JTCVS open最新文献

{"title":"Corrigendum to ‘Evaluation of dual-lumen pulmonary artery cannulation in extracorporeal right ventricular support’ [JTCVS Open. 2026;30:101699]","authors":"Valeria Lo Coco MD, Michele Di Mauro MD, PhD, Silvia Mariani MD, PhD, Elham Bidar MD, PhD, Kasia Hryniewicz MD, PhD, Antonio Loforte MD, PhD, Thomas Fux MD, PhD, Sam Heuts MD, PhD, Dominik Wiedemann MD, PhD, Michal Kawcynsky MD, PhD, Tom Verbelen MD, PhD, Lars Mikael Broman MD, PhD, Jamila Kremer MD, PhD, Matteo Pozzi MD, PhD, Koji Takeda MD, PhD, Udo Boeken MD, PhD, Yih-Sharng Chen MD, PhD, Paolo Masiello MD, PhD, Dominik J. Vogel MD, PhD, Jacinta J. Maas MD, PhD, Roberto Lorusso MD, PhD, FESC","doi":"10.1016/j.xjon.2026.102058","DOIUrl":"10.1016/j.xjon.2026.102058","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102058"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214539","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":"Evaluating preoperative imaging in patients with chronic thromboembolic pulmonary hypertension: Is computed tomography pulmonary angiography a reliable alternative to pulmonary angiography?","authors":"Rawan Alamri MD,&nbsp;Hamnah Majeed MD, CM, MSc, MA,&nbsp;Fayeza Ahmad MD, MSc,&nbsp;Ziyab Sarfaraz MD, FRCSC,&nbsp;Andrew Hirsch MD, FRCPC,&nbsp;Jean-François Morin MD, FRCSC","doi":"10.1016/j.xjon.2026.101960","DOIUrl":"10.1016/j.xjon.2026.101960","url":null,"abstract":"<div><h3>Objectives</h3><div>Chronic thromboembolic pulmonary hypertension is a potentially curable form of pulmonary hypertension, with pulmonary endarterectomy serving as a key surgical treatment option. Accurate preoperative imaging is critical for determining surgical candidacy and optimizing operative outcomes. Although digital subtraction pulmonary angiography remains the gold standard, computed tomography pulmonary angiography has emerged as a noninvasive alternative. This study compares the concordance of computed tomography pulmonary angiography and digital subtraction pulmonary angiography with intraoperative specimen findings to determine their diagnostic accuracy.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of patients who underwent pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension at a single Canadian center between 2014 and 2017. All patients underwent preoperative computed tomography pulmonary angiography and digital subtraction pulmonary angiography as part of their routine evaluation. Imaging findings were compared with operative findings using a territory-based anatomic assessment across major pulmonary artery segments. Functional and hemodynamic outcomes were also assessed before and after surgery.</div></div><div><h3>Results</h3><div>Seventeen patients (mean age 52.8 years [±3.7]; 53% female) were included. Computed tomography pulmonary angiography demonstrated greater agreement with operative findings in the right main pulmonary artery, left upper lobe, and lingula. Digital subtraction pulmonary angiography demonstrated greater agreement in the right upper lobe, whereas both modalities showed similar agreement in the left main pulmonary artery and left lower lobe. Patients experienced postoperative improvements in New York Heart Association functional class, pulmonary artery pressures, and cardiac index. Despite overall agreement between imaging and operative findings, discrepancies persisted across several vascular territories.