JTCVS open最新文献

{"title":"Protective biomechanical and histological changes in the false lumen wall in chronic type B aortic dissection","authors":"Hai Dong PhD ,&nbsp;Minliang Liu PhD ,&nbsp;Hannah L. Cebull PhD ,&nbsp;Arshiya Chhabra BE ,&nbsp;Yumeng Zhou BE ,&nbsp;Marina Piccinelli PhD ,&nbsp;John N. Oshinski PhD ,&nbsp;John A. Elefteriades MD, PhD (Hon) ,&nbsp;Rudolph L. Gleason Jr. PhD ,&nbsp;Bradley G. Leshnower MD","doi":"10.1016/j.xjon.2024.11.012","DOIUrl":"10.1016/j.xjon.2024.11.012","url":null,"abstract":"<div><h3>Objective</h3><div>The outer false lumen wall (FLW) changes from thin/compliant to thick/rigid as aortic dissection transitions from the acute to chronic phase. This study investigates biomechanical stiffness and histological changes of the FLW as the dissected aorta ages.</div></div><div><h3>Methods</h3><div>The free outer FLW from human tissue was analyzed from chronic type B dissection (chronic-FLW) n = 10, acute type A dissection (acute-FLW) n = 10, and transplant donor descending aorta that was manually peeled into 2 layers (control-FLW) n = 17. Biaxial tension testing in the longitudinal and circumferential directions was performed and stress-strain curves were obtained. A lower and higher tangent modulus was determined to assess stiffness. Quantification of collagen and elastin was performed by calculating the fibers’ volume fraction from Z-stack scans.</div></div><div><h3>Results</h3><div>The higher tangent modulus of chronic-FLW is larger (<em>P</em> &lt; .01) than the acute-FLW and control-FLW in longitudinal (5.09 ± 0.9 MPa vs 1.72 ± 0.56 MPa and 1.17 ± 0.22 MPa) and circumferential (4.16 ± 0.67 MPa vs 1.04 ± 0.24 MPa and 1.07 ± 0.16 MPa) directions. The lower tangent modulus of chronic-FLW is larger (<em>P</em> &lt; .05) than acute-FLW and control-FLW in both directions (longitudinal: 0.72 ± 0.24 MPa vs 0.13 ± 0.02 MPa and 0.27 ± 0.03 MPa circumferential:0.44 ± 0.13 MPa vs 0.12 ± 0.01 MPa and 0.21 ± 0.02 MPa). The volume fraction of collagen was increased (<em>P</em> &lt; .01) and the volume fraction of elastin was decreased (<em>P</em> &lt; .001) when comparing chronic-FLW, acute-FLW, and control-FLW (collagen-volume fraction: 0.24 ± 0.03 vs 0.12 ± 0.03 and 0.08 ± 0.02; elastin-volume fraction: 0.09 ± 0.03 vs 0.28 ± 0.03 and 0.39 ± 0.04).</div></div><div><h3>Conclusions</h3><div>As the acutely dissected aorta transitions to the chronic phase, the FL remodels by increasing collagen, decreasing elastin, and increasing aortic stiffness and thickness. This change in the chronic-FLW may be a protective adaptation to prevent FL enlargement and rupture in type B aortic dissection.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 60-68"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464438","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":"External validation of the German Registry for Acute Aortic Dissection Type A score in patients undergoing surgery for acute type A aortic dissection","authors":"Danial Ahmad MD, MPH ,&nbsp;Derek Serna-Gallegos MD, FACS ,&nbsp;Ariana Jackson BS ,&nbsp;David J. Kaczorowski MD ,&nbsp;Johannes Bonatti MD ,&nbsp;David M. West MD ,&nbsp;Pyongsoo D. Yoon MD ,&nbsp;Danny Chu MD ,&nbsp;Joe Squire MSN, RN ,&nbsp;Floyd Thoma BS ,&nbsp;Jianhui Zhu PhD ,&nbsp;Julie Phillippi PhD ,&nbsp;Ibrahim Sultan MD","doi":"10.1016/j.xjon.2024.12.007","DOIUrl":"10.1016/j.xjon.2024.12.007","url":null,"abstract":"<div><h3>Objective</h3><div>Surgery for acute type A aortic dissection carries a high risk of morbidity and mortality compared with routine cardiac surgical procedures. The German Registry for Acute Aortic Dissection Type A score has been recommended for use as a mortality risk-stratification tool in recent guidelines. We sought to externally validate this score in our local population.</div></div><div><h3>Methods</h3><div>All consecutive patients undergoing surgery for acute type A aortic dissection from 2007 to 2021 were included. Logistic regression analyses were performed. Model discrimination was assessed by C-statistic with 95% CIs as part of the receiver operating characteristic analysis. Model performance was visualized by calibration plot and quantified by the Brier score.