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Tricuspid valve surgery following septal myectomy in patients with a cardiac implantable electronic device 植入心脏电子装置的患者进行房间隔肌瘤切除术后的三尖瓣手术
JTCVS open Pub Date : 2024-08-01 DOI: 10.1016/j.xjon.2024.06.011
Tedy Sawma MD , Hartzell V. Schaff MD , Jeffrey B. Geske MD , Joseph A. Dearani MD , Steve R. Ommen MD
{"title":"Tricuspid valve surgery following septal myectomy in patients with a cardiac implantable electronic device","authors":"Tedy Sawma MD ,&nbsp;Hartzell V. Schaff MD ,&nbsp;Jeffrey B. Geske MD ,&nbsp;Joseph A. Dearani MD ,&nbsp;Steve R. Ommen MD","doi":"10.1016/j.xjon.2024.06.011","DOIUrl":"10.1016/j.xjon.2024.06.011","url":null,"abstract":"<div><h3>Background</h3><p>Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of developing cardiac arrhythmias and have a high prevalence of cardiac implantable electronic device (CIED) use. Tricuspid regurgitation (TR) is a potential complication of device leads and can be severe enough to prompt surgical intervention.</p></div><div><h3>Methods</h3><p>We identified 21 consecutive patients who underwent tricuspid valve (TV) surgery for device lead-induced TR late following septal myectomy (SM) for obstructive HCM. The primary endpoint was long-term all-cause mortality.</p></div><div><h3>Results</h3><p>The median patient age was 63 years (range, 55-71 years), 19 patients (91%) had New York Heart Association class III or IV limitation, and all patients were receiving diuretics for right heart failure. The median interval between device implantation and TV surgery was 4 years (range, 1.5-8.5 years). Eight patients (38%) underwent pacemaker implantation due to complete heart block following SM. Preoperatively, TR was severe in 81% of the patients. The primary mechanism of lead-induced TR was leaflet impingement without adherence (n = 15; 75%). Nine patients (43%) underwent TV replacement, and 12 patients (57%) underwent repair. Only 1 patient died early postoperatively. Patients with lead-induced TR had markedly reduced long-term survival compared to the overall population of patients undergoing SM; 5-year survival was 58%, compared to 96% for the contemporary SM group.</p></div><div><h3>Conclusions</h3><p>Late lead-induced TR is a potential complication of CIEDs in patients with HCM who have undergone SM. Although TV repair and replacement can be done with acceptable early mortality, late patient survival is poor.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 29-36"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001712/pdfft?md5=641af9c689d2d204d387914ed0975b63&pid=1-s2.0-S2666273624001712-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961061","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}
引用次数: 0
Discussion to: Salvage lung resection after immunotherapy is feasible and safe 讨论至免疫疗法后的挽救性肺切除术可行且安全
JTCVS open Pub Date : 2024-08-01 DOI: 10.1016/j.xjon.2024.04.012
{"title":"Discussion to: Salvage lung resection after immunotherapy is feasible and safe","authors":"","doi":"10.1016/j.xjon.2024.04.012","DOIUrl":"10.1016/j.xjon.2024.04.012","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 151-152"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001153/pdfft?md5=0724d0347417e8f1197b53d3b0a2e350&pid=1-s2.0-S2666273624001153-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756826","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}
引用次数: 0
Operative and nonoperative outcomes in patients with trisomy 13 and 18 with congenital heart disease 13 和 18 三体综合征合并先天性心脏病患者的手术和非手术治疗效果
JTCVS open Pub Date : 2024-08-01 DOI: 10.1016/j.xjon.2024.06.007
Christina L. Greene MD , Antonia Schulz MD , Mariana Chávez MD , Steven J. Staffa MS , David Zurakowski MS, PhD , Kevin G. Friedman MD , Sitaram M. Emani MD , Christopher W. Baird MD