</div></div><div><h3>Conclusions</h3><div>Computed tomography pulmonary angiography demonstrated substantial agreement with operative findings in central and lobar pulmonary arterial territories, supporting its role as an important frontline imaging modality in the evaluation of chronic thromboembolic pulmonary hypertension. However, persistent discrepancies between imaging and operative assessment, particularly in more distal territories, support the continued use of a multimodal approach integrating computed tomography pulmonary angiography, digital subtraction pulmonary angiography, hemodynamic assessment, and multidisciplinary evaluation when determining operability and treatment strategy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101960"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214451","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":"Aortic and innominate cannulations are equally safe in redo aortic surgery","authors":"Bo Chang Brian Wu MD,&nbsp;Meng-Han Tsai MD,&nbsp;Drake S. Rosenberg MSE,&nbsp;Kyndall Hadley BA,&nbsp;Joseph C. Cleveland Jr. MD,&nbsp;Muhammad Aftab MD,&nbsp;T. Brett Reece MD, MBA","doi":"10.1016/j.xjon.2026.102086","DOIUrl":"10.1016/j.xjon.2026.102086","url":null,"abstract":"<div><h3>Objective</h3><div>Chest reentry poses challenges for establishing cardiopulmonary bypass. This study aimed to compare postoperative neurologic outcomes between aortic (AC) and innominate cannulation (IC) in redo aortic surgery.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 201 patients undergoing redo sternotomy for aortic aneurysm repair from 2010 to 2024. Patients were stratified by cannulation site: AC (n = 119) or IC (n = 34); 48 patients who underwent other approaches were excluded. Demographics, intraoperative variables, and postoperative outcomes were compared. Propensity-score matching (PSM), logistic regression, and Kaplan-Meier analyses were performed.</div></div><div><h3>Results</h3><div>Median age was 62.4 years; 75.8% were male. Before PSM, patients in the AC group had a lower smoking rate (38.7% vs 64.7%, <em>P</em> = .012) but a greater incidence of partial/total arch replacement (68.9% vs 23.5%, <em>P</em> &lt; .001) compared with those in IC. IC was associated with lower nadir temperature (26.9 vs 27.5 °C, <em>P</em> = .044), longer crossclamp time (108.5 vs 87 minutes, <em>P</em> &lt; .001), and more antegrade cerebral perfusion alone (91.2% vs 29.4%, <em>P</em> &lt; .001). IC required more intraoperative fresh-frozen plasma (6 vs 4 units, <em>P</em> = .001). After PSM, crossclamp time did not differ, but IC had longer circulatory arrest (13 vs 9.4 minutes, <em>P</em> = .004) and lower end left cerebral oxygen saturation (67% vs 70%, <em>P</em> = .021). Postoperative stroke, encephalopathy/delirium, and mortality were similar. In multivariable regression analysis, cannulation site was not associated with postoperative stroke. Ten-year survival rates were 66.6% for AC and 65.0% for IC (<em>P</em>_log-rank = .551).</div></div><div><h3>Conclusions</h3><div>AC and IC are safe in redo sternotomy for aortic surgery, with similar neurologic and survival outcomes reported. Surgeons may choose either approach on the basis of preference and patient anatomy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102086"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214468","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":"Quality of life after open descending thoracic and thoracoabdominal aortic repair: A prospective cohort study","authors":"Pim S. van Sambeeck MD,&nbsp;Nesar A. Hasami MD,&nbsp;Stefan R. van Dinter MD,&nbsp;Foeke J.H. Nauta MD PhD,&nbsp;Nabil Saouti MD PhD,&nbsp;Michel W.A. Verkroost MD,&nbsp;Marieke Zegers PhD,&nbsp;Guillaume S.C. Geuzebroek MD PhD,&nbsp;Mark van den Boogaard PhD,&nbsp;Robin H. Heijmen MD PhD","doi":"10.1016/j.xjon.2026.102081","DOIUrl":"10.1016/j.xjon.2026.102081","url":null,"abstract":"<div><h3>Objective</h3><div>To longitudinally evaluate health-related quality of life (HRQoL) following open descending thoracic or thoracoabdominal aortic aneurysm repair, with validated patient-reported outcome measures.</div></div><div><h3>Methods</h3><div>In this prospective, single-center cohort study, patients who underwent open descending thoracic or thoracoabdominal aortic aneurysm repair between 2016 and 2023 were included. HRQoL was assessed preoperatively and at 3, 12, and 24 months postoperatively with the Short Form-12 physical component summary (PCS) and mental component summary (MCS) scores. Secondary quality-of-life scores were included as well. Additionally, complete-case analysis and the impact of baseline variables were assessed. Longitudinal changes were analyzed with linear mixed-effects models.