JTCVS open最新文献

{"title":"Left atrial pressure continuous monitoring improves early postoperative outcomes after double-lung transplantation for pulmonary hypertension","authors":"Olaf Mercier MD, PhD,&nbsp;Luce Dedier MD,&nbsp;Justin Issard MD, MSc,&nbsp;Laurent Savale MD, PhD,&nbsp;Emeline Plubel MD,&nbsp;Dominique Fabre MD, PhD,&nbsp;Delphine Mitilian MD,&nbsp;Jean Baptiste Menager MD, MSc,&nbsp;Thibaut Genty MD,&nbsp;Iolanda Ion MD,&nbsp;Jérôme Le Pavec MD PhD,&nbsp;Elie Fadel MD, PhD,&nbsp;Marie Lannelongue Transplantation Program","doi":"10.1016/j.xjon.2026.101967","DOIUrl":"10.1016/j.xjon.2026.101967","url":null,"abstract":"<div><h3>Objectives</h3><div>Double-lung transplantation (DLTx) has become the treatment of choice for patients with end-stage pulmonary hypertension (PH). However, DLTx remains a demanding procedure, associated with a greater incidence of severe primary graft dysfunction (PGD) compared with other indications. PH-induced cardiac remodeling includes diastolic left heart dysfunction, which may increase the risk of PGD. We hypothesized that continuous monitoring of left atrial pressure (LAP) could improve early outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the chart of patients who underwent DLTx for PH between 2015 and 2022. The use of postoperative LAP monitoring was left to the discretion of the attending transplant surgeon.</div></div><div><h3>Results</h3><div>A total of 135 patients underwent DLTx for PH. Among them, 72 were managed either with prophylactic postoperative extracorporeal membrane oxygenation (ECMO) or with ECMO weaning guided by transesophageal echocardiography and Swan-Ganz catheter, whereas 63 underwent systematic ECMO weaning after the placement of a LAP catheter maintained for 3 to 5 days. Both groups were comparable regarding age, PH diagnoses, and disease severity. The LAP group showed significantly less postoperative ECMO use (25% vs 83%, <em>P</em> &lt; .001), shorter duration of mechanical ventilation (5 days [2-13] vs 17.5 days [7-35], <em>P</em> &lt; .001), shorter stay in the intensive care unit (10 days [6-25] vs 28 days [14-49], <em>P</em> &lt; .001), and lower rates of bleeding, groin infection, and overall complications (<em>P</em> ≤ .05). Intraoperative red blood cell transfusion was identified as an independent predictor of LAP monitoring strategy failure. Ninety-day postoperative mortality was not significantly different between groups (1.5% vs 8.3%, <em>P</em> = .12).</div></div><div><h3>Conclusions</h3><div>Continuous postoperative monitoring of LAP after DLTx for PH was associated with improved early outcomes. This strategy may help reduce the incidence of severe postoperative complications in this high-risk population.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101967"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214456","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":"Hypothermic fibrillatory arrest may not increase stroke risk in minimally invasive mitral valve surgery: A 13-year propensity score–matched experience","authors":"Awab Ahmad MD,&nbsp;Christian Eidson BS,&nbsp;Walter Navid BS,&nbsp;Emma Stimpfl BS,&nbsp;Chen Chia Wang BS,&nbsp;Mark Petrovic BS,&nbsp;Aaron M. Williams MD,&nbsp;John Trahanas MD,&nbsp;Swaroop Bommareddi MD,&nbsp;Eric Quintana MD,&nbsp;Brian Lima MD, MBA,&nbsp;Ashish S. Shah MD,&nbsp;Tarek Absi MD","doi":"10.1016/j.xjon.2026.102054","DOIUrl":"10.1016/j.xjon.2026.102054","url":null,"abstract":"<div><h3>Objectives</h3><div>Hypothermic fibrillatory arrest (HFA) has been associated with increased stroke risk in minimally invasive mitral valve surgery, although selection bias may confound this association.</div></div><div><h3>Methods</h3><div>We performed a single-center retrospective analysis of minimally invasive mitral valve surgeries (July 2011 to December 2024) stratified by myocardial protection strategy (HFA vs aortic crossclamping [ACC]), assessed using propensity-score matching and multivariable logistic regression.</div></div><div><h3>Results</h3><div>Of 1258 patients, 984 underwent HFA and 274 received ACC. The fibrillatory arrest group had more complex profiles and greater rates of previous myocardial infarction (14.2% vs 4.7%), previous cardiac surgery (12.8% vs 2.2%), and urgent/emergent status (18.8% vs 10.2% all <em>P</em> &lt; .05). Despite these greater-risk profiles, postoperative stroke rates were comparable (3.1% vs 3.7%, <em>P</em> = .57). After propensity matching, stroke remained comparable (3.3% vs 3.7%), and fibrillatory arrest was not independently associated with increased stroke risk (odds ratio, 0.94; <em>P</em> = .91). In-hospital mortality was also comparable (HFA: 2.6% vs ACC: 1.5%).