</div></div><div><h3>Results</h3><div>A total of 587 patients were included. The mean age was 61 years (±13.5), with 42.08% of patients aged more than 65 years; 40.37% were female. The mean circulatory arrest time was 30.9 minutes (±16.5). Hemiarch replacement was performed in 62% of patients, and total arch replacement was performed in 35.3% of patients. Thirty-day mortality was observed in 66 patients (11.24%), and stroke was present in 7.16% of patients. The C-statistic revealed good discriminatory ability for predicting 30-day mortality (area under the receiver operating characteristic curve, 0.73; 95% CI, 0.67-0.79; <em>P</em> &lt; .0001). Model calibration was good (Brier score = 0.094).</div></div><div><h3>Conclusions</h3><div>The German Registry for Acute Aortic Dissection Type A score for 30-day mortality showed good discriminatory ability in our local population along with good ability for prediction of mortality, indicating its potential clinical utility in the population with acute type A aortic dissection.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 81-88"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464399","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":"Outcomes of surgical valve replacements for radiation-induced valvulopathy","authors":"Annie R. Abruzzo BA ,&nbsp;Siobhan McGurk BS ,&nbsp;George Tolis Jr MD ,&nbsp;Sary Aranki MD ,&nbsp;Ashraf Sabe MD ,&nbsp;Mark J. Cunningham MD ,&nbsp;Anju Nohria MD ,&nbsp;Akinobu Itoh MD, PhD","doi":"10.1016/j.xjon.2024.10.024","DOIUrl":"10.1016/j.xjon.2024.10.024","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with cancer who receive radiation therapy to the thorax often develop radiation-induced heart disease (RIHD) decades later. Previous chest radiation is associated with elevated perioperative risk of complications and mortality after cardiac surgery. Whether the type of valve (mechanical vs bioprosthetic) used affects outcomes in patients with RIHD is unknown.</div></div><div><h3>Methods</h3><div>This retrospective review analyzed the characteristics and postoperative outcomes of patients with a previous history of chest radiation for Hodgkin or non-Hodgkin lymphoma who underwent surgical valve replacement at a single institution between 2000 and 2021. Both 30-day perioperative outcomes and long-term survival were assessed.</div></div><div><h3>Results</h3><div>Patients who received mechanical valve tended to be younger, have more valves replaced, and have undergone previous coronary artery bypass grafting than bioprosthetic valve recipients. Valve type alone did not alter perioperative complications or overall survival. Median survival was 11.0 years in mechanical and 10.9 years in bioprosthetic valve patients (<em>P</em> = .930). Twelve patients underwent valve reinterventions (6 mechanical, 6 bioprosthetic), and 3 underwent transplant. Single-valve (aortic valve or mitral valve) recipients fared better with median survival of 13.3 years compared with 6.2 years in those who underwent combined aortic valve replacement plus mitral valve replacement (<em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>Patients with RIHD who undergo surgical valve replacement have similarly suboptimal short- and long-term outcomes regardless of mechanical versus bioprosthetic valve type. Those who required combined aortic and mitral valve replacement had especially high 10-year overall mortality. Further investigation in a larger dataset including transcatheter approaches is warranted.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 134-146"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464996","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":"Radiation therapy does not improve survival in patients who are upstaged after esophagectomy for clinical early-stage esophageal adenocarcinoma","authors":"Devanish N. Kamtam MBBS, MS ,&nbsp;Nicole Lin MD ,&nbsp;Douglas Z. Liou MD ,&nbsp;Natalie S. Lui MD ,&nbsp;Leah M. Backhus MD ,&nbsp;Joseph B. Shrager MD ,&nbsp;Mark F. Berry MD","doi":"10.1016/j.xjon.2024.11.001","DOIUrl":"10.1016/j.xjon.2024.11.001","url":null,"abstract":"<div><h3>Objective</h3><div>Radiation after esophagectomy may cause conduit dysfunction with unclear oncologic benefits. We hypothesized that adjuvant chemoradiation does not improve survival over chemotherapy alone for patients with pathologic upstaging after primary surgery for cT1-2N0M0 esophageal adenocarcinoma.