JTCVS open最新文献

{"title":"Surgical outcomes of the reinforced Ross procedure in the pediatric population","authors":"Markian M. Bojko MD, MPH,&nbsp;Neelesh Bagrodia BS,&nbsp;Luke Wiggins MD,&nbsp;Chace Mitchell MD,&nbsp;John D. Cleveland MD,&nbsp;David C. Cleveland MD,&nbsp;Vaughn A. Starnes MD","doi":"10.1016/j.xjon.2025.02.012","DOIUrl":"10.1016/j.xjon.2025.02.012","url":null,"abstract":"<div><h3>Objective</h3><div>External reinforcement of the Ross autograft is well described in adults. However, this technique is poorly studied in pediatric patients, and indications are not strictly defined. We aim to describe our institutions experience with external Ross reinforcement in pediatric patients.</div></div><div><h3>Methods</h3><div>Between 2008 and 2023, 43 patients (≤18 years) underwent the Ross procedure with external Dacron graft reinforcement. Baseline characteristics, echocardiographic measurements, and postoperative outcomes were analyzed. The median [range] follow-up (years) was 2.01 [0.13-14.94] in children &lt;13 years and 1.31 [0.05-11.57] in adolescents 13-18 years (<em>P</em> = .505).</div></div><div><h3>Results</h3><div>The median age [range] was 14 years [5-18], median weight was 56 kg [19-142], and the median body surface area was 1.6 m² [0.7-2.2]. A total of 39 of 43 patients had aortic insufficiency (AI) or mixed stenosis with insufficiency, and 4 of 43 had stenosis alone. The median [range] preoperative pulmonary valve diameter was 2.1 cm [1.8-2.9] and the median [range] aortic valve annulus diameter was 2.4 cm [1.2-3.7]. The most common Dacron graft size was 26 mm. The operative mortality rate was 1 of 43 (2.3%), and there were 5 of 43 (12%) unplanned cardiac reoperations in the postoperative period. At 1 month postprocedure, the median [range] peak valve gradient was 16 mm Hg [2-35] and 2 patients had moderate AI with the remainder having mild or less AI. There was one patient who required late autograft reintervention at 10 years for autograft stenosis. The 5-year Kaplan-Meier survival was 97.7% (93.3%-100.0%).</div></div><div><h3>Conclusions</h3><div>With careful patient selection, external Ross reinforcement can be performed in the pediatric population and achieves acceptable postoperative valve hemodynamics, survival, and freedom from reintervention.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 341-349"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854588","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":"Are early outcomes of reoperative aortic root surgery impacted by previous root procedure and indication for reintervention?","authors":"Haytham Elgharably MD ,&nbsp;Haley Jenkins MD ,&nbsp;Davut Cekmecelioglu MD ,&nbsp;Kamal S. Ayyat MD ,&nbsp;Ahmed K. Awad MD ,&nbsp;Patrick R. Vargo MD ,&nbsp;Shinya Unai MD ,&nbsp;Eric E. Roselli MD ,&nbsp;Lars G. Svensson MD, PhD ,&nbsp;Gosta B. Pettersson MD, PhD","doi":"10.1016/j.xjon.2025.02.005","DOIUrl":"10.1016/j.xjon.2025.02.005","url":null,"abstract":"<div><h3>Objective</h3><div>Reoperative aortic root surgery after a previous root procedure is technically demanding, which can impact outcomes. Herein, we examined the impact of previous root procedure and operative indication on early outcomes.</div></div><div><h3>Methods</h3><div>From January 2010 to December 2022, 632 patients underwent reoperative aortic root surgery after previous root procedure (true redo root) at our institution. Baseline characteristics, operative details, and in-hospital complications were compared between groups on the basis of type of previous root prosthesis and infective endocarditis indication.