JTCVS openPub Date : 2025-04-01DOI: 10.1016/j.xjon.2025.02.006
Winston L. Trope BE , Ntemena Kapula MS , Irmina A. Elliott MD , Brandon A. Guenthart MD , Natalie S. Lui MD , Leah M. Backhus MD , Mark F. Berry MD , Joseph B. Shrager MD , Douglas Z. Liou MD
{"title":"Factors and outcomes associated with successful minimally invasive pneumonectomy","authors":"Winston L. Trope BE , Ntemena Kapula MS , Irmina A. Elliott MD , Brandon A. Guenthart MD , Natalie S. Lui MD , Leah M. Backhus MD , Mark F. Berry MD , Joseph B. Shrager MD , Douglas Z. Liou MD","doi":"10.1016/j.xjon.2025.02.006","DOIUrl":"10.1016/j.xjon.2025.02.006","url":null,"abstract":"<div><h3>Objective</h3><div>To test the hypothesis that patients undergoing minimally invasive pneumonectomy at high-volume minimally invasive lung surgery centers have improved survival compared with patients who undergo open pneumonectomy.</div></div><div><h3>Methods</h3><div>Patients from the National Cancer Database who underwent pneumonectomy for lung cancer between 2010 and 2020 were stratified into 3 groups according to surgical technique (open, minimally invasive, converted from minimally invasive to open). Institutions were categorized as low-, mid-, or high-volume minimally invasive lung surgery centers according to percentage of total anatomic lung resections performed by video-assisted or robotic-assisted thoracoscopic surgery. Outcomes were compared using Cox regression, Kaplan-Meier survival analysis, and propensity score matching.</div></div><div><h3>Results</h3><div>In total, 5750 patients from 850 facilities were included, with 4597 (79.9%) undergoing upfront open pneumonectomy. Among the 1153 attempted minimally invasive pneumonectomies, 364 (31.6%) required conversion to open pneumonectomy. Surgery at a non−high-volume center was associated with greater conversion risk (adjusted odds ratio, 4.16; <em>P</em> < .001), whereas neoadjuvant therapy was associated with lower risk (adjusted odds ratio, 0.60; <em>P</em> = .015). Similar 5-year overall survival was seen among the 3 groups (open 45.2%, minimally invasive 48.3%, converted 43.3%); however, conversion from minimally invasive to open pneumonectomy demonstrated a trend towards increased risk of death (hazard ratio, 1.16; <em>P</em> = .058).</div></div><div><h3>Conclusions</h3><div>Minimally invasive pneumonectomy for lung cancer had similar 5-year survival compared with open pneumonectomy. However, conversion from minimally invasive to open pneumonectomy showed a trend toward increased risk of death, and conversion rates were high irrespective of institutional minimally invasive lung surgery volume. Careful patient selection is necessary when considering minimally invasive pneumonectomy so that long-term outcomes are not compromised.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 423-437"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854864","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":"National survey of coronary artery bypass grafting in patients with coronary artery lesions caused by Kawasaki disease in Japan from 2008 to 2019","authors":"Etsuko Tsuda MD, PhD , Hiraku Kumamaru MD, ScD , Tetsuya Kitagawa MD, PhD , Naoko Kinukawa PhD , Yoshihide Mitani MD, PhD , Noboru Motomura MD, PhD","doi":"10.1016/j.xjon.2024.10.016","DOIUrl":"10.1016/j.xjon.2024.10.016","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to know how the results of patients who underwent coronary artery bypass grafting for coronary arterial lesions caused by Kawasaki disease have changed in the past half-century after the first report of Kawasaki disease.</div></div><div><h3>Methods</h3><div>We investigated the national results of coronary artery bypass grafting in patients with Kawasaki disease who underwent the procedures between 2008 and 2019 from the Japan Cardiovascular Surgery Database Organization. The prevalence and outcome of patients with coronary artery bypass grafting were clarified. The factors that affected the condition upon discharge were analyzed. Furthermore, the outcomes of the patients in the late period after discharge were surveyed by questionnaires in 2021.