JTCVS open最新文献

{"title":"Biomarkers of postoperative cardiac surgery–associated acute kidney injury: Narrowing the field","authors":"Samuel C. Perez BS ,&nbsp;Joshua L. Manghelli DO ,&nbsp;Ali J. Khiabani MD ,&nbsp;Andrew E. Gelman PhD ,&nbsp;Richard B. Schuessler PhD ,&nbsp;Ralph J. Damiano MD ,&nbsp;Spencer J. Melby MD ,&nbsp;Matthew R. Schill MD ,&nbsp;Christian W. Zemlin PhD ,&nbsp;James Edgerton MD","doi":"10.1016/j.xjon.2025.03.021","DOIUrl":"10.1016/j.xjon.2025.03.021","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac surgery–associated acute kidney injury (CSA-AKI) is commonly observed after cardiac surgery and has been shown to be associated with increased morbidity and mortality. This study was conducted using the Kidney Disease Improving Global Outcomes (KDIGO) criteria to analyze potential perioperative biomarkers of CSA-AKI.</div></div><div><h3>Methods</h3><div>Blood was collected from patients intraoperatively on entry into the pericardium and at 4, 12, 24, and 48 hours postoperatively. Repeated-measures, mixed-model analysis was conducted to determine which cytokines and/or chemokines were associated with postoperative CSA-AKI. LASSO regression and random forest modeling were used for variable selection and incorporation into a multivariable regression model.</div></div><div><h3>Results</h3><div>There were no demographic or preoperative differences between patients with CSA-AKI and patients without CSA-AKI except for preoperative diabetes status, hemoglobin concentration, and CKD status. Additionally, there were no significant differences in preoperative medications between the 2 groups. Ten of the 40 biomarkers were statistically significant (<em>P</em> &lt; .05) for the between-group main effect after repeated measures analysis: myoglobin, growth/differentiation factor 15 (GDF-15), neutrophil gelatinase-associated lipocalin (NGAL), haptoglobin, tumor necrosis factor alpha (TNFα), monocyte chemoattractant protein 1 (MCP-1), interleukin (IL)-1RA, IL-8, IL-6, and C-reactive protein. Multivariable stepwise regression showed the earliest independent predictors of postoperative AKI were 4-hour myoglobin (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 1.12-3.12; <em>P</em> = .036), 4-hour IL-1RA (aOR, 1.001; 95% CI, 1.000-1.001; <em>P</em> = .48), and 4-hour haptoglobin (aOR, 1.07; 95% CI, 1.03-1.18; <em>P</em> = .001).</div></div><div><h3>Conclusions</h3><div>Multiple cytokines were significantly elevated between the CSA-AKI group and the CSA–non-AKI group. Myoglobin, haptoglobin, and IL-1RA are potential blood biomarkers for AKI after cardiac surgery. Further research is needed to investigate the roles of these biomarkers and their associations with CSA-AKI.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 264-274"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321484","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}