</div></div><div><h3>Results</h3><div>In the whole cohort, the operative mortality was 2.2% and estimated survival was 93%, 80%, and 67% at 1, 5, and 10 years, respectively. Operative mortality was similar between previous homograft, Bentall, Freestyle, valve-sparing root reimplantation, and Ross (2%, 4%, 0%, 4%, and 0%, respectively, <em>P</em> = .4). Reoperations after Bentall and valve-sparing root reimplantation (prosthetic grafts) had greater rates of postoperative complications, such as reoperation for bleeding (15% and 8%, <em>P</em> = .01), delayed chest closure (18% and 8%, <em>P</em> = .02), and pacemaker insertion (13% and 12%, <em>P</em> = .03). Although there was no significant difference in operative mortality among patients with endocarditis versus those with other indications (3% vs 1%, <em>P</em> = .08), the postoperative course showed greater rates of reoperation for bleeding (19% vs 5%, <em>P</em> &lt; .01) and prolonged ventilation (38% vs 18%, <em>P</em> &lt; .01).</div></div><div><h3>Conclusions</h3><div>At experienced centers, aortic root reoperation (true redo root) can be performed with low operative mortality. Explant of prosthetic graft material and endocarditis are associated with more complicated postoperative course, without significantly increased operative mortality.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 31-46"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854719","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":"In vivo virulence of Staphylococcus aureus in native versus prosthetic left-sided valve endocarditis","authors":"Haytham Elgharably MD ,&nbsp;Jan Claesen PhD ,&nbsp;Naseer Sangwan PhD ,&nbsp;Muhammad Etiwy MD ,&nbsp;Penny Houghtaling MS ,&nbsp;Gary W. Procop MD, MS ,&nbsp;Nabin K. Shrestha MD ,&nbsp;Brian Griffin MD ,&nbsp;Jose L. Navia MD ,&nbsp;Lars G. Svensson MD, PhD ,&nbsp;Daniel J. Wozniak PhD ,&nbsp;Gosta B. Pettersson MD, PhD","doi":"10.1016/j.xjon.2024.12.004","DOIUrl":"10.1016/j.xjon.2024.12.004","url":null,"abstract":"<div><h3>Objectives</h3><div><em>Staphylococcus aureus</em> infective endocarditis is commonly associated with invasive pathology and is worse in prosthetic valve endocarditis. In this study, we aim to examine <em>S. aureus</em> virulence and pathological features of native and prosthetic valve infective endocarditis.</div></div><div><h3>Methods</h3><div>Between 2002 and 2020, 438 patients underwent surgery for left-sided endocarditis caused by <em>S. aureus</em> at our center (59% native and 41% prosthetic valve endocarditis). Endocarditis registry was queried, and pathological features were based on the echocardiography and operative findings. In addition, vegetation samples were collected from 6 patients undergoing surgery for infective endocarditis (3 native and 3 prosthetic valve endocarditis). Total RNA was extracted from all specimens, and messenger RNA sequencing was executed for transcriptomic analysis. Data were pooled into STAR aligner, and gene expression related to virulence factors was compared between 2 groups.</div></div><div><h3>Results</h3><div>Rates of invasive pathology were higher in prosthetic versus native valve infective endocarditis (76% vs 40%, <em>P</em> &lt; .0001), which impacted the complexity of surgical procedures and perioperative course, but not in-hospital mortality. Transcriptomic analysis has shown differences in gene expression between vegetation specimens of native and prosthetic valve endocarditis, including genes for stress response, biofilm formation, and virulence factors. The gene <em>aur</em> (encodes for aureolysin) was highly upregulated in prosthetic valve vegetations compared with native valve vegetations (<em>P</em> = .023).</div></div><div><h3>Conclusions</h3><div>Prosthetic valve endocarditis caused by <em>S. aureus</em> is associated with further invasive pathology compared with native valve endocarditis, which could be related to upregulation of genes responsible for biofilm formation and metalloproteinase production.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 156-169"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854720","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":"Preoperative stroke predicts new postoperative clinically significant stroke in patients undergoing surgery for left-sided infective endocarditis","authors":"Nithya D. Rajeev BS,&nbsp;Markian M. Bojko MD, MPH,&nbsp;Jessica S. Clothier MD,&nbsp;Kamso Okonkwo BA,&nbsp;Kayvan Kazerouni MD,&nbsp;Serge Kobsa MD, PhD","doi":"10.1016/j.xjon.2024.09.027","DOIUrl":"10.1016/j.xjon.2024.09.027","url":null,"abstract":"<div><h3>Objective</h3><div>Operative timing remains controversial for patients with left-sided infective endocarditis (LSIE) with preoperative stroke (PREOS). Operative guidelines are determined on the basis of postoperative radiologically confirmed strokes (RCS). We evaluated the impact of PREOS on surgical outcomes.