{"title":"Operative and nonoperative outcomes in patients with trisomy 13 and 18 with congenital heart disease","authors":"Christina L. Greene MD ,&nbsp;Antonia Schulz MD ,&nbsp;Mariana Chávez MD ,&nbsp;Steven J. Staffa MS ,&nbsp;David Zurakowski MS, PhD ,&nbsp;Kevin G. Friedman MD ,&nbsp;Sitaram M. Emani MD ,&nbsp;Christopher W. Baird MD","doi":"10.1016/j.xjon.2024.06.007","DOIUrl":"10.1016/j.xjon.2024.06.007","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the short- and long-term outcomes of cardiac repair versus nonoperative management in patients with trisomy 13 and trisomy 18 with congenital heart disease.</p></div><div><h3>Methods</h3><p>An institutional review board-approved, retrospective review was undertaken to identify all patients admitted with trisomy 13/18 and congenital heart disease. Patients were divided into 2 cohorts (operated vs nonoperated) and compared.</p></div><div><h3>Results</h3><p>Between 1985 and 2023, 62 patients (34 operated and 28 nonoperated) with trisomy 13 (n = 9) and trisomy 18 (n = 53) were identified. The operated cohort was 74% girls, underwent mainly The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category 1 procedures (n = 24 [71%]) at a median age of 2.5 months (interquartile range [IQR], 1.3-4.5 months). This compares with the nonoperative cohort where 64% (n = 18) would have undergone The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category 1 procedures if surgery would have been elected. The most common diagnosis was ventricular septal defect. Postoperative median intensive care unit stay was 6.5 days (IQR, 3.7-15 days) with a total hospital length of stay of 15 days (IQR, 11-49 days). Thirty-day postoperative survival was 94%. There were 5 in-hospital deaths in the operated and 7 in the nonoperated cohort. Median follow-up was 15.4 months (IQR, 4.3-48.7 months) for the operated and 11.2 months (IQR, 1.2-48.3 months) for the nonoperated cohorts. One-year survival was 79% operated versus 51.5% nonoperated (<em>P</em> &lt; .003). Nonoperative treatment had an increased risk of mortality (hazard ratio, 3.28; 95% CI, 1.46-7.4; <em>P</em> = .004).</p></div><div><h3>Conclusions</h3><p>Controversy exists regarding the role of primary cardiac repair in patients with trisomy 13/18 and congenital heart disease. Cardiac repair can be performed safely with low early mortality and operated patients had higher long-term survival compared with nonoperated in our cohort.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 123-131"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001669/pdfft?md5=7f5c6941eee514d471dc97a60d6160e8&pid=1-s2.0-S2666273624001669-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141960995","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}
引用次数: 0
Discussion to: Identifying lung cancer disparities among Asian Americans: A novel analytic approach 讨论到:识别亚裔美国人的肺癌差异:一种新的分析方法
JTCVS open Pub Date : 2024-08-01 DOI: 10.1016/j.xjon.2024.05.001
{"title":"Discussion to: Identifying lung cancer disparities among Asian Americans: A novel analytic approach","authors":"","doi":"10.1016/j.xjon.2024.05.001","DOIUrl":"10.1016/j.xjon.2024.05.001","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 165-166"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001219/pdfft?md5=1602ca512303ca2f2f94ba095b471d2e&pid=1-s2.0-S2666273624001219-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141055694","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}
引用次数: 0
Intramyocardial injection of hypoxia-conditioned extracellular vesicles increases myocardial perfusion in a swine model of chronic coronary disease 在慢性冠心病猪模型中心肌内注射低氧调节细胞外囊泡可增加心肌灌注量
JTCVS open Pub Date : 2024-08-01 DOI: 10.1016/j.xjon.2024.06.003
{"title":"Intramyocardial injection of hypoxia-conditioned extracellular vesicles increases myocardial perfusion in a swine model of chronic coronary disease","authors":"","doi":"10.1016/j.xjon.2024.06.003","DOIUrl":"10.1016/j.xjon.2024.06.003","url":null,"abstract":"<div><h3>Objective</h3><p>Coronary artery disease remains a leading cause of morbidity and mortality worldwide. Patients with advanced coronary artery disease who are not eligible for endovascular or surgical revascularization have limited options. Extracellular vesicles have shown potential to improve myocardial function in preclinical models. Extracellular vesicles can be conditioned to modify their components. Hypoxia-conditioned extracellular vesicles have demonstrated the ability to reduce infarct size and apoptosis in small animals. Our objective is to assess the potential benefits of hypoxia-conditioned extracellular vesicles in a large animal model of coronary artery disease.</p></div><div><h3>Methods</h3><p>Coronary artery disease was induced in 14 Yorkshire swine by ameroid constriction of the left circumflex coronary artery. Two weeks postsurgery, swine underwent a repeat left thoracotomy for injections of hypoxia-conditioned extracellular vesicles (n = 7) or saline (control, n = 7). Five weeks later, all animals underwent terminal harvest for perfusion measurements and myocardial sectioning.