JTCVS open最新文献

{"title":"Weekend effect on operative mortality following coronary artery bypass grafting","authors":"John J. Squiers MD,&nbsp;Cody Dorton DO,&nbsp;Taylor Pickering DO,&nbsp;Jasjit K. Banwait PhD,&nbsp;Sarah Hale MS,&nbsp;J. Michael DiMaio MD,&nbsp;Justin M. Schaffer MD","doi":"10.1016/j.xjon.2026.101984","DOIUrl":"10.1016/j.xjon.2026.101984","url":null,"abstract":"<div><h3>Background</h3><div>Whether patients undergoing coronary artery bypass grafting (CABG) late in the workweek or on weekends experience excess mortality remains controversial.</div></div><div><h3>Methods</h3><div>Medicare beneficiaries undergoing isolated CABG from 2008 to 2019 were stratified by day of surgery (DOS; Monday-Sunday). A flexible parametric model adjusting for demographics, comorbidities, surgeon/hospital volume, and procedural details was used to evaluate whether CABG-DOS was associated with 30-day mortality. Regression standardization was applied to estimate standardized survival probabilities (SSPs). SSPs for CABG performed on Friday, Saturday, and Sunday were compared to those for CABG performed on Monday to Thursday in the overall cohort and within cohorts defined by admission urgency (proxy for surgical urgency).</div></div><div><h3>Results</h3><div>Among 735,603 beneficiaries undergoing CABG, surgery was performed on Friday in 144,220 (19.6%), Saturday in 18,568 (2.5%), and Sunday in 11,502 (1.6%). From Monday to Friday, approximately 50% of CABGs were elective; elective CABG composed 30% of Saturday cases and 22% of Sunday cases. Risk-adjusted 30-day SSPs were similar for CABGs performed on Monday to Thursday (97.0%; 95% confidence interval [CI], 96.9%-97.1%) and Friday (97.1%; 95% CI, 97.0%-97.2%) but were lower for CABGs performed on Saturday (96.2%; 95% CI, 95.9%-96.4%) and Sunday (95.4%; 95% CI, 95.0%-95.7%). A weekend effect on mortality was persistent across all admission urgency levels.</div></div><div><h3>Conclusions</h3><div>Compared with weekday operations, weekend CABG was associated with 1 to 2 excess mortalities per 100 procedures. These findings suggest that environmental factors specific to DOS, unique to weekends, and present regardless of case urgency may adversely impact early post-CABG survival.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101984"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214535","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":"The interaction of age and time on durable left ventricular assist device and its effect on heart transplant outcomes","authors":"Zachary W. Sollie MD,&nbsp;Jennie H. Kwon MD,&nbsp;Caroline C. Miller BS,&nbsp;Jingwen Zhang MS,&nbsp;Brett A. Welch MBA, MHA,&nbsp;Chakradhari Inampudi MD,&nbsp;Arman Kilic MD","doi":"10.1016/j.xjon.2026.102068","DOIUrl":"10.1016/j.xjon.2026.102068","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to assess the interaction between age and left ventricular assist device duration on heart transplant outcomes in the modern era.</div></div><div><h3>Methods</h3><div>All heart transplantation in adults with a fully magnetically levitated centrifugal flow left ventricular assist device between October 2018 and June 2025 were identified from the United Network for Organ Sharing database. Groups were stratified primarily by age less than 55 years and 55 years or more and secondarily by age less than 2 years and 2 years or more of left ventricular assist device support. The primary outcome was post–heart transplant survival.</div></div><div><h3>Results</h3><div>A total of 1005 patients were aged less than 55 years, with 608 having a left ventricular assist device for less than 2 years and 397 having a left ventricular assist device for 2 years or more. There was no significant difference in post–heart transplant survival between left ventricular assist device duration groups at 90 days (95.3% vs 94.4%, <em>P</em> = .57), 1 year (93.7% vs 90.2%, <em>P</em> = .07), or 3 years (88.0% vs 83.9%, <em>P</em> = .061). A total of 1411 patients were aged 55 years or more, with 935 having a left ventricular assist device for less than 2 years and 476 having a left ventricular assist device for 2 