JTCVS open最新文献

{"title":"Commentator Discussion: Outcomes of surgical valve replacements for radiation-induced valvulopathy","authors":"","doi":"10.1016/j.xjon.2024.11.006","DOIUrl":"10.1016/j.xjon.2024.11.006","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 147-149"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464997","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":"Zero superior vena cava injury lead extraction with rotational system: A contemporary experience","authors":"Iverson E. Williams BS,&nbsp;Omar M. Sharaf MD,&nbsp;Ryan Azarrafiy MD, MPH,&nbsp;Daniel Demos MD,&nbsp;Eric I. Jeng MD, MBA,&nbsp;Kirsten A. Freeman MD,&nbsp;John R. Spratt MD,&nbsp;Thomas M. Beaver MD, MPH","doi":"10.1016/j.xjon.2024.11.010","DOIUrl":"10.1016/j.xjon.2024.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Transvenous cardiac implantable electronic device (CIED) lead extraction (TLE) is susceptible to superior vena cava (SVC) injury and can be performed in the operating room (OR) or electrophysiology lab via a mechanical device or laser-powered extraction. This study reflects a contemporary experience of mechanical right-left rotational extraction by cardiac surgeons in the OR.</div></div><div><h3>Methods</h3><div>We conducted a retrospective single-center review of adult (age ≥18 years) TLE cases performed by cardiac surgeons between 2019 and 2021. Leads were extracted via a transvenous mechanical right-left controlled-rotation system in the OR under general anesthesia with transesophageal echocardiographic guidance. Procedural success was defined as complete extraction of all leads without major complications, based on the Heart Rhythm Society's 2017 guidelines.</div></div><div><h3>Results</h3><div>A total of 210 leads were extracted from 104 patients, including 72 males (69%). The mean patient age was 63.8 ± 16.7 years, and 26 patients (25%) had undergone prior sternotomy. The most common indication for CIED extraction was infection (69%; n = 72). Removed CIEDs included single-chamber defibrillators (46%; n = 48), pacemakers (33%; n = 34), and cardiac resynchronization therapy devices (21%; n = 22). The mean age of the oldest extracted lead by patient was 9.79 ± 7.25 years. Procedural success was obtained in 95% of cases (99/104). The remaining cases included distal lead fracture (n = 3), inferior vena cava laceration necessitating sternotomy (n = 1), and tricuspid valve damage requiring delayed valve replacement (n = 1). There were zero SVC injuries, and procedure-related mortality was 0%.</div></div><div><h3>Conclusions</h3><div>Mechanical, controlled-rotation TLE is effective and can be performed safely without SVC injury. TLE by cardiac surgeons in the OR enables rapid conversion to sternotomy in the event of major complications.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 171-175"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465000","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":"Recommendation letter language for applicants selected to interview at integrated cardiothoracic surgery residency: A qualitative assessment by gender","authors":"Siddharth Yarlagadda BA ,&nbsp;Jason J. Han MD ,&nbsp;Jacqueline M. Soegaard Ballester MD, MBMI ,&nbsp;Caroline O’Brien MS ,&nbsp;Justin T. Clapp PhD, MPH ,&nbsp;Marisa Cevasco MD, MPH","doi":"10.1016/j.xjon.2024.12.001","DOIUrl":"10.1016/j.xjon.2024.12.001","url":null,"abstract":"<div><h3>Objective</h3><div>Cardiothoracic (CT) surgery remains a male-dominated specialty. Letters of recommendation (LORs) influence trainee selection and are vulnerable to biases. We aimed to qualitatively assess differences in LORs to integrated residency on the basis of applicant gender.</div></div><div><h3>Methods</h3><div>LORs for applicants who interviewed at a single integrated CT residency program during one cycle were selected and pooled by applicant gender. Gendered and identifying references were redacted. Letters were analyzed by a thematic analysis approach and managed through NVivo software.