JTCVS open最新文献

{"title":"Assessing the impact of socioeconomic distress on hospital readmissions after cardiac surgery","authors":"Mohamad El Moheb MD ,&nbsp;Abhinav Kareddy BSc ,&nbsp;Steven Young MD ,&nbsp;Matthew Weber MD ,&nbsp;Sean Noona MD ,&nbsp;Alexander Wisniewski MD ,&nbsp;Anthony Norman MD ,&nbsp;Zeyad Sahli MD, MBA ,&nbsp;Raymond Strobel MD, MSc ,&nbsp;Andrew Young MD ,&nbsp;Jeffrey Rich MD ,&nbsp;Abdulla Damluji MD ,&nbsp;Mohammed Quader MD ,&nbsp;Leora Yarboro MD ,&nbsp;Nicholas Teman MD ,&nbsp;Ourania Preventza MD, MBA","doi":"10.1016/j.xjon.2024.07.002","DOIUrl":"10.1016/j.xjon.2024.07.002","url":null,"abstract":"<div><h3>Background</h3><div>The impact of socioeconomic distress on readmission rates following cardiac surgery has not been studied. We hypothesized that patients living in distressed communities would have a higher 30-day readmission rate after cardiac surgery compared to those living in less distressed communities.</div></div><div><h3>Methods</h3><div>Patients undergoing isolated coronary artery bypass grafting (CABG) between 2016 and 2023 within a regional collaborative were identified. The Distressed Communities Index (DCI) and Area Deprivation Index (ADI) were used to measure socioeconomic distress. Two logistic regression models were performed to evaluate 30-day readmission rates: one incorporating ADI and the other including DCI. Models were adjusted for the Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) score, postoperative complications, length of stay (LOS), year of surgery, and discharge disposition.</div></div><div><h3>Results</h3><div>A total of 16,369 patients were included, of whom 10% were readmitted within 30 days of discharge. Readmitted patients were more likely to be female (32% vs 23.3%) and to develop postoperative complications (47% vs 35%) and less likely to be discharged to home (70.6% vs 83.5%; <em>P</em> &lt; .001 for all). On multivariable analysis, STS PROM score, postoperative complications, prolonged LOS, and discharge to a facility or leaving against medical advice were predictive of higher readmission rates. Socioeconomic distress was not an independent predictor of readmission in the model that used DCI (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.76-1.15) or in the model that used ADI (OR, 1.17; 95% CI, 0.83-1.64).</div></div><div><h3>Conclusions</h3><div>In patients undergoing CABG, increasing socioeconomic distress does not predict higher 30-day readmission rate. Other factors, such as discharge location, have a greater impact on readmission rate.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 211-223"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141693106","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":"Investigation of a chronic single-stage sheep Fontan model","authors":"John M. Kelly MD ,&nbsp;Zinan Hu BS ,&nbsp;Felipe Takaesu BS ,&nbsp;Tatsuya Watanabe MD, PhD ,&nbsp;Judd Storrs PhD ,&nbsp;Benjamin Blais MD ,&nbsp;Satoshi Yuhara MD ,&nbsp;Adrienne Morrison BA ,&nbsp;Kirsten Nelson BA ,&nbsp;Anudari Ulziibayar MD ,&nbsp;Eric Heuer BA ,&nbsp;Cole Anderson BS ,&nbsp;Michael Jimenez BA ,&nbsp;Joseph Leland BA ,&nbsp;Raphael Malbrue DVM ,&nbsp;Carmen Arsuaga-Zorrilla DVM, MS ,&nbsp;Laurie Goodchild DVM ,&nbsp;Aymen Naguib MD ,&nbsp;Christopher McKee MD ,&nbsp;Jordan Varner BA ,&nbsp;Christopher K. Breuer MD","doi":"10.1016/j.xjon.2024.06.018","DOIUrl":"10.1016/j.xjon.2024.06.018","url":null,"abstract":"<div><h3>Objectives</h3><div>Our goal was to conduct a hemodynamic analysis of a novel animal model of Fontan physiology. Poor late-term outcomes in Fontan patients are believed to arise from Fontan-induced hemodynamics, but the mechanisms remain poorly understood. Recent advances in surgical experimentation have resulted in the development of a chronic sheep model of Fontan physiology; however, detailed analysis of this model is lacking.</div></div><div><h3>Methods</h3><div>We created a single-stage Fontan model in juvenile sheep with normal biventricular circulation. The superior vena cava was anastomosed to the main pulmonary artery, and the inferior vena cava was connected to the main pulmonary artery using an expanded polytetrafluoroethylene conduit. Longitudinal hemodynamics, including catheterization and magnetic resonance imaging were evaluated.