</div></div><div><h3>Results</h3><div>In total, 128 patients were included. PCS scores (95% CIs) decreased from 46.0 (44.1-48.0) preoperatively to 39.7 (37.6-41.7) at 3 months, with partial recovery to 42.2 (40.2-44.2) at 1 year and 41.0 (38.1-43.9) at 2 years (overall <em>P</em> &lt; .001). MCS scores (95% CIs) decreased initially from 47.4 (44.9-49.8) to 44.3 (41.8-46.9) (3 months), with recovery to 49.2 (46.7-51.7) (1 year) and 48.4 (44.6-52.2) (2 years) (overall <em>P</em> = .01). Complete-case analysis showed comparable trajectories. Anxiety decreased and cognitive complaints increased but remained within normal ranges. No baseline variables were independently associated with PCS or MCS score trajectories.</div></div><div><h3>Conclusions</h3><div>Open descending thoracic and thoracoabdominal aortic aneurysm repair is associated with a sustained reduction in physical HRQoL, while mental HRQoL recovers. These findings underscore the multidimensional nature of recovery and the importance of integrating patient-reported outcomes into perioperative care.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102081"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214472","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":"Low transplantation rate in the contemporary Fontan cohort: A marker of success or a reflection of unmet need?","authors":"Katherine Kearney MBBS, PhD,&nbsp;S. Lucy Roche MBChB, MRCPCH, MD,&nbsp;Peter Macdonald MBBS, PhD","doi":"10.1016/j.xjon.2026.102049","DOIUrl":"10.1016/j.xjon.2026.102049","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102049"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214493","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":"Twenty-four-hour continuous attending coverage in a dedicated cardiovascular intensive care unit decreases mortality after cardiac surgery","authors":"John R. Sharp DO,&nbsp;Stephanie Hayes BS,&nbsp;Shaynna Mann MD,&nbsp;Vaibhav Bora MD,&nbsp;Bhargav Doddala MPH,&nbsp;Richard Lee MD, JD","doi":"10.1016/j.xjon.2026.101852","DOIUrl":"10.1016/j.xjon.2026.101852","url":null,"abstract":"<div><h3>Objective</h3><div>The effect of continuous in-house attending coverage in a dedicated cardiovascular intensive care unit (CVICU) on postoperative cardiac surgery outcomes remains incompletely defined. This study evaluated morbidity and mortality data immediately before and after implementation of a 24/7 in-house critical care attending coverage model, in a dedicated CVICU, using the Society of Thoracic Surgeons risk-adjusted data for coronary artery bypass grafting and valvular repair/replacement surgeries.</div></div><div><h3>Methods</h3><div>Four hundred nineteen patients underwent coronary artery bypass grafting, and/or a mitral valve repair or replacement, and/or an aortic valve replacement at a single institution between April 2022 and 2024. From April 2022 to April 2023 patients recovered in a general surgical intensive care unit, with daytime attending critical care coverage and nighttime resident coverage with attending home call. From April 2023 to April 2024, patients recovered in a dedicated CVICU with continuous in-house, intensivist attending and resident coverage. Society of Thoracic Surgeons risk-adjusted outcomes were compared using exact Poisson and Fisher exact tests.</div></div><div><h3>Results</h3><div>Despite greater predicted mortality in the postintervention period, observed mortality was significantly reduced (0.46% vs 3.94%, <em>P</em> = .017), with a lower observed-to-expected ratio (<em>P</em> = .007). No significant differences were found in secondary outcomes: renal failure, prolonged ventilation, and long length of stay (<em>P</em> = .97, <em>P</em> = .47, and <em>P</em> = .94, respectively).