JTCVS open最新文献

{"title":"Obesity and outcomes after elective thoracoabdominal aortic aneurysm repair","authors":"Sanford Zeigler MD ,&nbsp;Kyle W. Blackburn BS ,&nbsp;Ahmad Tabatabaeishoorijeh BS ,&nbsp;Veronica A. Glover PhD ,&nbsp;Susan Y. Green MPH ,&nbsp;Marc R. Moon MD ,&nbsp;Scott A. LeMaire MD ,&nbsp;Joseph S. Coselli MD","doi":"10.1016/j.xjon.2025.02.004","DOIUrl":"10.1016/j.xjon.2025.02.004","url":null,"abstract":"<div><h3>Objective</h3><div>Obesity can complicate surgical repair, but its relationship to outcomes after open thoracoabdominal aortic aneurysm (TAAA) repair remains uncertain. Therefore, we examined whether obesity is associated with greater operative risk after elective TAAA repair.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated data from 2517 open, elective, single-practice TAAA repairs (from 1986 to 2023) and compared patients without obesity or underweight (body mass index [BMI] 18.6-29.9; n = 1977) with patients with obesity (BMI ≥30; n = 540 [21.5%]). Multivariable logistic regression modeling identified predictors of operative mortality in patients with obesity. We created propensity-matched cohorts (n = 540 pairs) and compared their early and late outcomes, including late survival, by Kaplan-Meier analysis and log-rank testing.</div></div><div><h3>Results</h3><div>Compared with patients without obesity, patients with obesity were younger (median age, 64 years [Q1-Q3: 56-71] vs 68 [59-73] years; <em>P</em> &lt; .001) and had greater rates of aortic dissection (45.7% vs 34.5%; <em>P</em> &lt; .001) and diabetes (13.1% vs 6.9%; <em>P</em> &lt; .001). Extent I repairs were more frequent in patients with obesity (30.6% vs 24.9%; <em>P</em> = .008). Operative mortality did not differ between groups (5.6% vs 6.6%; <em>P</em> = .9); however, persistent stroke was more frequent in patients with obesity (3.7% vs 2.0%, <em>P</em> = .02). Overall, BMI was not associated with operative mortality; within the patients with obesity, multivariable modeling found aortic dissection was independently associated with operative mortality. Propensity matching revealed no substantial differences in examined outcomes.</div></div><div><h3>Conclusions</h3><div>Patients with obesity undergoing TAAA repair differed from their counterparts without obesity regarding several factors. However, adjusted early outcomes after TAAA replacement did not differ by the presence or severity of obesity. We conclude that obesity alone should not deter surgeons from offering elective TAAA repair.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 16-30"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854718","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":"Describing the intersection of ethnicity and gender in early-stage non–small cell lung cancer","authors":"Hamza Rshaidat MD ,&nbsp;Isheeta Madeka MD ,&nbsp;Gregory L. Whitehorn BS ,&nbsp;Jonathan Martin BS ,&nbsp;Shale J. Mack BS ,&nbsp;Sneha Alaparthi MD ,&nbsp;Tyler R. Grenda MD ,&nbsp;Nathaniel R. Evans III MD ,&nbsp;Olugbenga T. Okusanya MD","doi":"10.1016/j.xjon.2024.12.015","DOIUrl":"10.1016/j.xjon.2024.12.015","url":null,"abstract":"<div><h3>Objective</h3><div>Female sex has been associated with improved survival after lung cancer resection. Our aim is to use a national database to describe sex disparities in early lung cancer treatment and evaluate whether outcomes of ethnic groups who traditionally have poorer outcomes are attenuated by female sex.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study using the 2020 National Cancer Database. Adult patients diagnosed between 2010 and 2019 with early-stage non–small cell lung cancer (clinical T1 or T2, N0, M0) who received surgical resection with a known vital status were included. Patients who received neoadjuvant systemic or radiation therapy were excluded. Demographic data; clinicopathologic variables; 30-day, 90-day, 5-year mortality; and 5-year overall survival were analyzed.</div></div><div><h3>Results</h3><div>We identified 192,927 patients with surgically resected early-stage non–small cell lung cancer. Mean patient age was 69 years (interquartile range, 62-75). Five-year overall survival among women was 72.8% versus 60.4% in men (<em>P</em> &lt; .001), with the largest difference between Asian Pacific Islander women and men. Among women, White and Black women had the lowest 5-year overall survival. White and Black women had a higher 5-year overall survival than White, Black, Hispanic, and Other men.