JTCVS open最新文献

{"title":"Valve-sparing root replacement: How old is too old?","authors":"Elizabeth L. Norton MD ,&nbsp;Yanhua Wang PhD ,&nbsp;Parth M. Patel MD ,&nbsp;Dov Levine MD ,&nbsp;Jose Binongo PhD ,&nbsp;Bradley G. Leshnower MD ,&nbsp;Hiroo Takayama MD ,&nbsp;Edward P. Chen MD","doi":"10.1016/j.xjon.2025.02.020","DOIUrl":"10.1016/j.xjon.2025.02.020","url":null,"abstract":"<div><h3>Objective</h3><div>Valve-sparing root replacement (VSRR) is associated with excellent short- and long-term outcomes. Although typically offered in young patients, VSRR is performed over a wide age range, including into the eighth decade of life. This study analyzed the influence of age and preoperative comorbidities on operative outcomes, reoperation, and survival following VSRR.</div></div><div><h3>Methods</h3><div>From 2004 to 2021, 780 patients underwent VSRR in an academic database. VSRR was performed using the David V reimplantation technique. A discriminating age cutoff for the effect of age on long-term survival was determined by Contal and O'Quigley methods and patients were divided into 2 groups based on age at time of surgery.</div></div><div><h3>Results</h3><div>The optimal age cutoff for patients undergoing VSRR was found to be 65 years; 16% were aged 65 years or older at time of surgery. Overall, in-hospital mortality was 1.5% and was significantly higher among the group of patients older than age 65 years (4.1% vs 1.1%; <em>P</em> = .03). The cumulative incidence of reoperation of the aortic valve or proximal aorta was similar between the group of patients aged 65 years and older and patients younger than age 65 years (5% vs 6%; <em>P</em> = .28). Overall, 10-year survival was 89% and significantly worse among the patients aged 65 years and older (76% vs 92%; <em>P</em> &lt; .0001). Age 65 years and older was an independent risk factor for late mortality (hazard ratio, 1.04; 95% CI, 1.01-1.07; <em>P</em> = .003).</div></div><div><h3>Conclusions</h3><div>VSRR can be performed with low operative mortality and excellent freedom from reoperation across age groups. In patients aged 65 years and older, serious consideration should be given when deciding on VSRR, especially in the setting of aortic dissection.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 10-22"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321018","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 mitral regurgitation reduction on uncorrected tricuspid regurgitation after left ventricular assist device implantation","authors":"Maxwell F. Kilcoyne DO ,&nbsp;Sarah Chen MD ,&nbsp;Sheldon Sutton MS ,&nbsp;Roshan Mathi MS ,&nbsp;Khaled Shorbaji MD ,&nbsp;John Foster MD ,&nbsp;Jennie Kwon MD ,&nbsp;Brett Welch MBA ,&nbsp;Arman Kilic MD","doi":"10.1016/j.xjon.2025.01.017","DOIUrl":"10.1016/j.xjon.2025.01.017","url":null,"abstract":"<div><h3>Objective</h3><div>Appropriate management of significant tricuspid regurgitation during left ventricular assist device implantation is unclear. This study evaluates the impact of post–left ventricular assist device mitral regurgitation reduction on uncorrected significant tricuspid regurgitation.</div></div><div><h3>Methods</h3><div>All patients who underwent HeartMate 3 implantation between January 2016 and December 2022 with preoperative moderate or greater tricuspid regurgitation were reviewed. Patients without preoperative mitral regurgitation or who underwent concomitant tricuspid valve intervention were excluded. The cohort was divided based on the degree of postoperative mitral regurgitation reduction: Group 1 included patients with 1.5 or less degrees of postoperative mitral regurgitation reduction, and group 2 included patients with more than 1.5 degrees. Primary outcomes included the relationship between tricuspid regurgitation and mitral regurgitation, and overall survival, which were calculated using Pearson correlation coefficient and Kaplan–Meier curves, respectively.