</div></div><div><h3>Methods</h3><div>The impact of adjuvant therapy after primary surgery for cT1-2N0M0 esophageal adenocarcinoma upstaged to pT3-4 or pN+ in the National Cancer Database (2004-2019) was evaluated with logistic regression, Kaplan–Meier analysis, and Cox modeling.</div></div><div><h3>Results</h3><div>A total of 574 patients met inclusion criteria, 300 (52.3%) who received adjuvant therapy (chemotherapy alone in 117 [39.0%], radiation alone in 15 [5.0%], chemoradiation in 168 [56.0%]) and 274 (47.7%) who did not. Adjuvant therapy was associated with improved 5-year survival (46.8% vs 32.7%, <em>P</em> &lt; .001). In multivariate analysis controlling for age, year of diagnosis, Charlson Comorbidity Index, pT, pN, and positive margins, adjuvant chemotherapy was independently associated with improved survival (hazard ratio, 0.62, 95% CI, 0.46-0.84, <em>P</em> = .002); radiation use did not have a statistically significant association with survival (hazard ratio, 1.19, 95% CI, 0.86-1.63, <em>P</em> = .29). Among patients who received chemotherapy, independent predictors of also receiving radiotherapy included pathological T-upstaging (odds ratio, 2.01, 95% CI, 1.04-3.88, <em>P</em> = .037) and distance from facility less than 50 miles (odds ratio, 2.13, 95% CI, 1.05-4.33, <em>P</em> = .037). In univariate analysis of patients who received adjuvant therapy, chemotherapy alone was associated with significantly better 5-year survival compared with chemoradiation (54.2% vs 41.6%, <em>P</em> = .004). Landmark analyses at 3 and 6 months were consistent with the primary analysis.</div></div><div><h3>Conclusions</h3><div>Using radiation with chemotherapy as adjuvant therapy for patients upstaged after esophagectomy for cT1-2N0 esophageal adenocarcinoma is not associated with improved survival and should be considered only in select situations based on careful clinical evaluation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 290-308"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465190","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: Potential advantage of magnetic resonance imaging in detecting thoracic wall infiltration in pleural mesothelioma. A retrospective single-center analysis","authors":"","doi":"10.1016/j.xjon.2024.10.022","DOIUrl":"10.1016/j.xjon.2024.10.022","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 326-327"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465193","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":"Long-term outcomes of heparin-induced thrombocytopenia after cardiac surgery","authors":"Emily Rodriguez BS ,&nbsp;Maria Daskam BS ,&nbsp;Benjamin L. Shou MD ,&nbsp;Charles Woodrum MS ,&nbsp;Ria Gupta BS ,&nbsp;Kathryn E. Dane PharmD ,&nbsp;Diane Alejo BA ,&nbsp;Marc Sussman MD ,&nbsp;Stefano Schena MD, PhD","doi":"10.1016/j.xjon.2024.10.029","DOIUrl":"10.1016/j.xjon.2024.10.029","url":null,"abstract":"<div><h3>Objective</h3><div>Heparin-induced thrombocytopenia (HIT) after cardiac surgery may lead to greater morbidity and mortality than predicted preoperatively. The aim of this study is to assess long-term outcomes of patients surviving HIT after cardiac surgery.</div></div><div><h3>Methods</h3><div>Single-institution, retrospective study of adult patients who underwent cardiac surgery between 2011 and 2023 and developed HIT postoperatively. The institutional Society of Thoracic Surgeons database and electronic medical record were integrated with longitudinal data from phone questionnaires. HIT was defined by combined clinical (4Ts score) and serologic manifestations: a platelet decrease &gt;50% from preoperative baseline, a high optical density positive heparin-PF4 antibody test, and a positive serotonin release assay.</div></div><div><h3>Results</h3><div>We identified 88 of 11,658 patients (0.8%) with HIT after cardiac surgery. The majority were male (74%), white (73.8%), and with a mean age of 65.6 ± 11.6 years. Seventy-seven (87.5%) survived to discharge, had a 4Ts score of 5 [4-6], and 58 (75.3%) were discharged on oral anticoagulation, with only 22 (28.6%) receiving treatment for the past 3 months, for a median of 1.3 [0.8-4.5] years. Median length of stay was 24 [17-35] days and length of follow-up was 4.6 [0.3-12] years. Readmission occurred in 70.1% (n = 54) of patients, with an average of 3 [1-6] readmissions/patient. Causes of death during follow-up included cardiac (n = 7, 24.1%), infectious (n = 6, 20.7%), or neurologic events (n = 5, 17.3). Ten-year survival probability was 48%.