years or more. Patients having a left ventricular assist device for less than 2 years exhibited improved survival at 90 days (92.4% vs 89.2%, <em>P</em> = .046), 1 year (87.8% vs 81.9%, <em>P</em> = .0051), and 3 years (81.4% vs 72.7%, <em>P</em> = .0011). Multivariable adjustment showed a significant impact of age 55 years or more on post–heart transplant mortality (hazard ratio, 1.96; 95% CI, 1.34-2.86; <em>P</em> &lt; .001); however, having a left ventricular assist device for 2 years or more showed no significant impact (hazard ratio, 1.47; 95% CI, 0.91-2.36; <em>P</em> = .116). Formal testing revealed no significant interaction of age and left ventricular assist device duration (hazard ratio, 1.1; 95% CI, 0.63-1.91; <em>P</em> = .735).</div></div><div><h3>Conclusions</h3><div>Although there is a lower observed post–heart transplant survival in patients aged 55 years or more and supported by a left ventricular assist device for 2 years or more, formal testing reveals no significant interaction of these variables on mortality.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102068"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214536","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":"Mechanical circulatory support strategy in post–myocardial infarction ventricular septal defect repair","authors":"Caroline A. Magro BSE,&nbsp;Caroline Snyder BS,&nbsp;Katherine Phillips MD,&nbsp;Deane Smith MD,&nbsp;Nader Moazami MD,&nbsp;Elias Zias MD,&nbsp;Aubrey Galloway MD","doi":"10.1016/j.xjon.2026.102071","DOIUrl":"10.1016/j.xjon.2026.102071","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102071"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214538","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":"Discrepancy between predicted and measured respiratory function after thoracoscopic segmentectomy versus lobectomy","authors":"Yukimi Shibuya MD, PhD,&nbsp;Kohei Hashimoto MD, PhD,&nbsp;Kazuharu Suda MD, PhD,&nbsp;Keisei Tachibana MD, PhD,&nbsp;Ryota Tanaka MD, PhD,&nbsp;Haruhiko Kondo MD, PhD","doi":"10.1016/j.xjon.2026.102078","DOIUrl":"10.1016/j.xjon.2026.102078","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102078"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214450","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":"Single-port robotic lung resection: A comparison against the standard multiport platform","authors":"Jonathan Villena-Vargas MD,&nbsp;Dan Jones MD,&nbsp;Rachel Grosser MD,&nbsp;Jesse Codner MD,&nbsp;Shaikha Al-Thani MD,&nbsp;Abu Nasar MS,&nbsp;Oliver S. Chow MD,&nbsp;Sebron Harrison MD,&nbsp;Nasser K. Altorki MD,&nbsp;Benjamin E. Lee MD,&nbsp;Jeffrey L. Port MD","doi":"10.1016/j.xjon.2026.102046","DOIUrl":"10.1016/j.xjon.2026.102046","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102046"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214454","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":"Clinical impact of deep-vein thrombosis screening in recipients of lung transplants: A contemporary single-center study","authors":"Jose Ramirez BA,&nbsp;Shrikar Modukuri BS,&nbsp;Kenyon Agrons MD,&nbsp;Marcelo Salan-Gomez MD,&nbsp;Andres Leon-Pena MD,&nbsp;Jason Thomas BS,&nbsp;Colton Andrews MD,&nbsp;Allen Kuncheria BS,&nbsp;Cyrus Vahdatpour MD,&nbsp;Senthil Sukumar MD, MS,&nbsp;Muhammad Hayat Syed MD,&nbsp;Subhasis Chatterjee MD,&nbsp;Gabriel Loor MD,&nbsp;Anh Nguyen PhD,&nbsp;Nirmal Sharma MD,&nbsp;Erik E. Suarez MD,&nbsp;Ramiro Fernandez MD","doi":"10.1016/j.xjon.2026.101979","DOIUrl":"10.1016/j.xjon.2026.101979","url":null,"abstract":"<div><h3>Objective</h3><div>Venous thromboembolism (VTE) events are common after lung transplantation and can have a significant impact on morbidity and mortality. Our objective was to assess the impact of a deep-vein thrombosis (DVT) screening program on VTE incidence and clinical outcomes in recipients of lung transplants.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective study of all adults who received lung transplants (≥18 years) at our center between May 2020 and June 2024, excluding multiorgan transplants. Patients were divided into prescreening (May 2020 to June 2022) and screening (June 2022 to June 2024) groups. We evaluated VTE incidence, graft function, bleeding complications, and survival.