</div></div><div><h3>Results</h3><div>A total of 343 patients were identified. Coronary artery bypass grafting after Kawasaki disease has been performed in approximately 40 patients per year recently. There were 264 male patients (77.0%) and 79 female patients (23.0%). The median age at the time of the operation was 39 years (5th-95th percentile, 13-72). The 30-day-operative mortality was 0.9%. Of the 183 patients (53.8%) with the quwtionaires after discharge, 176 survived (96.2%), and 7 died (3.8%). The 10-year survival rate was 94% (95% CI, 87-97%) (n = 183). The 5-year survivals depended on the preoperative left ventricular ejection fraction, which was 72% (95% CI, 13-96) (n = 9) for the poor group (left ventricular ejection fraction <30%), 98% (95% CI, 87-100) (n = 104) for the preserved group (≥60%), and 94% (95% CI, 81-98) (n = 70) for the intermediate group (≥30% but <60%) (<em>P</em> < .05).</div></div><div><h3>Conclusions</h3><div>A half-century after the first report of Kawasaki disease, the ages of the patients who undergo coronary artery bypass grafting in this population have changed from children to young adults. Although the preoperative left ventricular function affected the long-term outcome, the operative results were good.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 227-238"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854867","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":"Gender disparities in cardiothoracic surgical conference scholarly interactions: A prime opportunity for change in culture","authors":"Shanique A. Ries MD , Emily June Zolfaghari MD , Adrian Higaki BS , Justin A. Olivera BS , Busra Cangut MD , Adham Ahmed BS , Tiffany Hsiung BS , Jessica Carducci BS , Alexis Chidi MD , Mohanad Elshiekh MD , Ellelan Degife BS , Ryon Arrington BS , Rajika Jindani MD , Adegbemisola Aregbe Perkins BS , Emily Rodriguez BS , Michael Eisenberg MD , Elliot Servais MD , Gavitt Woodard MD , Mara B. Antonoff MD, FACS","doi":"10.1016/j.xjon.2025.02.008","DOIUrl":"10.1016/j.xjon.2025.02.008","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to characterize the failures of professional scholarly discourse at a national cardiothoracic surgical meeting, with particular attention directed toward gender-related inequities in treatment.</div></div><div><h3>Methods</h3><div>During the 2024 Society of Thoracic Surgery Annual Meeting, we used a standardized tool to conduct structured, real-time observations of professional behavior during meeting sessions. Fifteen observers gathered data from 22 sessions, including Plenary, Education/Quality/Wellness, General Thoracic, and Adult Cardiac Surgery. Survey items were designed to evaluate presenters', discussants', and moderators’, conduct, specifically pertaining to interruptions, use of appropriate titles, and adherence to allotted presentation times.</div></div><div><h3>Results</h3><div>Unprofessional behavior was observed in 13 of 22 (59%) studied sessions. During these sessions, 46 perpetrators were identified, among whom 38 (83%) were men and 8 (17%) were women. Women were significantly more likely to be addressed by an inappropriate title compared with men, 44% and 25%, respectively (<em>P</em> < .001). Of the 88 observed presenters, 65 (74%) were men and 23 (26%) were women. There were 4 (4%) students, 12 (14%) surgical residents, and 72 (82%) attending surgeon presenters. Among women presenters, 5 (13%) were interrupted compared with 3 men (7.7%). Speaking longer than time allotted occurred for 46 (49%) of observed presenters, with no significant difference observed between men and women presenters.</div></div><div><h3>Conclusions</h3><div>Unprofessional behavior occurred with regularity during this societal conference. Men more frequently engaged in these actions, with women being disproportionately affected. By shedding light on such issues, we can appropriately address biases and provide education regarding acceptable conduct.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 521-526"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854715","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}
JTCVS openPub Date : 2025-04-01DOI: 10.1016/j.xjon.2024.12.010
Yu Hohri MD, PhD , Erfan Faridmoayer MD , Yanling Zhao MS, MPH , Paul Kurlansky MD , Krushang Patel MD , Morgan Moroi MD , Christine Yang BS , Giovanni Ferrari PhD , Isaac George MD , Hiroo Takayama MD, PhD , Koji Takeda MD, PhD
