JTCVS open最新文献

{"title":"Outcomes of the lateral caval flap and conventional techniques for repair of right-sided partial anomalous pulmonary venous connection in adults","authors":"William C. Frankel MD ,&nbsp;Bogdan A. Kindzelski MD, MS ,&nbsp;Benjamin Yang MD ,&nbsp;Rashed Mahboubi MD ,&nbsp;Miza Salim Hammoud MD ,&nbsp;Andrew J. Toth MS ,&nbsp;Hani K. Najm MD, MSc ,&nbsp;Gösta B. Pettersson MD, PhD ,&nbsp;Tara Karamlou MD, MSc","doi":"10.1016/j.xjon.2024.10.023","DOIUrl":"10.1016/j.xjon.2024.10.023","url":null,"abstract":"<div><h3>Objective</h3><div>In an effort to overcome limitations of conventional techniques for surgical repair of partial anomalous pulmonary venous connection (PAPVC), we developed the lateral caval flap (LCF) technique, which leverages a native endocardial surface to create unobstructed recruitment of the anomalous pulmonary veins to the left atrium. In this study, we report the long-term outcomes of the LCF and conventional techniques for repair of right-sided PAPVC.</div></div><div><h3>Methods</h3><div>In total, 109 adult patients (mean age 48 years; 57% male) who underwent right-sided PAPVC repair (53 LCF, 34 single-patch, 13 double-patch, 7 pericardial roll, and 2 Warden procedure) from 1997 to 2022 were retrospectively reviewed. Outcomes included operative mortality, major morbidity, arrythmias, systemic and pulmonary venous pathway obstruction, survival, and reintervention.</div></div><div><h3>Results</h3><div>Operative mortality was 1% and there were no in-hospital deaths after LCF repair; 4 patients had strokes (4%) including 2 nondisabling strokes after LCF repair (4%), 19 patients developed new postoperative atrial fibrillation/flutter (24%) including 9 after LCF repair (24%), and 27 patients developed new early sinus node dysfunction (26%) including 13 after LCF repair (26%). Although sinus-node dysfunction was transient in most patients, 7 required permanent pacemaker implantation (7%). Survival at 1, 5, 10, and 15 years was 95%, 89%, 86%, and 81%, respectively. At a median follow-up of 6 years, 9 patients developed systemic or pulmonary venous pathway obstruction. Freedom from cardiac reintervention at 5 years was 89% overall and 98% after LCF repair.</div></div><div><h3>Conclusions</h3><div>All of the described techniques for repair of right-sided PAPVC yielded acceptable short- and long-term outcomes. LCF is a valid technique for right-sided PAPVC repair with a low risk of venous pathway obstruction compared with conventional techniques. Sinus node dysfunction and atrial tachyarrhythmias remain challenges.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 225-234"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465184","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":"Commercial hybrid graft versus traditional arch replacement with frozen elephant trunk: A multi-institutional comparison","authors":"Markian M. Bojko MD, MPH ,&nbsp;William Oslund MD ,&nbsp;Michael J. Kirsch MD ,&nbsp;Adam M. Carroll MD ,&nbsp;Emma Longo BS ,&nbsp;Jessica S. Clothier MD ,&nbsp;Kamso Okonkwo BA ,&nbsp;Nithya Rajeev BS ,&nbsp;Arjune Dhanekula MD ,&nbsp;Fenton McCarthy MD ,&nbsp;Anthony Cafarelli MD ,&nbsp;Jason Glotzbach MD ,&nbsp;Christopher R. Burke MD ,&nbsp;T. Brett Reece MD, MBA ,&nbsp;Serge Kobsa MD, PhD ,&nbsp;Fernando Fleischman MD","doi":"10.1016/j.xjon.2024.10.027","DOIUrl":"10.1016/j.xjon.2024.10.027","url":null,"abstract":"<div><h3>Objective</h3><div>Traditional total arch replacement with frozen elephant trunk requires 2 separate grafts in the descending thoracic aorta and arch, and frequently requires a graft-to-graft anastomosis, which is prone to bleeding. The Thoraflex (Terumo Aortic) device treats the arch and descending thoracic aorta in a single device but has not been compared directly to traditional total arch replacement with frozen elephant trunk and has not been studied in a real-world context in the United States.