</div></div><div><h3>Conclusions</h3><div>Female sex was associated with improved overall survival in patients with early-stage lung cancer regardless of ethnicity. However, there is significant variation between ethnic groups in the absolute size of this association. Additional studies are necessary to determine which factors contribute to this disparity, including but not limited to biological, clinical, and health-systems related.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 438-450"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854865","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 jejunostomy-tube placement in surgical patients with esophageal cancer","authors":"Hope Conrad MD ,&nbsp;Ahmed Elkamel MBBS ,&nbsp;Anthony Maltagliati MD ,&nbsp;Kevin Wang MD ,&nbsp;Chiu-Hsieh Hsu PhD ,&nbsp;Wendy Linville BA ,&nbsp;Michal Lada MD ,&nbsp;Praveen Sridhar MD ,&nbsp;Stephanie Worrell MD","doi":"10.1016/j.xjon.2025.01.003","DOIUrl":"10.1016/j.xjon.2025.01.003","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with esophageal cancer who undergo esophagectomy are at high risk for malnutrition. Jejunostomy tubes are often placed to provide enteral access for nutritional support. Traditionally, jejunostomy placement occurs at the time of esophagectomy. However, benefits have been described in patients with earlier jejunostomy placement. The purpose of this study is to determine outcomes of surgical patients with esophageal cancer on the basis of jejunostomy tube placement as well as to analyze the effect of placement timing on these factors.</div></div><div><h3>Methods</h3><div>This is a retrospective, multi-institutional study including 2 academic hospital systems. Patients with esophageal cancer who underwent esophagectomy were included. Patients who received a jejunostomy tube were compared with patients who did not receive a jejunostomy tube. Further analysis comparing early and routine jejunostomy placement timing was then performed.</div></div><div><h3>Results</h3><div>Of 327 included patients, 48.32% (158) had a jejunostomy tube and 51.68% (169) did not have any form of enteral access. For every day a patient had a jejunostomy tube in place, there was a reduction in hospital length of stay (LOS) and intensive care unit LOS (<em>P</em> ≤ .001 and &lt; .001).</div></div><div><h3>Conclusions</h3><div>Jejunostomy tube placement in patients with esophageal cancer undergoing esophagectomy significantly enhances nutritional outcomes, particularly in malnourished patients, and reduces 90-day mortality and recurrence rates. Patients with esophageal cancer who underwent esophagectomy and received an early jejunostomy tube had shorter hospital and intensive care unit LOS. Early placement of jejunostomy tubes should be considered to optimize nutritional support and improve overall patient resilience before surgery. Further prospective studies are warranted to confirm these findings and refine guidelines for jejunostomy tube placement in patients with esophageal cancer.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 496-509"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854870","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":"Potential of quantitative flow ratio in guiding conduit selection between radial artery and saphenous vein graft for coronary artery bypass grafting","authors":"Chunyuan Wang MD ,&nbsp;Meice Tian MD ,&nbsp;Yang Wang PhD ,&nbsp;Lei Song MD ,&nbsp;Zhihui Hou MD ,&nbsp;Sipeng Chen MS ,&nbsp;Wei Feng MD ,&nbsp;Yan Zhang MD ,&nbsp;Zhan Hu MD","doi":"10.1016/j.xjon.2025.01.019","DOIUrl":"10.1016/j.xjon.2025.01.019","url":null,"abstract":"<div><h3>Objectives</h3><div>Radial artery grafts and saphenous vein grafts exhibit heterogeneous responses to competitive flow, a phenomenon assessable through quantitative flow ratio. The present study aims to compare the patency of radial artery and saphenous vein grafts across various quantitative flow ratio ranges.</div></div><div><h3>Methods</h3><div>The clinical data and quantitative flow ratio values for each target vessel were retrospectively collected in patients receiving radial artery or conventional saphenous vein grafts in our center from 2017 to 2021. The primary outcome was graft occlusion assessed by coronary computed tomography angiography and coronary angiography, and the secondary outcome was major adverse cardiac or cerebrovascular events. Mixed-effect multivariable Cox regression models were used to assess the independent effect of graft conduit type and quantitative flow ratio on graft occlusion.