JTCVS open最新文献

{"title":"Outcomes associated with remote, centralized ex vivo lung perfusion (rc-EVLP) for donor lungs in a real-world setting","authors":"Anil J. Trindade MD ,&nbsp;Caitlin T. Demarest MD, PhD ,&nbsp;John W. Stokes MD ,&nbsp;Mathew Thomas MBBS, MD ,&nbsp;Ian Makey MD ,&nbsp;Matthew Bacchetta MD, MBA ,&nbsp;Jorge Mallea MD","doi":"10.1016/j.xjon.2025.04.002","DOIUrl":"10.1016/j.xjon.2025.04.002","url":null,"abstract":"<div><h3>Objective</h3><div>Ex vivo lung perfusion (EVLP) has resulted in a significant increase in the use of extended-criteria donor lungs without negatively impacting survival outcomes. However, in-house EVLP is resource-intensive, thereby limiting accessibility. Remote, centralized EVLP (rc-EVLP) has been used with acceptable outcomes in a highly protocolized feasibility study, although has not been assessed in a clinical setting. We characterized outcomes of rc-EVLP in a real-world setting and provide clinical associations related to donor use.</div></div><div><h3>Methods</h3><div>We performed a dual-center, retrospective analysis of consecutive extended-criteria donor lungs evaluated on rc-EVLP between December 1, 2020, and March 20, 2023. Outcomes included transplantation rate, predictors of use, incidence of primary graft dysfunction grade 3 (PGD3), and 1-year survival. Group comparisons were examined using the Fisher exact test or Mann-Whitney <em>U</em> test.</div></div><div><h3>Results</h3><div>Eighty-two donors were assessed by rc-EVLP; 65% would've been excluded in the previous feasibility trial. Forty-six lungs (56%) were ultimately transplanted. Vascular permeability, static compliance, and oxygen transfer all were associated with use. PGD3 incidence in rc-EVLP recipients was 17%, whereas 1-year survival was 93%. Donor from circulatory death (DCD) lungs assessed by rc-EVLP had a use of 6 of 19 (33%). Greater preprocurement partial pressure of oxygen, arterial/fraction of inspired oxygen ratio and greater oxygen transfer and static compliance assessed after 2 hours on EVLP were associated with increased DCD use. Although PGD3 incidence with DCD lungs was 33%, there was 100% 1-year recipient survival. Finally, 2-hour EVLP assessments may be sufficient for determining donor quality for all lungs.</div></div><div><h3>Conclusions</h3><div>Remote, centralized EVLP increases the use of extended-criteria donor lungs in a real-world setting and is associated with excellent outcomes. We provide objective criteria that are associated with the decision to use donor from brain death and DCD lungs assessed by rc-EVLP.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 292-298"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912928","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":"Concomitant atrial fibrillation ablation during aortic valve and aneurysm surgery","authors":"Eric Robinson MD, MSc,&nbsp;Tom Liu MD, MS,&nbsp;S. Chris Malaisrie MD,&nbsp;Jane Kruse BSN,&nbsp;Beth Whippo MSN,&nbsp;Seokyung An PhD,&nbsp;Abigail S. Baldridge DrPh,&nbsp;Douglas R. Johnston MD,&nbsp;James L. Cox MD,&nbsp;Patrick M. McCarthy MD,&nbsp;Duc T. Pham MD,&nbsp;Christopher K. Mehta MD","doi":"10.1016/j.xjon.2025.06.007","DOIUrl":"10.1016/j.xjon.2025.06.007","url":null,"abstract":"<div><h3>Objective</h3><div>Limited data are available on treatment of atrial fibrillation during ascending aortic aneurysm and aortic valve surgery. Ablation at the time of isolated aortic valve surgery has a Society of Thoracic Surgeons Class I indication. We sought to determine early and late outcomes of concomitant atrial fibrillation surgery at the time of ascending aortic aneurysm + aortic valve surgery.</div></div><div><h3>Methods</h3><div>From July 2008 to June 2023, patients undergoing elective ascending aortic aneurysm + aortic valve surgery ± atrial fibrillation surgery were compared. Clinical follow-up was conducted annually (median 5.6 [3.1-9.2] years).</div></div><div><h3>Results</h3><div>Of 792 patients in the cohort, 89 (11.2%) had preoperative atrial fibrillation and all underwent atrial fibrillation ablation procedures: pulmonary vein isolation (42.7%), left atrial cryoablation (19.1%), and biatrial cryoablation (38.2%). After 2:1 propensity score matching between the no atrial fibrillation (123) and ablation groups (67), postoperative complications were pacemaker implant (1.7% vs 1.6%; <em>P = .</em>952), new-onset dialysis (0.8% vs 3.0%, <em>P = .</em>251), and 30-day mortality (0.8% vs 1.5%, <em>P = .