</div></div><div><h3>Results</h3><div>Thirty LORs across 8 male applicants and 43 LORs across 11 female applicants were analyzed. There was no noticeable difference between the frequency of positive attributes assigned to each gender. Research accomplishments was the most emphasized competency, with no gender-based difference identified. LORs for female applicants tended to be longer and include stronger positive adjectives. For male applicants, descriptions of external recognition were almost exclusively via mention of scholarships or research, whereas female applicants were more likely to receive word-of-mouth recognition. Letter writers often attested to male applicants’ commitment to CT surgery, whereas female applicants received more commentary around effective patient care.</div></div><div><h3>Conclusions</h3><div>Letters for men tended to focus on research accolades and career commitment, whereas letters for women were longer and more likely to emphasize patient care or faculty endorsement. Future studies may discern whether this phenomenon reflects stronger applicant-writer relationships for female applicants or a disadvantageous approach by letter writers for female applicants that relies on subjective rationale.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 379-385"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465079","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":"Pulmonary artery enlargement as a predictor of long-term prognosis in patients with resected early-stage non–small cell lung cancer","authors":"Megumi Nishikubo MD ,&nbsp;Sanae Kuroda MD ,&nbsp;Nanase Haga MD ,&nbsp;Yuki Nishioka MD ,&nbsp;Nahoko Shimizu MD, PhD ,&nbsp;Yuko Fukuda MD, PhD ,&nbsp;Wataru Nishio MD, PhD","doi":"10.1016/j.xjon.2024.11.009","DOIUrl":"10.1016/j.xjon.2024.11.009","url":null,"abstract":"<div><h3>Objectives</h3><div>Although several studies have highlighted the potential prognostic value of computed tomography-measured pulmonary artery enlargement in various respiratory diseases, the long-term outcomes following lung cancer surgery remain unexplored. This study aimed to assess the predictive value of pulmonary artery enlargement for overall survival in patients with completely resected non–small cell lung cancer.</div></div><div><h3>Methods</h3><div>We retrospectively identified patients with pathological Tis-1cN0M0 non–small cell lung cancer who underwent complete resection between 2013 and 2018 in our hospital. We reviewed the routine preoperative computed tomography images and measured the pulmonary artery diameter at the bifurcation (PA) and the ascending aorta diameter (A) to calculate the PA/A ratio. Based on a PA/A threshold of 0.8, patients were categorized into high- and low-ratio groups, and their overall survival and cumulative incidence of cause-specific deaths were compared after propensity score matching.</div></div><div><h3>Results</h3><div>Of the 319 included patients, 116 were categorized into the high-ratio group and 203 into the low-ratio group. After propensity score matching, overall survival was significantly worse in the high-ratio group than in the low-ratio group (5-year overall survival: 89.4% vs 96.2%; <em>P</em> = .006). The high-ratio group had a significantly higher incidence of death not related to lung cancer than the low-ratio group (<em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>In patients with resected early-stage non–small cell lung cancer, those with preoperatively pulmonary artery enlargement had a poorer overall survival than those without, possibly attributed to a higher non-lung cancer-related death incidence. Measuring the preoperative PA/A ratio might be a useful tool for risk stratification, and selecting sublobar resection for these patients could improve the long-term prognosis.