</div></div><div><h3>Results</h3><div>A total of 1314 patients with 292 radial artery target vessels and 1736 saphenous vein graft target vessels were included. The median follow-up duration was 3 years. Quantitative flow ratio value of 0.57 was identified as the optimal threshold. Compared with saphenous vein graft, the radial artery exhibited lower patency in target vessels where quantitative flow ratio was greater than 0.57 (adjusted hazard ratio, 4.63, 95% CI, 2.61-8.21, <em>P</em> &lt; .001), but higher patency in vessels in which the quantitative flow ratio was 0.57 or less (adjusted hazard ratio, 0.14, 95% CI, 0.03-0.68, <em>P</em> = .015).</div></div><div><h3>Conclusions</h3><div>Radial artery grafts may achieve superior patency in target vessels with low quantitative flow ratio values, whereas saphenous vein grafts may be associated with higher short-term patency in vessels with higher quantitative flow ratio values.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 206-216"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854673","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":"Factors and outcomes associated with successful minimally invasive pneumonectomy","authors":"Winston L. Trope BE ,&nbsp;Ntemena Kapula MS ,&nbsp;Irmina A. Elliott MD ,&nbsp;Brandon A. Guenthart MD ,&nbsp;Natalie S. Lui MD ,&nbsp;Leah M. Backhus MD ,&nbsp;Mark F. Berry MD ,&nbsp;Joseph B. Shrager MD ,&nbsp;Douglas Z. Liou MD","doi":"10.1016/j.xjon.2025.02.006","DOIUrl":"10.1016/j.xjon.2025.02.006","url":null,"abstract":"<div><h3>Objective</h3><div>To test the hypothesis that patients undergoing minimally invasive pneumonectomy at high-volume minimally invasive lung surgery centers have improved survival compared with patients who undergo open pneumonectomy.</div></div><div><h3>Methods</h3><div>Patients from the National Cancer Database who underwent pneumonectomy for lung cancer between 2010 and 2020 were stratified into 3 groups according to surgical technique (open, minimally invasive, converted from minimally invasive to open). Institutions were categorized as low-, mid-, or high-volume minimally invasive lung surgery centers according to percentage of total anatomic lung resections performed by video-assisted or robotic-assisted thoracoscopic surgery. Outcomes were compared using Cox regression, Kaplan-Meier survival analysis, and propensity score matching.</div></div><div><h3>Results</h3><div>In total, 5750 patients from 850 facilities were included, with 4597 (79.9%) undergoing upfront open pneumonectomy. Among the 1153 attempted minimally invasive pneumonectomies, 364 (31.6%) required conversion to open pneumonectomy. Surgery at a non−high-volume center was associated with greater conversion risk (adjusted odds ratio, 4.16; <em>P</em> &lt; .001), whereas neoadjuvant therapy was associated with lower risk (adjusted odds ratio, 0.60; <em>P</em> = .015). Similar 5-year overall survival was seen among the 3 groups (open 45.2%, minimally invasive 48.3%, converted 43.3%); however, conversion from minimally invasive to open pneumonectomy demonstrated a trend towards increased risk of death (hazard ratio, 1.16; <em>P</em> = .058).</div></div><div><h3>Conclusions</h3><div>Minimally invasive pneumonectomy for lung cancer had similar 5-year survival compared with open pneumonectomy. However, conversion from minimally invasive to open pneumonectomy showed a trend toward increased risk of death, and conversion rates were high irrespective of institutional minimally invasive lung surgery volume. Careful patient selection is necessary when considering minimally invasive pneumonectomy so that long-term outcomes are not compromised.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 423-437"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854864","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":"National survey of coronary artery bypass grafting in patients with coronary artery lesions caused by Kawasaki disease in Japan from 2008 to 2019","authors":"Etsuko Tsuda MD, PhD ,&nbsp;Hiraku Kumamaru MD, ScD ,&nbsp;Tetsuya Kitagawa MD, PhD ,&nbsp;Naoko Kinukawa PhD ,&nbsp;Yoshihide Mitani MD, PhD ,&nbsp;Noboru Motomura MD, PhD","doi":"10.1016/j.xjon.2024.10.016","DOIUrl":"10.1016/j.xjon.2024.10.016","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to know how the results of patients who underwent coronary artery bypass grafting for coronary arterial lesions caused by Kawasaki disease have changed in the past half-century after the first report of Kawasaki disease.