JTCVS open最新文献

{"title":"Characterizing center-level variation in outcomes after the development of pulmonary complications in elective cardiac operations","authors":"Konmal Ali BS,&nbsp;Syed Shaheer Ali,&nbsp;Troy Coaston MSCR,&nbsp;Sidney Hinks,&nbsp;Owen Lai,&nbsp;Deep Mehta,&nbsp;Melissa Justo MD,&nbsp;Yas Sanaiha MD,&nbsp;Peyman Benharash MD","doi":"10.1016/j.xjon.2026.101973","DOIUrl":"10.1016/j.xjon.2026.101973","url":null,"abstract":"<div><h3>Objective</h3><div>Postoperative pulmonary complications (PCs) affect 5% to 25% of patients who undergo cardiac surgery. Variation in hospital-management strategies and resource availability may contribute to the incidence of PCs. We assessed the association of PCs with clinical outcomes after elective cardiac surgery and hospital-level variation across the United States.</div></div><div><h3>Methods</h3><div>Adults (≥18 years) undergoing elective coronary, valvular, or proximal aortic operations were identified from the 2016-2022 Nationwide Readmissions Database. PC was defined as a composite of postoperative pneumonia, prolonged mechanical ventilation (&gt;24 hours), reintubation, or tracheostomy. Primary outcome was in-hospital mortality; secondary outcomes included length of stay, hospitalization costs, nonhome discharge, and 30-day nonelective readmission. Multivariable logistic and linear regression models were used for risk adjustment. Mixed-effects modeling quantified hospital-level variation, with center-level effects assessed using the intraclass correlation coefficient.</div></div><div><h3>Results</h3><div>Among 862,984 patients, 38,596 (4.47%) experienced a PC, most commonly pneumonia (11.5%). Patients with PC were older and had greater comorbidity burden (<em>P</em> &lt; .001). After adjustment, PCs were associated with increased odds of in-hospital mortality (adjusted odds ratio, 1.24; 95% CI, 1.08-1.43), prolonged length of stay (β +0.76 days), greater hospitalization costs (β +$3871), and greater likelihood of nonhome discharge (all <em>P</em> &lt; .001). PC was also associated with decreased freedom from 30-day readmission. Hospital-level factors accounted for 15.3% of the observed variation in PC incidence, with greater institutional PC rates correlated with increased hospitalization expenditures.</div></div><div><h3>Conclusions</h3><div>PCs remain a persistent challenge, driving an increase in mortality and an estimated incremental increase in expenditures of $3800. Significant center-level variation suggests opportunities for quality improvement through targeted interventions addressing modifiable risk factors.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101973"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214488","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":"When stroke strikes: Predictors of stroke after open thoracoabdominal aortic aneurysm repair","authors":"Kyle W. Blackburn MD,&nbsp;Dominique I. Cope MD,&nbsp;Benjamin R. Zambetti MD,&nbsp;Veronica A. Glover PhD,&nbsp;Susan Y. Green MPH,&nbsp;Lauren K. Barron MD,&nbsp;Anna H. Xue MD,&nbsp;Vicente Orozco-Sevilla MD,&nbsp;Subhasis Chatterjee MD,&nbsp;Marc R. Moon MD,&nbsp;Joseph S. Coselli MD","doi":"10.1016/j.xjon.2026.102057","DOIUrl":"10.1016/j.xjon.2026.102057","url":null,"abstract":"<div><h3>Objective</h3><div>Postoperative stroke after thoracoabdominal aortic aneurysm (TAAA) repair is an uncommon but devastating complication that has been understudied. This analysis aimed to identify patients at greatest risk for ischemic or hemorrhagic stroke after TAAA repair.</div></div><div><h3>Methods</h3><div>We analyzed data from 3765 patients who underwent open TAAA repair from 1986 to 2024 at a single high-volume aortic surgery practice. We used multivariable logistic regression modeling to evaluate preoperative and operative predictors of all and persistent ischemic and hemorrhagic stroke. The effect of new-onset atrial fibrillation was evaluated.</div></div><div><h3>Results</h3><div>Postoperative stroke persisted to death or hospital discharge in 93 patients (2.5%) and was transient in 29 (0.8%). Those with persistent stroke had a greater mortality rate (61.3%, n = 57/93) than those without any stroke (7.3%, n = 267/3643). Most persistent strokes were ischemic (76.3%) rather than hemorrhagic (26.9%). Significant predictors of persistent ischemic stroke included older age (odds ratio [OR], 1.04; <em>P</em> = .007) and chronic kidney disease (OR, 1.98; <em>P</em> = .01), whereas Crawford extent III (OR, 0.38; <em>P</em> = .01) and IV repairs (OR, 0.35; <em>P</em> = .008) were protective. Significant predictors of persistent hemorrhagic stroke included heritable thoracic aortic disease (OR, 2.34; <em>P</em> = .04) and prophylactic cerebrospinal fluid drainage (OR, 7.99; <em>P</em> = .006). Prolonged aortic clamp time (OR, 1.03, <em>P</em> = .03) was associated with greater odds of death after a stroke.