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 266-275"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465187","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":"Potential advantage of magnetic resonance imaging in detecting thoracic wall infiltration in pleural mesothelioma: A retrospective single-center analysis","authors":"Isabel Barreto MD ,&nbsp;Sabine Franckenberg MD ,&nbsp;Thomas Frauenfelder MD ,&nbsp;Isabelle Opitz MD ,&nbsp;Olivia Lauk MD","doi":"10.1016/j.xjon.2024.10.012","DOIUrl":"10.1016/j.xjon.2024.10.012","url":null,"abstract":"<div><h3>Objectives</h3><div>Thoracic wall infiltration in pleural mesothelioma determines the extent of resection and can be an important prognostic factor. Currently, standardized imaging for restaging after neoadjuvant systemic therapy comprises contrast-enhanced computed tomography or positron emission tomography. Additional thoracic magnetic resonance imaging could better discriminate chest wall infiltration preoperatively and increase staging accuracy. For this reason, the added benefit of magnetic resonance imaging was evaluated at our center.</div></div><div><h3>Methods</h3><div>A retrospective analysis of the extended imaging protocol was performed from July 2018 to March 2024, including a descriptive analysis for the patient's sex, age, tobacco consumption, asbestos exposure, histological subtype, TNM stage, Modified Response Evaluation Criteria for Solid Tumors in solid tumors, and number of neoadjuvant therapy cycles. Preoperative restaging included routine imaging and magnetic resonance imaging. After histological diagnosis of pleural mesothelioma, neoadjuvant therapy was conducted, followed by intended macroscopic complete resection, with intraoperative biopsies of suspicious chest wall lesions. Computed tomography and magnetic resonance imaging results were compared with intraoperative biopsies.</div></div><div><h3>Results</h3><div>Twenty-six patients (mean age, 65.50 years, 11.50% female) with operable pleural mesothelioma were included. Of the 11 patients with histologically proven chest wall infiltration, 10 (90.91%) had a cT-stage 3 or greater and 4 (36.36%) underwent surgery that resulted in an R2 resection. Thoracic magnetic resonance imaging showed a high sensitivity (90.91%) for the detection of chest wall infiltration, especially when compared with the computed tomography scan (9.09%).</div></div><div><h3>Conclusions</h3><div>With the adjunctive use of magnetic resonance imaging, we demonstrated a higher sensitivity for detection of chest wall infiltration compared with conventional imaging before surgery. This may improve patient selection for surgery. Nevertheless, larger studies are required to confirm these results.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 318-325"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465192","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":"Pediatric cardiac surgical site infections: A single-center quality improvement initiative","authors":"Nhat Chau HBSc ,&nbsp;Crystal Tran HBSc, CCRP ,&nbsp;Megan Clarke MN, RN, CIC ,&nbsp;Jennifer Kilburn MN, RN ,&nbsp;Cecilia St. George-Hyslop MEd, RN, CNCCPC ,&nbsp;Diana Young RN ,&nbsp;Sandra L. Merklinger MN-NP, PhD ,&nbsp;Erica Mosolanczki MN-NP ,&nbsp;Vivian Trinder MN-NP ,&nbsp;Jill O'Hare MN-NP ,&nbsp;Karen Clarke RN ,&nbsp;Kate McCormick MScN, RN ,&nbsp;Rachel D. Vanderlaan MD, PhD, FRCSC","doi":"10.1016/j.xjon.2024.08.013","DOIUrl":"10.1016/j.xjon.2024.08.013","url":null,"abstract":"<div><h3>Objective</h3><div>Pediatric cardiac surgery site infections (SSI) represent significant morbidity. Our institution reported elevated SSI rates of 3.48 per 100 cases over a 5-year period above target rates of 2.5 per 100 cases. Therefore, as a quality improvement initiative, we implemented interventions with the goal of decreasing SSI rates by 30%.</div></div><div><h3>Methods</h3><div>Pediatric cardiovascular surgery patients (January 2021 to August 2023) who had SSI within 30 days of index operation were included (n = 1514) based on the National Healthcare Safety Network definition. Descriptive statistics were used to compare our preintervention cohort (pre-IV) (January 2021 to April 2022; n = 753) and postintervention cohort (post-IV) (May 2022 to August 2023; n = 761).