</div></div><div><h3>Methods</h3><div>A consecutive sample of total arch replacement with frozen elephant trunk patients across 5 different institutions between January 2018 and January 2024, identified 438 patients of which 83 out of 438 (18.9%) had a Thoraflex device. Propensity score matching in a 1:2 ratio identified 166 well-matched controls. Groups were compared across perioperative outcomes.</div></div><div><h3>Results</h3><div>One hundred forty out of 438 (32%) patients presented with acute type A dissection, 112 out of 438 (26%) had an aneurysm, and 87 out of 438 (20%) had chronic dissection with a previous proximal repair. One hundred thirty-two out of 438 (30%) underwent surgery on an emergency or emergency/salvage basis. Median (interquartile range [IQR]) crossclamp times in the Thoraflex and traditional matched groups were 71 (IQR, 48-105) and 82 (IQR, 62-123), respectively, (<em>P</em> = .012). Total circulatory arrest times were 19 minutes (IQR, 13-32 minutes) and 23 minutes (IQR, 17-37 minutes), respectively (<em>P</em> = .009). Total procedure times were 6.1 hours (IQR, 5.2-7.3 hours) and 6.8 hours (IQR, 5.7-8.2 hours), respectively (<em>P</em> = .012). The operative mortality, stroke, and paralysis rates were 11 out of 83 (13%), 16 out of 83 (19%), and 4 out of 83 (5%), respectively, in the Thoraflex group and were not significantly different than matched controls.</div></div><div><h3>Conclusions</h3><div>The Thoraflex hybrid device facilitates shorter crossclamp and circulatory arrest times for arch replacement, with similar observed mortality and stroke rates compared with matched controls.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 19-33"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465186","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":"Surgical resection of diffuse pulmonary arteriovenous malformations (PAVMs)","authors":"Aden R. Falk ,&nbsp;Lindsay J. Nitsche BS ,&nbsp;Colleen E. Bontrager BA ,&nbsp;Sarah Bond PA-C ,&nbsp;Lauren A. Beslow MD, MSCE ,&nbsp;Alexandra J. Borst MD ,&nbsp;Jennifer Pogoriler MD, PhD ,&nbsp;Paul J. Devlin MD ,&nbsp;Elizabeth Goldmuntz MD ,&nbsp;Sunil Singhal MD ,&nbsp;Scott O. Trerotola MD ,&nbsp;Stephanie M. Fuller MD, MS","doi":"10.1016/j.xjon.2024.11.002","DOIUrl":"10.1016/j.xjon.2024.11.002","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with pulmonary arteriovenous malformations (PAVM) can have significant morbidity and mortality. Surgical resection in isolation or with embolization is reported to treat diffuse-type PAVMs. Herein, we describe outcomes for children and adults for whom PAVMs were managed with elective surgical resection.</div></div><div><h3>Methods</h3><div>This retrospective analysis includes all patients treated with surgical resection for PAVM from August 1, 2009, to July 20, 2023. Demographic, diagnostic, treatment, and follow-up information were abstracted from medical records. Descriptive statistics were used.</div></div><div><h3>Results</h3><div>Among 18 patients who underwent surgical resection of PAVMs, 12 had hereditary hemorrhagic telangiectasia. Primary indications for surgery included hemoptysis (n = 4), dyspnea (n = 8), persistence of PAVM following embolotherapy (n = 5), and stroke (n = 1). Selected PAVMs were diffuse-type (n = 14) or highly complex (n = 4). Eight patients underwent embolotherapy before surgery. Most resections were performed via thoracotomy (16/18), with 2 video-assisted thoracoscopic surgeries. Resection consisted of lobectomy (n = 14), segmentectomy (n = 3), or pneumectomy (n = 1). Median oxygen saturation improved from 90% preoperatively to 97% postoperatively. The majority (17/18) of patients were extubated in the operating room, with no major complications. The median hospital length of stay was 4.5 days (range, 2-9 days), with a median of 1 intensive care unit day (range, 1-5 days). At median follow-up of 16 months (range, 6 months-12.1 years), median oxygen saturation was 98%, no bleeding recurred, and 100% survived.