</div></div><div><h3>Conclusions</h3><div>A dedicated CVICU with 24/7 in-house critical care attending coverage significantly reduced mortality as compared with resident-driven, lower-intensity intensive care unit model. This coverage change did not appear to influence renal failure, prolonged mechanical ventilation, or length of hospital stay.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101852"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214515","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":"Attrition in cardiac surgery: Structural drivers, career pathways, and implications for workforce retention","authors":"Iris Koch MD,&nbsp;Katharina Huenges MD, PhD,&nbsp;Tamari Tvildiani MD,&nbsp;Elpiniki Katsari MD,&nbsp;Ayse Cetinkaya MD, PhD,&nbsp;Nadejda Monsefi MD, PhD,&nbsp;Bastian Schmack MD, PhD,&nbsp;Anna L. Meyer MD, PhD,&nbsp;Jan D. Schmitto MD, PhD,&nbsp;Arjang Ruhparwar MD, PhD,&nbsp;Julie Cleuziou MD, PhD,&nbsp;Hassina Baraki MD, PhD,&nbsp;Gloria Faerber MD, PhD,&nbsp;Sabine Bleiziffer MD, PhD,&nbsp;Jasmin S. Hanke MD, PhD","doi":"10.1016/j.xjon.2026.101981","DOIUrl":"10.1016/j.xjon.2026.101981","url":null,"abstract":"<div><h3>Objectives</h3><div>Workforce shortages in cardiac surgery (CS) are increasing despite high initial interest among young physicians. Attrition remains poorly understood and is often attributed to individual limitations rather than systemic factors. This study aimed to identify determinants of attrition, characterize subsequent career pathways, and define targets for improving retention.</div></div><div><h3>Methods</h3><div>A German nationwide, anonymous, questionnaire-based survey (47 items) was conducted between July 2024 and January 2026 among physicians with previous employment in German CS departments. Descriptive statistics and subgroup analyses were performed.</div></div><div><h3>Results</h3><div>Seventy-five participants were included. Initial motivation for pursuing CS was high and mainly driven by interest in the specialty's technical and intellectual complexity. However, satisfaction with key aspects of training was low, particularly regarding surgical training (23.3% [17 out of 73]), scientific support (24.7% [18 out of 73]), and professional mentorship and career development (28.8% [21 out of 73]). The most frequently reported reasons for leaving were poor work-life balance (74.2% [46 out of 62]), dissatisfaction with workplace culture (67.7% [42 out of 62]), limited career opportunities (66.1% [41 out of 62]), and lack of appreciation (62.9% [39 out of 62]). Attrition occurred across all career stages, including board-certified surgeons and senior staff. Despite leaving the specialty, most participants were satisfied with their decision (95.1% [58 out of 61]), although only 11.7% (7 out of 60) considered returning to CS.</div></div><div><h3>Conclusions</h3><div>This exploratory survey suggests that attrition from CS is frequently associated with dissatisfaction regarding work-life balance, workplace culture, career perspectives, and training conditions rather than with self-perceived individual limitations. Although causal relationships cannot be established, the findings highlight potentially modifiable organizational factors that may represent targets for future retention strategies in CS.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101981"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214367","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":"Aortic valve repair versus biological replacement for aortic regurgitation with or without ascending aortic aneurysm: Heart Valve Society Aortic Valve Database Study","authors":"Pichoy Danial MD,&nbsp;Adine R. de Keijzer BSc,&nbsp;Johanna J.M. Takkenberg MD, PhD,&nbsp;Vincent Chauvette MD, PhD,&nbsp;Laurent de Kerchove MD, PhD,&nbsp;Jolanda Kluin MD,&nbsp;Claudia Romagnoni MD,&nbsp;Peter Verbrugghe MD, PhD,&nbsp;Pascal Leprince MD, PhD,&nbsp;Kevin M. Veen MD, PhD,&nbsp;Emmanuel Lansac MD, PhD","doi":"10.1016/j.xjon.2026.102085","DOIUrl":"10.1016/j.xjon.2026.102085","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the long-term outcomes of aortic valve repair (AVr) (REPAIR group) with biological aortic valve replacement (bAVR group).