</div></div><div><h3>Results</h3><div>There were a total of 287 patients in the study, 130 in the prescreening group and 157 in the screening group. DVT incidence was significantly greater in the screening group compared with the prescreening group (54.1% vs 20.7%; <em>P</em> &lt; .001). There was no difference in the incidence of pulmonary embolus, graft function by percent expiratory volume in 1 second predicted out to 1 year, overall survival out to 1 year, nor bleeding complications between groups.</div></div><div><h3>Conclusions</h3><div>DVT screening in recipients of lung transplants detects clinically insignificant DVTs and may introduce potential harm from overtreatment. The use of DVT-screening programs in recipients of lung transplants should be reconsidered.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101979"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214457","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":"Left ventricular ejection fraction decline shortly after mitral valve operation and associated survival","authors":"Kavya Rajesh MD,&nbsp;Megan Chung BA,&nbsp;Luis Gisli Rabelo BS,&nbsp;James Lao BS,&nbsp;Julia Kim BS,&nbsp;Marco Tagliafierro BS,&nbsp;Berk Inan BS,&nbsp;Ian Mason BS,&nbsp;Nathan Ott BS,&nbsp;Vivian Zhang BS,&nbsp;William Mitchell MD,&nbsp;Isaac George MD,&nbsp;Makoto Mori MD,&nbsp;Arnar Geirsson MD","doi":"10.1016/j.xjon.2026.101962","DOIUrl":"10.1016/j.xjon.2026.101962","url":null,"abstract":"<div><h3>Objective</h3><div>Reduction in left ventricular ejection fraction (LVEF) is common after mitral valve (MV) repair or replacement in patients with mitral regurgitation (MR). This study aims to evaluate the trajectory of postoperative LVEF reduction after MV surgery and determine whether this change in LVEF is associated with clinical outcomes.</div></div><div><h3>Methods</h3><div>This is a retrospective study of 625 patients who underwent MV surgery for moderate/severe MR between 2015 and 2023. Patients with aortic valve pathology, concomitant aortic procedures, endocarditis, and previous MV operations were excluded. Patients were divided into 4 quartiles on the basis of pre- and postoperative percent difference in LVEF. In-hospital outcomes and long-term mortality using Kaplan-Meier analysis were compared between groups. Cubic spline adjusted for preoperative LVEF was used to determine the impact of percent LVEF difference on mortality. Spaghetti plots depicted the trajectory in LVEF over a 2-year follow-up period.</div></div><div><h3>Results</h3><div>Patients were divided into percent LVEF reduction quartiles as follows: severely reduced (159 [25.4%], greater than −19%), moderately reduced (157 [25.1%], between −19% and −8%), stable (171 [27.4%], between −7% and +4%), and increased (138 [22.1%], greater than a +4%). Baseline characteristics were similar. There was no difference in the percent of patients undergoing MV repair versus replacement across LVEF reduction groups (<em>P</em> = .55). Postoperative outcomes were similar between groups, including reoperation for bleeding, stroke, and atrial fibrillation. Long-term survival probability over 7 years was similar between all 4 groups (<em>P</em> = .35). There was no significant change in hazards ratio for long-term mortality across range of LVEF differences. Patients with severely or moderately reduced LVEF postoperatively remained with a depressed LVEF during the 2-year follow-up period, whereas patients with the same or increased postoperative LVEF returned to baseline.</div></div><div><h3>Conclusions</h3><div>Reduction in LVEF is common after MV repair or replacement with effects persisting after 2 years. Changes in LVEF after MV operation do not appear to affect clinical outcomes and may by itself not accurately reflect myocardial dysfunction related to MR and subsequent intervention.