</em>661). In matched patients with no atrial fibrillation and atrial fibrillation surgery, overall survival at 1, 5, and 10 years was similar (<em>P = .</em>4) at a mean of 6.22 years follow-up. Stroke incidence was similar at 7.8% versus 3.3% (<em>P = .</em>236).</div></div><div><h3>Conclusions</h3><div>For patients undergoing aneurysm surgery concomitantly with aortic valve surgery, surgical ablation was effective and did not increase 30-day mortality. Survival and stroke outcomes were similar to a matched reference group without preoperative atrial fibrillation. Ablation of atrial fibrillation should be considered at the time of aortic surgery.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 52-60"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913234","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":"Insights into the molecular mechanism of pulmonary vein stenosis in pediatric patients with congenital heart disease","authors":"Alyssa B. Kalustian MD ,&nbsp;Pengfei Ji MS ,&nbsp;Lalita Wadhwa PhD ,&nbsp;Christopher A. Caldarone MD ,&nbsp;Manish Bansal MD ,&nbsp;Athar M. Qureshi MD ,&nbsp;Jeffrey S. Heinle MD ,&nbsp;Ravi K. Birla PhD","doi":"10.1016/j.xjon.2025.04.012","DOIUrl":"10.1016/j.xjon.2025.04.012","url":null,"abstract":"<div><h3>Objective</h3><div>Pediatric pulmonary vein stenosis (PVS) is associated with substantial morbidity and mortality for the subset of patients with recurrent or progressive disease. The molecular mechanisms underlying the development and trajectory of PVS remain unclear. This study characterizes the transcriptome of clinical and phenotypic subtypes of PVS.</div></div><div><h3>Methods</h3><div>Bulk RNA sequencing analysis was performed on human pulmonary vein tissue samples obtained from surgical interventions for pediatric patients with PVS. Transcriptomic profiles were compared for primary versus postrepair PVS as well as aggressive versus nonaggressive clinical phenotypes. Principal component analysis was performed, the differential gene expression quantified, and pathway analysis conducted on the basis of Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, and Reactome.</div></div><div><h3>Results</h3><div>When we compared aggressive (Agg) primary pulmonary vein stenosis (PPVS) versus nonaggressive (NonAgg) PPVS, differences were noted in the genes associated in extracellular matrix regulation and <em>PIEZO1</em>, a mechanosensitive receptor present in endothelial cells. In addition, there were notable changes in cardiac muscle contractility, calcium handling, respiratory and energy metabolism. These results point to a potential mechanism for aggressive PPVS phenotype, attributable to an overexpression of <em>PIEOZ1</em> in response to elevated shear stress, subsequent activation of intracellular signaling pathways, and leading to reduced contractility and intracellular calcium transients within cardiomyocytes.</div></div><div><h3>Conclusions</h3><div>These results suggests that aggressive PPVS phenotype may be driven by an increase in <em>PIEZO1</em> expression and subsequent changes in extracellular matrix production. The clinical and therapeutic relevance of <em>PIEZO1</em> warrant further investigation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 166-181"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913299","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":"Prognostic value of preoperative NT-proBNP in patients with obstructive hypertrophic cardiomyopathy undergoing septal myectomy","authors":"Tedy Sawma MD ,&nbsp;Hartzell V. Schaff MD ,&nbsp;Sina Danesh MD ,&nbsp;Austin Todd MS ,&nbsp;Steve R. Ommen MD ,&nbsp;Joseph A. Dearani MD ,&nbsp;Jeffrey B. Geske MD","doi":"10.1016/j.xjon.2025.06.017","DOIUrl":"10.1016/j.xjon.2025.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Proper risk stratification tools for patients with obstructive hypertrophic cardiomyopathy (oHCM) undergoing septal myectomy are lacking. Our objective was to assess the predictive value of preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) on perioperative outcomes and late survival in patients with oHCM undergoing transaortic septal myectomy.</div></div><div><h3>Methods</h3><div>Between 2008 and 2021, 834 patients with preoperative NT-proBNP measurements underwent septal myectomy. Restrictive cubic splines, along with multivariable logistic and Cox regression models, were used to examine the association between NT-proBNP and the outcomes. The study endpoints were early postoperative complications (postoperative atrial fibrillation, need for blood transfusion, intensive care unit [ICU] length of stay [LOS], total hospital LOS), and long-term all-cause mortality.