JTCVS open最新文献

{"title":"Mitral valve replacement versus repair for severe mitral regurgitation in patients with reduced left ventricular ejection fraction","authors":"Zara Dietze MD ,&nbsp;Mateo Marin-Cuartas MD ,&nbsp;Livia Berkei MD ,&nbsp;Manuela De La Cuesta MD ,&nbsp;Wolfgang Otto MSc ,&nbsp;Bettina Pfannmüller MD, PhD ,&nbsp;Philipp Kiefer MD, PhD ,&nbsp;Martin Misfeld MD, PhD ,&nbsp;Alexey Dashkevich MD, PhD ,&nbsp;Jagdip Kang MD ,&nbsp;Sergey Leontyev MD, PhD ,&nbsp;Michael A. Borger MD, PhD ,&nbsp;Thilo Noack MD, PhD ,&nbsp;Marcel Vollroth MD","doi":"10.1016/j.xjon.2024.07.021","DOIUrl":"10.1016/j.xjon.2024.07.021","url":null,"abstract":"<div><h3>Objective</h3><div>This study compares early and long-term outcomes following mitral valve (MV) repair and replacement in patients with mitral regurgitation (MR) and reduced left ventricular ejection fraction (LVEF).</div></div><div><h3>Methods</h3><div>Patients with primary or secondary MR and LVEF &lt;50% who underwent MV replacement or repair (with/without atrial septal defect closure and/or atrial fibrillation ablation) between 2005 and 2017 at our center were retrospectively analyzed using unadjusted and propensity score matching techniques (42 pairs).</div></div><div><h3>Results</h3><div>A total of 356 patients with either primary (n = 162 [45.5%]) or secondary MR (n = 194 [54.5%]) and LVEF &lt;50% underwent MV repair (n = 293 [82.3%]) or replacement (n = 63 [17.7%]) during the study period. In-hospital mortality was 0.3% (repair) and 1.6% (replacement) in the unmatched cohort (<em>P</em> = .32); there were no in-hospital deaths after matching. Estimated survival was 72.8% (repair) versus 50.1% (replacement) at 8 years in the unmatched (<em>P</em> &lt; .001), and 64.3% (repair) versus 50.7% (replacement) in the matched groups (<em>P</em> = .028). Eight-year cumulative incidence of reoperation was 7.0% and 11.6% in unmatched (<em>P</em> = .28), and 9.9% and 12.7% in matched (<em>P</em> = .69) repair and replacement groups, respectively. Markedly reduced LVEF (&lt;40%) was among the independent predictors of long-term mortality (hazard ratio, 1.7; 95% CI, 1.2-2.4; <em>P</em> = .002). In secondary MR, MV repair showed an 8-year survival benefit over replacement (65.1% vs 44.6%; <em>P</em> = .002), with no difference in reoperation rate (11.6% [repair] vs 17.0% [replacement]; <em>P</em> = .11).</div></div><div><h3>Conclusions</h3><div>MV repair performed in primary or secondary MR and reduced LVEF provides superior long-term results compared with replacement. Severe LV dysfunction is a significant predictor of reduced survival following MV surgery.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 191-207"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960083","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 following deep hypothermic circulatory arrest versus antegrade cerebral perfusion during aortic arch reconstruction","authors":"W. Hampton Gray MD ,&nbsp;Robert A. Sorabella MD ,&nbsp;Luz A. Padilla MD, MSPH ,&nbsp;Katherine Sprouse MD ,&nbsp;Shefali V. Shah MD ,&nbsp;Matthew G. Clark MD ,&nbsp;Carlisle O'Meara CCP, FPP ,&nbsp;Robert J. Dabal MD","doi":"10.1016/j.xjon.2024.08.015","DOIUrl":"10.1016/j.xjon.2024.08.015","url":null,"abstract":"<div><h3>Objective</h3><div>The optimal method for cerebral protection during aortic arch reconstruction in neonates and infants is unknown. We compare the outcomes of deep hypothermic circulatory arrest and selective antegrade cerebral perfusion strategies in neonatal and infant cardiac surgery.</div></div><div><h3>Methods</h3><div>We retrospectively identified all patients aged less than 1 year who underwent aortic arch reconstruction from 2012 to 2023. Patients were categorized on the cerebral perfusion strategy used during their procedure. Comparative analyses of perioperative and outcome variables were conducted to assess differences between cerebral protection strategies. A secondary analysis further stratifying by complexity of repair was performed. Examples of “complex” repair included the Norwood procedure, and “simple” repairs included isolated arch reconstructions. Adjusted regression models were used to identify specific outcomes associated with cerebral perfusion strategy used.