JTCVS open最新文献

{"title":"Long-term outcomes of primary surgical repair for communicating DeBakey IIIb chronic dissecting aortic aneurysm","authors":"Shuhei Miura MD,&nbsp;Yutaka Iba MD, PhD,&nbsp;Kei Mukawa MD,&nbsp;Keitaro Nakanishi MD,&nbsp;Takakimi Mizuno MD,&nbsp;Ayaka Arihara MD,&nbsp;Tsuyoshi Shibata MD, PhD,&nbsp;Junji Nakazawa MD, PhD,&nbsp;Tomohiro Nakajima MD, PhD,&nbsp;Nobuyoshi Kawaharada MD, PhD","doi":"10.1016/j.xjon.2024.05.009","DOIUrl":"10.1016/j.xjon.2024.05.009","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to evaluate the long-term outcomes of surgical strategies for communicating DeBakey IIIb chronic dissecting aortic aneurysm, considering the optimal primary surgical repair to prevent aortic events.</p></div><div><h3>Methods</h3><p>From 2002 to 2021, 101 patients with communicating DeBakey IIIb chronic dissecting aortic aneurysm who underwent surgical repair were categorized based on the primary surgical repair: 1-stage repair of thoracoabdominal aortic aneurysm (TAAAR) (n = 22) or staged repair, such as descending thoracic aneurysm repair (DTAR) (n = 43) or total arch replacement with elephant trunk implantation (TARET) (n = 25), and thoracic endovascular aortic repair (TEVAR) (n = 11). Early and late postoperative outcomes were compared among the groups.</p></div><div><h3>Results</h3><p>Early outcomes for TAAAR, DTAR, TARET, and TEVAR were associated with the incidence of stroke (9.1% vs 0% vs 4.0% vs 9.1%, respectively), spinal cord injury (13.6% vs 4.7% vs 8.0% vs 0%, respectively), and in-hospital mortality (9.1% vs 2.3% vs 0% vs 9.1%, respectively). During follow-up, the 10-year overall survival and 7-year aortic event-free rates for TAAAR, DTAR, TARET, and TEVAR were 61.8%, 71.6%, 21.5%, and 26.5% and 93.8%, 84.3%, 74.4%, and 51.4%, respectively. TAAAR had significantly higher overall survival (<em>P</em> = .05) and aortic event-free rates (<em>P</em> = .03) than TEVAR. TARET (hazard ratio, 2.27; <em>P</em> &lt; .01) and TEVAR (hazard ratio, 3.40; <em>P</em> &lt; .01) were independently associated with the incidence of aortic events during follow-up.</p></div><div><h3>Conclusions</h3><p>Considering the optimal primary surgical repair based on long-term outcomes, TEVAR was not a durable treatment option. Patient-specific TAAAR or DTAR should be considered rather than defaulting to minimally invasive primary repairs for all patients with communicating DeBakey IIIb chronic dissecting aortic aneurysm.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 1-13"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001293/pdfft?md5=12a1cfd48f6c60ac1e3e2435c9c36f1e&pid=1-s2.0-S2666273624001293-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141960983","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":"Prophylaxis for postoperative atrial fibrillation: Impact of the implementation of a medication bundle protocol","authors":"","doi":"10.1016/j.xjon.2024.05.014","DOIUrl":"10.1016/j.xjon.2024.05.014","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 37-39"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001591/pdfft?md5=26cf9000887935c40e2eb7753a65ff45&pid=1-s2.0-S2666273624001591-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141391214","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":"Timing of coronary artery bypass grafting after myocardial infarction influences late survival","authors":"","doi":"10.1016/j.xjon.2024.05.008","DOIUrl":"10.1016/j.xjon.2024.05.008","url":null,"abstract":"<div><h3>Objectives</h3><p>The role of timing of coronary artery bypass grafting after acute myocardial infarction on early and late outcomes remains uncertain.</p></div><div><h3>Methods</h3><p>We reviewed 1631 consecutive adult patients who underwent isolated coronary artery bypass grafting with information on timing of acute myocardial infarction. Early and late mortality were compared between patients receiving coronary artery bypass grafting within 24 hours after acute myocardial infarction, between 1 and 7 days after acute myocardial infarction, and more than 7 days after acute myocardial infarction. Sensitivity analyses were performed in subgroups of patients with ST-segment elevation myocardial infarction or non–ST-segment elevation myocardial infarction, and other high-risk groups.