JTCVS open最新文献

{"title":"Posterior left pericardiotomy reduces postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting surgery","authors":"Nikhil Sahdev MBBS ,&nbsp;Guiqing Liu MD ,&nbsp;Sahar Hasanzade MD ,&nbsp;Jasleen Nagi BSc ,&nbsp;Mansour Taghavi Azar Sharabiani PhD ,&nbsp;Prakash Punjabi MD, FRCS","doi":"10.1016/j.xjon.2025.04.006","DOIUrl":"10.1016/j.xjon.2025.04.006","url":null,"abstract":"<div><h3>Objective</h3><div>Atrial fibrillation (AF) is a common postoperative complication with an incidence of up to 10% to 33% after coronary artery bypass grafting surgery and is associated with worse morbidity and mortality. At present, studies have shown a promising reduction in postoperative AF (POAF) with posterior pericardiotomy (PP). However, there are limited data on the widespread use of PP amongst cardiac surgeons. This retrospective analysis assesses the influence of a real-world adoption of PP on the incidence and cumulative burden of POAF.</div></div><div><h3>Methods</h3><div>Patients who underwent coronary artery bypass grafting surgery between 2015 and 2022 were analyzed. One group had PP as part of their surgical procedure whilst the control group did not. For both groups, the incidence of POAF was analyzed. PP was performed via a 5-cm incision between the left inferior pulmonary vein and the phrenic nerve.</div></div><div><h3>Results</h3><div>Two thousand four hundred eighty patients were included in the analysis; 806 patients underwent PP and 1674 formed the control group. PP was associated with a 27.4% reduction in the odds of developing POAF (odds ratio, 0.73; 95% CI, 0.55-0.95; <em>P</em> = .023). Age was significantly associated with POAF, with a 4.3% increase in odds per additional year (odds ratio, 1.04; 95% CI, 1.03-1.06; <em>P</em> &lt; .001). In the multivariate model for AF, PP remained significantly protective, reducing the odds of POAF by 26.9% (odds ratio, 0.73; 95% CI, 0.55-0.96; <em>P</em> = .028). Patients who underwent PP had significantly reduced cumulative POAF duration, with a 5.3% average reduction (<em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>Posterior left pericardiotomy is associated with reduced odds and duration of POAF. A large, multicenter trial is indicated to confirm this finding as well as the influence of PP and POAF on postdischarge clinical outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 120-125"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320868","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":"Commentator Discussion: The implementation of an electronic symptom management (eSyM) system to monitor postoperative pain in thoracic surgery patients: A multicenter evaluation","authors":"","doi":"10.1016/j.xjon.2025.03.005","DOIUrl":"10.1016/j.xjon.2025.03.005","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Page 500"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321420","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":"Which cardiothoracic surgery training pathway is right for you?","authors":"AlleaBelle Bradshaw MD ,&nbsp;Ahmet Kilic MD ,&nbsp;Thomas E. MacGillivray MD ,&nbsp;Jennifer S. Lawton MD","doi":"10.1016/j.xjon.2025.04.003","DOIUrl":"10.1016/j.xjon.2025.04.003","url":null,"abstract":"<div><h3>Objective</h3><div>The training pathways in cardiothoracic surgery have evolved so that there are currently several viable options to this career. The purpose of this review is to give insight to medical students and mentors regarding the 4 different pathways.</div></div><div><h3>Methods</h3><div>The evolution of cardiothoracic surgery training and 4 current pathways are briefly reviewed. The main differences between these 4 pathways are then discussed in detail.</div></div><div><h3>Results</h3><div>Key differences between training pathways include time to completion, opportunities for dedicated academic development or research time, family planning considerations, board certification options, opportunities to change programs, competitiveness, and unique considerations for military personnel.</div></div><div><h3>Conclusions</h3><div>This detailed comparison of the training pathways can serve as a resource to help students make informed decisions about the pathway that is best suited to each individual.