</div></div><div><h3>Methods</h3><div>We investigated the national results of coronary artery bypass grafting in patients with Kawasaki disease who underwent the procedures between 2008 and 2019 from the Japan Cardiovascular Surgery Database Organization. The prevalence and outcome of patients with coronary artery bypass grafting were clarified. The factors that affected the condition upon discharge were analyzed. Furthermore, the outcomes of the patients in the late period after discharge were surveyed by questionnaires in 2021.</div></div><div><h3>Results</h3><div>A total of 343 patients were identified. Coronary artery bypass grafting after Kawasaki disease has been performed in approximately 40 patients per year recently. There were 264 male patients (77.0%) and 79 female patients (23.0%). The median age at the time of the operation was 39 years (5th-95th percentile, 13-72). The 30-day-operative mortality was 0.9%. Of the 183 patients (53.8%) with the quwtionaires after discharge, 176 survived (96.2%), and 7 died (3.8%). The 10-year survival rate was 94% (95% CI, 87-97%) (n = 183). The 5-year survivals depended on the preoperative left ventricular ejection fraction, which was 72% (95% CI, 13-96) (n = 9) for the poor group (left ventricular ejection fraction &lt;30%), 98% (95% CI, 87-100) (n = 104) for the preserved group (≥60%), and 94% (95% CI, 81-98) (n = 70) for the intermediate group (≥30% but &lt;60%) (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>A half-century after the first report of Kawasaki disease, the ages of the patients who undergo coronary artery bypass grafting in this population have changed from children to young adults. Although the preoperative left ventricular function affected the long-term outcome, the operative results were good.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 227-238"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854867","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":"Gender disparities in cardiothoracic surgical conference scholarly interactions: A prime opportunity for change in culture","authors":"Shanique A. Ries MD ,&nbsp;Emily June Zolfaghari MD ,&nbsp;Adrian Higaki BS ,&nbsp;Justin A. Olivera BS ,&nbsp;Busra Cangut MD ,&nbsp;Adham Ahmed BS ,&nbsp;Tiffany Hsiung BS ,&nbsp;Jessica Carducci BS ,&nbsp;Alexis Chidi MD ,&nbsp;Mohanad Elshiekh MD ,&nbsp;Ellelan Degife BS ,&nbsp;Ryon Arrington BS ,&nbsp;Rajika Jindani MD ,&nbsp;Adegbemisola Aregbe Perkins BS ,&nbsp;Emily Rodriguez BS ,&nbsp;Michael Eisenberg MD ,&nbsp;Elliot Servais MD ,&nbsp;Gavitt Woodard MD ,&nbsp;Mara B. Antonoff MD, FACS","doi":"10.1016/j.xjon.2025.02.008","DOIUrl":"10.1016/j.xjon.2025.02.008","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to characterize the failures of professional scholarly discourse at a national cardiothoracic surgical meeting, with particular attention directed toward gender-related inequities in treatment.</div></div><div><h3>Methods</h3><div>During the 2024 Society of Thoracic Surgery Annual Meeting, we used a standardized tool to conduct structured, real-time observations of professional behavior during meeting sessions. Fifteen observers gathered data from 22 sessions, including Plenary, Education/Quality/Wellness, General Thoracic, and Adult Cardiac Surgery. Survey items were designed to evaluate presenters', discussants', and moderators’, conduct, specifically pertaining to interruptions, use of appropriate titles, and adherence to allotted presentation times.</div></div><div><h3>Results</h3><div>Unprofessional behavior was observed in 13 of 22 (59%) studied sessions. During these sessions, 46 perpetrators were identified, among whom 38 (83%) were men and 8 (17%) were women. Women were significantly more likely to be addressed by an inappropriate title compared with men, 44% and 25%, respectively (<em>P</em> &lt; .001). Of the 88 observed presenters, 65 (74%) were men and 23 (26%) were women. There were 4 (4%) students, 12 (14%) surgical residents, and 72 (82%) attending surgeon presenters. Among women presenters, 5 (13%) were interrupted compared with 3 men (7.7%). Speaking longer than time allotted occurred for 46 (49%) of observed presenters, with no significant difference observed between men and women presenters.</div></div><div><h3>Conclusions</h3><div>Unprofessional behavior occurred with regularity during this societal conference. Men more frequently engaged in these actions, with women being disproportionately affected. By shedding light on such issues, we can appropriately address biases and provide education regarding acceptable conduct.