</div></div><div><h3>Results</h3><div>There were 165 cases included in our cohort (114 [69%] selective antegrade cerebral perfusions and 51 [31%] deep hypothermic circulatory arrests). Overall, hospital mortality was 7% (selective antegrade cerebral perfusion 9% vs deep hypothermic circulatory arrest 2%, <em>P</em> <em>=</em> .17). There were 6 total neurologic events in 4 patients after surgery in the selective antegrade cerebral perfusion group and none in the deep hypothermic circulatory arrest group. Irrespective of the cerebral perfusion strategy, there were no differences in mortality, stroke, seizures, renal failure, and catheterization reinterventions observed after surgery. This finding held true even when stratifying cerebral perfusion methods by complexity of repair. Regression analysis showed no associations for cerebral perfusion strategy with any outcome even after adjusting for age and complexity of repair.</div></div><div><h3>Conclusions</h3><div>There were no significant short-term differences and a low rate of neurologic events in both groups during aortic arch reconstruction among neonates and infants. Longer follow-up is necessary to evaluate the impact of cerebral perfusion strategy on neurocognitive development later in life.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 379-385"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959765","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":"Preoperative medication management turnkey order set for nonemergent adult cardiac surgery","authors":"Amanda Rea DNP, CRNP ,&nbsp;Rawn Salenger MD ,&nbsp;Michael C. Grant MD, MSE ,&nbsp;Jennifer Yeh PharmD ,&nbsp;Barbara Damas PharmD ,&nbsp;Cheryl Crisalfi MSN, RN ,&nbsp;Rakesh Arora MD, PhD ,&nbsp;Alexander J. Gregory MD ,&nbsp;Vicki Morton-Bailey DNP, CRNP ,&nbsp;Daniel T. Engelman MD","doi":"10.1016/j.xjon.2024.06.009","DOIUrl":"10.1016/j.xjon.2024.06.009","url":null,"abstract":"<div><h3>Objective</h3><div>The management of preoperative medications is an essential component of perioperative care for the cardiac surgical patient. This turnkey order set is part of a series created by the Enhanced Recovery After Surgery Cardiac Society, first presented at the Annual Meeting of The American Association for Thoracic Surgery in 2023. Numerous guidelines and expert consensus documents have been published to provide guidance in preoperative medication management. Our objective is to integrate these documents into an evidence-based order set that will facilitate standardized implementation of best practices for preoperative medication management for nonemergent adult cardiac surgery.</div></div><div><h3>Methods</h3><div>Subject matter experts were consulted to translate existing guidelines and peer reviewed literature into a sample turnkey order set for the preoperative management of patients’ medications. Orders derived from consistent Class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the order set in <strong>bold</strong> type. Selected orders that were inconsistently Class I or IIA, Class IIB, or supported by published evidence, were also included in <em>italicized</em> type.</div></div><div><h3>Results</h3><div>Holding antiplatelet and anticoagulant medications before nonemergent cardiac surgical procedures may reduce the risk of bleeding. Sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 agonists should also be discontinued to prevent acidosis and aspiration, respectively. Specific guidance for frequently used medications are complied within the manuscript, less frequently used medications are listed seperately.</div></div><div><h3>Conclusions</h3><div>Despite strong recommendations from major guidelines and consensus manuscripts, variation exists in preoperative medication orders, with limited availability of succinct implementation tools. This turnkey order set may facilitate standardized comprehensive preoperative medication management before nonemergent cardiac surgery.