{"title":"Outcomes of following transcatheter and surgical interventions in patients with acute valvular dysfunction with cardiogenic shock","authors":"Yu Hohri MD, PhD , Erfan Faridmoayer MD , Yanling Zhao MS, MPH , Paul Kurlansky MD , Krushang Patel MD , Morgan Moroi MD , Christine Yang BS , Giovanni Ferrari PhD , Isaac George MD , Hiroo Takayama MD, PhD , Koji Takeda MD, PhD","doi":"10.1016/j.xjon.2024.12.010","DOIUrl":"10.1016/j.xjon.2024.12.010","url":null,"abstract":"<div><h3>Objectives</h3><div>Although surgery remains the gold standard treatment for acute valvular dysfunction complicated by cardiogenic shock, transcatheter management has emerged as an alternative. We examined our contemporary experience with patients requiring surgical or transcatheter interventions in conjunction with mechanical circulatory support for acute valvular dysfunction complicated by cardiogenic shock.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients admitted with cardiogenic shock due to acute valvular dysfunction who underwent valve interventions at our center between 2016 and 2022. The primary end point was in-hospital mortality. Secondary end points included midterm mortality and major adverse cardiac events, including cardiac death, stroke, cardiac-related events, readmission for heart failure, and reintervention.</div></div><div><h3>Results</h3><div>Among 67 patients (median 75 years, interquartile range, 65-84), common valve pathologies included aortic stenosis (30 patients), mitral regurgitation (24 patients), and tricuspid regurgitation (17 patients). Preoperative mechanical circulatory support was required in 38 patients. Nineteen patients underwent open surgery, and 48 patients received transcatheter interventions, including transcatheter aortic valve replacement and edge-to-edge mitral repair. Mechanical circulatory support was required in 34 patients postoperatively. Overall in-hospital mortality was 26.9% (surgery 26.3% vs transcatheter 27.1%, <em>P</em> = 1.000). Median follow-up was 25.1 months (interquartile range, 20.6-33.9 months). The 2-year survival was 54.0% (95% CI, 42.2-69.0), and the cumulative incidence of major adverse cardiac events was 51.5% (95% CI, 33.8-64.4). Residual moderate or severe tricuspid regurgitation (hazard ratio, 2.266, 95% CI, 1.052-4.940, <em>P</em> = .037) and postoperative mechanical circulatory support (hazard ratio, 2.611, 95% CI, 1.194-5.965, <em>P</em> = .016) were associated with 2-year mortality.</div></div><div><h3>Conclusions</h3><div>Early and midterm mortality and morbidity rates remained high despite contemporary multimodal treatment approaches for acute valvular dysfunction with cardiogenic shock.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 217-226"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854717","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}
JTCVS openPub Date : 2025-04-01DOI: 10.1016/j.xjon.2025.01.007
Jiafang Zhang MS , Rowena Yip PhD, MPH , Emanuela Taioli MD, PhD , Raja M. Flores MD , Claudia I. Henschke PhD, MD , David F. Yankelevitz MD , Rebecca M. Schwartz PhD
{"title":"Quality of life outcomes after robotic-assisted and video-assisted thoracoscopic surgery for early-stage non–small cell lung cancer","authors":"Jiafang Zhang MS , Rowena Yip PhD, MPH , Emanuela Taioli MD, PhD , Raja M. Flores MD , Claudia I. Henschke PhD, MD , David F. Yankelevitz MD , Rebecca M. Schwartz PhD","doi":"10.1016/j.xjon.2025.01.007","DOIUrl":"10.1016/j.xjon.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>Limited research exists comparing the impacts of robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) on patients’ physical and mental health-related quality of life (QoL).</div></div><div><h3>Methods</h3><div>A prospective cohort of stage IA non–small cell lung cancer (NSCLC) patients in the Initiative for Early Lung Cancer Research on Treatment from Mount Sinai Health System had QoL measured before surgery and at 2, 6, and 12 months post-treatment using the Medical Outcomes Study Short-Form 12 (SF-12), with Physical Component Summary (PCS) and Mental Component Summary (MCS); the Functional Assessment of Cancer Therapy-Lung Cancer Subscale (FACT-LCS); and Patient Health Questionnaire-4 (PHQ-4; for depression/anxiety). A locally weighted smoothing curve was fitted to identify the best interval knot for post-treatment QoL trends. A piecewise linear mixed-effects model was developed to estimate differences in baseline, 2-month, and 12-month QoL scores and rates of change, adjusting for age, sex, race, ethnicity, smoking status, pack-years, nodule size/consistency, comorbidities, and surgical extent.