{"title":"Postcardiotomy extracorporeal membrane oxygenation in patients older than 70 years: Characteristics, outcomes, and variables associated with mortality","authors":"Maged Makhoul MD ,&nbsp;Silvia Mariani MD ,&nbsp;Bas C.T. van Bussel PhD ,&nbsp;Dominik Wiedemann ,&nbsp;Diyar Saeed PhD ,&nbsp;Michele Di Mauro PhD ,&nbsp;Matteo Pozzi PhD ,&nbsp;Luca Botta PhD ,&nbsp;Udo Boeken PhD ,&nbsp;Robertas Samalavicius PhD ,&nbsp;Karl Bounader MD ,&nbsp;Xiaotong Hou PhD ,&nbsp;Jeroen J.H. Bunge MD ,&nbsp;Hergen Buscher MD ,&nbsp;Leonardo Salazar MD ,&nbsp;Bart Meyns PhD ,&nbsp;Michael A. Mazzeffi MD, MPH ,&nbsp;Marco L. Sacha Matteucci MD ,&nbsp;Sandro Sponga PhD ,&nbsp;Graeme MacLaren MSc ,&nbsp;Roberto Lorusso PhD","doi":"10.1016/j.xjon.2025.04.004","DOIUrl":"10.1016/j.xjon.2025.04.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Age is the main determinant for mortality in patients requiring postcardiotomy extracorporeal membrane oxygenation (PC-ECMO), but strategies to reverse this trend are unknown. This study investigates PC-ECMO outcomes in older patients (≥70 years) compared with younger patients (&lt;70 years).</div></div><div><h3>Methods</h3><div>This retrospective study included patients who required PC-ECMO between 2000 and 2020. Variables independently associated with in-hospital mortality were identified using mixed Cox proportional hazards models.</div></div><div><h3>Results</h3><div>The study included 2057 patients (mean age: 62.3 [first and third quartile: 19-94]; male patients: n = 1213 [59%]): 1376 (67%) were &lt;70 years and 680 (33%) were ≥70 years old. Older patients had more preoperative comorbidities, whereas younger patients had lower cardiac function and more preoperative intubation and vasopressor use. In-hospital mortality was 56.3% (n = 775) and 68.8% (n = 468) in the &lt;70 year and ≥70 year groups, respectively (<em>P</em> &lt; .001). The 7-year postdischarge survival rate was greater for the younger patient group (<em>P</em> &lt; .001). Variables associated with in-hospital mortality in older patients were previous stroke (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.05-1.84), preoperative right ventricular failure (HR, 1.45; 95% CI, 1-2.1), aortic surgery (HR 1.65; 95% CI, 1.2-2.2), and postoperative complications including bleeding (HR 1.24; 95% CI, 1.0-1.5), cardiac arrest (HR, 1.65; 95% CI, 1.3-2.1), and right ventricular failure (HR, 1.29; 95% CI, 1.0-1.6).</div></div><div><h3>Conclusions</h3><div>PC-ECMO mortality is high in older patients. Preoperative factors including previous stroke and right ventricular failure and postoperative factors including bleeding, cardiac arrest, and right ventricular failure should be targeted to reduce in-hospital mortality after appropriate initial selection in older patients.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 163-172"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321711","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}

{"title":"Research and academic development during cardiothoracic surgery training","authors":"Chi Chi Do-Nguyen DO ,&nbsp;Justin Robinson MD ,&nbsp;Eliza Hompe MD ,&nbsp;Adishesh Narahari MD, PhD ,&nbsp;Sameer Hirji MD, MPH ,&nbsp;Gorav Ailawadi MD, MBA ,&nbsp;Irbaz Hameed MD","doi":"10.1016/j.xjon.2025.03.015","DOIUrl":"10.1016/j.xjon.2025.03.015","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 525-533"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321424","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}

{"title":"The careers of surgeon-mothers create positive influences beyond the operating room","authors":"Rajika Jindani MD, MPH, MS ,&nbsp;Laura DiChiacchio MD, PhD","doi":"10.1016/j.xjon.2025.03.007","DOIUrl":"10.1016/j.xjon.2025.03.007","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Page 534"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321425","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}

{"title":"Quantifying random variability in decision-making in pediatric cardiac surgery","authors":"Kayla V. Dlugos HBASc ,&nbsp;Mjaye Mazwi MD, MBChB ,&nbsp;Marisa Signorile MMath ,&nbsp;Chun-Po Steve Fan PhD ,&nbsp;Patricia Trbovich PhD ,&nbsp;Osami Honjo MD, PhD","doi":"10.1016/j.xjon.2025.02.014","DOIUrl":"10.1016/j.xjon.2025.02.014","url":null,"abstract":"<div><h3>Objective</h3><div>Random variability in day-to-day decision-making referred to as “noise” is associated with variation that negatively affects both the reproducibility and quality of decision-making. Although well described in other fields, the prevalence and significance of noise in medical decision-making are understudied and largely unknown. The goal of this study was to quantify noise in medical decision-making using a noise audit.</div></div><div><h3>Methods</h3><div>A noise audit was completed by 71 (n = 71) Heart Centre staff at the Hospital for Sick Children and Seattle Children's Hospital and involved a series of cases and questions surrounding decisions commonly encountered in the care for patients with transposition of the great arteries and critical aortic stenosis. Entropy was used to quantify total variation in responses. Because absolute entropy was not immediately comparable across audit questions with a different number of prespecified options, we reported a standardized version of entropy, which was calculated by dividing the absolute entropy by its theoretical maximum for each case. To compare responses in easy to hard questions across years of experience (&lt;10 years and &gt;10 years) and role, we reported aggregate entropy ratios. Aggregate entropy ratios were calculated by first stratifying by group of comparison and then calculating the standardized entropy for each question and taking the average of standardized entropies for easy questions and hard questions. Finally, to determine the ratio (easy to hard), we divided the average standardized entropy of the easy questions by the average standardized entropy of the hard questions.</div></div><div><h3>Results</h3><div>The overall audit aggregate entropy ratio was 0.85 less than 1, indicating lower-complexity questions had less variation than higher-complexity questions. The aggregate entropy ratio for those with more than 10 years of experience was 0.8 and 0.87, respectively, for those with less than 10 years of experience. The aggregate entropy ratios for those in cardiac critical care, cardiology, and cardiovascular surgery were 0.85, 0.83, and 0.96, respectively.</div></div><div><h3>Conclusions</h3><div>Noise was pervasive in medical decision-making in the analysis of our responses to common medical decisions made for patients with congenital heart disease and can be quantified in a manner that facilitates comparisons.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 382-392"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320936","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}