</div></div><div><h3>Results</h3><div>Four out of 12 animals survived, with the longest surviving animal living 3 years after single-stage Fontan. We showed a significant era effect regarding survival (1 out of 8 and subsequently 3 out of 4 animals surviving beyond 2 months) attributed in large part to the procedural learning curve. Key characteristics of Fontan hemodynamics, namely systemic venous hypertension and low normal cardiac output, were observed. However, recapitulation of passive human Fontan hemodynamics is affected by volume loading of the right ventricle given an anatomic difference in sheep azygous venous anatomy draining to the coronary sinus.</div></div><div><h3>Conclusions</h3><div>A significant learning curve exists to ensure long-term survival and future surgical modifications, including banding of the main pulmonary artery and ligation of the azygous to coronary sinus connection are promising strategies to improve the fidelity of model hemodynamics.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 268-278"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696904","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":"Commentator Discussion: Type B aortic dissection in patients with Marfan syndrome after the David procedure: Insights from patient-specific simulation","authors":"","doi":"10.1016/j.xjon.2024.06.016","DOIUrl":"10.1016/j.xjon.2024.06.016","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 17-18"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141689444","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":"Commentator Discussion: Durability of porcine and pericardial prostheses in tricuspid valve replacement","authors":"","doi":"10.1016/j.xjon.2024.07.009","DOIUrl":"10.1016/j.xjon.2024.07.009","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 88-89"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844407","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":"Combined pressure and volume loading for left ventricular training in patients with congenitally corrected transposition of the great arteries","authors":"Antonia Schulz MD ,&nbsp;Marcus Kelm MD ,&nbsp;Viktoria H.M. Weixler MD, PhD ,&nbsp;Peter Kramer MD ,&nbsp;Mi-Young Cho MD ,&nbsp;Stanislav Ovroutski MD ,&nbsp;Felix Berger MD ,&nbsp;Joachim Photiadis MD","doi":"10.1016/j.xjon.2024.08.016","DOIUrl":"10.1016/j.xjon.2024.08.016","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with congenitally corrected transposition of the great arteries may require left ventricular training before the double switch operation. We evaluated the effects of combined pressure and volume loading.</div></div><div><h3>Methods</h3><div>We performed a retrospective study of patients with congenitally corrected transposition of the great arteries who underwent left ventricular training between 2012 and 2022.</div></div><div><h3>Results</h3><div>Fifteen patients underwent left ventricular training at a median age of 1.5 years (interquartile range [IQR], 0.7-5.6). Their median left ventricular mass index was 21 g/m² (IQR, 18.9-36.6), left ventricular end-diastolic volume index was 65.1 mL/m² (IQR, 40.6-84.6), and systolic left ventricular/right ventricular pressure ratio was 0.35 (IQR, 0.31-0.5). In addition to pulmonary artery banding, atrial septectomy was performed in 12 patients (80%). Two patients already had a relevant shunt. One patient required systemic ventricular assist device implantation and heart transplantation. After a median of 1.9 years (IQR, 0.8-4.4), left ventricular mass index had increased to 38.5 g/m² (IQR, 25-49, <em>P</em> = .002), left ventricular end-diastolic volume index to 71.4 mL/m² (IQR, 50.1-94.4, <em>P</em> = .13), and systolic left ventricular/right ventricular pressure ratio to 0.94 (IQR, 0.84-1.1, <em>P</em> = .002). Older patients demonstrated a lower increase in left ventricular pressure. Six patients (6/14, 43%) have met eligibility criteria for the double switch operation (5 performed). Their age at the time of pulmonary artery banding was 1.7 years (IQR, 0.5-3.7), and the time between pulmonary artery banding and double switch operation was 3.1 years (IQR, 1.5-5.2). One patient required double switch operation takedown due to left ventricular failure. Two older patients were considered nonresponders to left ventricular training.