</div></div><div><h3>Conclusions</h3><div>This analysis of a large, single-practice series identified variables associated with stroke and stroke-related mortality after TAAA repair. Although stroke remains infrequent, its lethality highlights the importance of risk modeling. Mitigating the risk of hemorrhagic stroke in patients with heritable thoracic aortic disease should be prioritized.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102057"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214504","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":"Living-donor lung transplantation for patients on extracorporeal membrane oxygenation support: A case series","authors":"Taiki Ryo MD,&nbsp;Ichiro Sakanoue MD, PhD,&nbsp;Satona Tanaka MD, PhD,&nbsp;Akira Matsumoto MD,&nbsp;Katsutaka Mineura MD, PhD,&nbsp;Taichi Matsubara MD, PhD,&nbsp;Hidenao Kayawake MD, PhD,&nbsp;Yojiro Yutaka MD, PhD,&nbsp;Daisuke Nakajima MD, PhD,&nbsp;Toyofumi Fengshi Chen-Yoshikawa MD, PhD,&nbsp;Hiroshi Date MD, PhD","doi":"10.1016/j.xjon.2026.102059","DOIUrl":"10.1016/j.xjon.2026.102059","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102059"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214458","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":"One-year quality of life and functional outcomes after robotic diaphragm plication for unilateral paralysis: A retrospective cohort analysis","authors":"Philip Baum MD,&nbsp;Raffaela Griffo MD,&nbsp;Matthias Grott MD,&nbsp;Henrike Deissner MD,&nbsp;Alessio Campisi MD,&nbsp;Mavi Schellenberg MD,&nbsp;Felix Herth MD, PhD,&nbsp;Jacopo Lenzi PhD,&nbsp;Konstantin Uttinger MD,&nbsp;Hauke Winter MD,&nbsp;Martin E. Eichhorn MD","doi":"10.1016/j.xjon.2026.102084","DOIUrl":"10.1016/j.xjon.2026.102084","url":null,"abstract":"<div><h3>Objectives</h3><div>Unilateral diaphragm paralysis is a rare thoracic condition that can significantly impair respiratory function and quality of life. This retrospective study aims to evaluate the long-term functional and quality of life outcomes after robotic-assisted thoracoscopic diaphragm plication.</div></div><div><h3>Methods</h3><div>Between 2019 and 2024, 82 patients with symptomatic unilateral diaphragm paralysis were included in a prospectively maintained database at a single institution. All patients underwent robotic-assisted thoracoscopic diaphragm plication. Quality of life was assessed using the Diaphragmatic Paralysis Questionnaire, and lung function was evaluated by body plethysmography and spirometry in the upright position. Postoperative complications were graded according to the Clavien–Dindo classification.</div></div><div><h3>Results</h3><div>Quality of life improved significantly across all Diaphragmatic Paralysis Questionnaire domains at 3 months and 1 year (all <em>P</em> &lt; .001). Overall improvements were maintained over time, although the respiratory domain showed a modest change between 3 months and 1 year (<em>P</em> = .013). Forced expiratory volume in 1 second and forced vital capacity increased significantly at both follow-up time points (all <em>P</em> &lt; .001). No significant changes were observed in arterial blood gas parameters (partial pressure of oxygen and partial pressure of carbon dioxide). Diffusing capacity of the lung for carbon monoxide showed a modest improvement at 3 months (<em>P</em> = .009), which was not sustained at 1 year (<em>P</em> = .066). Within 90 days, 6 patients (7.3%) developed Clavien–Dindo grade III or greater complications, whereas pleural effusion (grade I) was the most frequent event.</div></div><div><h3>Conclusions</h3><div>This retrospective analysis of a prospectively collected cohort suggests that robotic-assisted thoracoscopic diaphragm plication is associated with improved long-term quality of life and pulmonary function in patients with symptomatic unilateral diaphragm paralysis.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102084"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214459","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":"Postoperative chylothorax following congenital heart surgery: Incidence, risks, therapy, and possible mechanisms","authors":"Thibault Schaeffer MD,&nbsp;Verena Kunke MS,&nbsp;Jonas Palm MD,&nbsp;Andrea Amici MD,&nbsp;Teresa Lemmen MS,&nbsp;Christina Ruda MS,&nbsp;Nicole Piber MD,&nbsp;Muneaki Matsubara MD, PhD,&nbsp;Paul Philipp Heinisch 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.2026.102062","DOIUrl":"10.1016/j.xjon.2026.102062","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the incidence, risks factors, outcomes, and mechanisms of postoperative chylothorax (PCT) following congenital heart surgery.