</p></div><div><h3>Results</h3><p>Myocardial perfusion analysis demonstrated a trend toward increase at rest and a significant increase during rapid pacing (<em>P =</em> .09, <em>P &lt;</em> .001). There were significant increases in activated phosphorylated endothelial nitric oxide synthase, endothelial nitric oxide synthase, phosphatidylinositol 3-kinase, phosphorylated protein kinase B, and the phosphorylated protein kinase B/protein kinase B ratio in the hypoxia-conditioned extracellular vesicles group compared with the control group (all <em>P</em> &lt; .05). Additionally, there was a significant decrease in the antiangiogenic proteins collagen 18 and angiostatin (<em>P =</em> .01, <em>P</em> = .01) in the hypoxia-conditioned extracellular vesicles group.</p></div><div><h3>Conclusions</h3><p>Intramyocardial injection of hypoxia-conditioned extracellular vesicles results in increased myocardial perfusion without a corresponding change in vessel density. Therefore, this improvement in perfusion is possibly due to changes in nitric oxide signaling. Hypoxia-conditioned extracellular vesicles represent a potential therapeutic strategy to increase myocardial perfusion in patients with advanced coronary artery disease.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 49-63"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266627362400161X/pdfft?md5=3c49ce287b9addf97d357dc18a02db15&pid=1-s2.0-S266627362400161X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413368","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}
引用次数: 0
RBT-1 Reduces Blood Product Utilization in Patients Undergoing Non-Emergent Coronary Artery Bypass Grafting and/or Valve Surgery RBT-1 可减少接受非急诊冠状动脉旁路移植术和/或瓣膜手术患者的血液制品使用量
JTCVS open Pub Date : 2024-07-01 DOI: 10.1016/j.xjon.2024.06.019
Charles A. Mack, M. Jessen, Andre Lamy, Ashish Khanna, Kevin Lobdell, Rakesh Arora, Jeannette Rodriguez, Stacey Ruiz, Bhupinder Singh
{"title":"RBT-1 Reduces Blood Product Utilization in Patients Undergoing Non-Emergent Coronary Artery Bypass Grafting and/or Valve Surgery","authors":"Charles A. Mack, M. Jessen, Andre Lamy, Ashish Khanna, Kevin Lobdell, Rakesh Arora, Jeannette Rodriguez, Stacey Ruiz, Bhupinder Singh","doi":"10.1016/j.xjon.2024.06.019","DOIUrl":"https://doi.org/10.1016/j.xjon.2024.06.019","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"67 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696725","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}
引用次数: 0
An evaluation of the outcomes associated with peritoneal catheter use in neonates undergoing cardiac surgery: A multicenter study 对接受心脏手术的新生儿使用腹膜导管的相关结果进行评估:一项多中心研究
JTCVS open Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.009
David M. Kwiatkowski MD, MS , Jeffrey A. Alten MD , Kenneth E. Mah MD , David T. Selewski MD , Tia T. Raymond MD, MBA , Natasha S. Afonso MD, MPH , Joshua J. Blinder MD , Matthew T. Coghill MD , David S. Cooper MD, MPH , Joshua D. Koch MD , Catherine D. Krawczeski MD , David L.S. Morales MD , Tara M. Neumayr MD , A.K.M. Fazlur Rahman PhD , Garrett Reichle MS , Sarah Tabbutt MD, PhD , Tennille N. Webb MD , Santiago Borasino MD
{"title":"An evaluation of the outcomes associated with peritoneal catheter use in neonates undergoing cardiac surgery: A multicenter study","authors":"David M. Kwiatkowski MD, MS ,&nbsp;Jeffrey A. Alten MD ,&nbsp;Kenneth E. Mah MD ,&nbsp;David T. Selewski MD ,&nbsp;Tia T. Raymond MD, MBA ,&nbsp;Natasha S. Afonso MD, MPH ,&nbsp;Joshua J. Blinder MD ,&nbsp;Matthew T. Coghill MD ,&nbsp;David S. Cooper MD, MPH ,&nbsp;Joshua D. Koch MD ,&nbsp;Catherine D. Krawczeski MD ,&nbsp;David L.S. Morales MD ,&nbsp;Tara M. Neumayr MD ,&nbsp;A.K.M. Fazlur Rahman PhD ,&nbsp;Garrett Reichle MS ,&nbsp;Sarah Tabbutt MD, PhD ,&nbsp;Tennille N. Webb MD ,&nbsp;Santiago Borasino MD","doi":"10.1016/j.xjon.2024.03.009","DOIUrl":"10.1016/j.xjon.2024.03.009","url":null,"abstract":"<div><h3>Objective</h3><p>The study objective was to determine if intraoperative peritoneal catheter placement is associated with improved outcomes in neonates undergoing high-risk cardiac surgery with cardiopulmonary bypass.</p></div><div><h3>Methods</h3><p>This propensity score–matched retrospective study used data from 22 academic pediatric cardiac intensive care units. Consecutive neonates undergoing Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery category 3 to 5 cardiac surgery with cardiopulmonary bypass at centers participating in the NEonatal and Pediatric Heart Renal Outcomes Network collaborative were studied to determine the association of the use of an intraoperative placed peritoneal catheter for dialysis or passive drainage with clinical outcomes, including the duration of mechanical ventilation.