</div></div><div><h3>Conclusions</h3><div>Combined pressure and volume loading resulted in a significant increase in left ventricular mass index and left ventricular pressure. Among older patients, there were nonresponders who remained not suitable for the double switch operation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 239-247"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553453","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":"Durable left ventricular assist devices following temporary circulatory support on a microaxial flow pump with and without extracorporeal life support","authors":"Daniel Lewin ,&nbsp;Sebastian V. Rojas MD ,&nbsp;Michael Billion MD ,&nbsp;Anna L. Meyer MD ,&nbsp;Ivan Netuka MD ,&nbsp;Janajade Kooij MD ,&nbsp;Marina Pieri MD ,&nbsp;Antonio Loforte MD ,&nbsp;Mariusz K. Szymanski MD ,&nbsp;Christian H. Moeller MD ,&nbsp;Payam Akhyari MD ,&nbsp;Khalil Jawad MD ,&nbsp;Ihor Krasivskyi MD ,&nbsp;Bastian Schmack MD ,&nbsp;Gloria Färber MD ,&nbsp;Marta Medina MD ,&nbsp;Assad Haneya MD ,&nbsp;Daniel Zimpfer MD ,&nbsp;Gaik Nersesian MD ,&nbsp;Mehmet Oezkur MD ,&nbsp;Evgenij V. Potapov MD","doi":"10.1016/j.xjon.2024.06.021","DOIUrl":"10.1016/j.xjon.2024.06.021","url":null,"abstract":"<div><h3>Background</h3><div>Circulatory support with a catheter-based microaxial flow pump (mAFP) plays a major role in the treatment of severe cardiogenic shock. In most patients who fail to recover while on temporary mechanical circulatory support (tMCS) and who are not eligible for heart transplantation, durable left ventricular assist device (dLVAD) implantation is usually considered a reliable option. This study aimed to describe the outcome of dLVAD therapy following mAFP support and to identify predictors of mortality.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of data from a multicenter registry on patients who underwent dLVAD implantation following tMCS with a mAFP between January 2017 and October 2022 (n = 332) from 19 European centers.</div></div><div><h3>Results</h3><div>Patients were supported with an Impella 5.5 (n = 92), 5.0 (n = 153) or CP (n = 87) and were transitioned to a HeartWare HVAD (n = 128) or Heartmate 3 (n = 204) during the same period. One hundred and twenty-five patients (39.2%) also required extracorporeal life support before and/or during mAFP therapy. The 30-day and 1-year survival were 87.8% and 71.1%, respectively. The following risk factors for 1-year mortality were identified: age (odds ratio [OR], 1.02), specifically age over 55 years (OR, 1.09), body mass index &gt;30 kg/m² (OR, 2.2), female sex (OR for male sex, 0.43), elevated total bilirubin (OR, 1.12), and low platelet count (OR, 0.996).</div></div><div><h3>Conclusions</h3><div>Based on the identified risk factors, a risk score for estimating 1-year mortality was calculated to optimize patient selection for dLVAD implantation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 168-179"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553537","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":"Importance of surgeon's experience in practicing valve-sparing aortic root replacement","authors":"Kavya Rajesh BS ,&nbsp;Megan Chung BA ,&nbsp;Dov Levine MD ,&nbsp;Elizabeth Norton MD ,&nbsp;Parth Patel MD ,&nbsp;Yu Hohri MD, PhD ,&nbsp;Chris He BS ,&nbsp;Paridhi Agarwal BS ,&nbsp;Yanling Zhao MS, MPH ,&nbsp;Pengchen Wang MS ,&nbsp;Paul Kurlansky MD ,&nbsp;Edward Chen MD ,&nbsp;Hiroo Takayama MD, PhD","doi":"10.1016/j.xjon.2024.07.013","DOIUrl":"10.1016/j.xjon.2024.07.013","url":null,"abstract":"<div><h3>Background</h3><div>Valve-sparing root replacement (VSRR) requires a unique skill set. This study aimed to examine the influence of surgeon's procedural volume on outcomes of VSRR.</div></div><div><h3>Methods</h3><div>This retrospective study included 1697 patients from 2 large, high-volume aortic centers who underwent aortic root replacement (ARR) between 2004 and 2021 and were potentially eligible for VSRR. Surgeons were classified as performing &lt;5 ARRs or ≥5 ARRs annually. Multivariable logistic regression was used to examine the independent association of surgeon volume and the decision to perform VSRR. Inverse probability treatment weighting (IPTW) was used to match patients who were operated on by &lt;5 ARR surgeons or ≥5 ARR surgeons and compare long-term survival probability. Cumulative incidence curves with mortality as a competing risk were plotted to compare the rate of aortic valve reoperation.