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 1-13"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959861","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":"Surgeon specialty and surveillance after resection for non–small cell lung cancer","authors":"Nicole Lin MD, MPH ,&nbsp;Julie Wu MD, PhD ,&nbsp;Scott Adams MPH, PhD ,&nbsp;Steven Asch MD, MPH ,&nbsp;Steven Zeliadt PhD, MPH ,&nbsp;Alex Sox-Harris PhD, MS ,&nbsp;Summer Han PhD ,&nbsp;Leah Backhus MD, MPH","doi":"10.1016/j.xjon.2024.09.001","DOIUrl":"10.1016/j.xjon.2024.09.001","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 470-475"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959946","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":"Impact of lung allocation policy change on Hispanic lung transplant outcomes: Addressing disparities and improving access","authors":"Eric Klipsch MD ,&nbsp;Jeffrey Rodgers MS ,&nbsp;Kelly Sokevitz BSN ,&nbsp;Jennie Kwon MD ,&nbsp;Khaled Shorbaji MD ,&nbsp;Ian Bostock MD, MS ,&nbsp;Barry C. Gibney DO ,&nbsp;Luca Paoletti MD ,&nbsp;Timothy P.M. Whelan MD ,&nbsp;Arman Kilic MD ,&nbsp;Kathryn E. Engelhardt MD, MS","doi":"10.1016/j.xjon.2024.09.012","DOIUrl":"10.1016/j.xjon.2024.09.012","url":null,"abstract":"<div><h3>Objective</h3><div>Racial disparities in organ allocation may result in differential survival for marginalized groups. This study aims to examine the impact of the November 2017 lung allocation policy change (LAPC) on trends and outcomes of Hispanic lung transplant (LT) recipients.</div></div><div><h3>Methods</h3><div>The United Network for Organ Sharing database was used to identify adult (older than age 18 years) LT recipients between January 2010 and March 2023. Recipients were categorized into 3 self-identified racial groups (Hispanic, non-Hispanic White, and non-Hispanic other). The Mann-Kendall trend test was used to assess the trend in rates of Hispanic LT over 5 years pre- and 5 years post-LAPC. The primary outcome was 1-year mortality.</div></div><div><h3>Results</h3><div>A total of 28,495 recipients from 80 centers were included, with 15,343 (53.8%) prepolicy change and 13,152 (46.2%) postpolicy change. The racial distribution of LT recipients was pre-LAPC: Hispanic: 1013 (6.6%), White: 12,601 (82.1%), Other: 1729 (11.3%) and post-LAPC: Hispanic: 1522 (11.6%), White: 9873 (75.0%), Other: 1757 (13.4%) (<em>P</em> &lt; .001). Between 2013 and 2017, the proportion of Hispanic LT recipients increased from 6.0% to 7.6% (<em>P</em> = .221). Post-LAPC, the proportion increased from 8.5% in 2018 to 14.4% in 2022 (<em>P</em> &lt; .027). Unadjusted 1-year survival rates were pre-LAPC: Hispanic: 88.8%, White: 87.6%, Other: 86.8% (log-rank <em>P</em> = .260) and post-LAPC: Hispanic: 90.6%, White: 88.2%, Other: 86.1% (log-rank <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>The LAPC has led to increased access to LT and improved 1-year survival rates among Hispanic patients. However, efforts should continue to address disparities among other racial groups and ensure equitable outcomes for all recipients of LT.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 504-518"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959963","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":"Comparing percutaneous coronary intervention and coronary artery bypass grafting for left main stenosis on the basis of current regional registry evidence","authors":"Hristo Kirov MD ,&nbsp;Tulio Caldonazo MD ,&nbsp;Aryan D. Khayyat MS ,&nbsp;Panagiotis Tasoudis MD ,&nbsp;Johannes Fischer MS ,&nbsp;Angelique Runkel MS ,&nbsp;Murat Mukharyamov MD ,&nbsp;Torsten Doenst MD, PhD","doi":"10.1016/j.xjon.2024.09.025","DOIUrl":"10.1016/j.xjon.2024.09.025","url":null,"abstract":"<div><h3>Objectives</h3><div>There is an ongoing debate whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is the better choice for treatment of left main (LM) stenosis. We aimed to provide external validation for the recently reviewed guideline recommendations for invasive LM therapy by evaluating the impact of CABG or PCI on long-term survival from local reports of different regions in the world. We performed a systematic review and meta-analysis to address contemporary registry studies comparing PCI and CABG for patients with LM stenosis.</div></div><div><h3>Methods</h3><div>Three databases were assessed. Our primary end point was long-term all-cause mortality. Secondary end points were major adverse cardiovascular events (MACE), myocardial infarction, repeat revascularization, stroke, and periprocedural mortality. Reconstruction of time-to-event data was performed.