</div></div><div><h3>Results</h3><div>In the post-IV cohort, we found a significant decrease in total SSI (1.97 SSIs per 100 cases [15 out of 761]) versus pre-IV (3.85 SSIs per 100 cases [29 out of 753]), demonstrating a 48% reduction (<em>P</em> = .029). In our post-IV cohort, there was a significant reduction in superficial SSIs (pre-IV, 3.19 SSIs per 100 cases [24 out of 753] vs post-IV, 1.58 SSIs out of 100 cases [12 out of 761]; <em>P</em> = .04). Wounds presenting at 1 to 3 weeks were also reduced in our post-IV cohort (pre-IV, 2.66 SSIs per100 cases [20 out of 753] vs post-IV, 0.66 SSIs per 100 cases [5 out of 761]; <em>P</em> = .002). A significant reduction in SSIs in nonneonates was also noted (pre-IV, 2.79 SSIs per 100 cases [21 out of 753] vs post-IV, 0.92 SSIs per 100 cases [7 out of 761]; <em>P</em> = .007). Additionally, there was a significant reduction in SSIs associated with the Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery Congenital Heart Surgery 1 mortality category (<em>P</em> = .033) and the number of readmissions in the post-IV cohort (<em>P</em> = .042).</div></div><div><h3>Conclusions</h3><div>A new surgical site dressing and multidisciplinary surveillance plan effectively reduced the overall burden of SSI rates at our institution. Future studies will address risk factors in specific subpopulations to further reduce SSIs at our institution.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 438-447"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959772","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":"Randomized study of temporary diaphragm pacing for enhanced recovery after surgery in cardiac surgery patients at risk of prolonged mechanical ventilation","authors":"Jessica R. Hungate MD ,&nbsp;Raymond P. Onders MD ,&nbsp;Mohammad El Diasty MD, PhD ,&nbsp;Yasir Abu-Omar MD, DPhil ,&nbsp;Rakesh C. Arora MD, PhD ,&nbsp;Cristian Baeza MD ,&nbsp;Yakov Elgudin MD, PhD ,&nbsp;Kelsey Gray MD ,&nbsp;Alan Markowitz MD ,&nbsp;Marc Pelletier MD ,&nbsp;Igo B. Ribeiro MD ,&nbsp;Pablo Ruda Vega MD ,&nbsp;Gregory D. Rushing MD ,&nbsp;Joseph F. Sabik III MD","doi":"10.1016/j.xjon.2024.09.031","DOIUrl":"10.1016/j.xjon.2024.09.031","url":null,"abstract":"<div><h3>Objective</h3><div>Prolonged mechanical ventilation after cardiac surgery significantly increases morbidity and mortality. The aim of this study is to establish the role of diaphragmatic pacing to decrease mechanical ventilation burden in high-risk patients undergoing cardiac surgery.</div></div><div><h3>Methods</h3><div>This is a prospective, randomized trial of temporary diaphragmatic pacing electrode use in patients undergoing cardiac surgery (NCT04899856). Prognostic enrichment strategy was used to identify patients at higher risk of prolonged mechanical ventilation by having inclusion criteria of prior open cardiac surgery, left ventricular ejection fraction less than 30%, history of stroke, intra-aortic balloon pump, or history of chronic obstructive pulmonary disease. Two electrodes were placed in each hemidiaphragm intraoperatively. On arrival to the intensive care unit, patients were randomized to immediate diaphragmatic pacing or standard of care.</div></div><div><h3>Results</h3><div>Forty patients received implants, with 19 in the treatment group and 21 in the standard of care group. Only 1 patient in the treatment group was on mechanical ventilation at 24 hours versus 4 patients in the standard of care group, resulting in a relative risk reduction of 71% being on mechanical ventilation at 24 hours postoperatively. Predictive enrichment strategy was used to identify patients most likely to respond to therapy of diaphragmatic pacing. In this analysis, median time on mechanical ventilation was 17.7 hours (interquartile range, 8.3-23.4) for the 15 patients in the standard of care group and 9.4 hours (interquartile range, 7.14-12.5) for the 13 patients in the treatment group, for an improvement of 8 hours with diaphragm pacing (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Temporary diaphragmatic pacing improved weaning from mechanical ventilation by 8 hours with a significant reduction of prolonged mechanical ventilation. Multicenter randomized trials confirming diaphragmatic pacing as an Enhanced Recovery After Surgery tool to decrease mechanical ventilation may reduce length of stay, postoperative infections, and additive costs.