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101962"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214444","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":"Descending aortic translocation for aerodigestive vascular compression","authors":"Sarah Tsou MD,&nbsp;Peter Chiu MD,&nbsp;Ryan Benavente BS,&nbsp;Daniel Castellanos MD,&nbsp;Jennifer Brown PA-C,&nbsp;Lianne Cole MSN, CPNP,&nbsp;Benjamin Zendejas MD,&nbsp;Christopher W. Baird MD","doi":"10.1016/j.xjon.2026.101888","DOIUrl":"10.1016/j.xjon.2026.101888","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with complex vascular ring anomalies can present with symptoms of esophageal and airway compression, occasionally persisting despite relief of the vascular ring, due to residual compression from the aorta. We report our early experience with descending aortic translocation to address aerodigestive vascular compression.</div></div><div><h3>Methods</h3><div>This is a retrospective single-center review of patients undergoing descending aortic translocation. The operation involves dividing the distal aortic arch on cardiopulmonary bypass, relocating the descending aorta beneath the carina and right pulmonary artery, and anastomosis to the posterior aspect of the ascending aorta, thereby entirely relieving compression on the aerodigestive tract. Concomitant esophageal mobilization and tracheopexies are performed as needed.</div></div><div><h3>Results</h3><div>From 2020 to 2023, 15 patients underwent descending aortic translocation. Anatomic variants included hairpin aorta (n = 2), circumflex aorta (n = 4), midline descending aorta (n = 7), and bowstring aorta (n = 2). Median age was 2 years. Preoperatively, most patients (80%) had mixed esophageal and airway symptoms and had undergone at least 1 prior operation (60%). Intraoperative bronchoscopy revealed improved airway patency for all patients. Postoperatively, 93% of patients had relief of respiratory symptoms, and 79% of patients had improved dysphagia. Postoperative complications included neurologic event (n = 1) with full resolution, right pulmonary artery compression requiring stenting (n = 1), and need for reoperation (n = 2).</div></div><div><h3>Conclusions</h3><div>Descending aortic translocation is a novel approach that can provide symptomatic relief of aerodigestive compression related to complex aortic anomalies. For patients with persistent symptoms after initial vascular ring repair, ongoing aortic compression may need to be addressed, thus also raising the question of whether descending aortic translocation should be considered as a first-line therapy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101888"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214506","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":"Pericardial fluid cardiac troponin I predicts postoperative atrial fibrillation after coronary artery bypass grafting","authors":"Yue Shu BS,&nbsp;Chaoyue Gao MS,&nbsp;Xiaoshuang Ren BS,&nbsp;Xun Deng BS,&nbsp;Lin Luo BS,&nbsp;Taiwei Wang MS,&nbsp;Zexinyao Ren BS,&nbsp;Jiahui Zhao BS,&nbsp;Yisi Liu PhD","doi":"10.1016/j.xjon.2026.101954","DOIUrl":"10.1016/j.xjon.2026.101954","url":null,"abstract":"<div><h3>Objective</h3><div>Cardiac troponin I (cTnI) is a sensitive biomarker of myocardial injury. We hypothesized that cTnI measured in pericardial drainage fluid (PCF), which reflects the cardiac microenvironment, may enhance risk stratification for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting.</div></div><div><h3>Methods</h3><div>In this prospective cohort study, 114 patients undergoing elective coronary artery bypass grafting were enrolled. The primary end point was new-onset POAF within 7 days postoperatively. Blood and PCF cTnI at 6 hours postoperatively were measured. Variables were screened using least absolute shrinkage and selection operator regression and were then incorporated into multivariable logistic regression to construct a predictive model. A simplified risk score (CALT score) was developed. Model performance was compared with existing POAF tools, including the POAF score, CHA₂DS₂-VASc, and the atrial fibrillation risk index.