</div></div><div><h3>Results</h3><div>A total of 2477 studies were retrieved. Seven studies with risk-adjusted populations were selected for the analysis. Four studies favored CABG and 3 studies showed no difference for the primary end point. Compared with PCI, patients who underwent CABG had lower risk of death (hazard ratio, 1.15; 95% confidence interval, 1.05-1.26, <em>P</em> &lt; .01) and MACE (hazard ratio, 1.54; 95% confidence interval, 1.40-1.69, <em>P</em> &lt; .01) during follow-up. Moreover, PCI was associated with more myocardial infarction, repeat revascularization, but less strokes when compared with CABG. There was no significant difference regarding periprocedural mortality. The MACE rate was lower after CABG in both early and late phase, which outweighs the higher rate of periprocedural stroke after CABG.</div></div><div><h3>Conclusions</h3><div>Regional registry evidence supports the current notion of superior long-term endpoints with CABG compared with PCI for the treatment of LM stenosis over time.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 257-271"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959984","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":"Enhanced Recovery After Surgery (ERAS) cardiac turnkey order set for perioperative pain management in cardiac surgery: Proceedings from the American Association for Thoracic Surgery (AATS) ERAS Conclave 2023","authors":"Alexander J. Gregory MD, FRCPC ,&nbsp;Rakesh C. Arora MD, PhD ,&nbsp;Subhasis Chatterjee MD, FACS, FACC ,&nbsp;Cheryl Crisafi MSN, RN, CNL ,&nbsp;Vicki Morton-Bailey DNP, MSN, AGNP-BC ,&nbsp;Amanda Rea DNP, CRNP, AGACNP-BC ,&nbsp;Rawn Salenger MD ,&nbsp;Daniel T. Engelman MD ,&nbsp;Michael C. Grant MD, MSE","doi":"10.1016/j.xjon.2024.08.018","DOIUrl":"10.1016/j.xjon.2024.08.018","url":null,"abstract":"<div><h3>Objective</h3><div>Optimal perioperative pain management is an essential component of perioperative care for the cardiac surgical patient. This turnkey order set is part of a series created by the Enhanced Recovery After Surgery Cardiac Society, first presented at the Annual Meeting of The American Association for Thoracic Surgery in 2023. Several guidelines and expert consensus documents have been published to provide guidance on pain management and opioid reduction in cardiac surgery. Our objective is to consolidate that guidance into an evidence-based order set that will assist in the implementation of a comprehensive multimodal approach to pain management.</div></div><div><h3>Methods</h3><div>Subject matter experts were consulted to translate existing guidelines and peer-reviewed literature into a sample turnkey order set for pain management. Orders derived from consistent Class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the order set in bold type. Selected orders that were inconsistently Class I or IIA, Class IIB, or supported by published evidence, were also included in italicized type.</div></div><div><h3>Results</h3><div>Opioid-based analgesia is associated with delayed recovery and opioid-related adverse events. Several multimodal medications have been shown to reduce reliance upon opioids. These include the scheduled use of acetaminophen, gabapentinoids, and nonsteroidal anti-inflammatory drugs. In addition, intravenous analgesics such as dexmedetomidine, ketamine, magnesium, and lidocaine have been shown to both complement the maintenance of anesthesia as well as optimize pain control postoperatively. Long-acting opioids remain a key component of pain management when provided to reduce the overall use of short-acting synthetic opioids or in direct response to break though pain after exhausting other alternatives. When applied in a bundled fashion, several studies have demonstrated a reduction in overall opioid administration and improved rates of postoperative recovery.</div></div><div><h3>Conclusions</h3><div>There has been increased awareness regarding the potential short- and long-term adverse effects of both inadequate analgesia and excessive opioid administration after cardiac surgery. This turnkey order set aims to facilitate implementation of a comprehensive approach toward provision of multimodal, opioid-sparing medications to optimize pain management in cardiac surgery.