</div></div><div><h3>Conclusions</h3><div>HFA demonstrated noninferior stroke outcomes compared with ACC when performed with meticulous protocols at high-volume centers. These findings do not support HFA as a replacement for ACC but rather as a viable alternative when clinically and technically indicated.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102054"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214445","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":"Contemporary chest drain practice after pulmonary resection: A multicenter registry study of drain strategy, outcomes, and center-level variation","authors":"Akshay J. Patel MA(Cantab), PhD, FRCS(CTh),&nbsp;Rebecca Weedle FRCS(CTh),&nbsp;Abdullah Al-Shammari MD,&nbsp;Jeesoo Choi MD,&nbsp;Andrea Bille MD, PhD","doi":"10.1016/j.xjon.2026.102053","DOIUrl":"10.1016/j.xjon.2026.102053","url":null,"abstract":"<div><h3>Objectives</h3><div>Chest drain management after pulmonary resection varies widely, particularly with respect to drain size, use of digital systems, and suction strategy. Although smaller drains and digital drainage systems are increasingly adopted, robust real-world data evaluating their impact on clinically relevant outcomes are limited. Using a large contemporary multicenter registry, we evaluated associations between chest drain characteristics and postoperative outcomes, and quantified center-level variation in drain practice.</div></div><div><h3>Methods</h3><div>A prospective multicenter observational registry including 3348 patients undergoing pulmonary resection across 21 international centers was analyzed. Patient, disease, operative, and drain-related variables were recorded. Primary outcome was prolonged air leak (&gt;5 days). Secondary outcomes included pulmonary complications, surgical emphysema, pleural readmission, length of stay, drain duration, and in-hospital mortality. Multivariable regression models adjusted for patient, operative, and center-level factors were constructed. Center-level variation in drain practice and outcomes was examined descriptively and using funnel plots.</div></div><div><h3>Results</h3><div>The cohort comprised 3348 patients, of whom 88% underwent minimally invasive resection. Prolonged air leak occurred in 9.0%, pulmonary complications in 7%, and in-hospital mortality in 0.9%. Larger drain size was independently associated with lower odds of prolonged air leak (adjusted odds ratio per 1Fr increase ≈1.12), whereas digital drainage systems were associated with higher detected prolonged air leak but shorter length of stay. Substantial center-level variation was observed in digital drain adoption, median drain size, and prolonged air leak rates, exceeding expected random variation in several centers. Reanalysis incorporating 3 additional international centers demonstrated no material change in adjusted effect estimates.</div></div><div><h3>Conclusions</h3><div>In this large contemporary registry, chest drain strategy was independently associated with postoperative outcomes after pulmonary resection. Marked intercenter variation in drain practice persists, underscoring the need for evidence-based standardization. These real-world data provide a platform to rationalize chest drain management and inform future pragmatic trials.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102053"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214469","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":"Dynamic bio-psychologic profiles: Tracking burnout and recovery in surgical trainees","authors":"Lauren Barron MD,&nbsp;Allison Weiderhold BS,&nbsp;Kevin G. Aubol PhD,&nbsp;Joshua Blair MSE,&nbsp;Tait Shanafelt MD,&nbsp;Ronald Cotton MD,&nbsp;Ravi Ghanta MD,&nbsp;Marc Moon MD","doi":"10.1016/j.xjon.2026.101969","DOIUrl":"10.1016/j.xjon.2026.101969","url":null,"abstract":"<div><h3>Objective</h3><div>Burnout affects 67% to 95% of surgical trainees and attrition approaches 3% per year, making both among the highest rates across all specialties. The discrepancy between burnout and attrition suggests potential reversibility and common strengths that foster retention. Most burnout studies utilize variable-centered analyses that average individuals’ trajectories obscuring distinct patterns of burnout and recovery. The lack of granularity hinders identification of interventions that address specific needs of individuals. This work explored physiologic markers of stress and burnout in surgical trainees to generate bio-psychologic profiles and potential profile-specific targets for intervention.