</div></div><div><h3>Results</h3><div>A total of 834 patients were included in the study (median age, 58 [interquartile range (IQR), 48-65] years; 41.8% females). The median NT-proBNP concentration was 698 (IQR, 265-1446) pg/mL. Maximal septal thickness and maximal left ventricular outflow tract gradient, among other echocardiographic parameters, were linearly associated with NT-proBNP concentration (<em>P</em> &lt; .001). Two patients died in the hospital (0.2%). On multivariable analysis, each 1000 pg/mL increase in NT-proBNP was independently associated with a 13% increase in blood transfusions (odds ratio, 1.13; 95% confidence interval [CI], 1.02-1.26), a 2-hour increase in ICU LOS (<em>P</em> &lt; .001), and a 4-hour increase in total hospital LOS. Additionally, every 100 pg/mL increase in NT-proBNP within the range of 0 to 800 pg/mL was independently correlated with a 10% increase in the odds of postoperative atrial fibrillation. NT-proBNP also was associated with long-term mortality (hazard ratio, 1.1; 95% CI 1.04-1.14; <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Preoperative NT-proBNP has strong, independent associations with early and late outcomes and may be useful in stratifying, managing, and monitoring oHCM patients.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 122-131"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913306","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":"Uncovering the impacts of cardiothoracic surgeon-mothers' careers on their children: Partner perspectives","authors":"Tanisha Rajah MSc ,&nbsp;Busra Cangut MD, MS ,&nbsp;Marianna Papageorge MD, MPH ,&nbsp;Sara Sakowitz MPH ,&nbsp;Rebekah Boyd MD ,&nbsp;Nicole Lin MD ,&nbsp;Madigan Stanley MD ,&nbsp;Ammara Watkins MD ,&nbsp;Stephanie G. Worrell MD ,&nbsp;Mara B. Antonoff MD","doi":"10.1016/j.xjon.2025.05.002","DOIUrl":"10.1016/j.xjon.2025.05.002","url":null,"abstract":"<div><h3>Objectives</h3><div>Careers in cardiothoracic (CT) surgery can substantially impact home dynamics, specifically influencing relationships and interactions with children. Factors impacting family experiences of CT surgeon-mothers have not been well-described. We sought to describe co-parent perceptions of child emotional and psychological well-being in families with CT surgeon-mothers.</div></div><div><h3>Methods</h3><div>An electronic survey was designed to elicit insights into the experiences of children of women CT surgeons. The survey was distributed to the parenting partners of 521 members of the Women in Thoracic Surgery, who shared their opinions on the benefits and disadvantages of their children having a CT surgeon-mother. Collected data were descriptively analyzed and quantitative data summarized.</div></div><div><h3>Results</h3><div>Thirty-five co-parents completed the survey. Among them, 13 (37%) had 1 child, 17 (49%) had 2, and 5 (14%) reported 3 or more. Their children's ages were 0-5 years, 12, 35%; 6-12 years, 8, 24%; 13-17 years, 9, 26%; and 18+ years, 5, 15%. For the youngest group, three-quarters (9, 75%) described their CT surgeon partner's career as nurturing their child's empathy. In the 18+ age group, CT surgeon-mothers’ careers were seen as promoting resilience and adaptability but also as impetus for feelings of isolation and resentment. Single-child families more frequently reported negative effects of a career in CT surgery, whereas families with 3+ children more frequently reported positive effects.</div></div><div><h3>Conclusions</h3><div>Children of CT surgeon-mothers experiences differ across ages and family sizes. Tailored interventions and support systems may help target specific needs of surgeons’ children, promoting resilience and healthy development.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 313-320"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912813","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":"Severe obesity increases risk of graft loss in pediatric heart transplantation","authors":"Joshua D. Sparks MD ,&nbsp;Sarah J. Wilkens MD ,&nbsp;Andrea Nicole Lambert MD ,&nbsp;Deborah Kozik DO ,&nbsp;Jaimin R. Trivedi MBBS, MPH ,&nbsp;Bahaaldin Alsoufi MD","doi":"10.1016/j.xjon.2025.04.023","DOIUrl":"10.1016/j.xjon.2025.04.023","url":null,"abstract":"<div><h3>Objectives</h3><div>Severe obesity is an established risk factor for adverse cardiovascular events and heart transplantation (HT) outcomes in adults. However, the effect of severe obesity on children after HT is not well studied. We aimed to examine the prevalence and effect of severe obesity on pediatric HT.