</div></div><div><h3>Results</h3><div>The study cohort comprised 698 patients, including 458 (65.6%) who underwent VATS and 240 (34.4%) who underwent RATS. The RATS group exhibited a more significant initial decline in physical health at 2 months post-surgery but showed significant recovery by 12 months, achieving similar or slightly higher physical scores compared to baseline. No significant differences in mental health scores over time were seen between the groups. Both groups displayed consistent anxiety and depression scores, with significant improvements in anxiety symptoms at the 2-month mark. The RATS group had fewer postoperative complications and conversion to open thoracotomy.</div></div><div><h3>Conclusions</h3><div>RATS and VATS offer similar long-term QoL outcomes for early-stage NSCLC patients, though RATS patients may experience a sharper initial decline in physical health.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 383-393"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854478","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}
JTCVS openPub Date : 2025-04-01DOI: 10.1016/j.xjon.2024.10.010
Haonan Cheng MS , Takuya Osawa MD , Christoph Röhlig MD , Jonas Palm MD , Thibault Schaeffer MD , Carolin Niedermaier MS , Nicole Piber MD , Paul Philipp Heinisch MD, PhD , Christian Meierhofer MD, PhD , Stanimir Georgiev MD, PhD , Alfred Hager MD, PhD , Peter Ewert MD, PhD , Jürgen Hörer MD, PhD , Masamichi Ono MD, PhD
{"title":"Impact of left ventricular rehabilitation on surgical outcomes in patients with borderline left heart hypoplasia","authors":"Haonan Cheng MS , Takuya Osawa MD , Christoph Röhlig MD , Jonas Palm MD , Thibault Schaeffer MD , Carolin Niedermaier MS , Nicole Piber MD , Paul Philipp Heinisch MD, PhD , Christian Meierhofer MD, PhD , Stanimir Georgiev MD, PhD , Alfred Hager MD, PhD , Peter Ewert MD, PhD , Jürgen Hörer MD, PhD , Masamichi Ono MD, PhD","doi":"10.1016/j.xjon.2024.10.010","DOIUrl":"10.1016/j.xjon.2024.10.010","url":null,"abstract":"<div><h3>Objective</h3><div>The clinical significance of left ventricular rehabilitation for borderline left ventricular hypoplasia is controversial. This study aimed to review the surgical results of patients with borderline left ventricular hypoplasia and to evaluate the impact of left ventricular rehabilitation on outcomes.</div></div><div><h3>Methods</h3><div>Patients diagnosed with borderline left ventricular hypoplasia and surgically treated from 2018 to 2022 were included. Overall surgical outcomes were evaluated. The changes in left ventricular volumes were calculated using angiography, and age-adjusted z-score N-terminal pro-B-type natriuretic peptide levels were analyzed in patients who underwent left ventricular rehabilitation.</div></div><div><h3>Results</h3><div>Thirty-three patients were included. Sixteen patients underwent primary biventricular repair, 3 patients underwent primary single ventricle palliation, and the remaining 14 patients underwent left ventricular rehabilitation; 9 received bilateral pulmonary artery banding and ductal stenting, 4 received central pulmonary artery banding, and 1 received ductal stenting. Of 14 patients who received left ventricular rehabilitation, 1 died, 1 underwent single ventricle palliation, 1 was waiting for further procedure, and 11 underwent biventricular repair. After biventricular repair, 2 patients died, and 1 patient developed hemodynamic failure. As a result, only 8 patients were alive and in good condition. In patients who underwent left ventricular rehabilitation, left ventricular end-diastolic volume index, end-systolic volume index, and left ventricular stroke volume index increased over time after left ventricular rehabilitation (<em>P</em> = .001, <em>P</em> = .007, and <em>P</em> = .009, respectively). The age-adjusted z-score N-terminal pro-B-type natriuretic peptide levels were stable until biventricular repair, but significantly higher in patients who presented with hemodynamic failure after biventricular repair compared with patients who did not exhibit hemodynamic failure.