JTCVS open最新文献

{"title":"Reply: The art of winning an unfair game: Immediate aortic repair for mesenteric malperfusion syndrome","authors":"James A. Brown MD, MS , Ibrahim Sultan MD","doi":"10.1016/j.xjon.2024.04.013","DOIUrl":"10.1016/j.xjon.2024.04.013","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 42-43"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001165/pdfft?md5=5ede001a5889f1a8537059923d79d0a8&pid=1-s2.0-S2666273624001165-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775020","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":"POBS-Card, a new score of severe bleeding after cardiac surgery: Construction and external validation","authors":"Emmanuel Besnier MD, PhD ,&nbsp;Pierre Schmidely MD ,&nbsp;Guillaume Dubois MD ,&nbsp;Prisca Lemonne MD ,&nbsp;Lucie Todesco MD ,&nbsp;Chadi Aludaat MD ,&nbsp;Thierry Caus MD, PHD ,&nbsp;Jean Selim MD, PhD ,&nbsp;Emmanuel Lorne MD, PhD ,&nbsp;Osama Abou-Arab MD, PhD","doi":"10.1016/j.xjon.2024.04.008","DOIUrl":"10.1016/j.xjon.2024.04.008","url":null,"abstract":"<div><h3>Objective</h3><p>Bleeding after cardiac surgery leads to poor outcomes. The objective of the study was to build the PeriOperative Bleeding Score in Cardiac surgery (POBS-Card) to predict bleeding after cardiac surgery.</p></div><div><h3>Methods</h3><p>We conducted a retrospective cohort study in 2 academic hospitals (2016-2019). Inclusion criteria were adult patients after cardiac surgery under cardiopulmonary bypass. Exclusion criteria were heart transplantation, assistance, aortic dissection, and preoperative hemostasis diseases. Bleeding was defined by the universal definition for perioperative bleeding score ≥2. POBS-Card score was built using multivariate regression (derivation cohort, one center). The performance diagnosis was assessed using the area under the curve in a validation cohort (2 centers) and compared with other scores.</p></div><div><h3>Results</h3><p>In total, 1704 patients were included in the derivation cohort, 344 (20%) with bleeding. Preoperative factors were body mass index &lt;25 kg/m² (odds ratio [OR], 1.48 [1.14-1.93]), type of surgery (redo: OR, 1.76 [1.07-2.82]; combined: OR, 1.81 [1.19-2.74]; ascendant aorta: OR, 1.56 [1.02-2.38]), ongoing antiplatelet therapy (single: OR, 1.50 [1.09-2.05]; double: OR, 2.00 [1.15-3.37]), activated thromboplastin time ratio &gt;1.2 (OR, 1.44 [1.03-1.99]), prothrombin ratio &lt;60% (OR, 1.91 [1.21-2.97]), platelet count &lt;150 g/L (OR, 1.74 [1.17-2.57]), and fibrinogen &lt;3 g/L (OR, 1.33 [1.02-1.73]). In the validation cohort of 597 patients, the area under the curve was 0.645 [0.605-0.683] and was superior to other scores (WILL-BLEED, Papworth, TRUST, TRACK). A threshold &gt;14 predicted bleeding with a sensitivity of 50% and a specificity of 73%.</p></div><div><h3>Conclusions</h3><p>POBS-Card score was superior to other scores in predicting severe bleeding after cardiac surgery. Performances remained modest, questioning the place of these scores in the perioperative strategy of bleeding-sparing.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 183-199"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001104/pdfft?md5=4b42f2c29a6781090215a943bfd8bbb0&pid=1-s2.0-S2666273624001104-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756817","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":"Current definitions of hemodynamic structural valve deterioration after bioprosthetic aortic valve replacement lack consistency","authors":"Bart J.J. Velders MD ,&nbsp;Michiel D. Vriesendorp MD, PhD ,&nbsp;Federico M. Asch MD ,&nbsp;Michael J. Reardon MD ,&nbsp;Francois Dagenais MD ,&nbsp;Michael G. Moront MD ,&nbsp;Joseph F. Sabik III MD ,&nbsp;Rolf H.H. Groenwold MD, PhD ,&nbsp;Robert J.M. Klautz MD, PhD","doi":"10.1016/j.xjon.2024.02.023","DOIUrl":"10.1016/j.xjon.2024.02.023","url":null,"abstract":"<div><h3>Objective</h3><p>New echocardiographic definitions have been proposed for hemodynamic structural valve deterioration. We aimed to study their consistency in classifying structural valve deterioration after surgical aortic valve replacement.