</div></div><div><h3>Methods</h3><div>Among all patients who underwent congenital heart surgery between 2001 and 2024, those who developed PCT during the same hospitalization were identified. The prevalence of chylothorax was analyzed, along with associated procedures, risk factors, and hemodynamics.</div></div><div><h3>Results</h3><div>Among 9892 congenital heart surgeries performed during the study period, 312 patients (3.2%) developed PCT. Patients with PCT had a higher proportion of males (64% vs 56%; <em>P</em> = .009), younger age at surgery (median, 0.6 years vs 1.2 years; <em>P</em> &lt; .001), and lower weight at surgery (median, 6.1 kg vs 8.6 kg; <em>P</em> &lt; .001) compared to those without PCT. Regarding surgical types, the most frequently performed operation was the Fontan procedure (20.5%), followed by repair of tetralogy of Fallot (TOF) with atrioventricular septal defect (11.8%), arterial switch operation (ASO), ventricular septal defect (VSD) closure, and aortic arch repair (10.0%). Younger age at operation (<em>P</em> &lt; .001; hazard ratio [HR], 0.745), the Fontan procedure (<em>P</em> &lt; .001; HR, 16.198), ASO, VSD closure, and aortic arch repair (<em>P</em> &lt; .001; HR, 2.835) were strong risk factors for PCT. Postoperative lower mean arterial pressure and higher central venous pressure were associated with PCT in patients following the Fontan procedure and TOF repair.</div></div><div><h3>Conclusions</h3><div>This large, single-center study of approximately 10,000 congenital heart surgeries reported a 3.2% incidence of PCT. The Fontan procedure had the highest incidence of PCT, followed by complex biventricular repair in neonates and young infants. Early postoperative lower mean arterial pressure and higher central venous pressure may trigger PCT.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102062"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214447","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":"Mitral repair for moderate ischemic mitral regurgitation in patients with end-stage ischemic cardiomyopathy","authors":"Yusuke Misumi MD, PhD,&nbsp;Daisuke Yoshioka MD, PhD,&nbsp;Shin Yajima MD, PhD,&nbsp;Takuji Kawamura MD, PhD,&nbsp;Ai Kawamura MD, PhD,&nbsp;Kazuma Handa MD,&nbsp;Akinobu Ohtani MD,&nbsp;Shunsuke Saito MD, PhD,&nbsp;Kazuo Shimamura MD, PhD,&nbsp;Shigeru Miyagawa MD, PhD,&nbsp;Osaka Cardiovascular Surgery Research study group","doi":"10.1016/j.xjon.2026.101963","DOIUrl":"10.1016/j.xjon.2026.101963","url":null,"abstract":"<div><h3>Objectives</h3><div>For patients with end-stage ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG), the indications for concomitant repair of moderate mitral regurgitation (MR) remain controversial. This study evaluated outcomes of concomitant mitral valve repair (MVr) for moderate ischemic MR in patients with advanced left ventricular (LV) remodeling and severely impaired LV function undergoing CABG.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 341 patients (mean age, 67 ± 9 years) with ischemic cardiomyopathy (LV ejection fraction, ≤40%) and less-than-severe MR who underwent CABG. Of these, 108 (32%) underwent concomitant MVr for clinically relevant moderate MR, and 233 (68%) underwent CABG alone for mild or absent MR. All patients had a prior myocardial infarction. The primary end point was overall survival. Secondary end points included postoperative changes in MR grade and LV function at 1 year. Median follow-up was 4.5 years (interquartile range, 2.4-7.3 years).</div></div><div><h3>Results</h3><div>Despite higher preoperative surgical risk in the CABG + MVr group (European System for Cardiac Operative Risk Evaluation II score, 6.7% vs 2.9%; <em>P</em> &lt; .001), 30-day mortality did not differ between groups (1.9% vs 2.1%; <em>P</em> = .88). Five-year overall survival was 73% versus 77% (log-rank <em>P</em> = .25). At 1 year, the CABG + MVr group demonstrated greater LV reverse remodeling (median LV end-diastolic volume index reduction: −26% vs −19%; <em>P</em> = .001), higher LV ejection fraction (46 ± 13% vs 42 ± 12%; <em>P</em> = .044), and a lower prevalence of significant MR (6% vs 13%; <em>P</em> = .032).