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 76-84"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959776","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":"Surgical management of giant cell arteritis of the proximal aorta","authors":"Motahar Hosseini MD ,&nbsp;Alberto Pochettino MD ,&nbsp;Joseph A. Dearani MD ,&nbsp;Alejandra Castro-Varela MD ,&nbsp;Hartzell V. Schaff MD ,&nbsp;Katherine S. King MS ,&nbsp;Richard C. Daly MD ,&nbsp;Kevin L. Greason MD ,&nbsp;Juan A. Crestanello MD ,&nbsp;Gabor Bagameri MD ,&nbsp;Nishant Saran MBBS","doi":"10.1016/j.xjon.2024.08.017","DOIUrl":"10.1016/j.xjon.2024.08.017","url":null,"abstract":"<div><h3>Objective</h3><div>Giant cell arteritis (GCA) may present as proximal aortic pathology requiring surgical intervention. We present our experience with surgical management of GCA in patients presenting with proximal aortic disease.</div></div><div><h3>Methods</h3><div>From January 1993 to May 2020, 184 adult patients were diagnosed with GCA on histopathology after undergoing cardiac surgery. Survival was estimated with Kaplan-Meier method. Reoperation rates were estimated with cumulative incidence accounting for competing risks of death.</div></div><div><h3>Results</h3><div>The most common indication for surgery was ascending aortic aneurysm (n = 179, 97.3%). Stroke occurred in 6 (3.3%), pneumonia in 8 (4.4%), and dialysis in 3 (1.6%) patients. Multivariable analysis found advanced age (hazard ratio [HR], 1.054; 95% confidence interval [CI], 1.026-1.082, <em>P</em> &lt; .001), recent heart failure (HR, 1.890; 95% CI, 1.016-3.516, <em>P</em> = .04), peripheral vascular disease (HR, 2.229; 95% CI, 1.458-3.624, <em>P</em> &lt; .001), and cerebrovascular disease (HR, 1.762; 95% CI, 1.035-3.000, <em>P</em> = .03) as predictors of late mortality. Median follow-up was 13.7 years, and 30-day mortality was 1.5%. Nineteen patients underwent 24 aortic reinterventions including aortic arch reconstruction (n = 4), descending thoracic aorta aneurysm repair (n = 8), thoracoabdominal aortic aneurysm repair (n = 11), and pseudoaneurysm repair (n = 1). Rate of reintervention on the aorta was 3.9% (95% CI, 1.9%-8.1%), 7.1% (95% CI, 4.1%-12.3%), 12.8% (95% CI, 8.3%-19.6%), and 12.8% (95% CI, 8.3%-19.6%) at 1, 5, 10, and 15 years, respectively.</div></div><div><h3>Conclusions</h3><div>Surgery in patients with GCA can be performed with acceptable early and late outcomes. Advancing age, heart failure, peripheral vascular disease, and cerebrovascular disease are risk factors for worse survival. Postoperative surveillance is important as need for aortic reintervention is not uncommon.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 123-131"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined simulation and ex vivo assessment of free-edge length in bicuspidization repair for congenital aortic valve disease","authors":"Perry S. Choi MD ,&nbsp;Amit Sharir BS ,&nbsp;Yoshikazu Ono MD ,&nbsp;Masafumi Shibata MD ,&nbsp;Alexander D. Kaiser PhD ,&nbsp;Yellappa Palagani PhD ,&nbsp;Alison L. Marsden PhD ,&nbsp;Michael R. Ma MD","doi":"10.1016/j.xjon.2024.09.008","DOIUrl":"10.1016/j.xjon.2024.09.008","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to investigate the effect of free-edge length on valve performance in bicuspidization repair of congenitally diseased aortic valves.