JTCVS open最新文献

{"title":"A less-invasive left atrial assist device concept for diastolic heart failure: First in vitro and in vivo assessment","authors":"Chihiro Miyagi MD, PhD ,&nbsp;Taiyo Kuroda MD ,&nbsp;Barry D. Kuban BS ,&nbsp;Shengquiang Gao PhD ,&nbsp;Christine R. Flick BS, BME ,&nbsp;Anthony R. Polakowski BS, MEng ,&nbsp;Jamshid H. Karimov MD, PhD ,&nbsp;Kiyotaka Fukamachi MD, PhD","doi":"10.1016/j.xjon.2024.08.011","DOIUrl":"10.1016/j.xjon.2024.08.011","url":null,"abstract":"<div><h3>Objective</h3><div>A less-invasive left atrial assist device (LAADx) is a novel and implantable, extracardiac blood pump concept, intended for the treatment of diastolic heart failure, represented by heart failure with preserved ejection fraction.</div></div><div><h3>Methods</h3><div>A mixed-flow pump was used as the working LAADx model. Its performance was evaluated at 3 speeds, using an in vitro pulsatile mock circulatory loop, with a pneumatic pump that can simulate diastolic heart failure conditions by adjusting the diastolic drive pressure. The LAADx model was implanted in 4 healthy calves. The pump's inflow and outflow cannulas were inserted into the left atrium (LA) and left ventricle (LV), respectively, without cardiopulmonary bypass. The LAADx was operated at 3 speeds, and diastolic heart failure-like conditions were induced by inflating a balloon, inserted into the LV.</div></div><div><h3>Results</h3><div>With the in vitro study, diastolic heart failure-like conditions were successfully induced, exhibiting decreased cardiac output and aortic pressure as well as increased mean LA pressure both mitigated with the LAADx support. With regard to the in vivo study, simulated diastolic heart failure conditions showed a decrease in aortic pressure and an increase in LA pressure and LV end-diastolic pressure, which were again mitigated by the LAADx. Echocardiography showed good positioning of the outflow cannula and neither cardiac dysfunction nor mitral interference was observed.</div></div><div><h3>Conclusions</h3><div>Initial in vitro and in vivo results confirmed that the LAADx model, a device concept driven by creating an extracardiac route from the LA to LV, has the potential to mitigate high LA pressure and improve LV filling of heart failure with preserved ejection fraction pathology.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 180-190"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553538","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":"Extended aortic coverage in thoracic aortic endovascular repair is not associated with spinal cord ischemia","authors":"George C. Chachati MD ,&nbsp;Sarah Yousef MD ,&nbsp;James A. Brown MD ,&nbsp;Nishant Agrawal ,&nbsp;Shwetabh Tarun ,&nbsp;Kristian Punu ,&nbsp;Derek Serna-Gallegos MD, FACS ,&nbsp;Julie Phillippi PhD ,&nbsp;Ibrahim Sultan MD","doi":"10.1016/j.xjon.2024.08.010","DOIUrl":"10.1016/j.xjon.2024.08.010","url":null,"abstract":"<div><h3>Objective</h3><div>Spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) remains a debilitating complication, occurring in 10% of patients. Studies have shown that extended aortic coverage is a risk factor for SCI. This study evaluates whether extended aortic length coverage is a significant risk factor for SCI.</div></div><div><h3>Methods</h3><div>This study retrospectively reviewed 277 consecutive patients who underwent TEVAR successfully between 2006 and 2021 at a single institution. The patients were classified into 2 groups: ≥205 mm and &lt;205 mm of thoracic aortic coverage. Analysis of variance was used to compare these variables and associated aortic coverage between the 2 groups. Univariable logistical regression was used to compare SCI and associated factors.</div></div><div><h3>Results</h3><div>Of the 269 patients who underwent successful TEVAR, 127 (47.2%) had ≥205 mm and 142 (52.8%) had &lt;205 mm of aorta coverage. Patients with ≥205 mm of thoracic aorta coverage were more likely to be smokers (<em>P</em> &lt; .01) and to have a history of previous stroke (<em>P</em> &lt; .05). Patients with extended coverage were more likely to receive a preoperative lumbar drain (LD) (<em>P</em> &lt; .01). Extended aortic coverage was not associated with a higher risk of SCI compared to standard aortic coverage (4.7% vs 4.2%; <em>P</em> = .84). Extended aortic coverage with or without a preoperative LD did not have an association with SCI (<em>P</em> = .91). Type II endoleaks were seen more in extended aortic coverage (<em>P</em> &lt; .01).</div></div><div><h3>Conclusions</h3><div>Extended aortic coverage (compared with the standard approach) was not associated with a higher risk of SCI; however, this may have been mitigated by a higher prevalence of prophylactic lumbar drainage in this population.