <em>P</em> = .430).</div></div><div><h3>Conclusions</h3><div>Extended Impella 5.5 device support beyond 14 days was not associated with increased incidence of mortality, major bleeding, or stroke in our study, and may be effective for patients requiring extended ventricular assist device support as bridge to heart transplant.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 173-189"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321651","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}