</p></div><div><h3>Results</h3><p>A total of 124 patients (5.7%) underwent coronary artery bypass grafting within 24 hours, 972 patients (51.2%) received coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, and 535 patients (43.2%) underwent coronary artery bypass grafting more than 7 days after acute myocardial infarction. Overall operative mortality was 2.7% with comparable adjusted early mortality among 3 groups. Over a median follow-up of 13.5 years (interquartile range, 8.9-17.1), compared with patients receiving coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, those receiving coronary artery bypass grafting at 7 days had greater adjusted risk for late overall mortality (hazard ratio, 1.39, 95% CI, 1.16-1.67; <em>P &lt;</em> .001), whereas those receiving coronary artery bypass grafting within 24 hours had comparable risk of late overall mortality (hazard ratio, 1.12, 95% CI, 0.86-1.47; <em>P =</em> .39). Timing of coronary artery bypass grafting was associated with late mortality in patients with non–ST-segment elevation myocardial infarction (patients receiving coronary artery bypass grafting at &gt;7 days had a higher risk of late mortality [hazard ratio, 1.38, 95% CI, 1.14-1.67, <em>P</em> &lt; .001] compared with those receiving coronary artery bypass grafting between 1 and 7 days), but not in patients with ST-segment elevation myocardial infarction.</p></div><div><h3>Conclusions</h3><p>Early revascularization through coronary artery bypass grafting within 7 days during the same hospitalization appears beneficial, especially for patients presenting with non–ST-segment elevation myocardial infarction.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 40-48"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001281/pdfft?md5=b852b8ef74d7f9907ec44d4e6128256e&pid=1-s2.0-S2666273624001281-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141139212","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":"Salvage lung resection after immunotherapy is feasible and safe","authors":"","doi":"10.1016/j.xjon.2024.03.018","DOIUrl":"10.1016/j.xjon.2024.03.018","url":null,"abstract":"<div><h3>Objectives</h3><p>Patients with non–small cell lung cancer treated with immunotherapy and modern chemoradiation regimens show improved progression-free and overall survival. However, patients with limited oligo-progression represent a potential population in which local therapy such as surgery may have a potential role as salvage treatment. The objectives of our study were to evaluate the feasibility and safety of salvage lung resection after immunotherapy in patients with non–small cell lung cancer.</p></div><div><h3>Methods</h3><p>The National Cancer Database was queried for patients diagnosed and treated for non–small cell lung cancer stage I to IV, from 2013 to 2020. Patients who underwent surgery as salvage after immunotherapy were defined as undergoing surgery &gt;5 months from the initiation of immunotherapy. As a sensitivity analysis, patients who underwent surgery as salvage after chemoradiation were also analyzed in a similar fashion. Surgical outcomes such as type of surgery, complete resection (R0) rates, and complete pathologic response rates were determined for feasibility. Length of stay, 30-day readmission rates, and 30-day mortality rates were determined and overall survivals were estimated with Kaplan-Meier analysis to evaluate for safety.</p></div><div><h3>Results</h3><p>Of the 934,093 patients diagnosed with non–small cell lung cancer stage I to IV from 2013 to 2020, 164 patients received immunotherapy and after 5 months underwent surgery. Lobectomy was the most commonly performed operation (74%) and pneumonectomy was required in 9% (n = 15). R0 resection was achieved in 89% (n = 146) and of these patients, 23% (n = 37) had complete pathologic response. Median length of stay was 4 days, 30-day readmission was 5%, and 30-day mortality was 0.6%. In our sensitivity analysis of chemoradiation patients (n = 445), the above data were similar to previously reported cohort studies of patients undergoing chemoradiation and subsequently salvage surgery.</p></div><div><h3>Conclusions</h3><p>Lung resection after immunotherapy appears to be a feasible salvage treatment option, with lobectomy being most common and with high R0 resection rates. Low patient morbidity and mortality rates also suggest the safety of this approach. Salvage surgery may be considered in patients who have oligo-progression after immunotherapy within the context of a comprehensive multidisciplinary treatment plan.