{"title":"Recurrent substance use and reoperative valve surgery for acute infective endocarditis","authors":"Hakam Rajjoub BS,&nbsp;Stanley Wolfe MD, MPH,&nbsp;Luigi F. Lagazzi MD,&nbsp;Lawrence Wei MD,&nbsp;Ali Darehzereshki MD,&nbsp;Nestor Dans MD,&nbsp;Nathan Kister MD,&nbsp;Goya Raikar MD,&nbsp;Vinay Badhwar MD,&nbsp;J. Hunter Mehaffey MD, MSc","doi":"10.1016/j.xjon.2025.03.013","DOIUrl":"10.1016/j.xjon.2025.03.013","url":null,"abstract":"<div><h3>Objective</h3><div>Reoperative valve surgery in the setting of infective endocarditis (REDO) conveys a high risk of morbidity and mortality. Recurrent substance use in patients with substance use disorder (SUD) may complicate decision making in valve reinfection. We sought to evaluate the relative impact of recurrent substance use in REDO.</div></div><div><h3>Methods</h3><div>An institutional multidisciplinary endocarditis database, including Society of Thoracic Surgeons (STS) data, was analyzed for all patients undergoing isolated or concomitant valve surgery for acute infective endocarditis between July 2016 and June 2024. Patients were stratified by REDO and recurrent substance use. Multivariable regression modeling assessed the interaction between REDO and SUD on risk-adjusted outcomes.</div></div><div><h3>Results</h3><div>A total of 741 consecutive patients undergoing valve surgery for endocarditis were analyzed, including 475 with SUD (64.1%) and 210 undergoing REDO (28.3%). The incidence of second or further REDO was higher among SUD patients compared to non-SUD patients (23.1% vs 16.1%; <em>P</em> = .003). Compared to first-time valve surgery, REDO was associated with higher rates of mortality (7.6% vs 2.6%; <em>P</em> = .002) and major morbidity (31.9% vs 23.0%; <em>P</em> = .012). After risk adjustment, REDO was associated with increased STS composite mortality or major morbidity in non-SUD patients (odds ratio [OR], 4.6; <em>P</em> = .005) but not in SUD patients (OR, 1.4; <em>P</em> = .271). However, &gt;2 reoperations in the setting of recurrent substance use was associated with higher risk-adjusted major morbidity or mortality (OR, 6.23; <em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>Reoperation for infective endocarditis is associated with increased morbidity and mortality. For patients with recurrent substance use, initial reoperative surgery did not independently impact outcomes, but multiple reoperations did. These data can inform surgical decision making when approaching recurrent endocarditis due to recurrent substance use.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 89-95"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320866","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}