</div></div><div><h3>Conclusions</h3><div>Although embolization has been the main therapy for most PAVMs, surgical resection of diffuse-type PAVMs is safe and effective. Outcomes were excellent with improvement of oxygen saturation and functional status.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 309-317"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465191","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 intraoperative transfusion of blood products with postoperative outcomes and midterm survival in acute type A aortic dissection repair","authors":"Elizabeth L. Norton MD,&nbsp;Akul Arora MD,&nbsp;Busra Cangut MD, MS,&nbsp;Divyaam Satija BS,&nbsp;Marc Titsworth BS,&nbsp;Rana-Armaghan Ahmad BS,&nbsp;Carol Ling MSc, PhD,&nbsp;Karen Kim MD,&nbsp;Shinichi Fukuhara MD,&nbsp;Himanshu J. Patel MD,&nbsp;Bo Yang MD, PhD","doi":"10.1016/j.xjon.2024.10.033","DOIUrl":"10.1016/j.xjon.2024.10.033","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to evaluate the impact of intraoperative blood product on postoperative outcomes and midterm survival in acute type A aortic dissection repair.</div></div><div><h3>Methods</h3><div>Patients undergoing open acute type A aortic dissection repair from January 2010 to April 2020 were divided into 2 groups: patients receiving intraoperative blood products and no intraoperative blood products, with a final propensity-matched cohort of 90 matched pairs by matching sex, age, body mass index, preoperative hemoglobin, coronary artery disease, renal failure, stroke, prior cardiac surgery, cardiogenic shock, cardiopulmonary bypass time, crossclamp time, peripheral vascular disease, and aortic insufficiency.</div></div><div><h3>Results</h3><div>Patients were similar in demographic and preoperative characteristics. The complexity of the surgery, including the extent of aortic root and arch repair, was similar between the groups. The intraoperative blood product group had longer intubation time (77 hours vs 44 hours, <em>P</em> = .023), longer postoperative (14 vs 10 days, <em>P</em> = .0001) and total (15 vs 10 days, <em>P</em> &lt; .0001) length of stays, and a higher rate of acute renal failure postoperatively (16.7% vs 6.7%, <em>P</em> = .037). The 6-year survival was similar between the intraoperative blood product group and no intraoperative blood product group (76.5% vs 83.3%, <em>P</em> = .48). The multivariate Cox proportional hazard model showed a statistically insignificant hazard ratio of 1.27 in the intraoperative blood product group for midterm mortality (95% CI, 0.64-2.54, <em>P</em> = .50).</div></div><div><h3>Conclusions</h3><div>Intraoperative blood product use during acute type A aortic dissection repair did not impact midterm survival but increased postoperative complications. Intraoperative blood product transfusion can be safely and cautiously used during acute type A aortic dissection repair.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 51-59"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464437","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":"Incomplete ablation as a mechanism of atrial fibrillation recurrence and atrial tachycardia development after maze procedure","authors":"Takashi Nitta MD, PhD ,&nbsp;Yuki Iwasaki MD, PhD ,&nbsp;Shun-ichiro Sakamoto MD, PhD ,&nbsp;Masahiro Fujii MD, PhD ,&nbsp;Toshiaki Otsuka MD, PhD ,&nbsp;Yosuke Ishii MD, PhD","doi":"10.1016/j.xjon.2024.10.031","DOIUrl":"10.1016/j.xjon.2024.10.031","url":null,"abstract":"<div><h3>Objective</h3><div>Atrial tachyarrhythmias are the most frequent complication after the maze procedure. We examined the mechanism of atrial tachyarrhythmias in association with the ablation energy and technique used at each lesion and by the findings of postoperative electrophysiological study.