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 510-515"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321422","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 implementation of an electronic symptom management system to monitor postoperative pain in thoracic surgery patients: A multicenter evaluation","authors":"Jorind Beqari MD ,&nbsp;Jacob Hurd BS ,&nbsp;Angela C. Tramontano MPH ,&nbsp;Christine Cronin BS ,&nbsp;Alexandra Potter BS ,&nbsp;Sandra Wong MD ,&nbsp;Deborah Schrag MD, MPH ,&nbsp;Don S. Dizon MD ,&nbsp;Jessica Bian MD ,&nbsp;Raymond U. Osarogiagbon MD ,&nbsp;Hannah Hazard-Jenkins MD ,&nbsp;Joseph D. Phillips MD ,&nbsp;Abbas E. Abbas MD ,&nbsp;Isha Mehta Warikoo MD ,&nbsp;Mitchell Anderson ,&nbsp;Kenneth P. Seastedt MD, MBA ,&nbsp;Michael Lanuti MD ,&nbsp;Yolonda L. Colson MD, PhD ,&nbsp;Cameron D. Wright MD ,&nbsp;Michael Hassett MD, MPH ,&nbsp;Chi-Fu Jeffrey Yang MD","doi":"10.1016/j.xjon.2025.02.010","DOIUrl":"10.1016/j.xjon.2025.02.010","url":null,"abstract":"<div><h3>Objective</h3><div>Few studies have evaluated postoperative recovery of patients after thoracic surgery using patient-reported outcome measures. This multi-institutional study analyzed postoperative pain and opioid use among patients undergoing thoracic surgery based on patient-reported outcome measures data collected through an electronic symptom management system.</div></div><div><h3>Methods</h3><div>The electronic symptom management system is a multi-symptom questionnaire based on a Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events that is integrated into the electronic health record and administered via the patient portal. Patients undergoing lung resections were invited to complete electronic symptom surveys within the electronic symptom management system during their 90-day postoperative period. Baseline patient demographics, surgical data, and postoperative opioid data were gathered from the electronic health record. Multivariable hierarchical regression was used to evaluate predictors of postoperative pain and opioid prescriptions.</div></div><div><h3>Results</h3><div>Of 680 patients who met the inclusion criteria, 258 (37.9%) reported at least 1 severe pain score. Patients reporting severe pain were more likely to have undergone open surgery, to receive at least 1 postoperative opioid prescription, and to become persistent opioid users compared with patients reporting no severe pain. In multivariable logistic regression analysis, the only factor associated with a severe pain score was female sex (odds ratio, 1.67, 95% CI, 1.17-2.39; <em>P</em> = .005).</div></div><div><h3>Conclusions</h3><div>This multicenter study used patient-reported outcome measures to evaluate predictors of postoperative pain and opioid prescriptions in patients undergoing thoracic surgery. Further investigation into the administration of patient-reported outcome measures is needed to assess their ability to impact postsurgical care and postoperative outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 485-499"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321419","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":"Commentator Discussion: Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperation","authors":"","doi":"10.1016/j.xjon.2025.04.005","DOIUrl":"10.1016/j.xjon.2025.04.005","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 23-24"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320930","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":"Acute kidney injury and chronic kidney disease after left ventricular assist device placement","authors":"Mias Pretorius MBChB, MSCI ,&nbsp;Anne Chen BA ,&nbsp;Melissa J. Kimlinger MD ,&nbsp;Matthew S. Shotwell PhD ,&nbsp;Allison M. Janda MD ,&nbsp;Matthew R. Danter MD ,&nbsp;Simon Maltais MD ,&nbsp;Keki R. Balsara MD ,&nbsp;Ashish S. Shah MD ,&nbsp;Frederic T. Billings IV MD, MSCI","doi":"10.1016/j.xjon.2025.04.001","DOIUrl":"10.1016/j.xjon.2025.04.001","url":null,"abstract":"<div><h3>Objective</h3><div>Left ventricular assist device (LVAD) implantation may lead to acute kidney injury (AKI), but LVAD therapy increases cardiac output and may reverse cardiorenal syndrome. We conducted this study to test the hypothesis that AKI after LVAD implantation is associated with glomerular filtration rate (eGFR) decline and chronic kidney disease (CKD) stage progression.</div></div><div><h3>Methods</h3><div>We included all patients undergoing LVAD implantation between August 2011 and August 2021 at a high-volume LVAD center. AKI was quantified using Kidney Disease: Improving Global Outcomes criteria. We estimated eGFR before and 30, 60, 90, and 365 days after LVAD implantation to stage CKD. We measured the associations between AKI and eGFR, adjusting for potential confounders and risk factors.</div></div><div><h3>Results</h3><div>One hundred ninety-one of the 482 subjects (39.6%) developed postoperative AKI. Overall, median eGFR change (25th, 75th percentile) was −5.9% (−22.3%, 15.6%) at 90 days after LVAD and −17.2% (−36.9%, 5.1%) at 1 year. In subjects who developed AKI, eGFR declined 11.7% (95% confidence interval, 4.2%-19.1%; <em>P</em> = .002) more at 90 days, more patients progressed to a greater stage of CKD, and death was 2.4-fold (95% confidence interval, 1.6-3.5; <em>P</em> &lt; .001) greater at 1 year than in subjects without postoperative AKI. Subjects with more advanced baseline CKD had less eGFR decline than subjects with less advanced baseline CKD.