</div></div><div><h3>Methods</h3><div>Over 15 years, 331 patients underwent valvular surgery for LSIE at our center. PREOS (n = 71, 21%) and non-PREOS (n = 260, 79%) cohorts were identified. Propensity score matching was performed. Logistic regression identified risk factors for postoperative clinical stroke (PCS, defined as any new postoperative neurologic deficit), RCS and mortality.</div></div><div><h3>Results</h3><div>Among patients with PREOS, 24 of 71 (34%) had a hemorrhagic component, 34 of 71 (48%) were within 2 weeks of surgery, 46 of 71 (65%) experienced residual deficits, and 2 of 71 (3%) experienced hemorrhagic conversion postoperatively. Operative mortality was 24 of 331 (7%) and did not significantly differ between groups (<em>P</em> = .083). Patients with PREOS had a greater incidence of PCS (<em>P</em> = .001), repeat imaging of the head (<em>P</em> &lt; .001), new renal failure (<em>P</em> = .006), and nonhome discharges (<em>P</em> &lt; .001). Propensity score matching upheld these trends. Logistic regression identified PREOS as a risk factor for PCS (odds ratio [OR], 8.76; <em>P</em> &lt; .001). Intraoperative abscess (OR, 4.83; <em>P</em> = .013), cardiogenic shock (OR 8.51; <em>P</em> = .023), and tricuspid procedures (OR 5.03; <em>P</em> = .02) were RCS risk factors. PREOS (OR 3.12; <em>P</em> = .025), preoperative renal failure (OR 2.67; <em>P</em> = .043), immunosuppression (OR 7.09; <em>P</em> = .022), tricuspid regurgitation (OR 4.36; <em>P</em> = .011), and aortic valve procedures (OR 4.38; <em>P</em> = .033) were risk factors for mortality.</div></div><div><h3>Conclusions</h3><div>Among patients with LSIE undergoing surgery, PREOS is a risk factor for PCS and new renal failure. Patients with PREOS may require greater level of care upon discharge and may benefit from more stringent preoperative evaluation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 170-184"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854721","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":"Multivessel coronary disease should be treated with coronary artery bypass grafting in all patients who are not (truly) high risk","authors":"Elizabeth C. Ghandakly MD, JD,&nbsp;Faisal G. Bakaeen MD","doi":"10.1016/j.xjon.2024.10.014","DOIUrl":"10.1016/j.xjon.2024.10.014","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 264-268"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854580","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":"Advocating MiECC: Proven benefits for high-risk cardiac surgery patients based on COMICS trial evidence","authors":"Ignazio Condello PhD","doi":"10.1016/j.xjon.2025.01.005","DOIUrl":"10.1016/j.xjon.2025.01.005","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Page 269"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854581","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":"Mitral regurgitation at the time of left ventricular assist device implantation: Should it be treated or not?","authors":"Hiroki Kohno MD, PhD ,&nbsp;Goro Matsumiya MD, PhD ,&nbsp;Yoshikatsu Saiki MD, PhD ,&nbsp;Koichiro Kinugawa MD, PhD ,&nbsp;Minoru Ono MD, PhD","doi":"10.1016/j.xjon.2025.02.002","DOIUrl":"10.1016/j.xjon.2025.02.002","url":null,"abstract":"<div><h3>Objective</h3><div>Mitral regurgitation may persist or progress after left ventricular assist device implantation. However, whether preexisting mitral regurgitation should be corrected at the time of implantation remains to be determined.