{"title":"The Ross/Ross-Konno operation in neonates and infants: A salvage strategy and a durable repair","authors":"John M. Karamichalis MD, PhD ,&nbsp;Morgan K. Moroi MD ,&nbsp;Alice V. Vinogradsky MD ,&nbsp;Edward Buratto MD, PhD ,&nbsp;Priyanka Asrani MD ,&nbsp;Diana Vargas Chaves MD ,&nbsp;Andrew B. Goldstone MD, PhD ,&nbsp;David Kalfa MD, PhD ,&nbsp;Emile A. Bacha MD","doi":"10.1016/j.xjon.2025.03.010","DOIUrl":"10.1016/j.xjon.2025.03.010","url":null,"abstract":"<div><h3>Objective</h3><div>To review a single-center experience of the Ross operation in neonates and infants with severe aortic valve disease.</div></div><div><h3>Methods</h3><div>Retrospective review identified patients younger than age 1 year who underwent Ross operation between 2010 and 2024. Primary outcome was cumulative incidence of death with transplant as a competing risk. Early and midterm outcomes were analyzed, including postoperative complications and reinterventions. A subgroup analysis of patients who remained hospitalized until Ross procedure was performed. Median follow-up was 5.7 years (interquartile range, 2.9-8.8. years).</div></div><div><h3>Results</h3><div>Twenty-nine patients (5 neonates and 24 infants) underwent the Ross operation, 24 (82.8%) of whom had a Konno procedure. Median age was 3.5 months (interquartile range, 1.1-5.7 months). Median weight was 4.9 kg (interquartile range, 3.9-6.0 kg). Five patients (27.2%) were born with isolated critical aortic stenosis, whereas 24 patients had other complex left-sided lesions. Twenty-five patients (86.2%) had prior aortic or aortic valve procedures: 14 balloon valvuloplasty, 3 open valvotomy, 1 surgical valve repair, 8 interrupted arch repairs, 5 coarctation or arch repairs, and 2 subaortic stenosis repairs. A subset (n = 11) could not be discharged from the hospital, mostly due to residual valve disease after balloon dilation, and underwent salvage Ross. Nineteen patients (65.5%) had concomitant operations. There was 1 in-hospital and 1 late mortality. Two patients required transplant. At follow-up, 1 patient had moderate or greater neoaortic insufficiency requiring reintervention.</div></div><div><h3>Conclusions</h3><div>The Ross operation can be performed in neonates and infants with excellent midterm outcomes. This operation can be safely offered as an exit strategy in neonates and infants with residual aortic valve disease who are unable to be discharged.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 312-325"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321013","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}

{"title":"Impact of mitral regurgitation reduction on uncorrected tricuspid regurgitation after left ventricular assist device implantation","authors":"Maxwell F. Kilcoyne DO ,&nbsp;Sarah Chen MD ,&nbsp;Sheldon Sutton MS ,&nbsp;Roshan Mathi MS ,&nbsp;Khaled Shorbaji MD ,&nbsp;John Foster MD ,&nbsp;Jennie Kwon MD ,&nbsp;Brett Welch MBA ,&nbsp;Arman Kilic MD","doi":"10.1016/j.xjon.2025.01.017","DOIUrl":"10.1016/j.xjon.2025.01.017","url":null,"abstract":"<div><h3>Objective</h3><div>Appropriate management of significant tricuspid regurgitation during left ventricular assist device implantation is unclear. This study evaluates the impact of post–left ventricular assist device mitral regurgitation reduction on uncorrected significant tricuspid regurgitation.</div></div><div><h3>Methods</h3><div>All patients who underwent HeartMate 3 implantation between January 2016 and December 2022 with preoperative moderate or greater tricuspid regurgitation were reviewed. Patients without preoperative mitral regurgitation or who underwent concomitant tricuspid valve intervention were excluded. The cohort was divided based on the degree of postoperative mitral regurgitation reduction: Group 1 included patients with 1.5 or less degrees of postoperative mitral regurgitation reduction, and group 2 included patients with more than 1.5 degrees. Primary outcomes included the relationship between tricuspid regurgitation and mitral regurgitation, and overall survival, which were calculated using Pearson correlation coefficient and Kaplan–Meier curves, respectively.</div></div><div><h3>Results</h3><div>A total of 178 patients underwent HeartMate 3 implantation during the study period, and 65 patients (36.5%) met inclusion criteria. There were no significant differences in baseline characteristics between group 1 (n = 35) and group 2 (n = 30). Mitral regurgitation reduction was significantly associated with tricuspid regurgitation reduction at 2 years (r = 0.25, <em>P</em> = .03) and 3 years (r = 0.27, <em>P</em> = .03). There was no significant difference in overall survival between groups at 2 years (79.0% vs 83.0%, <em>P</em> = .89) and 3 years (79.0% vs 76.0%, <em>P</em> = .89). At 2 years, there was no significant difference in the degree of tricuspid regurgitation between groups (<em>P</em> = .41), and 86.1% (n = 56) of patients had mild or less tricuspid regurgitation.</div></div><div><h3>Conclusions</h3><div>Preoperative moderate to severe tricuspid regurgitation improves with mitral regurgitation reduction after left ventricular assist device implantation. Future analyses should assess how this impacts patient selection for concomitant tricuspid valve repair.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 206-214"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321653","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}

