JTCVS open最新文献

{"title":"Substance use disorder–associated tricuspid endocarditis: Staged surgery from valvectomy to replacement","authors":"Joshua G. Crane MD,&nbsp;Toyokazu Endo MD,&nbsp;Jaimin R. Trivedi MD, MPH,&nbsp;Brian L. Ganzel MD,&nbsp;Sharini Shah MS,&nbsp;Siddharth V. Pahwa MD,&nbsp;Mark S. Slaughter MD,&nbsp;Michele Gallo MD","doi":"10.1016/j.xjon.2026.101957","DOIUrl":"10.1016/j.xjon.2026.101957","url":null,"abstract":"<div><h3>Objectives</h3><div>Optimal surgical treatment of infective tricuspid infective endocarditis (TVIE) is controversial in the setting of active substance use. This study evaluated patients who had endocarditis that was not amenable to tricuspid valve repair. In these patients, a valvectomy was performed to remove the diseased tissue. Patients were then offered a subsequent tricuspid valve replacement after proper follow-up and drug abstinence.</div></div><div><h3>Methods</h3><div>A single-center database was queried (2015-2025) to identify adults who underwent valvectomy for TVIE not amenable to repair after failed medical therapy and persistent positive blood cultures. Patients who underwent valvectomy with documented intravenous drug abstinence for 6 months were considered for staged tricuspid valve replacement (sTVR). Patients with persistent drug use did not receive further surgical treatment. Baseline characteristics, outcomes, and survival were evaluated.</div></div><div><h3>Results</h3><div>In total, 153 patients underwent surgical treatment for TVIE. Tricuspid valvectomy was required in 51 patients. Of the patients, 66% were female, with a median age of 30 years. There were 2 operative mortalities (3.9%). The 1-, 5-, and 8-year survival was 91%, 62%, and 51%, respectively; 26 (51%) received an sTVR and 25 (49%) did not receive sTVR (non-sTVR). In those that received an sTVR, there were 0 operative mortalities, median postoperative length of stay was 6 days, and median hours in the intensive care unit was 30. Intravenous drug use relapse after sTVR was present in 57.7% of patients. Survival at 1 and 5 years after the sTVR was 100% and 60%.</div></div><div><h3>Conclusions</h3><div>Tricuspid valvectomy is an acceptable initial treatment in high-risk patients. Tricuspid valve replacement after completing an abstinence program from intravenous drugs for 6 months has acceptable outcomes in a complex patient population. Further study of long-term outcomes is warranted.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101957"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214378","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":"Low palmar arch velocity does not predict hand dysfunction after radial artery harvest: A prospective analysis of duplex ultrasonography","authors":"Jonathan J. Szeto BA,&nbsp;James Lao BA,&nbsp;Pamela Beniwal BA,&nbsp;Miranda Song BS,&nbsp;Waseem Lutfi MD,&nbsp;Victor Xu BA,&nbsp;Marisa Konig MN,&nbsp;Ziwei Pan MS,&nbsp;Pablo Kurzan BA,&nbsp;Sankrit Kapoor BS,&nbsp;Jennifer J. Chung MD,&nbsp;Michael Ibrahim MD, PhD,&nbsp;Wilson Y. Szeto MD,&nbsp;Chase R. Brown MD, MS","doi":"10.1016/j.xjon.2026.102065","DOIUrl":"10.1016/j.xjon.2026.102065","url":null,"abstract":"<div><h3>Objectives</h3><div>Preoperative assessment of radial artery suitability commonly relies on the Allen test, a subjective bedside maneuver. We evaluated whether duplex ultrasonography flow metrics predict postoperative hand function after radial artery harvest for coronary artery bypass grafting.</div></div><div><h3>Methods</h3><div>Patients undergoing elective coronary artery bypass grafting (October 2024 to February 2026) with an appropriate second arterial conduit target underwent preoperative Allen testing and upper-extremity duplex ultrasonography, including palmar arch velocity with radial artery occlusion (PAVRO) and ulnar augmentation (percentage increase in ulnar artery flow with radial occlusion). Hand function (grip and pinch strength, fatigue, and dexterity) and patient-reported symptoms were measured preoperatively and at 1 month. Analysis of covariance and logistic regression models were adjusted for baseline hand function, age, sex, and the presence of diabetes.