</p></div><div><h3>Methods</h3><p>Data were used of patients undergoing surgical aortic valve replacement in a multicenter, prospective cohort study with a 5-year follow-up. All patients received the same stented bioprosthesis. Echocardiographic parameters were assessed by an independent core laboratory. Moderate or greater stenotic hemodynamic structural valve deterioration was defined according to Capodanno and colleagues, Dvir and colleagues, and the Valve Academic Research Consortium 3; regurgitation data were not considered in this analysis. Consistency was quantified on the basis of structural valve deterioration classification at subsequent time points.</p></div><div><h3>Results</h3><p>A total of 1118 patients received implants. Patients’ mean age was 70 years, and 75% were male. Hemodynamic structural valve deterioration at any visit was present in 51 patients (4.6%), 32 patients (2.9%), and 34 patients (3.0%) according to Capodanno, Dvir, and Valve Academic Research Consortium 3. A total of 1064 patients (95%) were never labeled with structural valve deterioration by any definition. After the first classification with structural valve deterioration, 59%, 59%, and 65% had no subsequent structural valve deterioration classification according to Capodanno, Dvir, and Valve Academic Research Consortium 3, respectively.</p></div><div><h3>Conclusions</h3><p>The current definitions of hemodynamic structural valve deterioration are strong negative predictors but inconsistent positive discriminators for the detection of stenotic hemodynamic structural valve deterioration. Although the diagnosis of structural valve deterioration may be categorical, echocardiographic indices lack this degree of precision in the first 5 years after surgical aortic valve replacement. The inconsistency of current structural valve deterioration definitions impedes the detection of true valve degeneration, which challenges the clinical usefulness of these definitions.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 68-90"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000597/pdfft?md5=b09e5cceb462850bc2444a7be1282d40&pid=1-s2.0-S2666273624000597-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140274921","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":"Noncomplex ventricular arrhythmia associated with greater freedom from recurrent ectopy at 1 year after mitral repair surgery","authors":"Dimosthenis Pandis MD, MSc ,&nbsp;Navindra David BS ,&nbsp;Ahmed EI-Eshmawi MD ,&nbsp;Marc A. Miller MD ,&nbsp;Percy Boateng MD ,&nbsp;Ana Claudia Costa MD, PhD ,&nbsp;Philip Robson PhD ,&nbsp;Maria Giovanna Trivieri MD ,&nbsp;Zahi Fayad PhD ,&nbsp;Anelechi C. Anyanwu MD, MSc ,&nbsp;David H. Adams MD","doi":"10.1016/j.xjon.2024.04.005","DOIUrl":"10.1016/j.xjon.2024.04.005","url":null,"abstract":"<div><h3>Objective</h3><p>The effect of mitral valve (MV) surgery on the natural history of ventricular arrhythmia (VA) in patients with arrhythmic MV prolapse remains unknown. We sought to evaluate the cumulative incidence of VA at 1 year after surgical mitral repair.</p></div><div><h3>Methods</h3><p>A retrospective review of progressively captured data identified 204 consecutive patients who underwent elective MV repair for significant degenerative mitral regurgitation as a first-time cardiovascular intervention in a quaternary reference center between January 2018 and December 2020. A subset of 62 consecutive patients with diagnosed arrhythmic MV prolapse was further evaluated for recurrent VA after MV repair.</p></div><div><h3>Results</h3><p>The median age was 62 years (range, 27-77 years) and 26 of 62 (41.9%) were female. The median time from initial mitral regurgitation/MV prolaspe diagnosis-to-referral was 13.8 years (interquartile range [IQR], 5.4-25) and from VA diagnosis-to-referral was 8 years (IQR, 3-10.6). Using the Lown-Wolf classification, complex VA (Lown grade ≥3) was identified in 36 of 62 patients (58%) at baseline, whereas 8 of 62 (13%) had a cardioverter/defibrillator implanted for primary (4/8) or secondary (4/8) prevention. Left ventricular myocardial scar was confirmed in 23 of 34 (68%) of patients scanned at baseline. The prevailing valve phenotype was bileaflet Barlow (59/62; 95.2%). All patients underwent surgical MV repair by the same team. Surgical repair was stabilized with an annuloplasty prosthesis (median size 36 mm [IQR, 34-38]). Concomitant procedures included tricuspid valve repair (51/62; 82.3%), cryo-maze ± left atrial appendage exclusion (14/62, 23%), and endocardial cryoablation of VA ectopy (4/62; 6.5%). The 30-day and 1-year freedom from recurrent VA were 98.4% and 75.9%, respectively. Absent VA after mitral repair was uniformly observed in patients with minor VA at baseline. Absent VA after mitral repair was uniformly observed in patients with minor VA preoperatively. Complex baseline VA was the strongest predictor of recurrent VA (hazard ratio, 10.8; 95% confidence interval, 1.4-84.2; <em>P</em> = .024), irrespective of myocardial fibrosis.