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 141-150"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001128/pdfft?md5=ffaf91ee55dcf62366d75060b2116206&pid=1-s2.0-S2666273624001128-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769501","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":"Outcomes of nonemergency cardiac surgery after overnight operative workload: A statewide experience","authors":"Tyler M. Bauer MD ,&nbsp;Michael J. Pienta MD ,&nbsp;Xiaoting Wu PhD ,&nbsp;Michael P. Thompson PhD ,&nbsp;Robert B. Hawkins MD ,&nbsp;Andrew L. Pruitt MD ,&nbsp;Alphonse Delucia III MD ,&nbsp;Shelly C. Lall MD ,&nbsp;Francis D. Pagani MD, PhD ,&nbsp;Donald S. Likosky PhD ,&nbsp;The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and The Video Assessment of CaRdiac Surgery QualITY (VARSITY) Surgery Investigators","doi":"10.1016/j.xjon.2024.04.018","DOIUrl":"10.1016/j.xjon.2024.04.018","url":null,"abstract":"<div><h3>Objective</h3><p>Cardiac surgeons experience unpredictable overnight operative responsibilities, with variable rest before same-day, first-start scheduled cases. This study evaluated the frequency and associated impact of a surgeon's overnight operative workload on the outcomes of their same-day, first-start operations.</p></div><div><h3>Methods</h3><p>A statewide cardiac surgery quality database was queried for adult cardiac surgical operations between July 1, 2011, and March 1, 2021. Nonemergency, first-start, Society of Thoracic Surgeons predicted risk of mortality operations were stratified by whether or not the surgeon performed an overnight operation that ended after midnight. A generalized mixed effect model was used to evaluate the effect of overnight operations on a Society of Thoracic Surgeons composite outcome (5 major morbidities or operative mortality) of the first-start operation.</p></div><div><h3>Results</h3><p>Of all first-start operations, 0.4% (239/56,272) had a preceding operation ending after midnight. The Society of Thoracic Surgeons predicted risk of morbidity and mortality was similar for first-start operations whether preceded by an overnight operation or not (overnight operation: 11.3%; no overnight operation: 11.7%, <em>P</em> = .42). Unadjusted rates of the primary outcome were not significantly different after an overnight operation (overnight operation: 13.4%; no overnight operation: 12.3%, <em>P</em> = .59). After adjustment, overnight operations did not significantly impact the risk of major morbidity or mortality for first-start operations (adjusted odds ratio, 1.1, <em>P</em> = .70).</p></div><div><h3>Conclusions</h3><p>First-start cardiac operations performed after an overnight operation represent a small subset of all first-start Society of Thoracic Surgeons predicted risk operations. Overnight operations do not significantly influence the risk of major morbidity or mortality of first-start operations, which suggests that surgeons exercise proper judgment in determining appropriate workloads.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 101-111"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001323/pdfft?md5=8a565e6b4333b3659f512bfb94eb7b11&pid=1-s2.0-S2666273624001323-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141960994","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":"Involving the next generation of cardiovascular surgeons","authors":"Vincent Q. Sier MSc ,&nbsp;Joris J. Blok MD, PhD ,&nbsp;Ferdi Akca MD, PhD ,&nbsp;Jesper Hjortnaes MD, PhD ,&nbsp;Joost R. van der Vorst MD, PhD","doi":"10.1016/j.xjon.2024.05.012","DOIUrl":"10.1016/j.xjon.2024.05.012","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Page 210"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001335/pdfft?md5=8033c79bed00a27961ffc9df5eb1c620&pid=1-s2.0-S2666273624001335-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961058","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":"Persistent income-based disparities in clinical outcomes of cardiac surgery across the United States: A contemporary appraisal","authors":"Sara Sakowitz MS, MPH ,&nbsp;Syed Shahyan Bakhtiyar MD, MBE ,&nbsp;Saad Mallick MD ,&nbsp;Arjun Verma BS ,&nbsp;Yas Sanaiha MD ,&nbsp;Richard Shemin MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.xjon.2024.05.015","DOIUrl":"10.1016/j.xjon.2024.05.015","url":null,"abstract":"<div><h3>Objective</h3><p>Although national efforts have aimed to improve the safety of inpatient operations, income-based inequities in surgical outcomes persist, and the evolution of such disparities has not been examined in the contemporary setting. We sought to examine the association of community-level household income with acute outcomes of cardiac procedures over the past decade.