</div></div><div><h3>Results</h3><div>Thirty-nine patients underwent radial harvest with complete follow-up. Low PAVRO was not associated with postoperative change in any hand function metrics. Increased ulnar augmentation was associated with greater postoperative mean grip strength (<em>P</em> = .017) and fatigue resistance (<em>P</em> = .002); no patient with ulnar augmentation &gt;40% had a clinically meaningful (&gt;20%) decrease in grip strength. Allen test results had low concordance with duplex ultrasonography: 11 of 23 patients deemed unsuitable by duplex had a normal Allen test result at the 3-second threshold, and 13 of 47 harvested patients had an abnormal Allen test results.</div></div><div><h3>Conclusions</h3><div>Low PAVRO does not predict hand dysfunction after radial artery harvest, whereas lower ulnar augmentation may better identify patients at risk of grip strength decrease postoperatively. Duplex ultrasonography provides objective flow metric data and should be prioritized in preoperative assessment.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102065"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214379","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":"Saphenous vein grafts from thigh versus calf: Comparison of angiographic patency and clinical outcomes","authors":"Suk Ho Sohn MD, PhD,&nbsp;Hee Ju Hong MD,&nbsp;Suji Oh MD,&nbsp;Yuri Lee MD,&nbsp;Yoonjin Kang MD, PhD,&nbsp;Jae Woong Choi MD, PhD,&nbsp;Ho Young Hwang MD, PhD","doi":"10.1016/j.xjon.2026.102079","DOIUrl":"10.1016/j.xjon.2026.102079","url":null,"abstract":"<div><h3>Objectives</h3><div>This study compared angiographic patency and clinical outcomes between patients who received saphenous vein (SV) grafts from the upper leg (UL) and those who received grafts from the lower leg (LL) for coronary artery bypass grafting (CABG).</div></div><div><h3>Methods</h3><div>A total of 1630 patients who received primary isolated off-pump CABG using the SV harvested via the no-touch technique from the UL (UL group, n = 203) or the LL (LL group, n = 1427) were enrolled in this study. Propensity score matching was performed, and 202 pairs were matched. Early, 1-year, and 5-year graft angiograms were obtained for 99.5%, 85.7%, and 31.2% of the cohort, respectively. The median follow-up duration was 85.8 months. The primary outcome was midterm angiographic patency, and the secondary outcomes were midterm clinical outcomes.</div></div><div><h3>Results</h3><div>There was no significant difference in baseline characteristics between the matched groups. Early clinical outcomes, including operative mortality (0.8%, 13 out of 1630), demonstrated no intergroup differences. Angiographic patency for SV grafts was not significantly different at early (98.3% vs 98.5% in the UL group vs the LL group, <em>P</em> = .80), 1-year (94.8% vs 95.4% in the UL group vs the LL group, <em>P</em> = .74), or 5-year evaluation (97.8% vs 96.0% in the UL group vs the LL group, <em>P</em> = .43). Midterm survival up to 7 years was comparable between the groups (<em>P</em> = .81).</div></div><div><h3>Conclusions</h3><div>SV grafts from the UL demonstrated comparable 5-year angiographic patency and 7-year clinical outcomes compared with those from the LL during off-pump CABG.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102079"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214380","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":"Evaluating the impact of electronic reminders for primary care physicians on lung cancer–screening rates","authors":"Devanish N. Kamtam MBBS, MS,&nbsp;Carolyn C. Chang MD,&nbsp;Yingjie Weng MHS,&nbsp;Irmina A. Elliott MD,&nbsp;Brandon Guenthart MD,&nbsp;Douglas Z. Liou MD,&nbsp;Leah M. Backhus MD,&nbsp;Mark F. Berry MD,&nbsp;Joseph B. Shrager MD,&nbsp;Anuradha J. Phadke MD,&nbsp;Summer Han PhD,&nbsp;Natalie S. Lui MD","doi":"10.1016/j.xjon.2026.102060","DOIUrl":"10.1016/j.xjon.2026.102060","url":null,"abstract":"<div><h3>Objective</h3><div>We evaluated the impact of electronic reminders for primary care physicians (PCPs) on lung cancer screening (LCS) rates.</div></div><div><h3>Methods</h3><div>The LCS Health Maintenance Due is an electronic health record–integrated tool that alerts PCPs when patients are due for low-dose computed tomography. Eligible patients were assigned a dynamic screening status on the basis of time since last imaging of the chest. Patients assigned as Not Due, Due Soon, or Due On at rollout were categorized as Baseline Screened, whereas those assigned as Overdue were categorized as Baseline Overdue. We retrospectively evaluated LCS rates at 1 year after rollout and evaluated factors associated with up to date screening status.