JTCVS open最新文献

{"title":"Reply to the commentary of Soletti and colleagues","authors":"Tomas Gudbjartsson MD, PhD , Luis Gisli Rabelo BSc , Igor Zindovic MD, PhD","doi":"10.1016/j.xjon.2025.01.004","DOIUrl":"10.1016/j.xjon.2025.01.004","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Page 270"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854582","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":"Patients from distressed communities have decreased survival after open thoracic aneurysm repair","authors":"Gerardo Ramos-Lemos BSc,&nbsp;Kavya Rajesh BSc,&nbsp;Dov Levine MD, PhD,&nbsp;Yanling Zhao MS, MPH,&nbsp;Yu Hohri MD, PhD,&nbsp;Thomas F.X. O'Donnell MD,&nbsp;Virendra Patel MD, MPH,&nbsp;Hiroo Takayama MD, PhD,&nbsp;Paul Kurlansky MD","doi":"10.1016/j.xjon.2025.01.012","DOIUrl":"10.1016/j.xjon.2025.01.012","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates the relationship between the Distressed Communities Index and long-term mortality in thoracic aortic aneurysm repair.</div></div><div><h3>Methods</h3><div>This single-center retrospective study includes patients who underwent open thoracic aortic aneurysm repair between 2005 and 2021. The Distressed Communities Index served as a metric for socioeconomic status by providing distress scores for each patient's zip code. Patients were placed into the nondistressed group with a score of 50 or less or the distressed group with a score greater than 50. The primary outcome of this study was 10-year mortality. Multivariable Cox regression evaluated factors associated with long-term mortality while accounting for patient demographics and operative characteristics.</div></div><div><h3>Results</h3><div>Of 1317 patients, 31% (n = 409) comprised the distressed group, which had higher rates of hypertension (<em>P</em> = .002), chronic obstructive pulmonary disease (<em>P</em> = .03), diabetes (<em>P</em> = .008), cerebrovascular disease (<em>P</em> = .04), and chronic kidney disease (<em>P</em> = .04). This group also experienced higher rates of surgical site infection (<em>P</em> = .02), postoperative respiratory failure (<em>P</em> = .006), and longer hospital stays (<em>P</em> &lt; .001), as well as decreased survival probability at 1 year (<em>P</em> &lt; .001) and beyond (<em>P</em> = .03). Multivariable logistic regression revealed that being in the distressed group was independently associated with increased long-term mortality risk (hazard ratio, 1.66; <em>P</em> = .005).</div></div><div><h3>Conclusions</h3><div>Being from a distressed community is associated with worse long-term mortality after thoracic aortic aneurysm repair. Socioeconomic status should be considered in surgical planning to improve patient outcomes and dismantle healthcare disparities.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 472-483"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854863","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":"Postcardiotomy extracorporeal membrane oxygenation after elective, urgent, and emergency cardiac operations: Insights from the PELS observational study","authors":"Silvia Mariani MD ,&nbsp;Alvaro Perazzo MD, MSc ,&nbsp;Maria Elena De Piero MD ,&nbsp;Bas C.T. van Bussel PhD ,&nbsp;Michele Di Mauro PhD ,&nbsp;Dominik Wiedemann PhD ,&nbsp;Sven Lehmann PhD ,&nbsp;Matteo Pozzi PhD ,&nbsp;Antonio Loforte PhD ,&nbsp;Udo Boeken PhD ,&nbsp;Robertas Samalavicius PhD ,&nbsp;Karl Bounader MD ,&nbsp;Xiaotong Hou PhD ,&nbsp;Jeroen J.H. Bunge MD ,&nbsp;Kogulan Sriranjan MD ,&nbsp;Leonardo Salazar MD ,&nbsp;Bart Meyns PhD ,&nbsp;Michael A. Mazzeffi PhD ,&nbsp;Sacha Matteucci MD ,&nbsp;Sandro Sponga PhD ,&nbsp;Roberto Lorusso PhD","doi":"10.1016/j.xjon.2025.01.018","DOIUrl":"10.1016/j.xjon.2025.01.018","url":null,"abstract":"<div><h3>Background</h3><div>Outcomes in cardiac surgery are influenced by surgical priority, with higher mortality in emergency cases. Whether this applies to postcardiotomy venoarterial (VA) extracorporeal membrane oxygenation (ECMO) remains unknown. This study describes characteristics and outcomes of patients undergoing cardiac operations and requiring VA ECMO, stratified by emergency, urgent, or elective operation.</div></div><div><h3>Methods</h3><div>This retrospective multicenter observational study included adults requiring postcardiotomy VA ECMO between 2000 and 2020. Preoperative and procedural characteristics, complications, and survival were compared among the 3 patient groups. The association between emergency surgery and in-hospital survival was investigated through mixed Cox proportional hazard models.