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 521-526"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854715","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 following transcatheter and surgical interventions in patients with acute valvular dysfunction with cardiogenic shock","authors":"Yu Hohri MD, PhD ,&nbsp;Erfan Faridmoayer MD ,&nbsp;Yanling Zhao MS, MPH ,&nbsp;Paul Kurlansky MD ,&nbsp;Krushang Patel MD ,&nbsp;Morgan Moroi MD ,&nbsp;Christine Yang BS ,&nbsp;Giovanni Ferrari PhD ,&nbsp;Isaac George MD ,&nbsp;Hiroo Takayama MD, PhD ,&nbsp;Koji Takeda MD, PhD","doi":"10.1016/j.xjon.2024.12.010","DOIUrl":"10.1016/j.xjon.2024.12.010","url":null,"abstract":"<div><h3>Objectives</h3><div>Although surgery remains the gold standard treatment for acute valvular dysfunction complicated by cardiogenic shock, transcatheter management has emerged as an alternative. We examined our contemporary experience with patients requiring surgical or transcatheter interventions in conjunction with mechanical circulatory support for acute valvular dysfunction complicated by cardiogenic shock.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients admitted with cardiogenic shock due to acute valvular dysfunction who underwent valve interventions at our center between 2016 and 2022. The primary end point was in-hospital mortality. Secondary end points included midterm mortality and major adverse cardiac events, including cardiac death, stroke, cardiac-related events, readmission for heart failure, and reintervention.</div></div><div><h3>Results</h3><div>Among 67 patients (median 75 years, interquartile range, 65-84), common valve pathologies included aortic stenosis (30 patients), mitral regurgitation (24 patients), and tricuspid regurgitation (17 patients). Preoperative mechanical circulatory support was required in 38 patients. Nineteen patients underwent open surgery, and 48 patients received transcatheter interventions, including transcatheter aortic valve replacement and edge-to-edge mitral repair. Mechanical circulatory support was required in 34 patients postoperatively. Overall in-hospital mortality was 26.9% (surgery 26.3% vs transcatheter 27.1%, <em>P</em> = 1.000). Median follow-up was 25.1 months (interquartile range, 20.6-33.9 months). The 2-year survival was 54.0% (95% CI, 42.2-69.0), and the cumulative incidence of major adverse cardiac events was 51.5% (95% CI, 33.8-64.4). Residual moderate or severe tricuspid regurgitation (hazard ratio, 2.266, 95% CI, 1.052-4.940, <em>P</em> = .037) and postoperative mechanical circulatory support (hazard ratio, 2.611, 95% CI, 1.194-5.965, <em>P</em> = .016) were associated with 2-year mortality.</div></div><div><h3>Conclusions</h3><div>Early and midterm mortality and morbidity rates remained high despite contemporary multimodal treatment approaches for acute valvular dysfunction with cardiogenic shock.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 217-226"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854717","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":"Quality of life outcomes after robotic-assisted and video-assisted thoracoscopic surgery for early-stage non–small cell lung cancer","authors":"Jiafang Zhang MS ,&nbsp;Rowena Yip PhD, MPH ,&nbsp;Emanuela Taioli MD, PhD ,&nbsp;Raja M. Flores MD ,&nbsp;Claudia I. Henschke PhD, MD ,&nbsp;David F. Yankelevitz MD ,&nbsp;Rebecca M. Schwartz PhD","doi":"10.1016/j.xjon.2025.01.007","DOIUrl":"10.1016/j.xjon.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>Limited research exists comparing the impacts of robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) on patients’ physical and mental health-related quality of life (QoL).</div></div><div><h3>Methods</h3><div>A prospective cohort of stage IA non–small cell lung cancer (NSCLC) patients in the Initiative for Early Lung Cancer Research on Treatment from Mount Sinai Health System had QoL measured before surgery and at 2, 6, and 12 months post-treatment using the Medical Outcomes Study Short-Form 12 (SF-12), with Physical Component Summary (PCS) and Mental Component Summary (MCS); the Functional Assessment of Cancer Therapy-Lung Cancer Subscale (FACT-LCS); and Patient Health Questionnaire-4 (PHQ-4; for depression/anxiety). A locally weighted smoothing curve was fitted to identify the best interval knot for post-treatment QoL trends. A piecewise linear mixed-effects model was developed to estimate differences in baseline, 2-month, and 12-month QoL scores and rates of change, adjusting for age, sex, race, ethnicity, smoking status, pack-years, nodule size/consistency, comorbidities, and surgical extent.