</div></div><div><h3>Results</h3><div>Among 8346 eligible patients, 779 (9.3%) were assigned to the Baseline Screened group and 7567 (91%) to the Baseline Overdue group. LCS rates increased from 9.3% at rollout to 16% at 1 year (<em>P</em> &lt; .001). Among patients in the Baseline Screened group, 396 (51%) maintained up to date screening at 1 year, with older age associated with greater odds of remaining up to date (odds ratio [OR], 1.53; <em>P</em> = .003). Among patients in the Baseline Overdue group, 963 (13%) achieved up to date screening at 1 year. Family history of cancer (OR, 2.0; <em>P</em> = .005) was associated with increased odds of screening, whereas greater travel distance (&gt;50 vs &lt;15 miles: OR, 0.38; <em>P</em> &lt; .001), Medicaid/Medi-Cal insurance (OR, 0.58; <em>P</em> &lt; .001), and patients who actively smoke (OR, 0.81; <em>P</em> = .007) were associated with lower odds of becoming up to date.</div></div><div><h3>Conclusions</h3><div>EHR-integrated electronic reminders for PCPs were associated with significantly increased LCS uptake at 1 year, supporting scalable system-level interventions to improve LCS rates.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102060"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214449","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":"Impact of left ventricular reshaping on postinfarction functional mitral regurgitation in a chronic swine model of advanced heart failure","authors":"Kosuke Nakamae MD, PhD,&nbsp;Chihiro Miyagi MD, PhD,&nbsp;Junya Matsuda MD, PhD,&nbsp;Syed Faizullah Hussaini MD, PhD,&nbsp;Tatsuya Watanabe MD, PhD,&nbsp;Satoshi Yuhara MD, PhD,&nbsp;Adrienne Morrison BA, LATG,&nbsp;Kirsten Nelson RVT, LAT,&nbsp;Filip Konecny DVM, PhD,&nbsp;Daisuke Onohara MD, PhD","doi":"10.1016/j.xjon.2026.102080","DOIUrl":"10.1016/j.xjon.2026.102080","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to evaluate the efficacy and feasibility of left ventricular reshaping in a swine model of late-stage ischemic heart failure with marked left ventricular dilation and functional mitral regurgitation.</div></div><div><h3>Methods</h3><div>A chronic heart failure model with ischemic mitral regurgitation was established in 8 Yorkshire swine via percutaneous injection of 100% ethanol into the left circumflex artery. The left ventricular reshaping device was implanted transapically at 6 months postinfarction and evaluated with echocardiography and pressure-volume loop analysis. The final efficacy analysis included 7 animals.</div></div><div><h3>Results</h3><div>The device was successfully implanted and significantly reduced mitral regurgitation (regurgitant volume: 43.29 ± 14.47 mL vs 9.90 ± 5.12 mL, <em>P</em> = .0026). Posterior excursion angle (22.71 ± 6.92° vs 39.14 ± 7.29°, <em>P</em> = .0042) and coaptation length (2.72 ± 0.44 mm vs 4.42 ± 0.76 mm, <em>P</em> = .0033) increased significantly. Left ventricular volume significantly decreased after reshaping (indexed end-diastolic volume: 140.30 ± 28.28 mL/m² vs 84.68 ± 18.51 mL/m², <em>P</em> = .0019; indexed end-systolic volume: 91.54 ± 24.01 mL/m² vs 48.23 ± 16.25 mL/m², <em>P</em> = .0003). Ejection fraction significantly increased (33.71% ± 3.30% vs 43.43% ± 7.12%, <em>P</em> = .0046), whereas load-independent indices of systolic function and measures of diastolic function did not change significantly.</div></div><div><h3>Conclusions</h3><div>Transapical left ventricular reshaping demonstrated acute efficacy and feasibility at 6 months postinfarction in advanced heart failure by reducing left ventricular volume and mitral regurgitation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102080"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214442","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":"Minimally invasive mitral surgery in patients with high pulmonary artery pressure: Results of a multicenter observational study","authors":"Silvia Mariani MD, PhD,&nbsp;Cristina Barbero PhD,&nbsp;Valentina Gislao MD,&nbsp;Cecilia Capozza MD,&nbsp;Pierluigi Stefano MD, PhD,&nbsp;Paolo Centofanti MD,&nbsp;Vittoria Lodo MD,&nbsp;Francesco Onorati MD,&nbsp;Giorgia Cibin MD, PhD,&nbsp;Germano Di Credico MD,&nbsp;Andrea Audo MD,&nbsp;Ruggero De Paulis MD, PhD,&nbsp;Mauro Rinaldi MD, PhD,&nbsp;Giovanni Marchetto MD, PhD,&nbsp;Minimally Invasive Mitral Valve Surgery Registry Investigators","doi":"10.1016/j.xjon.2026.101966","DOIUrl":"10.1016/j.xjon.2026.101966","url":null,"abstract":"<div><h3>Objectives</h3><div>Pulmonary hypertension is diagnosed in 40% to 75% of patients affected by mitral valve diseases. Little is known regarding outcomes of patients with pulmonary hypertension undergoing mitral valve oeprations through minimally invasive approaches. This study compares the characteristics and in-hospital outcomes of patients undergoing minimally invasive mitral valve surgery, stratified by systolic pulmonary artery pressure.