</div></div><div><h3>Results</h3><div>The study cohort comprised 1063 patients (52.2%) with elective operations, 445 (21.8%) with urgent operations, and 528 (26%) with emergency operations. Emergency operations included more coronary artery bypass grafting operations (n = 286; 54.2%; <em>P</em> &lt; .001) and aortic procedures (n = 126; 23.9%; <em>P</em> = .001) in patients with more unstable preoperative hemodynamic conditions compared to elective and urgent patients. VA ECMO was initiated more frequently intraoperatively in emergency patients (n = 353; 66.9%; <em>P</em> &lt; .001). Postoperative bleeding (n = 338; 64.3%; <em>P</em> &lt; .001), stroke (n = 79; 15%; <em>P</em> &lt; .001), and right ventricular failure (n = 124; 25.3%) were more frequent after emergency operations. In-hospital mortality was 60.5% in the elective group, 57.8% in the urgent group, 63.4% in the emergency group (<em>P</em> = .191). The crude hazard ratio for in-hospital mortality in emergency surgery was 1.15 (95% confidence interval [CI], 1.01-1.32; <em>P</em> = .039) and dropped to 1.09 (95% CI, 0.93-1.27; <em>P</em> = .295) after adjustment for indicators of preoperative instability. 5-year survival was comparable in 30-day survivors (<em>P</em> = .083).</div></div><div><h3>Conclusions</h3><div>One-quarter of postcardiotomy VA ECMOs are implemented after emergency operations. Despite more complications in emergency cases, in-hospital and 5-year survival are comparable between emergency, urgent, or elective operations.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 280-310"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854584","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":"Valve-sparing aortic root replacement: Strategies to avoid residual aortic regurgitation","authors":"Fabian A. Kari MD ,&nbsp;Martin Czerny MD, PhD ,&nbsp;Michael Borger MD, PhD ,&nbsp;Martin Misfeld MD, PhD ,&nbsp;Emmanuel Zimmer MD ,&nbsp;Matthias Siepe MD ,&nbsp;Christian Hagl MD ,&nbsp;Christian Detter MD ,&nbsp;Johannes Petersen MD ,&nbsp;Doreen Richardt MD ,&nbsp;Stephan Ensminger MD ,&nbsp;Paul Werner MD ,&nbsp;Martin Andreas MD ,&nbsp;Maximilian Pichlmaier MD ,&nbsp;Christoph S. Mueller MD","doi":"10.1016/j.xjon.2025.02.015","DOIUrl":"10.1016/j.xjon.2025.02.015","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to identify quantitative criteria to avoid residual aortic valve regurgitation after valve-sparing aortic root replacement.</div></div><div><h3>Methods</h3><div>Between 2016 and 2023, 738 adult patients were recruited into the German Aortic Root Repair Registry. A total of 562 patients with datasets on aortic root measurements and tricuspid valve treated with reimplantation valve-sparing aortic root replacement were selected. End points were any grade of residual aortic valve regurgitation and postrepair coaptation height. Tested variables included procedural and anatomic characteristics, including length of cusp margins and geometric cusp heights.</div></div><div><h3>Results</h3><div>The optimal classifier predicting freedom from residual aortic valve regurgitation was cusp coaptation height 8 to 9 mm or more (sensitivity = 0.7-0.8). Annular downsizing alone was not useful to predict residual aortic valve regurgitation (<em>P</em> = .472, 95% area CI, 0.414-0.54). Patients with a mean free margin length of at least 45 mm and a sum of free margin lengths of at least 125 mm were more likely to present coaptation heights of at least 10 mm (R2 0.038, <em>P</em> = .006).</div></div><div><h3>Conclusions</h3><div>The target coaptation height after valve-sparing aortic root replacement should exceed 8 to 9 mm. Chances of achieving it can be estimated on the basis of a measurement of cusp quantity. If in doubt when inspecting a valve, numerical criteria can help with surgical decision-making in favor of or against a valve-sparing approach.