</p></div><div><h3>Methods</h3><p>All adult hospitalizations for elective coronary artery bypass grafting/valve operations were tabulated from the 2010-2020 Nationwide Readmissions Database. Patients were stratified into quartiles of income, with records in the 76th to 100th percentile designated as highest and those in the 0 to 25th percentile as lowest. To evaluate the change in adjusted risk of in-hospital mortality, complications, and readmission over the study period, estimates were generated for each income level and year.</p></div><div><h3>Results</h3><p>Of approximately 1,848,755 hospitalizations, 406,216 patients (22.0%) were classified as highest income and 451,988 patients (24.4%) were classified as lowest income. After risk adjustment, lowest income remained associated with greater likelihood of in-hospital mortality (adjusted odds ratio, 1.61, 95% CI, 1.51-1.72), any postoperative complication (adjusted odds ratio, 1.19, CI, 1.15-1.22), and nonelective readmission within 30 days (adjusted odds ratio, 1.07, CI, 1.05-1.10). Overall adjusted risk of mortality, complications, and nonelective readmission decreased for both groups from 2010 to 2020 (<em>P &lt;</em> .001). Further, the difference in risk of mortality between patients of lowest and highest income decreased by 0.2%, whereas the difference in risk of major complications declined by 0.5% (both <em>P</em> &lt; .001).</p></div><div><h3>Conclusions</h3><p>Although overall in-hospital mortality and complication rates have declined, low-income patients continue to face greater postoperative risk. Novel interventions are needed to address continued income-based disparities and ensure equitable surgical outcomes.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 89-100"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001645/pdfft?md5=723790c8994ad7023d4a42089a7ee72d&pid=1-s2.0-S2666273624001645-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961059","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":"Patient-reported outcome measures after minimally invasive mitral valve surgery: The benefit may be early","authors":"Amy Brown MD, MSc, MPH,&nbsp;Rhys I. Beaudry PhD,&nbsp;Jolene Moen RN,&nbsp;Sean Kang MSc,&nbsp;Ali Fatehi Hassanabad MD, MSc,&nbsp;Vishnu Vasanthan MD,&nbsp;Alexander J. Gregory MD,&nbsp;William D.T. Kent MD, MSc,&nbsp;Corey Adams MD, MSc","doi":"10.1016/j.xjon.2024.05.010","DOIUrl":"10.1016/j.xjon.2024.05.010","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 26-28"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266627362400130X/pdfft?md5=479745961e97555770e1f148eae456d8&pid=1-s2.0-S266627362400130X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961060","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":"Oncologic outcomes after minimally invasive segmentectomy or lobectomy in patients with hypermetabolic clinical stage IA1-2 non–small cell lung cancer","authors":"","doi":"10.1016/j.xjon.2024.05.002","DOIUrl":"10.1016/j.xjon.2024.05.002","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the oncologic outcome of patients with hypermetabolic tumors resected by segmentectomy or lobectomy.</p></div><div><h3>Methods</h3><p>This was a retrospective analysis of all consecutive patients with peripheral clinical stage IA1-2 non–small cell lung cancer (January 2017-June 2023) who underwent resection by segmentectomy or lobectomy in a single center. A hypermetabolic tumor was defined as a tumor with a positron emission tomography (PET) maximum standardized uptake value &gt;2.5. Propensity score case-matching analysis was used to generate 2 balanced groups of patients with hypermetabolic tumors operated by segmentectomy or lobectomy. Four-year overall survival (OS), event-free survival (EFS), and cancer-specific survival were compared between the matched groups.