</div></div><div><h3>Methods</h3><div>We evaluated children (&gt;8 years) listed for HT using the United Network for Organ Sharing database. Severe obesity was defined per Centers for Disease Control and Prevention criteria using body mass index. Our study comprised 2 groups: a severe obesity group (n = 212, 8%) and a control group (n = 2417, 92%) consisting of the remaining children. We compared characteristics and outcomes between the 2 groups.</div></div><div><h3>Results</h3><div>After listing, there was no difference in transplant rate or waitlist mortality between the severe obesity and control groups (<em>P</em> = .89). Children with severe obesity were less likely to have congenital heart disease and more likely to be Black, have greater levels of creatinine, be supported with a left ventricular assist device, and receive grafts from older donors. Waitlist duration was comparable (<em>P</em> = .23). Incidences of primary graft dysfunction (<em>P</em> = .91), stroke (<em>P</em> = .36), dialysis (<em>P</em> = .18), and acute rejection (<em>P</em> = .4) were similar. However, severe obesity group had significant survival disadvantage (10 years: 47% vs 64%, <em>P</em> = .01), particularly in children older than 11 years, with diverging outcomes starting around 4 years posttransplant in those older than 15 years. Cox regression identified severe obesity as independent mortality risk factor (hazard ratio, 1.88; <em>P</em> = .0003), along with age, gender, race, congenital heart disease, creatinine, extracorporeal membrane oxygenation, and donor age.</div></div><div><h3>Conclusions</h3><div>There is a pressing need to improve assessment and treatment of obesity in children with end-stage heart failure awaiting transplantation. Although early survival rates are comparable, med- and long-term outcomes are concerning for severely obese children after heart transplant. Though unclear, the pathophysiologic effects are likely due to accelerated allograft vasculopathy from the metabolic derangement of obesity. Particularly in older children and adolescents, severe obesity should be considered a modifiable risk factor and aggressively managed before and after transplantation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 207-217"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912821","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":"Objective performance indicators provide a novel, quantitative method to evaluate surgeon proficiency in robotic lobectomy training","authors":"James Nawalaniec MD ,&nbsp;Mallory Shields PhD ,&nbsp;Hugh Auchincloss MD ,&nbsp;Chi-Fu Jeffrey Yang MD ,&nbsp;Lana Schumacher MD","doi":"10.1016/j.xjon.2025.02.011","DOIUrl":"10.1016/j.xjon.2025.02.011","url":null,"abstract":"<div><h3>Objective</h3><div>Current evaluation of robotic surgeon proficiency relies on subjective assessment. The robotic platform collects highly granular kinematic data on surgeon activity, known as objective performance indicators (OPIs). We sought to compare surgeon proficiency during lobectomies across training levels using OPIs.</div></div><div><h3>Methods</h3><div>Under institutional review board approval, we analyzed robotic lobectomies between November 2022 and February 2023 performed by 2 expert robotic thoracic surgeons (&gt;200 robotic lobectomies) and their trainees using OPI recorders. A professional annotator segmented each case into standardized steps, and an operating surgeon (trainee or attending) was assigned to that step on the basis of the active console. Kinematic data were compared between surgeon groups. A subgroup analysis was performed dividing the trainee group into junior (postgraduate year 3-5) and senior residents (postgraduate year 6-8).</div></div><div><h3>Results</h3><div>In total, 26 lobectomies with 410 discrete tasks performed by attending surgeons and 344 by trainees were included. In the attending group, there were significantly greater rates of camera clutching per minute compared with trainees (2.94 vs 2.52, respectively; <em>P</em> = .0005). The ratio of right to left hand use was significantly greater in the trainee group (1.52 vs 1.48, <em>P</em> = .0047). Average instrument speed was faster in the attending group (1.24 vs 1.13 meters/min, <em>P</em> = .0061). Differences in clutching and speed, but not hand dexterity, remained significant when the trainee group was subdivided into beginner and intermediate robotic surgeons.