</div></div><div><h3>Conclusions</h3><div>Patients who develop HIT after cardiac surgery have an overall poor prognosis even after hospital discharge. In addition to prolonged hospitalization, patients experience further complications leading to frequent early readmissions and elevated mortality in the long-term.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 190-198"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465194","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: Outcomes of surgical valve replacements for radiation-induced valvulopathy","authors":"","doi":"10.1016/j.xjon.2024.11.006","DOIUrl":"10.1016/j.xjon.2024.11.006","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 147-149"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464997","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":"Zero superior vena cava injury lead extraction with rotational system: A contemporary experience","authors":"Iverson E. Williams BS,&nbsp;Omar M. Sharaf MD,&nbsp;Ryan Azarrafiy MD, MPH,&nbsp;Daniel Demos MD,&nbsp;Eric I. Jeng MD, MBA,&nbsp;Kirsten A. Freeman MD,&nbsp;John R. Spratt MD,&nbsp;Thomas M. Beaver MD, MPH","doi":"10.1016/j.xjon.2024.11.010","DOIUrl":"10.1016/j.xjon.2024.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Transvenous cardiac implantable electronic device (CIED) lead extraction (TLE) is susceptible to superior vena cava (SVC) injury and can be performed in the operating room (OR) or electrophysiology lab via a mechanical device or laser-powered extraction. This study reflects a contemporary experience of mechanical right-left rotational extraction by cardiac surgeons in the OR.</div></div><div><h3>Methods</h3><div>We conducted a retrospective single-center review of adult (age ≥18 years) TLE cases performed by cardiac surgeons between 2019 and 2021. Leads were extracted via a transvenous mechanical right-left controlled-rotation system in the OR under general anesthesia with transesophageal echocardiographic guidance. Procedural success was defined as complete extraction of all leads without major complications, based on the Heart Rhythm Society's 2017 guidelines.</div></div><div><h3>Results</h3><div>A total of 210 leads were extracted from 104 patients, including 72 males (69%). The mean patient age was 63.8 ± 16.7 years, and 26 patients (25%) had undergone prior sternotomy. The most common indication for CIED extraction was infection (69%; n = 72). Removed CIEDs included single-chamber defibrillators (46%; n = 48), pacemakers (33%; n = 34), and cardiac resynchronization therapy devices (21%; n = 22). The mean age of the oldest extracted lead by patient was 9.79 ± 7.25 years. Procedural success was obtained in 95% of cases (99/104). The remaining cases included distal lead fracture (n = 3), inferior vena cava laceration necessitating sternotomy (n = 1), and tricuspid valve damage requiring delayed valve replacement (n = 1). There were zero SVC injuries, and procedure-related mortality was 0%.</div></div><div><h3>Conclusions</h3><div>Mechanical, controlled-rotation TLE is effective and can be performed safely without SVC injury. TLE by cardiac surgeons in the OR enables rapid conversion to sternotomy in the event of major complications.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 171-175"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465000","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":"Potential advantage of magnetic resonance imaging in detecting thoracic wall infiltration in pleural mesothelioma: A retrospective single-center analysis","authors":"Isabel Barreto MD ,&nbsp;Sabine Franckenberg MD ,&nbsp;Thomas Frauenfelder MD ,&nbsp;Isabelle Opitz MD ,&nbsp;Olivia Lauk MD","doi":"10.1016/j.xjon.2024.10.012","DOIUrl":"10.1016/j.xjon.2024.10.012","url":null,"abstract":"<div><h3>Objectives</h3><div>Thoracic wall infiltration in pleural mesothelioma determines the extent of resection and can be an important prognostic factor. Currently, standardized imaging for restaging after neoadjuvant systemic therapy comprises contrast-enhanced computed tomography or positron emission tomography. Additional thoracic magnetic resonance imaging could better discriminate chest wall infiltration preoperatively and increase staging accuracy. For this reason, the added benefit of magnetic resonance imaging was evaluated at our center.