</div></div><div><h3>Methods</h3><div>In addition to a constructed unicuspid aortic valve disease model, 3 representative groups—free-edge length to aortic diameter ratio 1.2, 1.57, and 1.8—were replicated in explanted porcine aortic roots (n = 3) by adjusting native free-edge length with bovine pericardium. Each group was run on a validated ex vivo univentricular system under physiological parameters for 20 cycles. All groups were tested within the same aortic root to minimize inter-root differences. Outcomes included transvalvular gradient, regurgitation fraction, and orifice area. Linear mixed effects model and pairwise comparisons were used to compare outcomes across groups.</div></div><div><h3>Results</h3><div>The diseased control group had a mean transvalvular gradient of 28.3 ± 5.5 mm Hg, regurgitation fraction of 29.6% ± 8.0%, and orifice area of 1.03 ± 0.15 cm². In ex vivo analysis, all repair groups had improved regurgitation and transvalvular gradient compared with the diseased control group (<em>P</em> &lt; .001). Free-edge length to aortic diameter of 1.8 had the highest amount of regurgitation among the repair groups (<em>P</em> &lt; .001) and 1.57 the least (<em>P</em> &lt; .001). Free-edge length to aortic diameter of 1.57 also exhibited the lowest mean gradient (<em>P</em> &lt; .001) and the largest orifice area (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Free-edge length to aortic diameter ratio significantly impacts valve function in bicuspidization repair of congenitally diseased aortic valves. As the ratio departs from 1.57 in either direction, effective orifice area decreases and both transvalvular gradient and regurgitation fraction increase.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 395-404"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959869","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":"Surgery versus surveillance for ascending aortic aneurysms in elderly patients","authors":"Veronica F. Chan BSc ,&nbsp;Ming Hao Guo MD, MSc ,&nbsp;Thais Coutinho MD ,&nbsp;Aryan Ahmadvand BSc ,&nbsp;Mahdi Zeghal BSc ,&nbsp;Adam Mussani BSc ,&nbsp;Talal Al-Atassi MD, MPH ,&nbsp;Roy Masters MD ,&nbsp;David Glineur MD, PhD ,&nbsp;Munir Boodhwani MD, MSc","doi":"10.1016/j.xjon.2024.08.021","DOIUrl":"10.1016/j.xjon.2024.08.021","url":null,"abstract":"<div><h3>Background</h3><div>Whether elderly patients with aortic root or ascending aortic aneurysm (ATAA) would benefit from the new surgical size threshold of 5.0 cm is unknown. This study aimed to evaluate the natural history of ATAA in elderly patients and to compare long-term outcomes of those who underwent initial surveillance versus surgery.</div></div><div><h3>Methods</h3><div>Patients age ≥75 years with an ATAA ≥40 mm were categorized into 2 groups: initial surgery and initial surveillance. The primary outcome was all-cause mortality; Kaplan-Meier curves were plotted for survival. A multivariable Cox proportional hazard regression model was used to identify independent predictors of long-term mortality.</div></div><div><h3>Results</h3><div>The study series comprised 300 patients, including 58 who underwent initial surgery and 242 who received surveillance between July 2010 and September 2022. In the surveillance cohort, the mean aneurysm growth rate was 0.10 cm/year. Comparing surveillance to surgery, at 8 years there was no difference in survival (mean, 77.8 ± 3.4% vs 71.8 ± 9.6%; <em>P</em> = .65). For 116 patients with an initial aneurysm diameter ≥5.0 cm, there was no difference in survival between the 2 groups at 8 years (76.5 ± 7.0% vs 68.4 ± 11.3%; <em>P</em> = .20). Larger body surface area (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.09-1.90; <em>P</em> = .01) and history of smoking (HR, 2.25; 95% CI, 1.27-3.98; <em>P</em> = .01) were identified as predictors of long-term mortality.</div></div><div><h3>Conclusions</h3><div>In our series of elderly patients with ATAA, there was no difference in 8-year survival between initial surveillance and surgical management, with a high competing risk of nonaortic mortality. Surveillance may be a reasonable alternative to surgery for selected older adults with ATAA &lt;5.5 cm.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 132-143"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959949","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}