</div></div><div><h3>Methods</h3><div>This multicenter, retrospective, prospective, observational study included adults undergoing mitral valve operations through a right minithoracotomy with or without tricuspid valve surgery and atrial fibrillation ablation between 2020 and 2024. Comparisons were performed between patients with systolic pulmonary artery pressure less than 31 mm Hg, systolic pulmonary artery pressure 31 to 55 mm Hg, and systolic pulmonary artery pressure more than 55 mm Hg based on European System for Cardiac Operative Risk Evaluation II cutoffs for systolic pulmonary artery pressure categories.</div></div><div><h3>Results</h3><div>This analysis included 1121 patients (female, 47.5%; median age, 69 years, interquartile range, 59-77). Median systolic pulmonary artery pressure was 38 mm Hg (interquartile range, 30-50; systolic pulmonary artery pressure &lt;31 mm Hg: n = 307, 27.4%; systolic pulmonary artery pressure 31-55 mm Hg: n = 152, 55.3%; systolic pulmonary artery pressure &gt;55 mm Hg: n = 194, 17.3%). Patients with higher systolic pulmonary artery pressure were older, mainly female, and characterized by more comorbidities including atrial fibrillation and renal disease. A critical perioperative state was diagnosed in 12% of patients with systolic pulmonary artery pressure more than 55 mm Hg (<em>P</em> &lt; .001). Patients with higher systolic pulmonary artery pressure more frequently underwent mitral valve replacement and tricuspid annuloplasty and experienced more postoperative dialysis and pacemaker implantation but comparable rates of conversions to sternotomy, respiratory and bleeding complications, and in-hospital mortality (systolic pulmonary artery pressure &lt;31 mm Hg: n = 3, 1%; systolic pulmonary artery pressure 31-55 mm Hg: n = 6, 1%; systolic pulmonary artery pressure &gt;55 mm Hg: n = 5, 2.6%; <em>P</em> = .222) compared with patients with lower systolic pulmonary artery pressure.</div></div><div><h3>Conclusions</h3><div>Despite a higher preoperative complexity, patients with high systolic pulmonary artery pressure could be considered for minimally invasive mitral valve surgery with acceptable rates of major intraoperative or postoperative complications regardless of their systolic pulmonary artery pressure values.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101966"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214474","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":"Sex-specific impact of computed tomography–defined sarcopenia on postoperative complications following elective cardiac surgery in older patients","authors":"Hitomi Ueda MD,&nbsp;Yoshiaki Kubota MD, PhD,&nbsp;Yuji Maruyama MD, PhD,&nbsp;Takuya Nishino PhD,&nbsp;Kuniya Asai MD, PhD,&nbsp;Yosuke Ishii MD, PhD","doi":"10.1016/j.xjon.2026.101975","DOIUrl":"10.1016/j.xjon.2026.101975","url":null,"abstract":"<div><h3>Objectives</h3><div>Sex-specific differences in sarcopenia-related prognosis after cardiac surgery are unclear. We aimed to investigate the association between preoperative computed tomography–defined sarcopenia and postoperative complications in older patients undergoing elective cardiac surgeries, focusing on sex-specific differences.</div></div><div><h3>Methods</h3><div>This retrospective observational study included 133 patients aged 65 years or more who underwent elective open surgeries. Sarcopenia was assessed using the psoas muscle area index derived from preoperative computed tomography scans and defined using sex-specific cutoff values. The primary outcome was postoperative complication.