</div></div><div><h3>Results</h3><div>POAF occurred in 30.7% of the cohort. Postoperative 6-hour PCF-cTnI was an independent predictor of POAF (odds ratio, 5.502; 95% CI, 1.887-16.045; <em>P</em> = .002) and significantly enhanced continuous net reclassification improvement (0.562; 95% CI, 0.189-0.921; <em>P</em> = .002). The CALT score comprised left circumflex artery lesions, left atrial diameter, left ventricular end-diastolic diameter, postoperative 0-hour serum calcium, and postoperative 6-hour PCF-cTnI. The PCF-cTnI–based model demonstrated good discrimination (area under the receiver operating characteristic curve = 0.821), with favorable calibration and clinical utility. Compared with commonly used risk scores, the CALT score exhibited superior discrimination and calibration.</div></div><div><h3>Conclusions</h3><div>This study provides novel evidence that PCF-cTnI is a strong predictor of POAF. The CALT score, integrating PCF-cTnI with clinical factors, provided superior predictive performance by capturing both the vulnerable atrial substrate and localized myocardial injury.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101954"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214517","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":"Clinical outcomes of primary Impella 5.5 versus transition from extracorporeal membrane oxygenation in cardiogenic shock: A Spanish multicenter cohort","authors":"José Manuel Martínez-Comendador MD,&nbsp;Elio Martín Gutiérrez MD,&nbsp;Daniel Ortiz Berbel MD,&nbsp;Lucía García Alcalde MD,&nbsp;Álvaro Pedraz Prieto MD,&nbsp;Christian Muñoz Guijosa MD,&nbsp;Carlos Esteban Martín López MD,&nbsp;Stefano Urso MD,&nbsp;Gregorio Rábago Juan Aracil MD,&nbsp;Juan Bustamante-Munguira MD,&nbsp;José Joaquín Cuenca Castillo MD,&nbsp;Manuel Pérez Guillén MD","doi":"10.1016/j.xjon.2026.101870","DOIUrl":"10.1016/j.xjon.2026.101870","url":null,"abstract":"<div><h3>Objective</h3><div>Mechanical circulatory support strategies for cardiogenic shock have traditionally relied on extracorporeal membrane oxygenation. However, newer high-flow ventricular support devices such as the Impella 5.5 device, capable of providing effective circulatory support, ventricular unloading, and early mobilization with fewer device-related complications, have begun to challenge the systematic use of an extracorporeal membrane oxygenation–first approach. The clinical evolution of patients treated with the Impella 5.5 device and the impact of different support trajectories remain poorly characterized. We describe the clinical evolution of patients treated with the Impella 5.5 device according to initial support trajectory, distinguishing primary implantation from transition after venoarterial extracorporeal membrane oxygenation.</div></div><div><h3>Methods</h3><div>This multicenter observational study included 114 consecutive patients with advanced heart failure or cardiogenic shock who underwent Impella 5.5 implantation in Spanish heart transplant centers. Patients were classified according to initial support trajectory: primary Impella 5.5 implantation (n = 72) or initial venoarterial extracorporeal membrane oxygenation support followed by transition to Impella 5.5 (venoarterial extracorporeal membrane oxygenation to Impella 5.5 transition, n = 42). Baseline characteristics, clinical trajectories, complications, and in-hospital outcomes were analyzed.</div></div><div><h3>Results</h3><div>All patients ultimately received Impella 5.5 device support. In-hospital mortality was 27.8% in the primary Impella group and 69.0% in the extracorporeal membrane oxygenation–Impella group (<em>P</em> &lt; .001), with an overall mortality of 43.0%. Heart transplantation as definitive therapy was achieved in 76.4% and 31.0% of patients, respectively (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>In transplant-oriented centers, outcomes among patients supported with the Impella 5.5 device appear to differ according to support trajectory. Primary implantation was associated with lower mortality and greater access to heart transplantation than transition from extracorporeal membrane oxygenation to the Impella 5.5 device.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101870"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214541","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}