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 366-371"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553339","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":"Using machine learning to predict neurologic injury in venovenous extracorporeal membrane oxygenation recipients: An ELSO Registry analysis","authors":"Andrew Kalra BS ,&nbsp;Preetham Bachina BS ,&nbsp;Benjamin L. Shou BS ,&nbsp;Jaeho Hwang MD ,&nbsp;Meylakh Barshay BA ,&nbsp;Shreyas Kulkarni BS ,&nbsp;Isaac Sears BS ,&nbsp;Carsten Eickhoff PhD ,&nbsp;Christian A. Bermudez MD ,&nbsp;Daniel Brodie MD ,&nbsp;Corey E. Ventetuolo MD, MS ,&nbsp;Glenn J.R. Whitman MD ,&nbsp;Adeel Abbasi MD, ScM ,&nbsp;Sung-Min Cho DO, MHS","doi":"10.1016/j.xjon.2024.06.013","DOIUrl":"10.1016/j.xjon.2024.06.013","url":null,"abstract":"<div><h3>Background</h3><div>Venovenous extracorporeal membrane oxygenation (VV-ECMO) is associated with acute brain injury (ABI), including central nervous system (CNS) ischemia (defined as ischemic stroke or hypoxic-ischemic brain injury [HIBI]) and intracranial hemorrhage (ICH). Data on prediction models for neurologic outcomes in VV-ECMO are limited.</div></div><div><h3>Methods</h3><div>We analyzed adult (age ≥18 years) VV-ECMO patients in the Extracorporeal Life Support Organization (ELSO) Registry (2009-2021) from 676 centers. ABI was defined as CNS ischemia, ICH, brain death, and seizures. Data on 67 variables were extracted, including clinical characteristics and pre-ECMO/on-ECMO variables. Random forest, CatBoost, LightGBM, and XGBoost machine learning (ML) algorithms (10-fold leave-one-out cross-validation) were used to predict ABI. Feature importance scores were used to pinpoint the most important variables for predicting ABI.</div></div><div><h3>Results</h3><div>Of 37,473 VV-ECMO patients (median age, 48.1 years; 63% male), 2644 (7.1%) experienced ABI, including 610 (2%) with CNS ischemia and 1591 (4%) with ICH. The areas under the receiver operating characteristic curve for predicting ABI, CNS ischemia, and ICH were 0.70, 0.68, and 0.70, respectively. The accuracy, positive predictive value, and negative predictive value for ABI were 85%, 19%, and 95%, respectively. ML identified higher center volume, pre-ECMO cardiac arrest, higher ECMO pump flow, and elevated on-ECMO serum lactate level as the most important risk factors for ABI and its subtypes.</div></div><div><h3>Conclusions</h3><div>This is the largest study of VV-ECMO patients to use ML to predict ABI reported to date. Performance was suboptimal, likely due to lack of standardization of neuromonitoring/imaging protocols and data granularity in the ELSO Registry. Standardized neurologic monitoring and imaging are needed across ELSO centers to detect the true prevalence of ABI.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 140-167"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697796","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":"Regional variation in donation after circulatory death heart allograft utilization","authors":"Oliver K. Jawitz MD, MHS ,&nbsp;Adam D. Devore MD ,&nbsp;Chetan B. Patel MD ,&nbsp;Jeffrey E. Keenan MD ,&nbsp;Carmelo A. Milano MD ,&nbsp;Jacob N. Schroder MD","doi":"10.1016/j.xjon.2024.07.004","DOIUrl":"10.1016/j.xjon.2024.07.004","url":null,"abstract":"<div><h3>Objective</h3><div>Randomized data support transplantation of hearts from donors after circulatory death. This may lead to a sizeable increase in the donor pool. Regional variations in donors after circulatory death heart use were examined to help elucidate barriers to donor pool expansion.</div></div><div><h3>Methods</h3><div>The United Network for Organ Sharing deceased donor dataset was queried for adult (age ≥ 18 years) donors after circulatory death donors of at least 1 organ between January 2020 and December 2023. Donors were stratified by the extent their respective cardiac allografts progressed through the donation process. United Network for Organ Sharing region-level use rates and annual trends were assessed.</div></div><div><h3>Results</h3><div>Of 17,239 adult donors after circulatory death donors who donated at least 1 organ for transplant during the study period, 1196 (9.4%) were heart donors. Regional donors after circulatory death heart donor pursuit rates ranged from 97% to 100%, consent attainment rates from 94% to 99%, and heart recovery rates from 5% to 10%. The transplantation rate of recovered organs ranged from 90% to 97%. Multivariable logistic regression demonstrated United Network for Organ Sharing region to be independently associated with donors after circulatory death heart use after controlling for baseline differences in donor risk.