</div></div><div><h3>Conclusions</h3><div>In patients with advanced ischemic cardiomyopathy and moderate MR, concomitant MVr can be performed with acceptable operative risk and promotes superior LV reverse remodeling. Long-term survival was comparable to patients with nonsignificant MR who did not require mitral intervention, suggesting that targeted mitral repair may normalize the adverse prognostic influence of moderate ischemic MR.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101963"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214473","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: Failing Fontan circulation: Equity in access to heart transplantation via experts in congenital heart disease","authors":"Igor E. Konstantinov MD, PhD, FRACS, OAM","doi":"10.1016/j.xjon.2026.102077","DOIUrl":"10.1016/j.xjon.2026.102077","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102077"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214485","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":"Atrioventricular septal defect and aortic arch obstruction: A challenging combination","authors":"Santiago Villar MD,&nbsp;Alisa Lu MD,&nbsp;Thao T. Wu AA,&nbsp;Tam T. Doan MD,&nbsp;Temitope Olarinde BS,&nbsp;Junsang Cho MD,&nbsp;Sarah K. Clunie BSN, RN,&nbsp;Michiaki Imamura MD,&nbsp;Jeffrey S. Heinle MD,&nbsp;Yishay Orr MD, PhD","doi":"10.1016/j.xjon.2026.102082","DOIUrl":"10.1016/j.xjon.2026.102082","url":null,"abstract":"<div><h3>Objective</h3><div>The combination of atrioventricular septal defect and aortic arch obstruction (AVSD-AAO) is rare and associated with significant morbidity and mortality. We characterized our institutional experience to identify variables influencing the surgical strategy and outcomes in this heterogeneous patient population.</div></div><div><h3>Methods</h3><div>A retrospective review was performed on all patients undergoing biventricular AVSD repair at Texas Children’s Hospital between January 1995 and August 2024. Patients with AVSD-AAO were identified and stratified by age at first intervention (neonates vs infants) and surgical strategy (staged vs concurrent repair). Kaplan-Meier survival estimates, competing risks analysis, and Wilcoxon rank-sum tests were employed in statistical analysis.</div></div><div><h3>Results</h3><div>Of 790 AVSD patients, 33 (4.2%) had concurrent AAO. Compared to AVSD without AAO, AVSD-AAO patients had significantly higher cumulative incidence of a left atrioventricular valve reoperation (32.2% vs 14.4%, <em>P</em> = .0006), left ventricular outflow flow tract obstruction repair (18% vs 4.7%, <em>P</em> = .0015), and the mortality (15-year survival, 77.6% vs 94.2%, <em>P</em> &lt; .0001). Staged repair with an initial arch repair followed by AVSD repair trended toward improved survival compared to concurrent repair (87.8% vs 67.0%, <em>P</em> = .13). Survival was not different between patients who underwent an initial intervention as neonates versus infants (81.9% vs 73.3%, <em>P</em> = .50).</div></div><div><h3>Conclusions</h3><div>AVSD-AAO carries substantially higher rates of reoperation and mortality compared with AVSD alone. AAO is the primary driver of surgical timing due to the frequent duct-dependent systemic blood flow; however, neonatal AVSD repair is challenging. Temporizing surgical interventions that optimize systemic and pulmonary blood flow may allow for somatic growth, the valve maturation, and the normalization of pulmonary vascular resistance prior to definitive repair.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102082"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214489","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":"Weekend versus weekday cardiac surgery: A comprehensive meta-analysis of more than 500,000 cases with meta-regression","authors":"Kristine Santos BSc, MD,&nbsp;Joo Young Belen Kim Kim,&nbsp;Clara Campoverde Fárez MD,&nbsp;Bezalel Hakkeem MD,&nbsp;Ghislain Irakoze Habiyambere,&nbsp;Mario Saul Lira-Castañeda MD,&nbsp;Tomasz Płonek MD, PhD, FEBCTS","doi":"10.1016/j.xjon.2026.101978","DOIUrl":"10.1016/j.xjon.2026.101978","url":null,"abstract":"<div><h3>Objectives</h3><div>The “weekend effect” describes worse outcomes with weekend hospital care, but its impact on cardiac surgery remains unclear. We performed a comprehensive meta-analysis and meta-regression to assess whether weekend cardiac surgery is associated with poorer perioperative outcomes than weekday procedures.