</div></div><div><h3>Results</h3><div>Forty-nine patients (36.8%) had sarcopenia. Although the incidence of complications was higher in this group, the difference was not statistically significant between the groups. Multivariate logistic regression analysis excluding patients with preexisting atrial fibrillation revealed that sarcopenia was independently associated with a higher risk of postoperative complications (odds ratio, 3.73, 95% CI, 1.49-9.84, <em>P</em> = .006). The male patients with sarcopenia showed a higher incidence of complications versus those without (56.8% vs 33.9%, <em>P</em> = .046), whereas no association was observed in the female patients. Sex-stratified analyses confirmed the independent prognostic value of sarcopenia in male patients only (odds ratio, 2.52, 95% CI, 1.08-6.01, <em>P</em> = .033).</div></div><div><h3>Conclusions</h3><div>Preoperative computed tomography–defined sarcopenia was independently associated with postoperative complications in older male patients undergoing elective cardiac surgeries, but not in female patients. These findings suggest that the prognostic significance of sarcopenia is sex-specific and highlight the importance of sex-specific risk stratification strategies in older patient populations undergoing cardiac surgeries.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101975"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214477","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":"Compliments to the surgeon: An artificial intelligence-based analysis of online patient reviews on cardiac surgical care in the United States","authors":"M. Melih Dogan MD,&nbsp;Samuel F. Sears PhD,&nbsp;Verena Sarrazin DPhil,&nbsp;Dina Dejanovic MPH,&nbsp;Maeve M. Sargeant MA,&nbsp;Julie Oehlert DNP, RN,&nbsp;Joseph G. Taylor PhD,&nbsp;Ahmet Kilic MD,&nbsp;Shahab A. Akhter MD,&nbsp;Michael J. Bates MD,&nbsp;Walter Douglas Boyd MD,&nbsp;Wiley L. Nifong MD,&nbsp;Benjamin C. Degner MD","doi":"10.1016/j.xjon.2026.102075","DOIUrl":"10.1016/j.xjon.2026.102075","url":null,"abstract":"<div><h3>Objective</h3><div>Patients increasingly describe care in their own words on public review platforms, but this evidence has been too large and unstructured to use. We aimed to develop and validate a reproducible artificial intelligence (AI)-based method to make this source usable and apply it to cardiac surgery.</div></div><div><h3>Methods</h3><div>Patient comments on online platforms (2020-2026) were collected. Cardiac surgery comments were identified by registered specialty or, where absent, by key word filtering and AI classification (Claude API [Anthropic], validated by physician, 95% sensitivity, and 85% specificity). Sentiment and praise and complaint themes were classified by the same approach and validated by a psychologist (91% accuracy). Cardiac surgery was compared against 4 noncardiac surgery groups, and 6 cardiac surgery subgroups were compared using Wilcoxon rank-sum tests for comment ratings and χ² tests for theme comparisons.</div></div><div><h3>Results</h3><div>Of 28.8 million comments, 14,678 cardiac surgery comments were identified. Sentiment was positive in 82%. Cardiac surgery rated higher than every noncardiac comparator, including clinically comparable specialties (4.31 vs 4.13; <em>P</em> &lt; .001). The most common complaints were interpersonal (unprofessionalism, coldness, dismissiveness, and poor communication), whereas surgical complications ranked sixth. Among subgroups, aortic surgery alone rated significantly higher; transplant patients showed uniquely lower praise across themes, whereas congenital surgery combined elevated gratitude with the only elevated complaint theme.</div></div><div><h3>Conclusions</h3><div>Patients describe cardiac surgical care with overwhelming gratitude and rate it above every comparator group examined. Where they voice dissatisfaction, it centers on how patients are treated as people rather than on the surgical outcomes, identifying communication as the principal target for improvement.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102075"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214505","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":"Evaluating the 2023 safety-net kidney policy: Eligibility and outcomes of heart transplant recipients in the United States","authors":"Hedwig Zappacosta BS,&nbsp;Malini Daniel MD,&nbsp;Natalie Tan BS,&nbsp;Peter D. Cho BS,&nbsp;Joseph Song BS,&nbsp;John P. White BA,&nbsp;Abbas Ardehali MD","doi":"10.1016/j.xjon.2026.102087","DOIUrl":"10.1016/j.xjon.2026.102087","url":null,"abstract":"<div><h3>Objectives</h3><div>In 2023, a safety-net kidney policy granting priority kidney allocation to heart transplant (HT) recipients with persistent renal dysfunction was implemented. We aim to compare early outcomes of safety-net kidney-eligible HT recipients and simultaneous heart-kidney transplant (SHKT) recipients.