</div></div><div><h3>Methods</h3><div>Physiologic markers, program characteristics, and burnout assessments were obtained from surgical residents over a 3-month period. Correlations, linear mixed models, and unsupervised clustering were used to explore the relationships among these variables.</div></div><div><h3>Results</h3><div>We evaluated 1470 nights of sleep and 179 burnout assessments across 29 surgical residents. On average, subjects contributed 56 (interquartile range, 38-71) nights of sleep and 6 (interquartile range, 5-7) burnout assessments. High levels of emotional exhaustion and depersonalization were reported in 41.3% and 39.7% of surveys, respectively, and low levels of personal accomplishment in 41.9%. Greater bedtime variability over the prior 7 days was associated with lower personal accomplishment (<em>P</em> = .004) and was more pronounced earlier in training (<em>P</em> = .001). Trainees clustered into 6 hypothesized profiles with an average of 1.05 transitions between profiles per person.</div></div><div><h3>Conclusions</h3><div>Longitudinal bio-psychologic profiling in surgical trainees is feasible. Residents appear to transition between profiles, suggesting that targeted interventions tailored to profile-specific drivers warrant validation in larger cohorts.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101969"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214471","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":"Postoperative changes in QRS duration and long-term mortality after septal myectomy","authors":"Takahiro Kitsuka MD, PhD,&nbsp;Nathan Peffley MD,&nbsp;Patrick M. Wieruszewski PharmD, MS,&nbsp;Richard C. Daly MD,&nbsp;Hartzell V. Schaff MD","doi":"10.1016/j.xjon.2026.101935","DOIUrl":"10.1016/j.xjon.2026.101935","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate whether change in QRS duration (ΔQRS), defined as postoperative QRS duration minus preoperative QRS duration, after septal myectomy for obstructive hypertrophic cardiomyopathy (oHCM) has prognostic significance for all-cause mortality.</div></div><div><h3>Methods</h3><div>We performed a retrospective, single-center cohort study of patients with oHCM who underwent transaortic septal myectomy between July 23, 2009, and July 30, 2020, with available preoperative and early postoperative (days 4-7) electrocardiography (ECG) data. Patients with a preoperative or postoperative permanent pacemaker were excluded. The primary outcome was all-cause mortality. Multivariable Cox models were adjusted for age, sex, operative time, major concomitant surgery, and preoperative right bundle branch block. ECG analyses examined preoperative QRS duration, ΔQRS (postoperative minus preoperative QRS), and, in exploratory models, postoperative left bundle branch block (LBBB) and absolute postoperative QRS duration.</div></div><div><h3>Results</h3><div>Among 1143 patients (1141 in complete-case multivariable analyses), the mean preoperative QRS duration was 129.5 ± 25.4 ms and increased modestly postoperatively (133.5 ± 26.0 ms); the mean ΔQRS was 4.0 ± 12.8 ms. A total of 122 deaths occurred during follow-up. Preoperative QRS duration was not associated with mortality (hazard ration [HR] per 10 ms, 1.01; 95% confidence interval [CI], 0.94-1.09; <em>P</em> = .78). In contrast, greater ΔQRS was independently associated with higher mortality (HR per 10 ms, 1.16; 95% CI, 1.01-1.34; <em>P</em> = .037), including after adjustment for preoperative QRS duration. Threshold analyses demonstrated increased risk with ΔQRS ≥0 ms (HR, 1.88; 95% CI, 1.17-3.03; <em>P</em> = .009) and ΔQRS ≥10 ms (HR, 1.84; 95% CI, 1.26-2.68; <em>P</em> = .001). Absolute postoperative QRS duration ≥150 ms was not associated with mortality (HR, 1.14; 95% CI, 0.76-1.71; <em>P</em> = .52). In exploratory comparison models, ΔQRS showed a stronger and more consistent association with mortality compared to postoperative LBBB or absolute postoperative QRS duration.</div></div><div><h3>Conclusions</h3><div>ΔQRS following transaortic septal myectomy for oHCM was independently associated with all-cause mortality. In exploratory comparison models, ΔQRS showed a stronger and more consistent association with mortality compared to postoperative LBBB or absolute postoperative QRS duration. ΔQRS may represent a simple, clinically available marker to enhance postoperative risk stratification following septal myectomy for oHCM.