</div></div><div><h3>Methods</h3><div>Four-hundred fifty-three patients who underwent the maze procedure with biatrial incisions and bilateral pulmonary vein (PV) isolation were examined for the incidence and mechanism of recurrence of atrial fibrillation (AF) and development of atrial tachycardia (AT). PV isolation was performed by radiofrequency (RF) ablation, cryothermia, or cut-and-sew technique. The atrioventricular isthmi and the coronary sinus (CS) were ablated by RF, cryothermia, or a combination of these.</div></div><div><h3>Results</h3><div>Of 443 patients who survived surgery (98%), 54 patients (12.2%) had recurrent AF and 36 patients (8.1%) developed AT during the median of 28 months (interquartile range, 3-75) postoperatively. Multivariate logistic regression analysis showed preoperative left atrial dimension and nonperformance of intraoperative PV pacing were the independent predictors for AF recurrence. Electrophysiologic study in patients with AT demonstrated incomplete ablation in 24 patients (67%), most frequently at the CS in 16 patients (67%), and non-PV focal activations in 16 patients (44%). Preoperative New York Heart Association functional class of 1 and nonperformance of additional epicardial ablation of the CS were the independent predictors for postoperative AT development.</div></div><div><h3>Conclusions</h3><div>Incomplete ablation is a cause of AF recurrence and AT development after the maze procedure. Intraoperative PV pacing prevents AF recurrence and additional epicardial CS ablation prevents AT development.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 110-119"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464456","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":"Reply: A history of cardiothoracic surgery in Africa","authors":"Beshoy Allam MSc,&nbsp;Mahmoud Alhussaini MD,&nbsp;Moustafa Loay MB, BCH,&nbsp;Mostafa Kotb MB, BCH,&nbsp;Hussein Elkhayat MD","doi":"10.1016/j.xjon.2024.11.016","DOIUrl":"10.1016/j.xjon.2024.11.016","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Page 386"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465080","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":"Correlation of the femoral pulse and mesenteric perfusion pressure in acute aortic dissection","authors":"Benjamin M. Pinsky BS ,&nbsp;Minhaj S. Khaja MD, MBA ,&nbsp;Bo Yang MD, PhD ,&nbsp;Himanshu J. Patel MD ,&nbsp;Karen M. Kim MD ,&nbsp;Shinichi Fukuhara MD ,&nbsp;G. Michael Deeb MD ,&nbsp;Nicholas Burris MD ,&nbsp;Amber Liles MD, MPH ,&nbsp;William Sherk MD ,&nbsp;David M. Williams MD","doi":"10.1016/j.xjon.2024.10.028","DOIUrl":"10.1016/j.xjon.2024.10.028","url":null,"abstract":"<div><h3>Background</h3><div>Visceral malperfusion is a serious complication of acute aortic dissection. Currently, diagnosis relies on signs of end-organ failure, which may be clinically obscure and delay crucial treatment.</div></div><div><h3>Objective</h3><div>The aim was to investigate external iliac (IA) and superior mesenteric artery (SMA) pressures in cases where both vessels originate exclusively from the true lumen to develop and validate a novel early indicator of visceral malperfusion.</div></div><div><h3>Methods</h3><div>Endovascular pressure measurements from 488 patients with acute aortic dissection were analyzed. Exclusion criteria included static obstruction of the branch vessel or substantial re-entry tear below the SMA origin.</div></div><div><h3>Results</h3><div>In acute type A aortic dissection, 69 out of 244 (28.3%) patients had at least 1 common IA and the SMA with exclusive true lumen perfusion. Among all patients with acute type A aortic dissection, 41 (16.8%) patients with 49 external IA pressure measurements met inclusion criteria. Pressures in right external IA (n = 27) and left external IA (n = 22) correlated significantly with SMA perfusion pressure (<em>r</em>² = 0.86 [95% CI, 0.71-0.93; <em>P</em> = 1.03^E-08] and <em>r</em>² = 0.86 [95% CI, 0.69-0.94; <em>P</em> = 2.85^E-07], respectively).