</div></div><div><h3>Conclusions</h3><div>In patients with borderline left heart hypoplasia, the left ventricular rehabilitation procedure promoted an increase in left ventricular volume and contributed to establishing a biventricular circulation. The short-term results of this strategy are satisfactory, but further studies are essential to determine the long-term outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 359-373"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854475","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":"Patients from distressed communities have decreased survival after open thoracic aneurysm repair","authors":"Gerardo Ramos-Lemos BSc, Kavya Rajesh BSc, Dov Levine MD, PhD, Yanling Zhao MS, MPH, Yu Hohri MD, PhD, Thomas F.X. O'Donnell MD, Virendra Patel MD, MPH, Hiroo Takayama MD, PhD, Paul Kurlansky MD","doi":"10.1016/j.xjon.2025.01.012","DOIUrl":"10.1016/j.xjon.2025.01.012","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates the relationship between the Distressed Communities Index and long-term mortality in thoracic aortic aneurysm repair.</div></div><div><h3>Methods</h3><div>This single-center retrospective study includes patients who underwent open thoracic aortic aneurysm repair between 2005 and 2021. The Distressed Communities Index served as a metric for socioeconomic status by providing distress scores for each patient's zip code. Patients were placed into the nondistressed group with a score of 50 or less or the distressed group with a score greater than 50. The primary outcome of this study was 10-year mortality. Multivariable Cox regression evaluated factors associated with long-term mortality while accounting for patient demographics and operative characteristics.</div></div><div><h3>Results</h3><div>Of 1317 patients, 31% (n = 409) comprised the distressed group, which had higher rates of hypertension (<em>P</em> = .002), chronic obstructive pulmonary disease (<em>P</em> = .03), diabetes (<em>P</em> = .008), cerebrovascular disease (<em>P</em> = .04), and chronic kidney disease (<em>P</em> = .04). This group also experienced higher rates of surgical site infection (<em>P</em> = .02), postoperative respiratory failure (<em>P</em> = .006), and longer hospital stays (<em>P</em> < .001), as well as decreased survival probability at 1 year (<em>P</em> < .001) and beyond (<em>P</em> = .03). Multivariable logistic regression revealed that being in the distressed group was independently associated with increased long-term mortality risk (hazard ratio, 1.66; <em>P</em> = .005).</div></div><div><h3>Conclusions</h3><div>Being from a distressed community is associated with worse long-term mortality after thoracic aortic aneurysm repair. Socioeconomic status should be considered in surgical planning to improve patient outcomes and dismantle healthcare disparities.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 472-483"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854863","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}
JTCVS openPub Date : 2025-04-01DOI: 10.1016/j.xjon.2025.01.018
Silvia Mariani MD , Alvaro Perazzo MD, MSc , Maria Elena De Piero MD , Bas C.T. van Bussel PhD , Michele Di Mauro PhD , Dominik Wiedemann PhD , Sven Lehmann PhD , Matteo Pozzi PhD , Antonio Loforte PhD , Udo Boeken PhD , Robertas Samalavicius PhD , Karl Bounader MD , Xiaotong Hou PhD , Jeroen J.H. Bunge MD , Kogulan Sriranjan MD , Leonardo Salazar MD , Bart Meyns PhD , Michael A. Mazzeffi PhD , Sacha Matteucci MD , Sandro Sponga PhD , Roberto Lorusso PhD
{"title":"Postcardiotomy extracorporeal membrane oxygenation after elective, urgent, and emergency cardiac operations: Insights from the PELS observational study","authors":"Silvia Mariani MD , Alvaro Perazzo MD, MSc , Maria Elena De Piero MD , Bas C.T. van Bussel PhD , Michele Di Mauro PhD , Dominik Wiedemann PhD , Sven Lehmann PhD , Matteo Pozzi PhD , Antonio Loforte PhD , Udo Boeken PhD , Robertas Samalavicius PhD , Karl Bounader MD , Xiaotong Hou PhD , Jeroen J.H. Bunge MD , Kogulan Sriranjan MD , Leonardo Salazar MD , Bart Meyns PhD , Michael A. Mazzeffi PhD , Sacha Matteucci MD , Sandro Sponga PhD , Roberto Lorusso PhD","doi":"10.1016/j.xjon.2025.01.018","DOIUrl":"10.1016/j.xjon.2025.01.018","url":null,"abstract":"<div><h3>Background</h3><div>Outcomes in cardiac surgery are influenced by surgical priority, with higher mortality in emergency cases. Whether this applies to postcardiotomy venoarterial (VA) extracorporeal membrane oxygenation (ECMO) remains unknown. This study describes characteristics and outcomes of patients undergoing cardiac operations and requiring VA ECMO, stratified by emergency, urgent, or elective operation.</div></div><div><h3>Methods</h3><div>This retrospective multicenter observational study included adults requiring postcardiotomy VA ECMO between 2000 and 2020. Preoperative and procedural characteristics, complications, and survival were compared among the 3 patient groups. The association between emergency surgery and in-hospital survival was investigated through mixed Cox proportional hazard models.