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101935"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214534","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":"Neurocognitive dysfunction among patients undergoing coronary artery bypass surgery—A prospective study","authors":"Thanathu Krishnan Nair Jayakumar MBBS, MS, MCh, CTVS, DNB, CTVS,&nbsp;Kavitha Chandran Chandrakumari PhD,&nbsp;Vinitha Viswambharan Nair MCh, DNB CTVS, FRCS, FEBCTS","doi":"10.1016/j.xjon.2026.101965","DOIUrl":"10.1016/j.xjon.2026.101965","url":null,"abstract":"<div><h3>Objective</h3><div>Neurocognitive dysfunction (NCD) remains a common complication after coronary artery bypass grafting (CABG); however, the trajectory of cognitive recovery and associated risk factors remain incompletely understood. This study evaluated the prevalence, early postoperative course, and predictors of NCD among patients undergoing elective CABG.</div></div><div><h3>Methods</h3><div>In this prospective observational study, 110 consecutive patients undergoing elective CABG between January 2025 and August 2025 at a tertiary care center were enrolled. Neurocognitive function was assessed using Addenbrooke's Cognitive Examination–III preoperatively, at hospital discharge, and at postoperative day 10 follow-up. Changes in cognitive performance were analyzed using repeated-measures analysis of variance with Bonferroni-adjusted pairwise comparisons. Transitions in categorical cognitive status were evaluated using the McNemar-Bowker test. Associations between patient characteristics and NCD were examined using multivariable analyses.</div></div><div><h3>Results</h3><div>A total of 110 patients undergoing CABG were included in the study, with a mean age of 57.5 ± 8.5 years; 79.1% were male, and 85.5% underwent off-pump CABG. Mean Addenbrooke's Cognitive Examination–III scores declined significantly from baseline (77.0 ± 9.1) to discharge (73.8 ± 9.9), followed by recovery at follow-up (77.1 ± 10.0) (<em>P</em> &lt; .001). Bonferroni-adjusted comparisons demonstrated a significant decline from baseline to discharge (mean difference −3.2; 95% CI, −4.8 to −1.6; <em>P</em> = .001) and a significant improvement from discharge to follow-up (mean difference +3.3; 95% CI, 1.7-4.9; <em>P</em> = .001), whereas baseline and follow-up scores did not differ significantly (mean difference +0.1; 95% CI, −1.5 to 1.7; <em>P</em> = .865). NCD was present in 68.2% of patients preoperatively, increased to 80.0% at discharge, and decreased to 64.5% at follow-up. Multivariable logistic regression analysis identified increasing age as independently associated with NCD at follow-up (adjusted odds ratio, 1.08; 95% CI, 1.02-1.14; <em>P</em> = .007)</div></div><div><h3>Conclusions</h3><div>In this group of patients undergoing CABG, cognitive impairment was often seen before surgery. There was a temporary decline right after the operation, followed by partial recovery by the early follow-up. The link between older age and early postoperative cognitive issues indicates that older patients may benefit from cognitive screening around the time of surgery. More research is needed to look at long-term cognitive changes and the effectiveness of specific interventions.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101965"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214376","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":"Tricuspid valve leaflet multiplicity and Doppler-derived right-heart hemodynamic trajectories after surgical repair","authors":"Tomohiro Iwakura MD, PhD,&nbsp;Mitsunobu Kitamura MD, PhD,&nbsp;Yoshinori Nakahara MD,&nbsp;Kanako Kishiki MD,&nbsp;Yuki Izumi MD, PhD,&nbsp;Makoto Ono MD, PhD,&nbsp;Atsushi Yano MD,&nbsp;Kohei Sumi MD,&nbsp;Akira Marui MD, PhD,&nbsp;Thilo Noack MD, PhD,&nbsp;Itaru Takamisawa MD, PhD,&nbsp;Mamoru Nanasato MD, PhD,&nbsp;Jun Shimizu MD, PhD,&nbsp;Mitsuaki Isobe MD, PhD","doi":"10.1016/j.xjon.2026.102089","DOIUrl":"10.1016/j.xjon.2026.102089","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether tricuspid leaflet multiplicity is associated with divergent postoperative hemodynamic trajectories after surgical repair.</div></div><div><h3>Methods</h3><div>One hundred seventeen patients undergoing tricuspid valve surgery (January 2023 to March 2025) were prospectively enrolled, with leaflet morphology classified by intraoperative visualization and serial echocardiography over 1 year. The prespecified primary end point was a Doppler-derived tricuspid regurgitation pressure gradient (TRPG) increase, defined as a 5-mm Hg-or-greater increase in TRPG from discharge to 1 year.