</div></div><div><h3>Conclusions</h3><div>Among patients receiving LVAD therapy, AKI and eGFR decline were common, and postoperative AKI was independently associated with eGFR decline and CKD progression at 90 and 365 days.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 190-199"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321652","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":"Discrepancies in survival following pediatric heart transplantation and the effect of race and socioeconomic status on outcomes","authors":"Bahaaldin Alsoufi MD ,&nbsp;Jaimin Trivedi MD, MPH ,&nbsp;Deborah Kozik DO ,&nbsp;Sarah Wilkens MD ,&nbsp;Andrea Nicole Lambert MD ,&nbsp;Shriprasad Deshpande MBBS, MS ,&nbsp;Joshua D. Sparks MD","doi":"10.1016/j.xjon.2025.02.021","DOIUrl":"10.1016/j.xjon.2025.02.021","url":null,"abstract":"<div><h3>Objectives</h3><div>Poor health literacy and resources paucity in families with low socioeconomic status can be detrimental in children requiring complex outpatient management such as heart transplantation. We assessed the influence of socioeconomic status and insurance type on heart transplantation outcomes.</div></div><div><h3>Methods</h3><div>The cohort of children undergoing heart transplantation was generated by merging the United Network for Organ Sharing and Pediatric Health Information System databases. Family's annual income was used as surrogate for socioeconomic status. Children were divided into 3 groups: low-income (lower quartile, &lt;$32 700; n = 639), medium-income (second and third quartiles, $32 700-$53 600; n = 1305), or high-income (upper quartile, &gt;$53 600; n = 649).</div></div><div><h3>Results</h3><div>Comparison showed racial discrepancies (more Whites in high-income, more Blacks in low-income groups), and insurance type variations (more private in high-income, more Medicaid in low-income groups). On univariate analysis, survival was higher for high-income compared with medium-income and low-income groups (<em>P</em> = .04). On multivariable analysis, Black race (hazard ratio, 1.389; 95% CI, 1.041-1.703; <em>P</em> = .0075), Medicaid (hazard ratio, 1.373; 95% CI, 1.115-1.721; <em>P</em> = .0038), and other government insurance (hazard ratio, 1.611; 95% CI, 1.104-2.423; <em>P</em> = .0126) were significant risk factors, whereas income group effect was neutralized. Treated rejection episodes at 1 year were lowest (10%) in high-income and highest (15%) in low-income groups, with trend for less rejection in the low-income group with private insurance (12% vs 16%). Death from cardiac arrest was significantly less in the high-income (8%) compared with the medium-income (18%) and low-income (19%) groups (<em>P</em> &lt; .01).</div></div><div><h3>Conclusions</h3><div>Black and low socioeconomic status children face significant disadvantages in heart transplant outcomes, including lower survival, higher rejection rates, and increased risk of death secondary to cardiac arrest. Access to private insurance leads to better survival but might be proxy to better resources, education, and compliance.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 354-363"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320933","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":"Commentator Discussion: Surgical pathways and risk categories in the management of hypoplastic left heart syndrome and variants","authors":"","doi":"10.1016/j.xjon.2025.04.017","DOIUrl":"10.1016/j.xjon.2025.04.017","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 344-345"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321016","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":"Commentator Discussion: AATS 2024: Should moderate tricuspid regurgitation be repaired at the time of mitral surgery? Results from a large registry-based study","authors":"","doi":"10.1016/j.xjon.2025.04.018","DOIUrl":"10.1016/j.xjon.2025.04.018","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 87-88"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321344","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":"Commentary: Carpe diem! Moderate tricuspid regurgitation can no longer be ignored","authors":"Matthew Kazaleh DO, MSc,&nbsp;Ricky Patil MD,&nbsp;Gorav Ailawadi MD, MBA","doi":"10.1016/j.xjon.2025.04.015","DOIUrl":"10.1016/j.xjon.2025.04.015","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 85-86"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321426","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}