</div></div><div><h3>Results</h3><div>The study cohort comprised 1063 patients (52.2%) with elective operations, 445 (21.8%) with urgent operations, and 528 (26%) with emergency operations. Emergency operations included more coronary artery bypass grafting operations (n = 286; 54.2%; <em>P</em> < .001) and aortic procedures (n = 126; 23.9%; <em>P</em> = .001) in patients with more unstable preoperative hemodynamic conditions compared to elective and urgent patients. VA ECMO was initiated more frequently intraoperatively in emergency patients (n = 353; 66.9%; <em>P</em> < .001). Postoperative bleeding (n = 338; 64.3%; <em>P</em> < .001), stroke (n = 79; 15%; <em>P</em> < .001), and right ventricular failure (n = 124; 25.3%) were more frequent after emergency operations. In-hospital mortality was 60.5% in the elective group, 57.8% in the urgent group, 63.4% in the emergency group (<em>P</em> = .191). The crude hazard ratio for in-hospital mortality in emergency surgery was 1.15 (95% confidence interval [CI], 1.01-1.32; <em>P</em> = .039) and dropped to 1.09 (95% CI, 0.93-1.27; <em>P</em> = .295) after adjustment for indicators of preoperative instability. 5-year survival was comparable in 30-day survivors (<em>P</em> = .083).</div></div><div><h3>Conclusions</h3><div>One-quarter of postcardiotomy VA ECMOs are implemented after emergency operations. Despite more complications in emergency cases, in-hospital and 5-year survival are comparable between emergency, urgent, or elective operations.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 280-310"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854584","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}
JTCVS openPub Date : 2025-04-01DOI: 10.1016/j.xjon.2025.02.015
Fabian A. Kari MD , Martin Czerny MD, PhD , Michael Borger MD, PhD , Martin Misfeld MD, PhD , Emmanuel Zimmer MD , Matthias Siepe MD , Christian Hagl MD , Christian Detter MD , Johannes Petersen MD , Doreen Richardt MD , Stephan Ensminger MD , Paul Werner MD , Martin Andreas MD , Maximilian Pichlmaier MD , Christoph S. Mueller MD
{"title":"Valve-sparing aortic root replacement: Strategies to avoid residual aortic regurgitation","authors":"Fabian A. Kari MD , Martin Czerny MD, PhD , Michael Borger MD, PhD , Martin Misfeld MD, PhD , Emmanuel Zimmer MD , Matthias Siepe MD , Christian Hagl MD , Christian Detter MD , Johannes Petersen MD , Doreen Richardt MD , Stephan Ensminger MD , Paul Werner MD , Martin Andreas MD , Maximilian Pichlmaier MD , Christoph S. Mueller MD","doi":"10.1016/j.xjon.2025.02.015","DOIUrl":"10.1016/j.xjon.2025.02.015","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to identify quantitative criteria to avoid residual aortic valve regurgitation after valve-sparing aortic root replacement.</div></div><div><h3>Methods</h3><div>Between 2016 and 2023, 738 adult patients were recruited into the German Aortic Root Repair Registry. A total of 562 patients with datasets on aortic root measurements and tricuspid valve treated with reimplantation valve-sparing aortic root replacement were selected. End points were any grade of residual aortic valve regurgitation and postrepair coaptation height. Tested variables included procedural and anatomic characteristics, including length of cusp margins and geometric cusp heights.</div></div><div><h3>Results</h3><div>The optimal classifier predicting freedom from residual aortic valve regurgitation was cusp coaptation height 8 to 9 mm or more (sensitivity = 0.7-0.8). Annular downsizing alone was not useful to predict residual aortic valve regurgitation (<em>P</em> = .472, 95% area CI, 0.414-0.54). Patients with a mean free margin length of at least 45 mm and a sum of free margin lengths of at least 125 mm were more likely to present coaptation heights of at least 10 mm (R2 0.038, <em>P</em> = .006).</div></div><div><h3>Conclusions</h3><div>The target coaptation height after valve-sparing aortic root replacement should exceed 8 to 9 mm. Chances of achieving it can be estimated on the basis of a measurement of cusp quantity. If in doubt when inspecting a valve, numerical criteria can help with surgical decision-making in favor of or against a valve-sparing approach.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 85-95"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854625","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}