</div></div><div><h3>Results</h3><div>Among 100 patients with paired data, the primary end point occurred more frequently in the 4/5-leaflet group despite similar residual tricuspid regurgitation (TR) and discharge TRPG (48.5% vs 26.9%; odds ratio, 2.56; 95% CI, 1.07-6.12; <em>P</em> = .034); the age-adjusted association was borderline (aOR, 2.39; <em>P</em> = .054) and the within-group rise significant only in that cohort (<em>P</em> = .024). Severe-or-greater TR recurrence was rare (3.0% vs 0.0%; <em>P</em> = .327). Discharge tricuspid annular plane systolic excursion was lower in the 4/5-leaflet group (0.96 ± 0.36 vs 1.15 ± 0.36 cm; <em>P</em> = .010) but converged by 1 year (<em>P</em> = .585).</div></div><div><h3>Conclusions</h3><div>Tricuspid leaflet multiplicity was associated with a subphenotype showing preserved early TR reduction, lower discharge tricuspid annular plane systolic excursion, and a greater 1-year frequency of Doppler-derived TRPG increase. Morphology-based stratification may refine postoperative surveillance pending external validation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102089"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214443","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":"Association of triglyceride-glucose index and triglyceride–glucose–body mass index with all-cause mortality in critically ill patients with aortic disease: A retrospective cohort study","authors":"Jie Liu MD,&nbsp;Zhaoxin Qian MD, PhD,&nbsp;Jing Cao MD, PhD","doi":"10.1016/j.xjon.2026.102052","DOIUrl":"10.1016/j.xjon.2026.102052","url":null,"abstract":"<div><h3>Objective</h3><div>Aortic diseases represent a group of life-threatening vascular disorders that impose a substantial socioeconomic burden. This study aimed to investigate the association between insulin resistance indices and all-cause mortality in with aortic diseases who are critically ill.</div></div><div><h3>Methods</h3><div>Patients diagnosed with aortic diseases were identified, and relevant data were extracted from the Medical Information Mart for Intensive Care IV database. The outcomes of interest were in-hospital, 30-day, 360-day, and 5-year all-cause mortality. Kaplan-Meier survival curves and multivariable Cox regression models were constructed to evaluate the associations of the triglyceride-glucose (TyG) index and triglyceride–glucose–body mass index (TyG-BMI) with mortality. Subgroup analyses were performed to assess the robustness of the associations. Receiver operating characteristic curves were used to compare the predictive performance of the 2 indices.</div></div><div><h3>Results</h3><div>A total of 1726 patients were included in the final analysis. Kaplan-Meier analysis and multivariable Cox regression revealed that elevated TyG and TyG-BMI indices were significantly associated with mortality of aortic diseases. The robust association between the TyG index and mortality was consistent across most subgroups and remained significant even in patients without diabetes mellitus, chronic kidney disease, or stroke. Receiver operating characteristic curve analysis indicated that only the model incorporating the TyG index yielded a significant improvement in predictive performance for 360-day and 5-year mortality.</div></div><div><h3>Conclusions</h3><div>Both the TyG and TyG-BMI indexes were significantly associated with mortality risk in critically ill population with aortic diseases. The TyG index served as a potential prognostic index of all-cause mortality in critically ill population with aortic diseases.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102052"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214503","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":"Extracardiac conduit versus lateral tunnel: Exploring the optimal surgical approach in the EUROFONTAN experience","authors":"Emma Bergonzoni MD,&nbsp;Irene Cao MD,&nbsp;Luca Vedovelli PhD,&nbsp;Mark Hazekamp MD,&nbsp;Jürgen Hörer MD,&nbsp;Eleftherios M. Protopapas MD,&nbsp;Masamichi Ono MD,&nbsp;Eva Sames-Dolzer MD,&nbsp;Gregor Gierlinger MD,&nbsp;Friso M. Rijnberg MD,&nbsp;Lorenzo Galletti MD,&nbsp;Gianfranco Butera MD,&nbsp;Bart Meyns MD,&nbsp;Joeri Van Puyvelde MD,&nbsp;lliya Yemets MD,&nbsp;Elshad Bairamov MD,&nbsp;Andrzey Kansy MD,&nbsp;Matej Nosal MD,&nbsp;Marien Lenoir MD,&nbsp;Gaetano Gargiulo MD,&nbsp;Massimo A. Padalino MD, PhD, FESC","doi":"10.1016/j.xjon.2026.101970","DOIUrl":"10.1016/j.xjon.2026.101970","url":null,"abstract":"<div><h3>Objective</h3><div>The Fontan procedure is a crucial surgical intervention for single-ventricle physiology, with the extracardiac conduit (ECC) and lateral tunnel (LT) techniques being the predominant approaches. This study aimed to compare early and late clinical outcomes of ECC and LT, using inverse probability of treatment weighting (IPTW) to ensure robust assessments.