</div></div><div><h3>Conclusions</h3><div>Transplantation of donors after circulatory death heart allografts has increased in the United States since 2020, but the overall number of hearts procured and transplanted from donors after circulatory death donors remains low. The operational barriers to transplantation of donors after circulatory death hearts require further investigation. Further, significant regional variation exists regarding rates of progression of donors after circulatory death hearts through the donation process. Sharing of successful practices among Organ Procurement Organizations and transplant centers will facilitate maximal use of this new donor pool.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 191-196"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838642","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: Are there etiology specific risk factors for adverse outcomes in patients with surgically implanted 5.5 liter temporary microaxial transvalvular left ventricular assist devices?","authors":"","doi":"10.1016/j.xjon.2024.07.006","DOIUrl":"10.1016/j.xjon.2024.07.006","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 138-139"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843201","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":"Discussion to: Outcomes of pediatric heart transplantation in children with selected genetic syndromes","authors":"","doi":"10.1016/j.xjon.2024.06.014","DOIUrl":"10.1016/j.xjon.2024.06.014","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 288-289"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553456","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":"Lung cancer screening among minority groups: Identifying gaps in screening and opportunities for intervention","authors":"Fatima G. Wilder MD, MSc, MPH ,&nbsp;Busra Cangut MD, MS ,&nbsp;Rajika Jindani MD, MPH, MS ,&nbsp;Oyepeju Abioye MD, MSc ,&nbsp;Narjust Florez MD","doi":"10.1016/j.xjon.2024.07.001","DOIUrl":"10.1016/j.xjon.2024.07.001","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 341-348"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141707274","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":"Replacing post–chest tube removal chest radiographs with clinical assessment in adult thoracic surgery patients: A single-center prospective study","authors":"Andreea C. Matei MD, MSc ,&nbsp;Awrad Nasralla MD ,&nbsp;Najib Safieddine MD, FRCSC ,&nbsp;Sayf Gazala MD, FRCSC ,&nbsp;Carmine Simone MD, FRCSC ,&nbsp;Negar Ahmadi MD, MSc, MPH, FRCSC","doi":"10.1016/j.xjon.2024.07.015","DOIUrl":"10.1016/j.xjon.2024.07.015","url":null,"abstract":"<div><h3>Objective</h3><div>The necessity and utility of chest radiographs in the absence of clinical symptoms have been questioned after chest tube removal. This study aimed to evaluate the impact of replacing routine chest radiographs after chest tube removal with clinical observation on outcomes in patients undergoing elective thoracic surgery.</div></div><div><h3>Methods</h3><div>This was a single-center prospective study of adult patients undergoing elective lung resection. Standard chest radiographs after chest tube removal were replaced with a clinical observation protocol for 2 hours after removal. Chest radiographs after chest tube removal were meant to be obtained only for symptomatic patients. The primary outcome was the incidence of adverse events related to this change. Secondary outcomes included changes in clinical management, length of stay, and postoperative complications.</div></div><div><h3>Results</h3><div>A total of 248 patients were included in the study period, and the majority (n = 185, 75%) did not have chest radiographs after chest tube removal. There was no significant difference in the incidence of adverse events or postoperative complications between patients who received chest radiographs and those who did not. Additionally, length of stay was significantly shorter in patients who did not receive chest radiographs (median 2.3 vs 3 days; <em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Clinical observation can safely replace routine chest radiographs after chest tube removal in asymptomatic patients undergoing elective thoracic surgery. This approach may lead to shorter hospital stays and reduced healthcare costs without compromising patient safety. The findings support a clinically driven use of postoperative imaging in this patient population, highlighting the importance of individualized patient care.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 358-365"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841548","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":"Reoperation after aortic root replacement and its impact on long-term survival","authors":"","doi":"10.1016/j.xjon.2024.05.003","DOIUrl":"10.1016/j.xjon.2024.