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 85-95"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854625","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":"The current landscape and challenges facing international medical graduates in cardiothoracic surgery training","authors":"Kelly A. McGovern MD ,&nbsp;Anastasiia K. Tompkins BS ,&nbsp;Louis F. Chai MD ,&nbsp;Simran Randhawa MD ,&nbsp;Vignesh Raman MD ,&nbsp;Jessa Cintron BA ,&nbsp;Gokcen Tugral-Gurk JD ,&nbsp;Joseph Coselli MD ,&nbsp;Michael Jaklitsch MD ,&nbsp;David T. Cooke MD ,&nbsp;Cherie P. Erkmen MD","doi":"10.1016/j.xjon.2024.12.016","DOIUrl":"10.1016/j.xjon.2024.12.016","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 527-533"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854716","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":"Graft patency of no-touch versus conventionally harvested saphenous vein conduits in coronary artery bypass grafting: A frequentist and Bayesian meta-analysis of randomized trials","authors":"Mimi X. Deng MD ,&nbsp;Zhenyu Li MSc ,&nbsp;Dominique Vervoort MD, MPH, CPH, MBA ,&nbsp;Rebecca N. Evan PhD ,&nbsp;Stephen E. Fremes MD, MSc","doi":"10.1016/j.xjon.2025.02.007","DOIUrl":"10.1016/j.xjon.2025.02.007","url":null,"abstract":"<div><h3>Background</h3><div>No-touch (NT) saphenous vein harvest is a technique that minimizes intimal injury and has been shown to improve patency. This study aimed to directly compare NT saphenous vein grafts (SVGs) to conventional skeletonized (CON) SVGs through a meta-analysis.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted for randomized controlled trials comparing the angiographic patency of NT-SVG and CON-SVG. The primary outcome was graft occlusion as a proportion of the total grafts assessed. Secondary outcomes were graft occlusion per patient, all-cause mortality, and leg wound complications. A random-effects model using a frequentist approach and Bayesian analysis were performed.</div></div><div><h3>Results</h3><div>A total of 235 studies were retrieved, of which 7 ultimately were chosen for analysis, with a total of 3334 randomized patients and 5798 SVGs. The pooled estimated age was 63.5 and 62.8 years for NT and CON, respectively, with approximately 14% of patients being women. The weighted mean angiographic follow-up was 11.6 months. Relative to CON-SVG, NT-SVG was associated with lower rates of graft occlusion per graft (relative risk [RR], 0.57; 95% confidence interval [CI], 0.46-0.72; <em>P</em> &lt; .001) and per patient (RR, 0.61; 95% CI, 0.46–0.79; <em>P</em> &lt; .001), comparable all-cause mortality (RR, 1.12; 95% CI, 0.56-2.25; <em>P</em> = .75), and a higher rate of leg wound complications (RR, 2.32; 95% CI, 1.78-3.02; <em>P</em> &lt; .001). Findings for occlusion per graft were consistent with Bayesian analysis (RR, 0.57; 95% credible interval, 0.41-0.79).</div></div><div><h3>Conclusions</h3><div>Compared to CON, NT confers significantly better patency and equivalent survival but poorer harvest site healing. The clinical benefit of NT remains uncertain, and further evidence is needed.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 185-205"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854722","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":"Role of a multidisciplinary team approach in the management of chronic thromboembolic pulmonary hypertension","authors":"Benjamin Yang MD ,&nbsp;Anthony Zaki MD ,&nbsp;Nicholas Oh MD ,&nbsp;Juan Umana-Pizano MD ,&nbsp;Ihab Haddadin MD ,&nbsp;Alice Goyanes MD ,&nbsp;Nicholas Smedira MD, MBA ,&nbsp;Haytham Elgharably MD ,&nbsp;Michael Zhen-Yu Tong MD, MBA ,&nbsp;Gustavo A. Heresi MD, MS","doi":"10.1016/j.xjon.2024.12.011","DOIUrl":"10.1016/j.xjon.2024.12.011","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic thromboembolic pulmonary hypertension (CTEPH) is an under-recognized complication of pulmonary embolism that, if left untreated, leads to heart failure. This study aimed to characterize the role of a multidisciplinary team in the management of CTEPH.</div></div><div><h3>Methods</h3><div>Starting in 2011, a multidisciplinary team was assembled to systematically evaluate and manage all CTEPH patients based on hemodynamic profile, extent of thromboembolic disease burden, and comorbidities. From 1997 to 2021, 306 patients underwent pulmonary thromboendarterectomy for CTEPH. The cohort was divided into an early era prior to 2011 (62 cases) and a recent era from 20,211 to 2021 (244 cases).