</p></div><div><h3>Conclusions</h3><p>In a series of 62 consecutive patients operated electively for arrhythmic mitral prolapse, VA remained undetected in 75.9% of patients at 1 year. Freedom from recurrent VA was greater among patients without complex VA preoperatively, whereas baseline Lown grade ≥3 was the strongest independent risk factor for recurrent VA at 1 year. These findings attest to the importance of early recognition and prompt referral of patients with mitral prolapse and progressive VA to specialty interdisciplinary care.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 94-113"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001074/pdfft?md5=654dde242501a48612881a9d15e1694d&pid=1-s2.0-S2666273624001074-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140771302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-specific and organ-centric approach in malperfusion in acute type A dissection","authors":"Bashisth Mishra Mch ,&nbsp;Simiyu R. Namungu MMED ,&nbsp;Abdifatah A. Mohamed MD","doi":"10.1016/j.xjon.2024.04.002","DOIUrl":"10.1016/j.xjon.2024.04.002","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Page 44"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001049/pdfft?md5=57653fce47760fd7e905da7c0c7bb4a2&pid=1-s2.0-S2666273624001049-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781329","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":"Management of aortoesophageal fistula primarily using esophageal preservation","authors":"Alexander Mills DO ,&nbsp;Akiko Tanaka MD, PhD ,&nbsp;Ashley Dawson MD ,&nbsp;Robert Hetz MD ,&nbsp;Holly Smith MD ,&nbsp;Michael Lopez DO ,&nbsp;Hazim Safi MD ,&nbsp;Anthony Estrera MD","doi":"10.1016/j.xjon.2024.04.004","DOIUrl":"10.1016/j.xjon.2024.04.004","url":null,"abstract":"<div><h3>Objective</h3><p>Aortoesophageal fistula is a rare, life-threatening condition. There is no consensus regarding the surgical management of the esophagus in this condition.</p></div><div><h3>Methods</h3><p>We retrospectively evaluated 13 patients diagnosed with aortoesophageal fistulas at a single institution from 2003 to 2021. Descriptive statistics were used to analyze patient characteristics, operative characteristics, and patient outcomes. Kaplan–Meier survival analysis was performed.</p></div><div><h3>Results</h3><p>Patients’ mean age was 63.5 years, and 6 (46.2%) were female. The most common presenting symptoms were hemoptysis/hematemesis (69.2%), chest/back pain (46.2%), and fever (38.5%). Twelve patients (92.3%) had a history of aortic procedures. The median time between the index operation and repair of the secondary aortoesophageal fistula in the 12 patients was 5 months. The index operation was a thoracic endovascular aortic repair in 10 of 12 patients (83.3%). Eleven patients (84.6%) underwent primary esophageal repair with flap coverage (omentum or muscle). One of these patients needed an esophagectomy within 1 year. The primary surgical management of the aorta was graft excision and replacement, aside from 1 patient who underwent primary repair. The 30-day survival was 69.2%, and 1-year and 5-year survivals were 31.7%. There were no recurrent infections at the esophageal fistula site.</p></div><div><h3>Conclusions</h3><p>Aortoesophageal fistula remains a rare condition, but its case numbers have increased with thoracic endovascular aortic repair. It continues to be a difficult condition to manage and has a high fatality rate. Esophageal-preserving surgery may be a safe and less-invasive option for patients with a small defect.