</div></div><div><h3>Results</h3><div>The study cohort comprised 698 patients, including 458 (65.6%) who underwent VATS and 240 (34.4%) who underwent RATS. The RATS group exhibited a more significant initial decline in physical health at 2 months post-surgery but showed significant recovery by 12 months, achieving similar or slightly higher physical scores compared to baseline. No significant differences in mental health scores over time were seen between the groups. Both groups displayed consistent anxiety and depression scores, with significant improvements in anxiety symptoms at the 2-month mark. The RATS group had fewer postoperative complications and conversion to open thoracotomy.</div></div><div><h3>Conclusions</h3><div>RATS and VATS offer similar long-term QoL outcomes for early-stage NSCLC patients, though RATS patients may experience a sharper initial decline in physical health.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 383-393"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854478","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 left ventricular rehabilitation on surgical outcomes in patients with borderline left heart hypoplasia","authors":"Haonan Cheng MS ,&nbsp;Takuya Osawa MD ,&nbsp;Christoph Röhlig MD ,&nbsp;Jonas Palm MD ,&nbsp;Thibault Schaeffer MD ,&nbsp;Carolin Niedermaier MS ,&nbsp;Nicole Piber MD ,&nbsp;Paul Philipp Heinisch MD, PhD ,&nbsp;Christian Meierhofer MD, PhD ,&nbsp;Stanimir Georgiev MD, PhD ,&nbsp;Alfred Hager MD, PhD ,&nbsp;Peter Ewert MD, PhD ,&nbsp;Jürgen Hörer MD, PhD ,&nbsp;Masamichi Ono MD, PhD","doi":"10.1016/j.xjon.2024.10.010","DOIUrl":"10.1016/j.xjon.2024.10.010","url":null,"abstract":"<div><h3>Objective</h3><div>The clinical significance of left ventricular rehabilitation for borderline left ventricular hypoplasia is controversial. This study aimed to review the surgical results of patients with borderline left ventricular hypoplasia and to evaluate the impact of left ventricular rehabilitation on outcomes.</div></div><div><h3>Methods</h3><div>Patients diagnosed with borderline left ventricular hypoplasia and surgically treated from 2018 to 2022 were included. Overall surgical outcomes were evaluated. The changes in left ventricular volumes were calculated using angiography, and age-adjusted z-score N-terminal pro-B-type natriuretic peptide levels were analyzed in patients who underwent left ventricular rehabilitation.</div></div><div><h3>Results</h3><div>Thirty-three patients were included. Sixteen patients underwent primary biventricular repair, 3 patients underwent primary single ventricle palliation, and the remaining 14 patients underwent left ventricular rehabilitation; 9 received bilateral pulmonary artery banding and ductal stenting, 4 received central pulmonary artery banding, and 1 received ductal stenting. Of 14 patients who received left ventricular rehabilitation, 1 died, 1 underwent single ventricle palliation, 1 was waiting for further procedure, and 11 underwent biventricular repair. After biventricular repair, 2 patients died, and 1 patient developed hemodynamic failure. As a result, only 8 patients were alive and in good condition. In patients who underwent left ventricular rehabilitation, left ventricular end-diastolic volume index, end-systolic volume index, and left ventricular stroke volume index increased over time after left ventricular rehabilitation (<em>P</em> = .001, <em>P</em> = .007, and <em>P</em> = .009, respectively). The age-adjusted z-score N-terminal pro-B-type natriuretic peptide levels were stable until biventricular repair, but significantly higher in patients who presented with hemodynamic failure after biventricular repair compared with patients who did not exhibit hemodynamic failure.</div></div><div><h3>Conclusions</h3><div>In patients with borderline left heart hypoplasia, the left ventricular rehabilitation procedure promoted an increase in left ventricular volume and contributed to establishing a biventricular circulation. The short-term results of this strategy are satisfactory, but further studies are essential to determine the long-term outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 359-373"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854475","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}