</div></div><div><h3>Methods</h3><div>A retrospective analysis of the extended imaging protocol was performed from July 2018 to March 2024, including a descriptive analysis for the patient's sex, age, tobacco consumption, asbestos exposure, histological subtype, TNM stage, Modified Response Evaluation Criteria for Solid Tumors in solid tumors, and number of neoadjuvant therapy cycles. Preoperative restaging included routine imaging and magnetic resonance imaging. After histological diagnosis of pleural mesothelioma, neoadjuvant therapy was conducted, followed by intended macroscopic complete resection, with intraoperative biopsies of suspicious chest wall lesions. Computed tomography and magnetic resonance imaging results were compared with intraoperative biopsies.</div></div><div><h3>Results</h3><div>Twenty-six patients (mean age, 65.50 years, 11.50% female) with operable pleural mesothelioma were included. Of the 11 patients with histologically proven chest wall infiltration, 10 (90.91%) had a cT-stage 3 or greater and 4 (36.36%) underwent surgery that resulted in an R2 resection. Thoracic magnetic resonance imaging showed a high sensitivity (90.91%) for the detection of chest wall infiltration, especially when compared with the computed tomography scan (9.09%).</div></div><div><h3>Conclusions</h3><div>With the adjunctive use of magnetic resonance imaging, we demonstrated a higher sensitivity for detection of chest wall infiltration compared with conventional imaging before surgery. This may improve patient selection for surgery. Nevertheless, larger studies are required to confirm these results.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 318-325"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465192","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":"Recommendation letter language for applicants selected to interview at integrated cardiothoracic surgery residency: A qualitative assessment by gender","authors":"Siddharth Yarlagadda BA ,&nbsp;Jason J. Han MD ,&nbsp;Jacqueline M. Soegaard Ballester MD, MBMI ,&nbsp;Caroline O’Brien MS ,&nbsp;Justin T. Clapp PhD, MPH ,&nbsp;Marisa Cevasco MD, MPH","doi":"10.1016/j.xjon.2024.12.001","DOIUrl":"10.1016/j.xjon.2024.12.001","url":null,"abstract":"<div><h3>Objective</h3><div>Cardiothoracic (CT) surgery remains a male-dominated specialty. Letters of recommendation (LORs) influence trainee selection and are vulnerable to biases. We aimed to qualitatively assess differences in LORs to integrated residency on the basis of applicant gender.</div></div><div><h3>Methods</h3><div>LORs for applicants who interviewed at a single integrated CT residency program during one cycle were selected and pooled by applicant gender. Gendered and identifying references were redacted. Letters were analyzed by a thematic analysis approach and managed through NVivo software.</div></div><div><h3>Results</h3><div>Thirty LORs across 8 male applicants and 43 LORs across 11 female applicants were analyzed. There was no noticeable difference between the frequency of positive attributes assigned to each gender. Research accomplishments was the most emphasized competency, with no gender-based difference identified. LORs for female applicants tended to be longer and include stronger positive adjectives. For male applicants, descriptions of external recognition were almost exclusively via mention of scholarships or research, whereas female applicants were more likely to receive word-of-mouth recognition. Letter writers often attested to male applicants’ commitment to CT surgery, whereas female applicants received more commentary around effective patient care.</div></div><div><h3>Conclusions</h3><div>Letters for men tended to focus on research accolades and career commitment, whereas letters for women were longer and more likely to emphasize patient care or faculty endorsement. Future studies may discern whether this phenomenon reflects stronger applicant-writer relationships for female applicants or a disadvantageous approach by letter writers for female applicants that relies on subjective rationale.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 379-385"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465079","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}