</div></div><div><h3>Results</h3><div>A total of 178 patients underwent HeartMate 3 implantation during the study period, and 65 patients (36.5%) met inclusion criteria. There were no significant differences in baseline characteristics between group 1 (n = 35) and group 2 (n = 30). Mitral regurgitation reduction was significantly associated with tricuspid regurgitation reduction at 2 years (r = 0.25, <em>P</em> = .03) and 3 years (r = 0.27, <em>P</em> = .03). There was no significant difference in overall survival between groups at 2 years (79.0% vs 83.0%, <em>P</em> = .89) and 3 years (79.0% vs 76.0%, <em>P</em> = .89). At 2 years, there was no significant difference in the degree of tricuspid regurgitation between groups (<em>P</em> = .41), and 86.1% (n = 56) of patients had mild or less tricuspid regurgitation.</div></div><div><h3>Conclusions</h3><div>Preoperative moderate to severe tricuspid regurgitation improves with mitral regurgitation reduction after left ventricular assist device implantation. Future analyses should assess how this impacts patient selection for concomitant tricuspid valve repair.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 206-214"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321653","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":"Commentator Discussion: Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperation","authors":"","doi":"10.1016/j.xjon.2025.04.005","DOIUrl":"10.1016/j.xjon.2025.04.005","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 23-24"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320930","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":"Commentator Discussion: The implementation of an electronic symptom management (eSyM) system to monitor postoperative pain in thoracic surgery patients: A multicenter evaluation","authors":"","doi":"10.1016/j.xjon.2025.03.005","DOIUrl":"10.1016/j.xjon.2025.03.005","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Page 500"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321420","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":"Which cardiothoracic surgery training pathway is right for you?","authors":"AlleaBelle Bradshaw MD ,&nbsp;Ahmet Kilic MD ,&nbsp;Thomas E. MacGillivray MD ,&nbsp;Jennifer S. Lawton MD","doi":"10.1016/j.xjon.2025.04.003","DOIUrl":"10.1016/j.xjon.2025.04.003","url":null,"abstract":"<div><h3>Objective</h3><div>The training pathways in cardiothoracic surgery have evolved so that there are currently several viable options to this career. The purpose of this review is to give insight to medical students and mentors regarding the 4 different pathways.</div></div><div><h3>Methods</h3><div>The evolution of cardiothoracic surgery training and 4 current pathways are briefly reviewed. The main differences between these 4 pathways are then discussed in detail.</div></div><div><h3>Results</h3><div>Key differences between training pathways include time to completion, opportunities for dedicated academic development or research time, family planning considerations, board certification options, opportunities to change programs, competitiveness, and unique considerations for military personnel.</div></div><div><h3>Conclusions</h3><div>This detailed comparison of the training pathways can serve as a resource to help students make informed decisions about the pathway that is best suited to each individual.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 510-515"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321422","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 implementation of an electronic symptom management system to monitor postoperative pain in thoracic surgery patients: A multicenter evaluation","authors":"Jorind Beqari MD ,&nbsp;Jacob Hurd BS ,&nbsp;Angela C. Tramontano MPH ,&nbsp;Christine Cronin BS ,&nbsp;Alexandra Potter BS ,&nbsp;Sandra Wong MD ,&nbsp;Deborah Schrag MD, MPH ,&nbsp;Don S. Dizon MD ,&nbsp;Jessica Bian MD ,&nbsp;Raymond U. Osarogiagbon MD ,&nbsp;Hannah Hazard-Jenkins MD ,&nbsp;Joseph D. Phillips MD ,&nbsp;Abbas E. Abbas MD ,&nbsp;Isha Mehta Warikoo MD ,&nbsp;Mitchell Anderson ,&nbsp;Kenneth P. Seastedt MD, MBA ,&nbsp;Michael Lanuti MD ,&nbsp;Yolonda L. Colson MD, PhD ,&nbsp;Cameron D. Wright MD ,&nbsp;Michael Hassett MD, MPH ,&nbsp;Chi-Fu Jeffrey Yang MD","doi":"10.1016/j.xjon.2025.02.010","DOIUrl":"10.1016/j.xjon.2025.02.010","url":null,"abstract":"<div><h3>Objective</h3><div>Few studies have evaluated postoperative recovery of patients after thoracic surgery using patient-reported outcome measures. This multi-institutional study analyzed postoperative pain and opioid use among patients undergoing thoracic surgery based on patient-reported outcome measures data collected through an electronic symptom management system.