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 3300 patients from the EUROFONTAN registry was conducted, with data collected from 21 European centers. The cohort included 3010 patients who underwent the ECC technique and 290 patients who underwent the LT technique. IPTW was used to balance baseline characteristics. Primary outcomes were early and late mortality, Fontan failure, and adverse events. Secondary outcomes included postoperative complications and nonsurgical adverse events.</div></div><div><h3>Results</h3><div>Propensity-matched analysis showed significantly better outcomes for ECC. Early mortality was lower for ECC (1.2% vs 3.9%, <em>P</em> = .003), whereas late mortality at 20-year follow-up was 8.6% in LT versus 3.2% in ECC after IPTW (<em>P</em> = .003). Patients who underwent the ECC technique experienced fewer postoperative complications (47% vs 66%, <em>P</em> = .025) and less frequent Fontan failure (12% vs 19%, <em>P</em> = .032). Kidney-related events were more frequent in patients who underwent the LT technique (3% vs 0.6%, <em>P</em> = .004). The development of arrhythmia initially appeared greater in the LT group but equalized after matching. Long-term complications, such as protein-losing enteropathy and hepatic issues, showed no significant differences.</div></div><div><h3>Conclusions</h3><div>ECC was associated with better early and intermediate outcomes than LT in this multicenter European registry. However, surgical era and hospital center explain a substantial part of the observed difference. Continued long-term surveillance of the Fontan pathway is essential to optimize lifelong outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101970"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214492","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 after conversion from mechanical to bioprosthetic valves for anticoagulation-related complications","authors":"Vincy Tam MBBS,&nbsp;Hartzell V. Schaff MD,&nbsp;Kevin L. Greason MD,&nbsp;Richard C. Daly MD,&nbsp;Alexander Lee BS,&nbsp;Austin Todd MS,&nbsp;Kimberly Holst MD,&nbsp;Juan A. Crestanello MD","doi":"10.1016/j.xjon.2026.101927","DOIUrl":"10.1016/j.xjon.2026.101927","url":null,"abstract":"<div><h3>Background</h3><div>Conversion from mechanical to bioprosthetic valves is sometimes pursued for anticoagulation-related complications, yet outcomes after such conversion remain poorly characterized.</div></div><div><h3>Methods</h3><div>We analyzed 62 consecutive patients undergoing mechanical-to-bioprosthetic valve replacement owing to major bleeding, recurrent thromboembolism, or nonbleeding/nonthromboembolic warfarin-related difficulty between 2000 and 2005. The primary endpoint was time to first postoperative bleeding or thromboembolic event, with death treated as a competing risk. Survival was estimated using Kaplan-Meier analysis.</div></div><div><h3>Results</h3><div>The median interval from mechanical valve implantation to conversion was 7 years (interquartile range, 1-17 years). Fifty-eight percent of procedures were urgent or emergent, and hospital mortality was 13%. Among hospital survivors, 66% were discharged on and remained on warfarin therapy beyond 3 months. Overall survival was 82% at 1 year and 71% at 5 years. The 5-year cumulative incidence of bleeding or thromboembolism was 27%, with 63% of events occuring while patients were receiving warfarin.</div></div><div><h3>Conclusions</h3><div>Conversion from a mechanical valve to a bioprosthetic valve for anticoagulation-related complications carries substantial early risk and frequently does not eliminate the need for anticoagulation. Recurrent bleeding and thromboembolic events remain clinically significant, underscoring the importance of careful patient counseling and shared decision making.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101927"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214516","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}