</div></div><div><h3>Results</h3><div>Of 1697 patients who met the study inclusion criteria, 944 underwent composite-valve conduit ARR and 753 underwent VSRR. The median age of the cohort was 57 years (interquartile range, 45-66 years), and 268 (15.8%) were female. Aortic insufficiency was present in 1105 patients (65.1%), and 200 of the procedures (11.8%) were reoperations. The indication for surgery was aneurysm in 1496 patients (88.2%) and dissection in 201 (11.8%). Among the 743 patients who underwent VSRR, 691 (92%) were operated on by ≥ 5 ARR surgeons and 62 (8%) were operated on by &lt;5 ARR surgeons. In multivariable logistic regression, ≥5 ARRs (odds ratio, 3.33; 95% confidence interval, 2.34-4.73; <em>P</em> &lt; .001) was associated with VSRR as the procedure of choice. Following IPTW, there was no significant difference between &lt;5 ARR and ≥5 ARR surgeons in survival probability after VSRR (<em>P</em> = .59) or in the rate of aortic valve reoperation (<em>P</em> = .60).</div></div><div><h3>Conclusions</h3><div>In the setting of a high-volume aortic center, patients who undergo ARR are less likely to receive VSRR if operated on by a &lt;5 ARR surgeon; however, VSRR may be safely performed by &lt;5 ARR surgeons.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 19-34"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840999","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":"Reply: Arch intervention in type A dissection: Just do it?","authors":"Malak Elbatarny MD ,&nbsp;Adham El-Sherbini BHSc ,&nbsp;Maral Ouzounian MD, PhD","doi":"10.1016/j.xjon.2024.07.011","DOIUrl":"10.1016/j.xjon.2024.07.011","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 65-66"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842482","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":"Notice of Correction","authors":"","doi":"10.1016/j.xjon.2024.05.004","DOIUrl":"10.1016/j.xjon.2024.05.004","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Page 210"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553451","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":"Practice variation using the hybrid stage I procedure in congenital heart disease: Results from a national survey","authors":"Dominic B. Zanaboni MD ,&nbsp;Christopher T. Sower MD ,&nbsp;Sunkyung Yu MS ,&nbsp;Ray Lowery BA ,&nbsp;Jennifer C. Romano MD, MS ,&nbsp;Jeffrey D. Zampi MD","doi":"10.1016/j.xjon.2024.07.020","DOIUrl":"10.1016/j.xjon.2024.07.020","url":null,"abstract":"<div><h3>Objectives</h3><div>Hybrid stage I palliation has been used in many clinical scenarios including initial palliation in single ventricle heart disease, a bridge to biventricular repair, a bridge to transplant, and as a destination therapy. There is considerable hybrid stage I palliation practice variation, which we aimed to better understand in this study.</div></div><div><h3>Methods</h3><div>Survey-based assessment of practice variation related to hybrid stage I palliation was sent to congenital heart centers across the United States and Canada.</div></div><div><h3>Results</h3><div>Of the 106 centers surveyed, responses were received from 54 centers (50.9%). Of respondents, 45 centers perform hybrid stage I palliation. Centers most commonly (97.7%) perform hybrid stage I palliation on “high-risk” patients with single ventricle heart disease. Regarding the technical aspects of hybrid stage I palliation, most centers (95.3%) accomplish restrictive pulmonary blood flow using pulmonary artery bands and primarily use changes in oxygen saturation (34.1%) to identify appropriate restriction. Ductal stents are most often used (67.4%) to maintain ductal patency. Only 10 centers (23.3%) routinely enlarge the atrial septal defect. Indications for atrial septal defect intervention varied widely. Most centers (71.9%) discharge patients home to follow with a formal “interstage” program.</div></div><div><h3>Conclusions</h3><div>There is significant variation in practice patterns for hybrid stage I palliation indications, technical aspects, and postoperative care. Therefore, generalizability of single-center studies on outcomes after hybrid stage I palliation is limited. Future multicenter studies are needed to best delineate which patients benefit most from hybrid stage I palliation and to further define optimal approaches to caring for these patients.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 248-256"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553454","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}