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 31-38"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001062/pdfft?md5=3c0fe3be244cf9cb1470ed655f4e4cc7&pid=1-s2.0-S2666273624001062-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140785770","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":"Costal margin reconstruction for slipping rib syndrome: Outcomes of more than 500 cases and advancements beyond earlier sutured repair technique","authors":"Adam J. Hansen MD,&nbsp;Jeremiah Hayanga MD, MPH,&nbsp;Alper Toker MD,&nbsp;Vinay Badhwar MD","doi":"10.1016/j.xjon.2024.03.007","DOIUrl":"https://doi.org/10.1016/j.xjon.2024.03.007","url":null,"abstract":"<div><h3>Objectives</h3><p>To evaluate results of sutured repair for slipping rib syndrome (SRS), identify failure points, and discuss technique modifications to improve outcomes through costal margin reconstruction (CMR).</p></div><div><h3>Methods</h3><p>Patients undergoing repair of SRS between February 2019 and February 2024 at an academic referral institution were retrospectively analyzed. Pain scores, quality of life, pain medication use, and reoperations were evaluated pre- and postoperatively at 1 and 6 months. In patients failing sutured repair we identified specific failure points and devised a new CMR technique to overcome them. Subsequent CMR patients were followed at 1, 6, 12, 18, and 24 months using the same outcome measures.</p></div><div><h3>Results</h3><p>Four hundred forty-nine patients underwent repair. Two hundred forty-one patients underwent sutured repair with revision required in 66. Median time to revision was 14 months. CMR was developed and performed in 247 patients. In CMR patients, preoperative mean pain score of 7.5 out of 10 dropped postoperatively to 4.0, 2.5, 1.9, 1.3, and 0.9 at 1, 6, 12, 18, and 24 months, respectively (<em>P</em> &lt; .001). Mean quality of life of 38% improved to 73%, 83%, 88%, 93%, and 95% at the same intervals (<em>P</em> &lt; .001). Preoperatively, 29% of patients chronically used opioid medications. Opioid use dropped postoperatively to 11%, 4%, 4%, 0%, and 0% at the same intervals. Use of nonopioid medications followed a similar pattern. One CMR patient required full revision.</p></div><div><h3>Conclusions</h3><p>SRS is a debilitating, but correctable disorder. Improved pain and quality of life, reduction in chronic opioid use, and freedom from revision surgery suggest that CMR should be considered the standard operation for SRS.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 347-354"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000664/pdfft?md5=53e4ab02a54de8967f7d2ec6c4ee0297&pid=1-s2.0-S2666273624000664-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141325241","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":"Defining resectability: When do you try to take it out?","authors":"Harry Etienne MD, PhD ,&nbsp;Bianca Battilana MM ,&nbsp;Jonathan Spicer MD, PhD ,&nbsp;Raphael S. Werner MD, MSc ,&nbsp;Isabelle Opitz MD","doi":"10.1016/j.xjon.2024.03.012","DOIUrl":"10.1016/j.xjon.2024.03.012","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 338-346"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000913/pdfft?md5=1af9d8abb787755f90ddb4f65dcd94d4&pid=1-s2.0-S2666273624000913-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140401526","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":"Mesenteric malperfusion syndrome is the game changer in acute aortic dissection","authors":"Koray Ak MD, PhD","doi":"10.1016/j.xjon.2024.03.014","DOIUrl":"10.1016/j.xjon.2024.03.014","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Page 41"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000937/pdfft?md5=0e99e5b911d55c9fffad5b6a57c0b750&pid=1-s2.0-S2666273624000937-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403819","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":"Discussion to: Outcomes of single- versus multi-port video-assisted thoracoscopic surgery: Data from a multicenter randomized controlled trial of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer","authors":"","doi":"10.1016/j.xjon.2024.04.011","DOIUrl":"10.1016/j.xjon.2024.04.011","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 309-310"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001141/pdfft?md5=e11649c1ea9361cb462ce1f1b2524926&pid=1-s2.0-S2666273624001141-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140786961","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}