</div></div><div><h3>Methods</h3><div>PubMed, Scopus, and the Cochrane Library were systematically searched for studies comparing weekend versus weekday cardiac surgery outcomes. Pooled odds ratios (ORs) and mean differences with 95% CIs were calculated using a random-effects model. Subgroup analyses were performed by procedure type (emergent, coronary artery bypass grafting, acute type A aortic dissection) and geographic region. Meta-regressions explored effects of mean age, percentage of female patients, proportion of emergent cases, and publication year. A day-by-day mortality heat map was constructed to assess daily trends.</div></div><div><h3>Results</h3><div>Seventeen studies comprising 527,195 patients were included; 7.4% underwent surgery on weekends. Weekend surgery was associated with significantly greater mortality (OR, 1.5; 95% CI, 1.2-1.8; <em>P</em> = .001) and longer stay in the intensive care unit (mean difference, 0.4 days; 95% CI, 0.1-0.7; <em>P</em> = .01). No significant differences were found for acute kidney injury, stroke, aortic crossclamp time, reoperation for bleeding, or total hospital stay. The incidence of transient ischemic attack was slightly lower on weekends (OR, 0.8; 95% CI, 0.6-1.0; <em>P</em> = .02). Subgroup analyses showed consistently elevated mortality in weekend cases across emergent, coronary artery bypass grafting, and acute type A aortic dissection subgroups, and in studies from Asia and the United States but not Europe. Meta-regression showed no significant effect of age, sex, emergent case proportion, or publication year on mortality differences.</div></div><div><h3>Conclusions</h3><div>Weekend cardiac surgery is associated with greater mortality and longer stay in the intensive care unit, independent of case mix. The absence of patient-level effect modification suggests that systemic or institutional factors, rather than patient acuity, underlie the weekend effect, supporting the need for policies ensuring consistent care across all days.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101978"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214522","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":"Five-year outcomes of chordal replacement therapy for primary mitral regurgitation: The CHAGALL (CHordArt System Study for the Treatment of Mitral ReGurgitAtion due to Leaflet ProLapse or fLail) study","authors":"Alberto Weber MD,&nbsp;Kestutis Rucinskas MD,&nbsp;Jodi Akin PhD,&nbsp;Maurizio Taramasso MD,&nbsp;Michel Zuber MD,&nbsp;Rolf Vogel MD, PhD,&nbsp;Andrej Podkopajev MD,&nbsp;Vilius Janusauskas MD,&nbsp;Diana Zakarkaite MD,&nbsp;Thomas Bauer MedIng,&nbsp;Thierry Carrel MD","doi":"10.1016/j.xjon.2026.102055","DOIUrl":"10.1016/j.xjon.2026.102055","url":null,"abstract":"<div><h3>Objectives</h3><div>The CHAGALL (CHordArt System Study for the Treatment of Mitral ReGurgitAtion due to Leaflet ProLapse or fLail) study is a prospective, first-in-human early feasibility study evaluating the technical feasibility, the long-term safety, and device durability of a novel chordal replacement system for the treatment of primary degenerative mitral regurgitation.</div></div><div><h3>Methods</h3><div>Five patients with symptomatic severe primary degenerative mitral regurgitation attributable to isolated central posterior leaflet prolapse or flail underwent surgical implantation of the ChordArt chordal replacement system through a left atrial approach under cardiopulmonary bypass combined with ring annuloplasty. Clinical and transthoracic echocardiographic follow-up was prospectively performed at discharge and through 60 months.</div></div><div><h3>Results</h3><div>Technical device success was achieved in all patients. Mitral regurgitation was reduced to none or trace immediately after implantation and remained stable throughout the 5-year follow-up. No device-related major adverse events, structural device failure, implant dislodgement, chordal rupture, reoperation, or rehospitalization occurred. Reverse cardiac remodeling was observed, including reduction in left ventricular end-diastolic diameter and left atrial volume, whereas left ventricular function remained preserved during long-term follow-up.</div></div><div><h3>Conclusions</h3><div>Surgical implantation of the ChordArt chordal replacement system was simple to perform and demonstrated excellent long-term technical durability and sustained clinical performance over 5 years. These findings support further clinical evaluation of this technology and the ongoing development of a fully transcatheter transseptal delivery platform.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102055"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214377","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}