</div><div>In settings of acute type B aortic dissection, 81 out of 244 (33.2%) patients had at least 1 common IA and the SMA with exclusive true lumen perfusion. Among all patients with acute type B aortic dissection, 35 (14.3%) patients with 44 external IA pressure measurements met inclusion criteria. The right external IA (n = 24) and left external IA (n = 20) pressures correlated significantly with SMA perfusion pressure (<em>r</em>² = 0.92 [95% CI, 0.83-0.97; <em>P</em> = 1.^59E-10] and <em>r</em>² = 0.87 [95% CI, 0.70-0.95; <em>P</em> = 6.12^E-07], respectively).</div></div><div><h3>Conclusions</h3><div>In acute aortic dissection where the SMA and a common IA are supplied exclusively by the true lumen, external IA systolic pressures correlate significantly with SMA systolic pressures. In this group, therefore, clinical loss of the femoral pulse likely indicates significantly decreased SMA pressures, raising concern for visceral malperfusion, possibly before visceral enzymes can respond. We believe that computed tomography reports should highlight this anatomical finding to alert the clinical team monitoring the patient.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 34-43"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465180","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":"Commentator Discussion: Routine use of jejunostomy tubes after esophagectomy: The good, the bad, and the ugly!","authors":"","doi":"10.1016/j.xjon.2024.10.021","DOIUrl":"10.1016/j.xjon.2024.10.021","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 288-289"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465189","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":"Use of bupivacaine liposomal injectable suspension in children aged 2 to 6 years undergoing cardiac surgery does not accelerate recovery","authors":"Lindsay J. Nitsche BS ,&nbsp;Paul J. Devlin MD, MSc ,&nbsp;Sarah J. Bond MS, PA-C ,&nbsp;Jeremy A. Friedman MD ,&nbsp;Kaitlyn R. Rubnitz PA-C ,&nbsp;Emily Schwartz MSN, CRNP ,&nbsp;Colleen E. Bontrager BA ,&nbsp;Lauren I. Karel PharmD ,&nbsp;Susan C. Nicolson MD ,&nbsp;Stephanie M. Fuller MD, MS","doi":"10.1016/j.xjon.2024.11.013","DOIUrl":"10.1016/j.xjon.2024.11.013","url":null,"abstract":"<div><h3>Objective</h3><div>Bupivacaine liposomal injectable suspension is proven safe and effective for selective postsurgical analgesia in children older than 6 years. We evaluated if intraoperative bupivacaine liposomal injectable suspension administration decreases postoperative opioid use, peak pain scores, and length of stay in children aged 2 to 6 years undergoing cardiac surgery via median sternotomy.</div></div><div><h3>Methods</h3><div>Serial patients aged 2 to 6 years undergoing cardiac surgery received 4 mg/kg bupivacaine liposomal injectable suspension mixed with 0.25% bupivacaine hydrochloride and 0.9% sodium chloride via local infiltration at the conclusion of their procedure. They were matched with controls who underwent operation within the past 5 years by procedure, age, gender, and weight. Postoperative opioid use was converted into morphine milligram equivalents, and pain severity was measured using the Face, Legs, Activity, Cry, and Consolability scale. Paired <em>t</em> tests, chi-square tests, and descriptive statistics were used depending on the nature of the data.