</div></div><div><h3>Results</h3><div>Baseline demographic and hemodynamic profiles were similar in the 2 eras, with a mean age of 53 ± 14 years, mean pulmonary artery pressure of 44.9 ± 11.2 mm Hg, and mean pulmonary vascular resistance of 7.4 ± 3.9 Wood units. Early era patients had more severe right ventricular dysfunction (49.1% vs 25.0%; <em>P</em> &lt; .001). Recent era patients underwent more concomitant tricuspid valve repairs (22% vs 2.9%; <em>P</em> &lt; .001) despite similar tricuspid regurgitation severity. Following surgery, recent era patients had lower in-hospital mortality (2.9% vs 12%) with less morbidity, including less prolonged ventilation (32% vs 59%), less need for dialysis (1.6% vs 21%), and shorter hospital length of stay (16 days vs 21 days). The difference in survival was sustained long-term (88% vs 70% at 6 years).</div></div><div><h3>Conclusions</h3><div>Outcomes after pulmonary thromboendarterectomy improved since the establishment of the multidisciplinary team—most notably, more complete resolution of pulmonary hypertension and improved overall survival. A team-based approach for selection and perioperative management of these complex patients can be associated with improved early outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 147-155"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854577","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 gender differences on optimal oxygen delivery thresholds to prevent acute kidney injury in cardiac surgeries with cardiopulmonary bypass","authors":"Tomoya Oshita CE ,&nbsp;Arudo Hiraoka MD, PhD ,&nbsp;Kosuke Nakajima CE ,&nbsp;Ryosuke Muraki CE ,&nbsp;Masahisa Arimichi CE ,&nbsp;Genta Chikazawa MD, PhD ,&nbsp;Hidenori Yoshitaka MD, PhD","doi":"10.1016/j.xjon.2025.01.001","DOIUrl":"10.1016/j.xjon.2025.01.001","url":null,"abstract":"<div><h3>Background</h3><div>The nadir oxygen delivery index (DO₂i) during cardiopulmonary bypass (CPB) is reportedly associated with acute kidney injury (AKI) in patients undergoing cardiac surgery. However, there are few reports on the relationship between patient sex and the nadir DO₂i threshold to prevent AKI. The aim of this study was to seek and evaluate the optimal DO₂i threshold differences between males and females to avoid AKI during on-pump cardiac surgery.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed a total of 430 patients who underwent cardiac surgery between March 2017 and February 2023. A receiver operating characteristic analysis and univariable and multivariable regression analyses were performed to evaluate the association between perioperative variables, including the nadir DO₂i and incidence of AKI, in males and females.</div></div><div><h3>Results</h3><div>The nadir DO₂i was significantly lower (median, 294 [interquartile range (IQR), 272-317] mL/min/m² versus 277 [IQR, 262-295] mL/min/m²; <em>P</em> &lt; .001) and cumulative time below the DO₂i of 270 mL/min/m² was longer (0.3 [IQR, 0-4.2] minutes vs 3.0 [IQR, 0-11.7] minutes; <em>P</em> &lt; .001) in the female patients. However, the incidence rate of AKI was similar in males and females (15.2% [n = 39/256] vs 16.7% [n = 29/174]; <em>P</em> = .68). The best cut-off values of nadir DO₂i for AKI were &lt;301 mL/min/m² (sensitivity, 82.1%; specificity, 39.5%) in males and &lt;273 mL/min/m² (sensitivity, 69.0%; specificity, 61.4%) in females.</div></div><div><h3>Conclusions</h3><div>The optimal DO₂i to prevent AKI during cardiac surgery differs between males and females. Therefore, CPB management should be adjusted by sex based on the different cut-off values of nadir DO₂i.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 271-279"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854583","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":"Midterm outcomes of thoracic endovascular aortic repair versus optimal medical therapy for uncomplicated acute type B dissection","authors":"Kevin G. Hu BS ,&nbsp;Wei-Guo Ma MD ,&nbsp;Stevan Pupovac MD ,&nbsp;Irbaz Hameed MD ,&nbsp;Soraya Fereydooni MD ,&nbsp;Eric S. Li MD ,&nbsp;Haleigh Larson MD ,&nbsp;Mohammad Zafar MBBS ,&nbsp;Britt Tonnessen MD ,&nbsp;Jonathan Cardella MD ,&nbsp;Eduard Aboian MD ,&nbsp;Raul Guzman MD ,&nbsp;Cassius Ochoa Chaar MD ,&nbsp;David Strosberg MD ,&nbsp;Matthew Williams MD ,&nbsp;Naiem Nassiri MD ,&nbsp;Roland Assi MD ,&nbsp;Prashanth Vallabhajosyula MD, MS","doi":"10.1016/j.xjon.2024.12.013","DOIUrl":"10.1016/j.xjon.2024.12.013","url":null,"abstract":"<div><h3>Objective</h3><div>We sought to compare the early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) versus optimal medical therapy (OMT) for uncomplicated acute type B aortic dissection.