</div></div><div><h3>Methods</h3><div>A retrospective, registry-based analysis was performed on 1398 continuous-flow left ventricular assist device recipients who underwent implantation between 2010 and 2022. Patients were compared for significant mitral regurgitation, defined as moderate-to-severe or greater mitral regurgitation after implantation, and major adverse events during left ventricular assist device support. Comparisons were made between patients untreated for mitral regurgitation but who had moderate or greater preexisting mitral regurgitation (n = 414) and those who had no or mild preexisting mitral regurgitation (n = 368) (cohort 1), and between patients with moderate or greater mitral regurgitation who underwent concomitant mitral valve surgery (n = 86) and those who did not (n = 414) (cohort 2).</div></div><div><h3>Results</h3><div>The cumulative incidence of significant mitral regurgitation was higher in patients with untreated moderate or greater mitral regurgitation in both cohorts (<em>P</em> &lt; .001 and <em>P</em> = .025, cohorts 1 and 2, respectively). However, the cumulative incidence of all-cause mortality and readmission, and the risk of other major left ventricular assist device complications such as stroke and right heart failure were comparable between groups in both cohorts. The results were also consistent for the propensity score–matched population created in each cohort.</div></div><div><h3>Conclusions</h3><div>Significant mitral regurgitation may be prevented by concomitant surgery, but late survival and the risk of other major adverse events were not significantly improved by the procedure and were similar between patients with untreated moderate or greater mitral regurgitation and those with no or untreated mild mitral regurgitation. Our results suggest that mitral regurgitation during left ventricular assist device implantation may have only limited benefits from concomitant surgery.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 96-112"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ‘Superior transseptal versus left atriotomy approaches in isolated mitral valve surgery’[JTCVS Open Volume 22, December 2024, Pages 208-213]","authors":"Zohaib R. Khawaja BS ,&nbsp;Gabriel E. Cambronero MD ,&nbsp;Yusuf M. Aboutabl BS ,&nbsp;Elizabeth C. Wood MD ,&nbsp;James E. Jordan PhD ,&nbsp;Timothy E. Craven MSPH ,&nbsp;Patrick M. Kozak MD ,&nbsp;Prashant D. Bhave MD ,&nbsp;Adrian L. Lata MD ,&nbsp;Edward H. Kincaid MD ,&nbsp;Neal D. Kon MD ,&nbsp;Bartlomiej R. Imielski MD","doi":"10.1016/j.xjon.2025.02.013","DOIUrl":"10.1016/j.xjon.2025.02.013","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 113-114"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854627","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 isolated tricuspid replacement versus repair among older patients with tricuspid regurgitation in the United States","authors":"Tomonari M. Shimoda MD ,&nbsp;Hiroki A. Ueyama MD ,&nbsp;Yoshihisa Miyamoto MD ,&nbsp;Atsuyuki Watanabe MD ,&nbsp;Hiroshi Gotanda MD, PhD ,&nbsp;Sammy Elmariah MD, MPH ,&nbsp;Yujiro Yokoyama MD ,&nbsp;Shinichi Fukuhara MD ,&nbsp;Tsuyoshi Kaneko MD ,&nbsp;Toshiki Kuno MD, PhD ,&nbsp;Yusuke Tsugawa MD, PhD","doi":"10.1016/j.xjon.2024.10.018","DOIUrl":"10.1016/j.xjon.2024.10.018","url":null,"abstract":"<div><h3>Objective</h3><div>Evidence is limited regarding early-term outcomes after isolated tricuspid operations for tricuspid regurgitation (TR). We compared the early-term outcomes after isolated tricuspid valve replacement versus repair using the contemporary data.</div></div><div><h3>Methods</h3><div>We analyzed the national data on Medicare beneficiaries aged ≥65 years who underwent isolated tricuspid valve replacement or repair for TR between January 2016 and December 2020. The primary outcome was early-term (up to 3 years) all-cause mortality. The secondary outcomes included early-term major adverse cardiovascular events (MACE) and heart failure hospitalizations. MACE encompassed all-cause mortality, heart failure hospitalization, stroke, and tricuspid reoperations. A propensity score matching analysis was conducted to compare between replacement and repair.