</div></div><div><h3>Results</h3><div>A total of 100 patients receiving bupivacaine liposomal injectable suspension and matching historical control patients aged 2 to 6 years were analyzed. There were no significant differences in preoperative variables. Patients receiving bupivacaine liposomal injectable suspension received an average of 3.6 (95% CI, 1.2-6.0) fewer morphine milligram equivalents (<em>P</em> = .003). However, there was no significant difference in peak pain score (<em>P</em> = .4), time to first enteral intake (<em>P</em> = .5), intensive care unit length of stay (<em>P</em> = 1), or hospital length of stay (<em>P</em> = .2). The median cost of bupivacaine liposomal injectable suspension was higher than that of bupivacaine hydrochloride (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Intraoperative bupivacaine liposomal injectable suspension use in children aged 2 to 6 years undergoing cardiac surgery showed statistically but not clinically significant decreases in postoperative opioid use. Bupivacaine liposomal injectable suspension use had no impact on intensive care unit or hospital length of stay but was substantially more expensive.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 245-255"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465268","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":"Total aortic arch replacement versus proximal aortic repair for acute type a aortic dissection: A single-center 30-year experience","authors":"Delano J. de Oliveira Marreiros BS ,&nbsp;Bardia Arabkhani MD, PhD ,&nbsp;Jos L. Verhoef MS ,&nbsp;Niels Keekstra MD ,&nbsp;Joost R. van der Vorst MD, PhD ,&nbsp;Jan van Schaik MD ,&nbsp;Jerry Braun MD, PhD ,&nbsp;Robert J.M. Klautz MD, PhD ,&nbsp;Rolf H.H. Groenwold MD, PhD ,&nbsp;Jesper Hjortnaes MD, PhD","doi":"10.1016/j.xjon.2024.11.014","DOIUrl":"10.1016/j.xjon.2024.11.014","url":null,"abstract":"<div><h3>Objective</h3><div>Optimal surgical management of the aortic arch for acute type A aortic dissection remains contentious. We assessed clinical outcomes after total arch replacement and proximal aortic repair (ascending aortic ± hemiarch replacement) for acute type A aortic dissection.</div></div><div><h3>Methods</h3><div>All patients surgically treated for acute type A aortic dissection at our institution between 1992 and 2021 were included. Study end points included all-cause mortality, distal aortic reintervention, stroke, and malperfusion syndrome.</div></div><div><h3>Results</h3><div>A total of 357 patients underwent surgery for acute type A aortic dissection; 76 (21.3%) received total arch replacement, and 281 (78.7%) received proximal aortic repair. The frequency of total arch replacement increased over time (<em>P &lt; .</em>01). In-hospital mortality was higher for total arch replacement between 1992 and 2009 (39.2% vs 20.3%, <em>P = .</em>03), but became more comparable to proximal aortic repair from 2010 onward (16.7% vs 13.0%, <em>P = .</em>53). For total arch replacement and proximal aortic repair, 10-year cumulative survival was 64.3% (95% CI, 52.3-76.2) and 54.3% (95% CI, 47.6-61.0), respectively. After initial 30-day postoperative survival, long-term mortality risk appeared lower for total arch replacement (hazard ratio, 0.49, 95% CI, 0.23-1.07), although not statistically significant. No significant differences in distal aortic reinterventions were observed (hazard ratio, 1.38; 95% CI, 0.67-2.82). The incidence of in-hospital stroke (17.1% vs 17.1%, <em>P</em> = 1.00) and malperfusion syndrome (28.9% vs 28.2%, <em>P</em> = .90) was comparable between both groups.</div></div><div><h3>Conclusions</h3><div>In-hospital mortality after acute type A aortic dissection decreased over time despite the implementation of an aggressive approach to the dissected aortic arch. Long-term survival appears favorable after total arch replacement, but remains contingent on early postoperative survival. The surgical approach should be based on the patient's clinical presentation, while considering total arch replacement in patients at risk of aortic arch reinterventions.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 69-80"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464398","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}