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>Reoperation after aortic root replacement (ARR) is associated with increased operative risk and complexity. This study evaluated clinical outcomes and reoperation rates in patients undergoing ARR.</div></div><div><h3>Methods</h3><div>From 2004 to 2021, 2700 adult patients underwent an ARR in a 2-institution database. Among 2542 surviving patients, 705 patients who had a history of previous cardiac surgery as well as 11 patients who underwent transcatheter aortic valve replacement after index ARR were excluded. Among the finalized cohort of 1826 patients, 88 (4.8%) underwent a reoperation (REDO) on the aortic valve or proximal aorta (root/ascending) a mean of 3.1 years after index ARR whereas 1738 (95%) did not undergo reoperation (no-REDO). A subgroup analysis was performed among those undergoing reoperation by indication including valve dysfunction (48%), endocarditis/graft infection (33%), and aortic aneurysm/dissection/rupture (12%). Reoperative indication was unknown in 6 patients (7%).</div></div><div><h3>Results</h3><div>The REDO group was younger at time of index ARR (52 vs 58 years, <em>P</em> &lt; .0001) and had more bicuspid aortic valves (56% vs 37%, <em>P</em> = .0003). Most patients underwent modified Bentall ARR (61%), whereas 38% underwent a valve-sparing root replacement. Index root operations were similar between groups. At time of reoperation, 53% underwent aortic valve replacement and 35% underwent redo root replacement. Long-term survival was similar between REDO and no-REDO groups (80% vs 85%, <em>P</em> = .26) and reoperation was not a risk factor for late mortality (hazard ratio, 1.31; <em>P</em> = .26); however, REDO ARR was a risk factor for late mortality (hazard ratio, 2.41; <em>P</em> = .02).</div></div><div><h3>Conclusions</h3><div>The incidence of aortic valve and/or proximal aorta reoperation after index ARR is relatively low at 4.8%; however, root reoperation is a risk factor for late mortality.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 45-57"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141131395","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":"Tricuspid valve surgery for acute infective endocarditis can be performed with very low operative mortality","authors":"Ali Darehzereshki MD,&nbsp;J. Hunter Mehaffey MD, MSc,&nbsp;J.W. Awori Hayanga MD, MPH,&nbsp;Lawrence Wei MD,&nbsp;Taylor D'etcheverry PA-C,&nbsp;Luigi F. Lagazzi MD,&nbsp;Vinay Badhwar MD","doi":"10.1016/j.xjon.2024.06.012","DOIUrl":"10.1016/j.xjon.2024.06.012","url":null,"abstract":"<div><h3>Objective</h3><div>Tricuspid valve surgery historically has been perceived as having elevated operative risk, prompting the recent development of transcatheter therapies including aspiration vegetectomy for endocarditis. The opioid epidemic has exacerbated tricuspid valve endocarditis, particularly in people who inject drugs. We sought to evaluate contemporary outcomes of tricuspid valve surgery in real-world practice.</div></div><div><h3>Methods</h3><div>An institutional multidisciplinary endocarditis database inclusive of clinical, microbiologic, and echocardiographic data was analyzed for those undergoing isolated or concomitant tricuspid valve surgery for acute active endocarditis. Consecutive patients between 2016 and 2021 were followed for longitudinal outcomes.</div></div><div><h3>Results</h3><div>A total of 283 patients with tricuspid valve endocarditis underwent tricuspid valve repair (n = 137, 48.4%) or replacement (n = 146, 51.6%). Median age was 31 (27-37) years, 63.1% were female, and 257 (90.8%) were active people who inject drugs. The leading indications for surgery were severe valvular insufficiency (71.2%), vegetation size greater than 2 cm (51.3%), or septic shock (23.3%). Concomitant procedures were performed in 44 patients (15.5%). In patients who underwent isolated tricuspid valve surgery (n = 239), no patient required permanent pacemaker after tricuspid valve repair, whereas 13.3% required permanent pacemaker after tricuspid valve replacement. Overall and isolated tricuspid valve surgery operative mortality were 1.8% and 1.3%, respectively. Overall and isolated tricuspid valve surgery 1-year survivals were 89.3% and 89.7%, respectively.</div></div><div><h3>Conclusions</h3><div>Tricuspid valve surgery for endocarditis has low operative mortality. When feasible, repair is preferred over replacement. In an era of promulgation of investigational therapies, heart teams should note that tricuspid valve surgery is low risk and remains the first-line beyond antibiotics.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 67-75"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553618","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}