</p></div><div><h3>Results</h3><p>Among 1490 eligible neonates in the NEonatal and Pediatric Heart Renal Outcomes Network dataset, a propensity-matched analysis was used to compare 395 patients with peritoneal catheter placement with 628 patients without peritoneal catheter placement. Time to extubation and most clinical outcomes were similar. Postoperative length of stay was 5 days longer in the peritoneal catheter placement cohort (17 vs 22 days, <em>P</em> = .001). There was a 50% higher incidence of moderate to severe acute kidney injury in the no-peritoneal catheter cohort (12% vs 18%, <em>P</em> = .02). Subgroup analyses between specific treatments and in highest risk patients yielded similar associations.</p></div><div><h3>Conclusions</h3><p>This study does not demonstrate improved outcomes among neonates with placement of a peritoneal catheter during cardiac surgery. Outcomes were similar apart from longer hospital stay in the peritoneal catheter cohort. The no-peritoneal catheter cohort had a 50% higher incidence of moderate to severe acute kidney injury (12% vs 18%). This analysis does not support indiscriminate peritoneal catheter use, although it may support the utility for postoperative fluid removal among neonates at risk for acute kidney injury. A multicenter controlled trial may better elucidate peritoneal catheter effects.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 275-295"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000688/pdfft?md5=c36f936319a101fe5d6c4b4f8d96cfa9&pid=1-s2.0-S2666273624000688-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399684","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}
引用次数: 0
Long-term outcomes of surgical or endovascular treatment of adult with midaortic syndrome: A single-center retrospective study over a 14-year period 手术或血管内治疗成人大动脉综合征的长期疗效
JTCVS open Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.011
Hao Liu MD, PhD , Tianyue Pan MD, PhD , Bin Chen MD, PhD , Junhao Jiang MD, PhD , Weiguo Fu MD, PhD , Zhihui Dong MD, PhD
{"title":"Long-term outcomes of surgical or endovascular treatment of adult with midaortic syndrome: A single-center retrospective study over a 14-year period","authors":"Hao Liu MD, PhD ,&nbsp;Tianyue Pan MD, PhD ,&nbsp;Bin Chen MD, PhD ,&nbsp;Junhao Jiang MD, PhD ,&nbsp;Weiguo Fu MD, PhD ,&nbsp;Zhihui Dong MD, PhD","doi":"10.1016/j.xjon.2024.03.011","DOIUrl":"10.1016/j.xjon.2024.03.011","url":null,"abstract":"<div><h3>Objective</h3><p>Midaortic syndrome is a rare clinical condition that has been mainly studied in juveniles through case reports and series. This study aims to report the anatomic characteristics and long-term outcomes of 41 adult patients with midaortic syndrome who received open surgical treatment or endovascular treatment over a 14-year period.</p></div><div><h3>Methods</h3><p>A consecutive cohort of 41 adult patients diagnosed with midaortic syndrome at our center between January 2008 and November 2021 were enrolled in the study. Patients’ baseline and anatomic characteristics were collected and analyzed. Primary follow-up outcomes included death and reintervention. Other follow-up outcomes included hypertension and complications.</p></div><div><h3>Results</h3><p>The study enrolled 41 adult patients with midaortic syndrome with a mean age of 37.5 ± 13.4 years. Twenty-five patients received open surgical treatment, and 16 patients received endovascular treatment. Isolated infrarenal lesions were more likely to be found in the endovascular treatment group (<em>P = .</em>005), whereas patients with multiple (<em>P = .</em>002) or intravisceral involvement (<em>P = .</em>001) were more likely to be found in the open surgical treatment group. The open surgical treatment group was more likely to have a lower postoperative peak systolic pressure gradient (<em>P = .</em>020). The 5- and 10-year reintervention-free survivals were 87.7% and 71.7% in the open surgical treatment group and 92.3% and 79.1% in the endovascular treatment group, respectively.</p></div><div><h3>Conclusions</h3><p>Both open surgical treatment and endovascular treatment showed satisfactory long-term efficacy outcomes for adult patients with midaortic syndrome. Given the patients’ relatively young age and long life expectancy, strict and regular lifelong follow-up is necessary.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 1-8"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000901/pdfft?md5=c66160fa35c72c9abeb3ef82a7d4063b&pid=1-s2.0-S2666273624000901-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140401330","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}