</div></div><div><h3>Methods</h3><div>Adults who underwent REPAIR or bAVR for aortic regurgitation (AR) +/− ascending aortic aneurysm (AscAA), recorded in the Heart Valve Society database until April 2024, were included. Propensity score matching was used to adjust for confounders. Differences in long-term survival, major adverse valve-related events (MAVRE), and other valve-related events were assessed.</div></div><div><h3>Results</h3><div>In total, 7318 patients were included (REPAIR n = 6773, bAVR n = 545). Propensity score matching resulted in 1006 REPAIR patients matched to 530 bAVR patients (median age: 67 years [interquartile range, 59.0-73.0], 22% female). In the matched cohort, early mortality (≤30 days) was comparable between REPAIR and bAVR patients (1.2% vs 2.1%, <em>P</em> = .070). At 7.5 years, overall matched survival was lower in the bAVR group compared to the REPAIR group (73.9% [95% CI, 66.5%-82.1%] vs 85.6% [95% CI, 82.3%-89.3%], <em>P</em> &lt; .001), with a higher proportion of valve-related deaths (bAVR 4.2% vs REPAIR 1.2%, <em>P</em> &lt; .001). At 7.5 years, patients with bAVR had significantly lower freedom from MAVRE (<em>P</em> &lt; .001) and more infective endocarditis (<em>P</em> = .006), and severe valve dysfunction (<em>P</em> &lt; .001) compared to patients with REPAIR. The incidences of aortic valve reintervention (<em>P</em> = .388) and pacemaker implantation (<em>P</em> = .671) were comparable.</div></div><div><h3>Conclusions</h3><div>Among patients in whom repair was deemed feasible and surgery was performed at mainly expert centers, repair was associated with more favorable long-term outcomes, including improved survival, compared with bAVR in an older propensity-matched cohort. These findings support the consideration of AVr when technically feasible in patients with AR, with or without AscAA.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102085"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214439","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":"Is pneumonectomy appropriate after chemoimmunotherapy? Outcomes of neoadjuvant chemoimmunotherapy followed by pneumonectomy in the United States","authors":"Giorgio Caturegli MD,&nbsp;Ebony Jernigan MD,&nbsp;Maureen Canavan PhD,&nbsp;Abigail Lynch BS,&nbsp;Ryan Kramer MD,&nbsp;Jayaditya Patil MBBS,&nbsp;Gabriela Esnaola BA,&nbsp;Daniel J. Boffa MD,&nbsp;Benjamin J. Resio MD","doi":"10.1016/j.xjon.2026.102047","DOIUrl":"10.1016/j.xjon.2026.102047","url":null,"abstract":"<div><h3>Objective</h3><div>The appropriateness of pneumonectomy for non–small cell lung cancer after neoadjuvant therapy is not well characterized, and there is concern for substantially greater mortality on the basis of results of trials such as Intergroup-0139. Here, we present current use and outcomes of pneumonectomy after neoadjuvant chemoimmunotherapy.</div></div><div><h3>Methods</h3><div>Using the National Cancer Database, we identified and included adults with clinical stage I-III lung adenocarcinoma or squamous cell carcinoma who were diagnosed between 2018 and 2023 and treated with neoadjuvant chemoimmunotherapy followed by lobectomy or pneumonectomy. Three-year overall survival was assessed by Kaplan-Meier. Propensity matching and Cox proportional hazards models were based on patient and tumor characteristics.