</div></div><div><h3>Conclusions</h3><div>There are significant differences in objective performance indicators between expert and beginner robotic surgeons. These results demonstrate the feasibility of incorporating kinematic performance data into thoracic surgeon assessment in a clinical setting.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 299-305"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is segmentectomy actually superior to lobectomy for early-stage lung cancer? A discrepancy between the JCOG0802 trial and real-world practice","authors":"Hiroyuki Tsuchida MD ,&nbsp;Masaya Yotsukura MD ,&nbsp;Tomohiro Haruki MD ,&nbsp;Yukihiro Yoshida MD ,&nbsp;Kimiteru Ito MD ,&nbsp;Hirokazu Watanabe MD ,&nbsp;Tomonori Mizutani MD ,&nbsp;Yasushi Yatabe MD ,&nbsp;Shun-ichi Watanabe MD","doi":"10.1016/j.xjon.2025.05.005","DOIUrl":"10.1016/j.xjon.2025.05.005","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether results of the JCOG0802/WJOG4607L trial, which demonstrated the superiority of segmentectomy over lobectomy in terms of overall survival for patients with peripheral small-sized lung cancer, are applicable to clinical practice.</div></div><div><h3>Methods</h3><div>In this single-center retrospective analysis, we categorized patients who underwent lobectomy or segmentectomy during the enrollment period of the JCOG0802/WJOG4607L trial into 3 groups: patients enrolled in the trial (Cohort A), patients who were eligible but not enrolled (Cohort B), and ineligible patients (Cohort C). We assessed whether trial participants reflected typical patients seen in clinical practice (representativeness) and whether trial results could be applied in routine practice (generalizability) by comparing patient characteristics and survival between cohorts, using Cohort A as the reference.</div></div><div><h3>Results</h3><div>Cohorts A, B, and C included 91, 163, and 81 patients, respectively. Overall survival at 5 years was 91.2% (95% confidence interval [CI], 83.1%-95.5%), 93.9% (95% CI, 88.5%-96.8%), and 87.7% (95% CI, 77.7%-93.4%), respectively, with no significant different among the 3 cohorts (<em>P</em> = .269). Hazard ratios for segmentectomy over lobectomy were 0.125 (95% CI, 0.015-0.987) in Cohort A, 0.281 (95% CI, 0.036-2.147) in Cohort B, and 1.806 (95% CI, 0.573-5.690) in Cohort C, indicating that the results observed in Cohort A were not replicated in Cohort B.</div></div><div><h3>Conclusions</h3><div>In this single-center retrospective study, segmentectomy was associated with numerically improved overall survival rates than lobectomy in JCOG0802-eligible patients not enrolled in the trial, although the difference was not statistically significant. Given the study's retrospective nature and underpowered statistics with a small sample size, these findings should be interpreted cautiously.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 234-241"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912819","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":"An alternative approach to repair of giant paraesophageal hernia in selected patients with minimal history of reflux: Analysis of outcomes in more than 100 patients","authors":"Shuyin Liang MD ,&nbsp;James D. Luketich MD ,&nbsp;Edgar Aranda-Michel MD, PhD ,&nbsp;Nicholas Baker MD ,&nbsp;Evan Alicuben MD ,&nbsp;Ryan M. Levy MD ,&nbsp;Omar Awais DO ,&nbsp;William E. Gooding MS ,&nbsp;Hong Wang PhD ,&nbsp;Inderpal Sarkaria MD ,&nbsp;Neil A. Christie MD ,&nbsp;Matthew J. Schuchert MD ,&nbsp;Arjun Pennathur MD ,&nbsp;University of Pittsburgh/UPMC Paraesophageal Hernia Study Group","doi":"10.1016/j.xjon.2025.04.019","DOIUrl":"10.1016/j.xjon.2025.04.019","url":null,"abstract":"<div><h3>Objectives</h3><div>Laparoscopic repair of giant paraesophageal hernia (LGPEHR) is a complex operation and typically includes an antireflux procedure (ARS); however, some patients without a history of reflux may be able to avoid an ARS. The objective of this study was to evaluate an alternative approach for giant paraesophageal hernia (GPEH) repair with restoration of the normal anatomy and an extended gastropexy in selected patients with minimal reflux symptoms.