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 14-24"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959985","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":"Interatrial block is an independent risk factor for new-onset atrial fibrillation after cardiac surgery","authors":"Spela Leiler MD ,&nbsp;Andre Bauer PhD ,&nbsp;Wolfgang Hitzl PhD ,&nbsp;Rok Bernik MD ,&nbsp;Valentin Guenzler MD ,&nbsp;Matthias Angerer MD ,&nbsp;Theodor Fischlein PhD ,&nbsp;Jurij Matija Kalisnik PhD","doi":"10.1016/j.xjon.2024.10.003","DOIUrl":"10.1016/j.xjon.2024.10.003","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to investigate the association between interatrial conduction block and postoperative atrial fibrillation, which can precipitate acute cardiopulmonary instability and is associated with subsequent heart failure, stroke, and mortality following cardiac surgery.</div></div><div><h3>Methods</h3><div>Perioperative 12-channel electrocardiograms from 3405 patients undergoing myocardial revascularization, valve surgery, aortic surgery, or combinations thereof, were considered. Clinical and electrographic parameters were compared between patients with and without atrial fibrillation, and significant variables were analyzed using univariate and multivariate logistic regression.</div></div><div><h3>Results</h3><div>Among 2108 analyzed patients, 764 (36.2%) developed atrial fibrillation. Preoperative interatrial block was a strong independent risk factor (3.18; 95% CI, 2.55, 3.96; <em>P</em> &lt; .001), significantly improving area under the receiver operator characteristics curve from 71.8% to 75.6% (Delong's test: <em>P</em> = .013). Other risk factors included advanced age (1.05; 95% CI, 1.03, 1.07; <em>P</em> &lt; .001), female gender (1.86; 95% CI, 1.45, 2.38; <em>P</em> &lt; .001), history of cardiogenic shock (1.44; 95% CI, 0.99, 2.09; <em>P</em> = .057), reduced left ventricular ejection fraction &lt;40% (1.57; 95% CI, 1.06, 2.33; <em>P</em> = .024), cessation of preoperative β-blockers (1.17; 95% CI, 0.95, 1.46; <em>P</em> = .145), score for clinical prediction rules for estimating the risk of stroke in people with non-rheumatic atrial fibrillation (CHAS₂DS₂-VASc) and European System for Cardiac Operative Risk Evaluation II score (0.87; 95% CI, 0.79, 0.97; <em>P</em> = .01) and (1.04; 95% CI, 0.99, 1.11; <em>P</em> = .138), preexisting left bundle branch block (1.59; 95% CI, 0.92, 2.74; <em>P</em> = .097), cardiopulmonary bypass time (1.00; 95% CI, 1.00, 1.00; <em>P</em> = .049), bicaval cannulation (1.45; 95% CI, 0.88, 2.41; <em>P</em> = .035), cardiac surgery-associated acute kidney injury (3.19; 95% CI, 2.45, 4.15; <em>P</em> &lt; .001), and postoperative atrioventricular block (1.20; 95% CI, 0.96, 1.51; <em>P</em> = .105), particularly Mobitz I (6.73; 95% CI, 1.98, 31.51; <em>P</em> = .005).</div></div><div><h3>Conclusions</h3><div>Perioperative electrocardiogram-derived parameters, especially interatrial block, are associated with postoperative atrial fibrillation. Further research is needed to clarify the link between conduction abnormalities and postoperative atrial fibrillation, enabling targeted prophylactic therapies for high-risk patients.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 345-353"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959998","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":"Longitudinal assessment of health-related quality of life in patients with adult congenital heart disease undergoing cardiac surgery","authors":"Brittany A. Potz MD ,&nbsp;Justin A. Robinson MD ,&nbsp;Jeevanantham Rajeswaran PhD ,&nbsp;Carla Duvall MSN ,&nbsp;Beata Earl BS ,&nbsp;John Urchek BS ,&nbsp;Natalie Salvatore DNP, MBA, RN ,&nbsp;Lars G. Svensson MD, PhD ,&nbsp;Tara Karamlou MD, MSc","doi":"10.1016/j.xjon.2024.09.011","DOIUrl":"10.1016/j.xjon.2024.09.011","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to assess longitudinal postoperative health-related quality of life among patients with adult congenital heart disease facilitated by a novel electronic medical record–based patient-reported outcomes follow-up platform.</div></div><div><h3>Methods</h3><div>From January 2022 to October 2023, 559 patients with adult congenital heart disease underwent cardiac surgery; 491 (88%) completed a 23-element health-related quality of life questionnaire covering 3 domains (physical, mental, and social) yielding 911 assessments. Automated questionnaires via electronic medical record were sent at 7 days preoperatively and postoperatively at 1, 3, 6, and 12 months. Nonlinear multiphase mixed effects models and boosting approach using multivariate trees were used to assess longitudinal trends and the relationship among patient characteristics, clinical variables, and health-related quality of life outcomes.