引用次数: 0
Left ventricular reverse remodeling after aortic valve replacement or repair in bicuspid aortic valve with moderate or greater aortic regurgitation 二尖瓣主动脉瓣置换或修复术后左心室反向重塑,主动脉瓣中度或重度反流
JTCVS open Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.006
Jonathan D. Kochav MD , Hiroo Takayama MD, PhD , Andrew Goldstone MD, PhD , David Kalfa MD, PhD , Emile Bacha MD , Marlon Rosenbaum MD , Matthew J. Lewis MD, MPH
{"title":"Left ventricular reverse remodeling after aortic valve replacement or repair in bicuspid aortic valve with moderate or greater aortic regurgitation","authors":"Jonathan D. Kochav MD ,&nbsp;Hiroo Takayama MD, PhD ,&nbsp;Andrew Goldstone MD, PhD ,&nbsp;David Kalfa MD, PhD ,&nbsp;Emile Bacha MD ,&nbsp;Marlon Rosenbaum MD ,&nbsp;Matthew J. Lewis MD, MPH","doi":"10.1016/j.xjon.2024.03.006","DOIUrl":"10.1016/j.xjon.2024.03.006","url":null,"abstract":"<div><h3>Objective</h3><p>Bicuspid aortic valve (AV) patients with aortic regurgitation (AR) differ from tricuspid AV patients given younger age, greater left ventricle (LV) compliance, and more prevalent aortic stenosis (AS). Bicuspid AV-specific data to guide timing of AV replacement or repair are lacking.</p></div><div><h3>Methods</h3><p>Adults with bicuspid AV and moderate or greater AR who underwent aortic valve replacement or repair at our center were studied. The presurgical echocardiogram, and echocardiograms within 3 years postoperatively were evaluated for LV geometry/function, and AV function. Semiquantitative AS/AR assessment was performed in all patients with adequate imaging.</p></div><div><h3>Results</h3><p>One hundred thirty-five patients (85% men, aged 44.5 ± 15.9 years) were studied (63% pure AR, 37% mixed AS/AR). Following aortic valve replacement or repair, change in LV end-diastolic dimension and change in LV end-diastolic volume were associated with preoperative LV end-diastolic dimension (β = 0.62 Δcm/cm; 95% CI, 0.43-0.73 Δcm/cm; <em>P</em> &lt; .001), and LV end-diastolic volume (β = 0.6 ΔmL/mL; 95% CI, 0.4-0.7 ΔmL/mL; <em>P</em> &lt; .001), respectively, each independent of AR/AS severity (<em>P</em> = not significant). Baseline LV size predicted postoperative normalization (LV end-diastolic dimension: odds ratio, 3.75/cm; 95% CI, 1.61-8.75/cm, LV end-diastolic volume: odds ratio, 1.01/mL; 95% CI, 1.004-1.019/mL, both <em>P</em> values &lt; .01) whereas AR/AS severity did not (<em>P</em> = not significant). Indexed LV end diastolic volume outperformed LV end-diastolic dimension in predicting postoperative LV normalization (area under the curve = 0.74 vs 0.61) with optimal diagnostic cutoffs of 99 mL/m<sup>2</sup> and 6.1 cm, respectively. Postoperative indexed LV end diastolic volume dilatation was associated with increased risk of death, transplant/ventricular assist device, ventricular arrhythmia, and reoperation (hazard ratio, 6.1; 95% CI, 1.7-21.5; <em>P</em> &lt; .01).</p></div><div><h3>Conclusions</h3><p>Remodeling extent following surgery in patients with bicuspid AV and AR relates to preoperative LV size independent of valve disease phenotype or severity. Many patients with LV end-diastolic dimension below current surgical thresholds did not normalize LV size. LV volumetric assessment offered superior diagnostic performance for predicting residual LV dilatation, and postoperative indexed LV end diastolic volume dilatation was associated with adverse prognosis.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 47-60"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000652/pdfft?md5=228f2024c58b19ea8c78046c1a5112de&pid=1-s2.0-S2666273624000652-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402467","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}
引用次数: 0
Thoracic aortic surgery in low- and middle-income countries: Time to bridge the gap? 中低收入国家的胸主动脉手术:缩小差距的时机已到?
JTCVS open Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.002
Dominique Vervoort MD, MPH, MBA , Dimitri Tchienga MD , Maral Ouzounian MD, PhD , Charles Mve Mvondo MD
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