</div></div><div><h3>Methods</h3><div>Data were analyzed for 200 consecutive patients with uncomplicated acute type B aortic dissection from February 1992 to July 2022, including 147 with initial OMT and 53 undergoing TEVAR at index hospitalization. Baseline, intraoperative, and postoperative data, survival, and (re)intervention were compared between the two strategies.</div></div><div><h3>Results</h3><div>In-hospital/30-day mortality was 7.5% (15/200) for the entire series, which was significantly lower in the TEVAR group compared with the OMT group (0 vs 10.2% [15/147]; <em>P</em> = .013). Thirty-day rates were 5.7% (3/53) for reintervention after TEVAR and 15.6% (23/147) for intervention after OMT (<em>P</em> = .064). Death within 30 days of (re)intervention was 0 (n = 0) in the TEVAR group and 18.4% (n = 14) in the OMT group (<em>P</em> = .063). There were no significant differences in the incidences of stroke, paraplegia, acute kidney injury, sepsis, or malperfusion syndrome after initial treatment. Kaplan–Meier survival in the TEVAR group was 92.3% (95% CI, 80.7-97.0) at 1 year and 3 years, significantly higher than in the OMT group (80.3% [95% CI, 72.8-85.8] and 71.4% [95% CI, 63.4-78.0]; <em>P</em> = .012). In patients aged 65 years or more, TEVAR also achieved a significantly higher survival, which was 93.7% (95% CI, 77.5-98.3 vs 69.7% [95% CI, 58.0-78.7]) at 1 year and 93.7% (95% CI, 77.3-98.3] vs 60.5% [95% CI, 48.7-70.5]) at 3 years (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>In this single-institution experience, upfront TEVAR performed at index hospitalization for uncomplicated acute type B aortic dissection was associated with improved survival at early and midterm follow-up.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 67-76"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854675","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":"Delays in phases of care from identification to treatment of suspicious lung nodules","authors":"Nihar Rama BS ,&nbsp;Rachel Nordgren PhD ,&nbsp;Aliya N. Husain MD ,&nbsp;Aditya Juloori MD ,&nbsp;Christine M. Bestvina MD ,&nbsp;Rajat Thawani MD ,&nbsp;Marina Garassino MD ,&nbsp;Septimiu Murgu MD ,&nbsp;Ajay Wagh MD, MS ,&nbsp;D. Kyle Hogarth MD ,&nbsp;Carrie Barth MS ,&nbsp;Darren Bryan MD ,&nbsp;Mark K. Ferguson MD ,&nbsp;Jessica Donington MD ,&nbsp;Maria Lucia Madariaga MD","doi":"10.1016/j.xjon.2025.01.006","DOIUrl":"10.1016/j.xjon.2025.01.006","url":null,"abstract":"<div><h3>Objectives</h3><div>Shorter time to lung cancer diagnosis and treatment is associated with improved outcomes. We analyzed the time spent from nodule identification to treatment to identify targets for improving the timeliness of suspicious lung nodule care in a diverse patient population.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of patients with suspicious lung nodules (suspected clinical stage I/II primary lung cancer) at a single academic medical center (2020-2022). Patients with suspected stage III/IV or nonprimary lung cancers were excluded. Multivariable Cox regressions were performed to assess factors associated with timeliness of care.</div></div><div><h3>Results</h3><div>Of 157 patients, 59% were female, 53% were Black, and mean age was 70 ± 8.6 years. Nodules were identified incidentally (52%) or via screening (48%). Treatment was surgery in 52% and stereotactic body radiotherapy in 44%, and 10.2% were benign. Median (interquartile range) times from referral to diagnosis and from referral to treatment were 34 (22-56) days and 65 (44-84) days, respectively. Consultation to biopsy (20 [12-34] days) and diagnosis to treatment (28 [8-43] days) were the longest phases of care. Longer time from referral to diagnosis was associated with Black race and widowed status, whereas longer time from referral to treatment was associated with female gender, widowed status, frailty, body mass index greater than 18.5, Eastern Cooperative Oncology Group performance status less than 2, bronchoscopic biopsy, and treatment with stereotactic body radiotherapy.</div></div><div><h3>Conclusions</h3><div>Increased time spent in suspicious lung nodule care is associated with demographic, social, and clinical factors. The longest phases are time from consultation to biopsy and from diagnosis to treatment. Improving multidisciplinary care coordination for vulnerable patient populations could improve the timeliness of suspicious lung nodule care.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 451-471"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854868","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}