</div></div><div><h3>Results</h3><div>A total of 1501 patients were included (replacement: 610 patients, repair: 891 patients). In the matched cohort (n = 547 in each group), the overall mortality and MACE were 39% and 46% at 3 years, respectively. Tricuspid valve replacement was associated with similar all-cause mortality in comparison to repair (adjusted hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.86-1.30; <em>P</em> = .600). Similarly, the rates of MACE and heart failure hospitalizations were similar (adjusted HR, 1.01; 95% CI, 0.84-1.22, <em>P</em> = .910; subdistribution HR, 1.04; 95% CI, 0.72-1.49, <em>P</em> = .850, respectively) between these 2 procedures.</div></div><div><h3>Conclusions</h3><div>Isolated surgical tricuspid valve replacement was associated with similar clinical outcomes compared to repair. Importantly, the high overall early-term mortality and morbidity with either treatment underscores the need for alternative intervention choices and further research to optimize the indication and timing of intervention.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 127-146"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854629","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":"Effect of lower-body ischemia duration in aortic arch surgery under mild-to-moderate hypothermic circulatory arrest","authors":"Giacomo Murana MD ,&nbsp;Chiara Nocera MD ,&nbsp;Luca Zanella MD ,&nbsp;Luca Di Marco MD ,&nbsp;Silvia Snaidero MD ,&nbsp;Sabrina Castagnini MD ,&nbsp;Carlo Mariani MD ,&nbsp;Davide Pacini MD, PhD","doi":"10.1016/j.xjon.2025.01.015","DOIUrl":"10.1016/j.xjon.2025.01.015","url":null,"abstract":"<div><h3>Objectives</h3><div>Aortic arch surgery is performed at increasingly higher circulatory arrest temperatures. This might affect visceral protection. We analyzed the effect of visceral ischemic time in arch surgery under mild-to-moderate hypothermia.</div></div><div><h3>Methods</h3><div>We divided the population into 3 groups: group 1 (visceral ischemic time ≤30 minutes), group 2 (31-60 minutes), and group 3 (&gt;60 minutes). The link between visceral ischemic times and in-hospital outcomes, and visceral function biomarker levels were retrospectively analyzed through chi-square test, nonparametric analysis of variance, and cubic spline interpolation.</div></div><div><h3>Results</h3><div>From 1995 to 2023, 1325 patients underwent aortic arch surgery under circulatory arrest at our center. Mild-to-moderate hypothermia (nasopharyngeal temperature ≥25°) was used in 960 cases. There was no significant difference among the groups for in-hospital death (group 1 = 8.5%, group 2 = 13.2%, group 3 = 11.3%; <em>P</em> = .224), renal complications (group 1 = 13.0%, group 2 = 19.7%, group 3 = 22.6%; <em>P</em> = .056), and gastrointestinal complications (group 1 = 5%, group 2 = 5.5%, group 3 = 7.1%; <em>P</em> = .696). However, respiratory complications (group 1 = 19.4%, group 2 = 28.1%, group 3 = 21.4%; <em>P</em> = .027) and transient dialysis (group 1 = 2.8%, group 2 = 7.8%, group 3 = 11.3%; <em>P</em> = .011) were linked to longer visceral ischemic times. Groups 2 and 3 presented significantly higher levels of creatinine (<em>P</em> &lt; .01), glutamic-oxaloacetic transaminase (<em>P</em> &lt; .05), and glutamic pyruvic transaminase (24 and 48 hours postsurgery, <em>P</em> &lt; .01). Cubic spline analysis showed that the incidence of renal complications reached a minimum at a low visceral ischemic time and then consistently increased. Respiratory complications showed a maximum incidence at approximately 50 minutes of visceral ischemic time and then subsequently decreased.</div></div><div><h3>Conclusions</h3><div>Mild-to-moderate hypothermia is a safe strategy for visceral organ protection regardless of visceral ischemic time. However, longer visceral ischemic times are linked to renal complications.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 58-66"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854674","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}