</div></div><div><h3>Methods</h3><div>Patients who underwent GPEH repair with an extended gastropexy were reviewed retrospectively. The procedure was not a “simple gastropexy.” The LGPEHR included complete mediastinal dissection, hernia-sac reduction that restored anatomic intra-abdominal positioning of the stomach with careful preservation of the crura and vagal nerves, and tension-free crural repair. Then, an extended gastropexy was performed by placing a series of horizontal mattress sutures along the line of the short gastric vessels to the left crus and diaphragm. Perioperative outcomes, symptomatic improvement, recurrence, need for reoperation, and quality of life (Gastroesophageal Reflux Disease-Health-Related Quality of Life questionnaire) were evaluated.</div></div><div><h3>Results</h3><div>A total of 114 patients (median age 77.4 years) underwent GPEH repair with gastropexy (elective n = 81; urgent/emergent n = 33). Perioperative complications occurred in 11 patients (9.6%). Dysphagia improved significantly (<em>P</em> &lt; .01), and the median Gastroesophageal Reflux Disease-Health-Related Quality of Life score after GPEH repair was 2 (considered excellent). Imaging follow-up was performed at a median time of 14 months, with recurrence of hiatal hernia in 4 patients; 2 required reoperation.</div></div><div><h3>Conclusions</h3><div>LGPEHR with restoration of the normal anatomy and an extended gastropexy appears to be safe with good outcomes when key elements of repair are incorporated. If further validated, this option may be considered in selected high-risk patients who are not candidates for an ARS.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 243-254"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912923","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":"Study on the remodeling of distal residual dissection after surgery in patients with type A aortic dissection and Marfan syndrome","authors":"Junyu Wang MBBS ,&nbsp;Huiwen Gao MBBS ,&nbsp;Xuelan Zhang PhD ,&nbsp;Kai Tang MD ,&nbsp;Hui Han MD ,&nbsp;Chang Shu MD ,&nbsp;Xiangyang Qian MD ,&nbsp;MingYao Luo MD","doi":"10.1016/j.xjon.2025.06.011","DOIUrl":"10.1016/j.xjon.2025.06.011","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the remodeling of the distal aorta and outcomes after aortic surgery for type A aortic dissection (TAAD) in patients with Marfan syndrome and investigate whether morphologic characteristics of the dissection can predict negative remodeling.</div></div><div><h3>Methods</h3><div>Between 2013 and 2021, we performed total arch with a frozen elephant trunk for 325 patients with Marfan syndrome with DeBakey type I aortic dissection. Mean age was 47.13 ± 7.33 years, and 204 were men (63%). Follow-up was complete in 91.1% (296 out of 325) at a mean of 48.3 ± 13.1 months. Four-year incidence of death was 8.6% and reoperation rate was 10.4%. Negative remodeling was defined as an average growth rate &gt;5 mm/year or &gt;10% at any segment detected by computed tomography angiography.</div></div><div><h3>Results</h3><div>After surgery, negative remodeling occurred in 19.3% and 26.7% at TAAD follow-up at a mean of 13.6 and 38.3 months, respectively. There were 15.2% (12 out of 79) late deaths and 26.6% (21 out of 79) distal reoperations for those patients. The positive remodeling patients share a low rate of late death and distal reoperations of 6.5% (14 out of 217) and 7.8% (17 out of 217) (<em>P</em> &lt; .01). Maximal aortic sizes before discharge for negative remodeling patients were 43.2, 35.1, and 32.5 mm, and growth rates were 4.5 ± 1.52, 3.1 ± 1.14, and 3.5 ± 1.33 mm/year at the level of diaphragm, celiac trunk, and renal artery respectively, which is larger and expands more quickly than the patients with positive remodeling (<em>P</em> &lt; .01). Distal maximal aortic size (<em>P</em> &lt; .01), number of entry tears (<em>P</em> = .03), and average entry tears size (<em>P</em> = .02) predicted rate of negative remodeling.</div></div><div><h3>Conclusions</h3><div>Our results suggest that TAAD has a high rate of negative aortic remodeling in patients with Marfan syndrome. Distal maximal aortic size, number of entry tears, and average entry tears size were associated with the rate of negative aortic remodeling in patients with TAAD and Marfan syndrome.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 15-21"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913129","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}