{"title":"Safety and efficacy of empagliflozin in heart failure among patients with a history of valvular heart disease: Insights from EMPEROR-Pooled","authors":"Nitish K. Dhingra MD ,&nbsp;Ekene Nwajei MD ,&nbsp;Raj Verma MD ,&nbsp;Egon Pfarr Dipl Stat ,&nbsp;Tomasz Gasior MD ,&nbsp;Subodh Verma MD","doi":"10.1016/j.xjon.2025.03.018","DOIUrl":"10.1016/j.xjon.2025.03.018","url":null,"abstract":"<div><h3>Background</h3><div>Valvular heart disease (VHD)-associated heart failure (HF) remains an important and growing cause of morbidity and mortality. There are no contemporary data on the efficacy and safety of SGLT2 inhibitors in patients with a history of VHD.</div></div><div><h3>Methods</h3><div>The EMPEROR-Pooled trial analyzed 9718 patients with HF who were enrolled in the randomized trials of empagliflozin versus placebo in HF with reduced left ventricular ejection fraction (HfrEF; EMPEROR-Reduced) and HF with preserved left ventricular ejection fraction (HFpEF; EMPEROR-Preserved). These trials evaluated a primary outcome of time to first HF hospitalization or cardiovascular death. Here we analyze outcomes of the EMPEROR-Pooled patients according to the presence and etiology of VHD history.</div></div><div><h3>Results</h3><div>Of the 9717 patients enrolled in EMPEROR-Pooled with available data, 1484 (15.3%) had a history of VHD. Of the patients with VHD history, a history of isolated mitral disease (39.2%) was the most common subtype. In patients randomized to placebo, the risk of the primary outcome was higher among patients with VHD history (hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.10-1.53; <em>P</em> &lt; .01), and particularly those with a history of multivalvular disease (HR, 1.51; 95% CI, 1.13-2.04; <em>P</em> &lt; .01) compared with no valvular disease. No heterogeneity was introduced by VHD history with respect to the efficacy of empagliflozin on all major clinical outcomes evaluated in EMPEROR-Pooled (<em>P</em>_interaction &gt; .05).</div></div><div><h3>Conclusions</h3><div>We present the first large analysis of SGLT2i (empagliflozin) use in HF patients by history of VHD. Although VHD history was associated with worse outcomes in HF patients, empagliflozin demonstrated consistent safety, efficacy, and patient-reported outcomes across all categories of VHD history.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 143-153"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321709","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}

{"title":"Valve-sparing root replacement: How old is too old?","authors":"Elizabeth L. Norton MD ,&nbsp;Yanhua Wang PhD ,&nbsp;Parth M. Patel MD ,&nbsp;Dov Levine MD ,&nbsp;Jose Binongo PhD ,&nbsp;Bradley G. Leshnower MD ,&nbsp;Hiroo Takayama MD ,&nbsp;Edward P. Chen MD","doi":"10.1016/j.xjon.2025.02.020","DOIUrl":"10.1016/j.xjon.2025.02.020","url":null,"abstract":"<div><h3>Objective</h3><div>Valve-sparing root replacement (VSRR) is associated with excellent short- and long-term outcomes. Although typically offered in young patients, VSRR is performed over a wide age range, including into the eighth decade of life. This study analyzed the influence of age and preoperative comorbidities on operative outcomes, reoperation, and survival following VSRR.</div></div><div><h3>Methods</h3><div>From 2004 to 2021, 780 patients underwent VSRR in an academic database. VSRR was performed using the David V reimplantation technique. A discriminating age cutoff for the effect of age on long-term survival was determined by Contal and O'Quigley methods and patients were divided into 2 groups based on age at time of surgery.</div></div><div><h3>Results</h3><div>The optimal age cutoff for patients undergoing VSRR was found to be 65 years; 16% were aged 65 years or older at time of surgery. Overall, in-hospital mortality was 1.5% and was significantly higher among the group of patients older than age 65 years (4.1% vs 1.1%; <em>P</em> = .03). The cumulative incidence of reoperation of the aortic valve or proximal aorta was similar between the group of patients aged 65 years and older and patients younger than age 65 years (5% vs 6%; <em>P</em> = .28). Overall, 10-year survival was 89% and significantly worse among the patients aged 65 years and older (76% vs 92%; <em>P</em> &lt; .0001). Age 65 years and older was an independent risk factor for late mortality (hazard ratio, 1.04; 95% CI, 1.01-1.07; <em>P</em> = .003).</div></div><div><h3>Conclusions</h3><div>VSRR can be performed with low operative mortality and excellent freedom from reoperation across age groups. In patients aged 65 years and older, serious consideration should be given when deciding on VSRR, especially in the setting of aortic dissection.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 10-22"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321018","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}