</p></div><div><h3>Results</h3><p>A total of 164 segmentectomies and 234 lobectomies were analyzed. There were 91 (55%) hypermetabolic tumors in the segmentectomy group versus 178 in the lobectomy group (76%), <em>P</em> &lt; .001. The comparison of the matched groups with hypermetabolic tumors showed a better 4-year OS after lobectomy compared with segmentectomy (lobectomy 87%; 95% confidence interval [CI], 76-93; segmentectomy, 67%; 95% CI, 49-80; <em>P</em> = .029). The 4-year EFS appeared to have a better trend after lobectomy (77%; 95% CI, 65-85) compared with segmentectomy (58%; 95% CI, 39-72), <em>P</em> = .088. The 4-year cancer-specific survival, however, was similar between the matched groups (lobectomy, 95%; 95% CI, 86-98 vs segmentectomy, 94%; 95% CI, 78-99, <em>P</em> = .79).</p></div><div><h3>Conclusions</h3><p>Early-stage peripheral hypermetabolic tumors are associated with poorer oncologic outcomes compared with less PET-avid tumors. Despite poorer OS and EFS after segmentectomy likely caused by cancer-unrelated deaths, cancer-specific survival in this high-risk group was similar after lobectomy or segmentectomy. In well-selected patients, a high PET maximum standardized uptake value should not be considered a contraindication to segmentectomy.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 167-173"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001220/pdfft?md5=40682cf1a1bc1e6fc266fe416da171a5&pid=1-s2.0-S2666273624001220-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141141281","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":"Greater ipsilateral rectus muscle atrophy after robotic thoracic surgery compared with open and video-assisted thoracoscopic surgery approaches","authors":"Yoyo Wang BS ,&nbsp;Ryan J. Randle MD ,&nbsp;Prasha Bhandari MPH ,&nbsp;Hao He PhD ,&nbsp;Winston L. Trope BA ,&nbsp;Brandon A. Guenthart MD ,&nbsp;H. Henry Guo MD ,&nbsp;Douglas Z. Liou MD ,&nbsp;Leah M. Backhus MD ,&nbsp;Mark F. Berry MD ,&nbsp;Joseph B. Shrager MD ,&nbsp;Natalie S. Lui MD","doi":"10.1016/j.xjon.2024.05.011","DOIUrl":"10.1016/j.xjon.2024.05.011","url":null,"abstract":"<div><h3>Objective</h3><p>Robotic thoracic surgery provides another minimally invasive approach in addition to video-assisted thoracoscopic surgery (VATS) that yields less pain and faster recovery compared with open surgery. However, robotic incisions are generally placed more inferiorly, which may increase the risk of intercostal nerve injury that affects the abdominal wall. We hypothesized that a robotic approach causes greater ipsilateral rectus muscle atrophy compared with open and VATS approaches.</p></div><div><h3>Methods</h3><p>The cross-sectional area and density of bilateral rectus abdominis muscles were measured on computed tomography scans in patients who underwent lobectomy in 2018. The differences between the contralateral and ipsilateral muscles were compared between preoperative and 6-month surveillance scans. Changes were compared among the open, VATS, and robotic approaches through a mixed effects model after adjustments of correlation and covariates.</p></div><div><h3>Results</h3><p>Of 99 lobectomies, 25 (25.3%) were open, 56 (56.6%) VATS, and 18 (18.1%) robotic. The difference between the contralateral and ipsilateral rectus muscle cross-sectional area was significantly larger at 6 months after robotic surgery compared with open (31.4% vs 9.5%, <em>P</em> = .049) and VATS (31.4% vs 14.1%, <em>P</em> = .021). There were no significant differences in the cross-sectional area between the open and VATS approach.</p></div><div><h3>Conclusions</h3><p>In this retrospective analysis, there was greater ipsilateral rectus muscle atrophy associated with robotic thoracic surgery compared with open or VATS approaches. These findings should be correlated with clinical symptoms and followed to assess for resolution or persistence.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 202-209"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001311/pdfft?md5=b8117a758f48bb0120e84f964c3dc660&pid=1-s2.0-S2666273624001311-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961057","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}