</div></div><div><h3>Methods</h3><div>Adults in the United Network for Organ Sharing database between July 2023 and November 2025 were stratified into isolated heart or SHKT groups. Isolated HT recipients were further categorized by safety-net kidney eligibility, as defined by the Organ Procurement and Transplantation Network Policy. The primary outcome was 1-year survival for safety-net kidney-eligible and simultaneous heart-kidney recipients. Secondary outcomes included 6-month mortality and acute cardiac rejection within 1 year.</div></div><div><h3>Results</h3><div>During the study period, there were 309 SHKT recipients and 181 isolated HT recipients who were safety-net kidney-eligible, 67 of whom received a kidney transplant within the study period. One-year survival was similar for safety-net kidney-eligible and SHKT recipients (96.7% vs 93.5%, <em>P</em> = .46). Mortality at 6 months did not differ between groups (2.2% vs 3.2%, <em>P</em> = .51). Acute cardiac rejection within 1 year was higher among safety-net kidney-eligible recipients (17.4% vs 8.1%, <em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>The safety-net kidney pathway yields comparable 1-year survival compared with SHKT. However, in this early analysis, staged transplantation is associated with higher rates of acute cardiac rejection. Further studies are needed to validate the incidence and persistence of acute cardiac rejection and ascertain longer-term outcomes to better inform timing of renal transplantation for HT recipients.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102087"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214508","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 cardiac arrest after cardiac surgery: Can we improve our rescue rate?","authors":"Parth B. Patel MD,&nbsp;Caroline R. Gross MD,&nbsp;Abhinav Kumar MS,&nbsp;Mehdi Oloomi MD,&nbsp;Zdravka Zafirova MD,&nbsp;David H. Adams MD,&nbsp;Robin Varghese MD, MS","doi":"10.1016/j.xjon.2026.101956","DOIUrl":"10.1016/j.xjon.2026.101956","url":null,"abstract":"<div><h3>Objective</h3><div>Despite improvements in rescue strategies, postoperative cardiac arrest in adults undergoing cardiac surgery has not been examined in the contemporary era. This study assesses the incidence, outcomes, and predictors of survival in patients who had an in-hospital cardiac arrest after cardiac surgery.</div></div><div><h3>Methods</h3><div>Adult patients with cardiac arrest after open surgery from January 2012 to May 2019 at a single institution were studied. Patients were excluded if they underwent heart transplantation or left ventricular assist device implantation, experienced preoperative or intraoperative cardiac arrest, received preoperative or intraoperative temporary mechanical circulatory support, or were deemed as do not resuscitate or care was withdrawn before the arrest.</div></div><div><h3>Results</h3><div>Of 9946 patients, 162 (1.6%) experienced a postoperative arrest with failure to rescue in 59 patients (36.4%). The etiology of cardiac arrest was cardiovascular in 101 patients (62.3%), respiratory in 27 patients (16.7%), metabolic in 15 patients (9.3%), other in 12 patients (7.4%), and unknown in 7 patients (4.3%). Thirteen patients (8.0%) were placed on extracorporeal membrane oxygenation postarrest with only 4 (30.8%) surviving to discharge. Patients were more likely to die in-hospital if they had postoperative, prearrest organ dysfunction (adjusted odds ratio, 7.08, 95% CI, 2.92-17.16).</div></div><div><h3>Conclusions</h3><div>Although the incidence of cardiac arrest was low, more than one-third of patients failed to be rescued. Prearrest major organ dysfunction portended a significantly worse prognosis. Early recognition of a nonthriving patient and rapid escalation of specialized care may be critical in successful rescue from cardiac arrest and aborting catastrophic outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101956"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214518","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}