</div></div><div><h3>Methods</h3><div>The electronic symptom management system is a multi-symptom questionnaire based on a Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events that is integrated into the electronic health record and administered via the patient portal. Patients undergoing lung resections were invited to complete electronic symptom surveys within the electronic symptom management system during their 90-day postoperative period. Baseline patient demographics, surgical data, and postoperative opioid data were gathered from the electronic health record. Multivariable hierarchical regression was used to evaluate predictors of postoperative pain and opioid prescriptions.</div></div><div><h3>Results</h3><div>Of 680 patients who met the inclusion criteria, 258 (37.9%) reported at least 1 severe pain score. Patients reporting severe pain were more likely to have undergone open surgery, to receive at least 1 postoperative opioid prescription, and to become persistent opioid users compared with patients reporting no severe pain. In multivariable logistic regression analysis, the only factor associated with a severe pain score was female sex (odds ratio, 1.67, 95% CI, 1.17-2.39; <em>P</em> = .005).</div></div><div><h3>Conclusions</h3><div>This multicenter study used patient-reported outcome measures to evaluate predictors of postoperative pain and opioid prescriptions in patients undergoing thoracic surgery. Further investigation into the administration of patient-reported outcome measures is needed to assess their ability to impact postsurgical care and postoperative outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 485-499"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321419","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":"Acute kidney injury and chronic kidney disease after left ventricular assist device placement","authors":"Mias Pretorius MBChB, MSCI ,&nbsp;Anne Chen BA ,&nbsp;Melissa J. Kimlinger MD ,&nbsp;Matthew S. Shotwell PhD ,&nbsp;Allison M. Janda MD ,&nbsp;Matthew R. Danter MD ,&nbsp;Simon Maltais MD ,&nbsp;Keki R. Balsara MD ,&nbsp;Ashish S. Shah MD ,&nbsp;Frederic T. Billings IV MD, MSCI","doi":"10.1016/j.xjon.2025.04.001","DOIUrl":"10.1016/j.xjon.2025.04.001","url":null,"abstract":"<div><h3>Objective</h3><div>Left ventricular assist device (LVAD) implantation may lead to acute kidney injury (AKI), but LVAD therapy increases cardiac output and may reverse cardiorenal syndrome. We conducted this study to test the hypothesis that AKI after LVAD implantation is associated with glomerular filtration rate (eGFR) decline and chronic kidney disease (CKD) stage progression.</div></div><div><h3>Methods</h3><div>We included all patients undergoing LVAD implantation between August 2011 and August 2021 at a high-volume LVAD center. AKI was quantified using Kidney Disease: Improving Global Outcomes criteria. We estimated eGFR before and 30, 60, 90, and 365 days after LVAD implantation to stage CKD. We measured the associations between AKI and eGFR, adjusting for potential confounders and risk factors.</div></div><div><h3>Results</h3><div>One hundred ninety-one of the 482 subjects (39.6%) developed postoperative AKI. Overall, median eGFR change (25th, 75th percentile) was −5.9% (−22.3%, 15.6%) at 90 days after LVAD and −17.2% (−36.9%, 5.1%) at 1 year. In subjects who developed AKI, eGFR declined 11.7% (95% confidence interval, 4.2%-19.1%; <em>P</em> = .002) more at 90 days, more patients progressed to a greater stage of CKD, and death was 2.4-fold (95% confidence interval, 1.6-3.5; <em>P</em> &lt; .001) greater at 1 year than in subjects without postoperative AKI. Subjects with more advanced baseline CKD had less eGFR decline than subjects with less advanced baseline CKD.