</div></div><div><h3>Results</h3><div>Mean age of patients was 53 years (range, 19-86), 238 (43%) were female, 109 (20%) were STAT category 3 or 4, postoperative mortality was 0, and stroke was 4 (0.7%). Diagnosis included hypertrophic obstructive cardiomyopathy (276, 50%), anomalous coronary artery (42, 7.5%), congenital aortic valve disease (42, 7.5%), bicuspid aortic valve (64, 12%), and aortic aneurysm (25, 4.5%). Although baseline health-related quality of life scores were below population norms, rapid postoperative increases were seen in physical, mental, and social scores, surpassing population norms between 2 and 6 months. Patients with higher baseline health-related quality of life had higher longitudinal scores. Female patients and those of Black race had higher Area Deprivation Index and lower postoperative physical health-related quality of life scores.</div></div><div><h3>Conclusions</h3><div>Patients with adult congenital heart disease require lifelong medical surveillance and repeated interventions. Our innovative electronic medical record–embedded time-series tool assessing health-related quality of life after cardiac surgery shows improved patient-reported outcomes across mental, physical, and social domains that endure through at least the first postoperative year.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 407-426"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960076","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":"Multimodal analgesia with parasternal plane block protocol within an enhanced recovery after cardiac surgery program decreases opioid use","authors":"Marc Darras MD ,&nbsp;Clément Schneider MD ,&nbsp;Sandrine Marguerite MD ,&nbsp;Saadé Saadé MD ,&nbsp;Anne-Lise Maechel MD ,&nbsp;Walid Oulehri MD ,&nbsp;Olivier Collange MD, PhD ,&nbsp;Jean-Philippe Mazzucotelli MD, PhD ,&nbsp;Paul-Michel Mertes MD, PhD ,&nbsp;Michel Kindo MD, PhD","doi":"10.1016/j.xjon.2024.08.007","DOIUrl":"10.1016/j.xjon.2024.08.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigated the efficacy of a multimodal analgesia (MMA) with an opioid-sparing strategy, incorporating a parasternal plane block (PPB) within a systematic standardized Enhanced Recovery After Surgery (ERAS) program for patients undergoing elective cardiac surgery.</div></div><div><h3>Methods</h3><div>From 2015 to 2021, 3153 patients underwent elective coronary artery bypass grafting and/or valve procedures. Patients were dichotomized by the presence or absence of an ERAS program including a perioperative MMA with an opioid-sparing approach and PPB protocols. Propensity score matching yielded 1026 well-matched pairs. The primary outcomes were the opioid-free rate and the opioid consumption in morphine milligram equivalents (MME) in the intensive care unit (ICU). The secondary outcomes were postoperative visual analog scale (VAS) scores, mechanical ventilation duration, ileus, delirium, bronchopneumonia, and length of ICU stay.</div></div><div><h3>Results</h3><div>The ICU opioid-free rate was significantly increased in the ERAS group (94.0%) compared with the control group (19.9%; <em>P</em> &lt; .001). The ERAS group had significantly lower opioid consumption in the ICU compared with the control group (median; 11.0 MME vs 31.0 MME; <em>P</em> &lt; .001; respectively). The VAS scores were analogous between the control and ERAS groups during the ICU stay. In the ERAS group, mechanical ventilation duration, ileus, delirium, bronchopneumonia rates, as well as length of ICU stay, were significantly reduced (both <em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Within a systematic, standardized ERAS program, MMA with an opioid-sparing strategy and PPB enables opioid-free analgesia in the majority of patients, significantly decreases opioid consumption, and ensures effective postoperative pain management, thereby improving outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 25-35"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959580","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}