</div></div><div><h3>Results</h3><div>The study included 2703 (94%) lobectomies and 173 (6%) pneumonectomies. Patients who underwent pneumonectomy had a more advanced T stage (64% vs 47% T3+, <em>P</em> &lt; .001) but a lower comorbidity burden (71% vs 58% Charlson-Deyo of 0, <em>P</em> = .01). They had greater rates of 30-day unplanned readmission (9% vs 4%, <em>P</em> = .001) and R1+ resection (7.1% vs 3.9%, <em>P</em> = .046) but comparable 90-day mortality (&lt;4.5% vs 2%, <em>P</em> = .24). Unadjusted 3-year overall survival was not significantly different between the 2 groups: 80% for pneumonectomy and 82% for lobectomy (<em>P</em> = .08). Similar trends were observed after propensity-matching for patient and tumor characteristics: 79% for pneumonectomy and 78% for lobectomy (<em>P</em> = .19). On Cox models, pneumonectomy was associated with a greater hazard ratio of mortality, but this was not statistically significant (odds ratio, 1.56; 95% CI, 0.91-2.68; <em>P</em> = .09).</div></div><div><h3>Conclusions</h3><div>Pneumonectomy after induction chemoimmunotherapy demonstrated comparable early survival with lobectomy among selected patients in the United States. Use of pneumonectomy after chemoimmunotherapy in appropriate candidates appears reasonable.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102047"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214448","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":"Neoadjuvant immunotherapy in geriatric patients with non–small cell lung cancer: A real-world analysis","authors":"Jordan Dourlain BA,&nbsp;Omar Bushara MD, MPH,&nbsp;Mohammad Saad Farooq MD, MSTR,&nbsp;Julia Gasior MD,&nbsp;Karina Bruestle MD,&nbsp;Jarrod Predina MD,&nbsp;Doraid Jarrar MD,&nbsp;Giorgos Karakousis MD,&nbsp;John C. Kucharczuk MD,&nbsp;Sunil Singhal MD","doi":"10.1016/j.xjon.2026.101950","DOIUrl":"10.1016/j.xjon.2026.101950","url":null,"abstract":"<div><h3>Objectives</h3><div>Neoadjuvant immunotherapy has been shown to significantly improve survival in patients with stage IB-IIIB non–small cell lung cancer. However, it is unknown whether geriatric patients experience similar benefits. Using a large national cohort, we studied outcomes of neoadjuvant immunotherapy in geriatric patients with stage IB-IIIB non–small cell lung cancer.</div></div><div><h3>Methods</h3><div>Patients with stage IB-IIIB non–small cell lung cancer treated over 24 months (2022-2023) were identified in the National Cancer Database. Geriatric patients were defined as being older than 75 years. Geriatric patients and younger patients aged 75 years or less were compared in terms of treatment intensity, perioperative outcomes, and survival. Kaplan–Meier curves, log-rank tests, and Cox proportional hazards models were used for statistical analysis of survival. Multivariable logistic regression was used to analyze perioperative outcomes.</div></div><div><h3>Results</h3><div>21,070 patients aged more than 75 years with clinical stage IB-IIIB non–small cell lung cancer were included in this analysis. Among them, 4467 (21.2%) received surgery and 447 (10.0%) received neoadjuvant immunotherapy, compared with 35.3% and 17.9% of younger patients, respectively (<em>P</em> &lt; .001). Both surgery (adjusted HR 0.34 [0.27-0.43], <em>P</em> &lt; .001) and neoadjuvant immunotherapy (0.39 [0.25-0.63], <em>P</em> &lt; .001) were associated with improved survival in geriatric patients. Geriatric patients who received neoadjuvant immunotherapy also demonstrated acceptable perioperative outcomes.</div></div><div><h3>Conclusions</h3><div>In a large national cohort, we show that although geriatric patients have lower treatment intensity than younger patients, both surgery and neoadjuvant immunotherapy render a survival benefit while retaining acceptable perioperative outcomes. Whenever possible, standard of care treatment should be pursued in geriatric patients, and age in isolation should not exclude patients from optimal treatments.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101950"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214481","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}