</div></div><div><h3>Conclusions</h3><div>Among patients receiving LVAD therapy, AKI and eGFR decline were common, and postoperative AKI was independently associated with eGFR decline and CKD progression at 90 and 365 days.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 190-199"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321652","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":"Discrepancies in survival following pediatric heart transplantation and the effect of race and socioeconomic status on outcomes","authors":"Bahaaldin Alsoufi MD ,&nbsp;Jaimin Trivedi MD, MPH ,&nbsp;Deborah Kozik DO ,&nbsp;Sarah Wilkens MD ,&nbsp;Andrea Nicole Lambert MD ,&nbsp;Shriprasad Deshpande MBBS, MS ,&nbsp;Joshua D. Sparks MD","doi":"10.1016/j.xjon.2025.02.021","DOIUrl":"10.1016/j.xjon.2025.02.021","url":null,"abstract":"<div><h3>Objectives</h3><div>Poor health literacy and resources paucity in families with low socioeconomic status can be detrimental in children requiring complex outpatient management such as heart transplantation. We assessed the influence of socioeconomic status and insurance type on heart transplantation outcomes.</div></div><div><h3>Methods</h3><div>The cohort of children undergoing heart transplantation was generated by merging the United Network for Organ Sharing and Pediatric Health Information System databases. Family's annual income was used as surrogate for socioeconomic status. Children were divided into 3 groups: low-income (lower quartile, &lt;$32 700; n = 639), medium-income (second and third quartiles, $32 700-$53 600; n = 1305), or high-income (upper quartile, &gt;$53 600; n = 649).</div></div><div><h3>Results</h3><div>Comparison showed racial discrepancies (more Whites in high-income, more Blacks in low-income groups), and insurance type variations (more private in high-income, more Medicaid in low-income groups). On univariate analysis, survival was higher for high-income compared with medium-income and low-income groups (<em>P</em> = .04). On multivariable analysis, Black race (hazard ratio, 1.389; 95% CI, 1.041-1.703; <em>P</em> = .0075), Medicaid (hazard ratio, 1.373; 95% CI, 1.115-1.721; <em>P</em> = .0038), and other government insurance (hazard ratio, 1.611; 95% CI, 1.104-2.423; <em>P</em> = .0126) were significant risk factors, whereas income group effect was neutralized. Treated rejection episodes at 1 year were lowest (10%) in high-income and highest (15%) in low-income groups, with trend for less rejection in the low-income group with private insurance (12% vs 16%). Death from cardiac arrest was significantly less in the high-income (8%) compared with the medium-income (18%) and low-income (19%) groups (<em>P</em> &lt; .01).</div></div><div><h3>Conclusions</h3><div>Black and low socioeconomic status children face significant disadvantages in heart transplant outcomes, including lower survival, higher rejection rates, and increased risk of death secondary to cardiac arrest. Access to private insurance leads to better survival but might be proxy to better resources, education, and compliance.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 354-363"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320933","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":"Commentator Discussion: Surgical pathways and risk categories in the management of hypoplastic left heart syndrome and variants","authors":"","doi":"10.1016/j.xjon.2025.04.017","DOIUrl":"10.1016/j.xjon.2025.04.017","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 344-345"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321016","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":"Commentator Discussion: AATS 2024: Should moderate tricuspid regurgitation be repaired at the time of mitral surgery? Results from a large registry-based study","authors":"","doi":"10.1016/j.xjon.2025.04.018","DOIUrl":"10.1016/j.xjon.2025.04.018","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 87-88"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321344","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}