JTCVS open最新文献

{"title":"Commentator Discussion: Out of the ice age: Preservation of cardiac allografts with a reusable 10 °C cooler","authors":"","doi":"10.1016/j.xjon.2024.09.013","DOIUrl":"10.1016/j.xjon.2024.09.013","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 320-322"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959925","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":"Significant reduction in blood product usage, same early outcomes: Blood conservation in infants undergoing open heart surgery","authors":"Lyubomyr Bohuta MD, PhD ,&nbsp;Titus Chan MD, MS, MPP ,&nbsp;Kevin Charette CCP ,&nbsp;Gregory Latham MD ,&nbsp;Christina L. Greene MD ,&nbsp;David Mauchley MD ,&nbsp;Andrew Koth MD ,&nbsp;D. Michael McMullan MD","doi":"10.1016/j.xjon.2024.10.006","DOIUrl":"10.1016/j.xjon.2024.10.006","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effect of a blood conservation program on trends in use of donor blood products and early clinical outcomes in infants undergoing open heart surgery.</div></div><div><h3>Methods</h3><div>Four hundred nine patients younger than age 1 year undergoing open-heart surgery between October 1, 2020, and June 30, 2023, were reviewed. The study period was divided into 4 eras with the first era as a before blood conservation baseline using traditional blood management. The following 3 eras comprised incremental implementation and evolution of blood conservation strategies. The total volume of blood products transfused for each surgical hospitalization was calculated and indexed to body weight at time of surgery.</div></div><div><h3>Results</h3><div>There was no significant difference in age at surgery, body weight, distribution of The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery categories, and in postoperative length of mechanical ventilation, intensive care unit or hospital length of stay, or postoperative mortality (<em>P</em> &gt; .05 for all) across the 4 eras. Median total volume of blood products administered during hospitalization decreased from 128 mL/kg (range, 92-220 mL/kg) during the baseline period to 21 mL/kg (range, 6-44 mL/kg) during the last era (<em>P</em> &lt; .01). Multivariate analysis demonstrated that later eras were associated with decreased odds of experiencing exposure to blood products during hospitalization.</div></div><div><h3>Conclusions</h3><div>Blood conservation is associated with significant reduction in usage of blood products during open heart surgery in infants with no significant effect on early outcomes. This trend is observed across all categories of surgical complexity. Additional studies are needed to prove consistency and to determine the longer-term clinical impact of this strategy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 450-457"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959936","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":"Clinicopathologic and genomic features associated with brain metastasis after resection of lung adenocarcinoma","authors":"Elizabeth G. Dunne MD ,&nbsp;Cameron N. Fick MD ,&nbsp;Brooke Mastrogiacomo MS ,&nbsp;Kay See Tan PhD ,&nbsp;Nicolas Toumbacaris MSPH ,&nbsp;Stijn Vanstraelen MD ,&nbsp;Gaetano Rocco MD ,&nbsp;Jaime E. Chaft MD ,&nbsp;Puneeth Iyengar MD ,&nbsp;Daniel Gomez MD ,&nbsp;Prasad S. Adusumilli MD ,&nbsp;Bernard J. Park MD ,&nbsp;James M. Isbell MD ,&nbsp;Matthew J. Bott MD ,&nbsp;Smita Sihag MD ,&nbsp;Daniela Molena MD ,&nbsp;James Huang MD ,&nbsp;David R. Jones MD","doi":"10.1016/j.xjon.2024.09.030","DOIUrl":"10.1016/j.xjon.2024.09.030","url":null,"abstract":"<div><h3>Objective</h3><div>To identify clinicopathologic and genomic features associated with brain metastasis after resection of lung adenocarcinoma (LUAD) and to evaluate survival after brain metastasis.</div></div><div><h3>Methods</h3><div>Patients who underwent complete resection of stage I-IIIA LUAD between 2011 and 2020 were included. A subset of patients had broad-based panel next-generation sequencing performed on their tumors. Fine-Gray models for the development of brain metastasis were constructed, with death without brain metastasis as a competing risk.</div></div><div><h3>Results</h3><div>A total of 2660 patients were included. The median duration of follow-up was 71 months (95% confidence interval [CI], 69-73 months). The cumulative incidence of brain metastasis at 10 years was 9.8%. Among patients who developed a brain metastasis, the median time from surgery to brain metastasis was 21 months (interquartile range, 10-42 months). Higher maximum standardized uptake value of the primary tumor, neoadjuvant therapy, lymphovascular invasion, and stage III disease were associated with the development of brain metastasis. Among patients who underwent next-generation sequencing, a multivariable analysis identified neoadjuvant therapy, pathologic stage, and <em>TP53</em> mutations as associated with development of brain metastasis. The median survival after brain metastasis was 18 months (95% CI, 13-24 months). Better performance status, lack of extracranial metastasis, stereotactic radiosurgery, and targeted therapy were associated with better survival after brain metastasis.</div></div><div><h3>Conclusions</h3><div>Brain metastasis is common after complete resection of LUAD and often occurs within 2 years. Markers of aggressive tumor biology, including higher maximum standardized uptake value, lymphovascular invasion, and <em>TP53</em> mutations, and neoadjuvant therapy are associated with brain metastasis.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 458-469"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959942","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":"Five-year comparison of clinical and echocardiographic outcomes of pure aortic stenosis with pure aortic regurgitation or mixed aortic valve disease in the COMMENCE trial","authors":"Vinod H. Thourani MD ,&nbsp;John D. Puskas MD ,&nbsp;Bartley Griffith MD ,&nbsp;Lars G. Svensson MD, PhD ,&nbsp;Philippe Pibarot DVM, PhD ,&nbsp;Michael A. Borger MD, PhD ,&nbsp;David Heimansohn MD ,&nbsp;Thomas Beaver MD, MPH ,&nbsp;Eugene H. Blackstone MD ,&nbsp;Anna Liza M. Antonio DrPH ,&nbsp;Joseph E. Bavaria MD, MPH ,&nbsp;COMMENCE Trial Investigators","doi":"10.1016/j.xjon.2024.08.020","DOIUrl":"10.1016/j.xjon.2024.08.020","url":null,"abstract":"<div><h3>Objective</h3><div>To compare outcomes of aortic valve replacement (AVR) in patients with pure aortic stenosis (Pure AS) and those with pure aortic regurgitation (Pure AR) or mixed AS and AR (MAVD) in the COMMENCE trial.</div></div><div><h3>Methods</h3><div>Of 689 patients who underwent AVR in the COMMENCE trial, patients with moderate or severe AR with or without AS (Pure AR + MAVD; n = 135) or Pure AS (n = 323) were included. Inverse probability of treatment weighting Kaplan-Meier survival curves were used for time-to-event endpoints, and longitudinal changes in hemodynamics were evaluated using mixed-effects models. Echocardiographic outcomes were assessed by an echo core laboratory and clinical outcomes adjudicated by a clinical events committee. The mean duration of follow-up was 5.3 ± 2.2 years.</div></div><div><h3>Results</h3><div>At 5 years, adjusted safety endpoints were not statistically different between groups; no structural valve deterioration (SVD) event occurred in either group. After adjustment, the Pure AR + MAVD group had a greater change in body surface area–corrected left ventricular (LV) mass reduction (<em>P</em> = .03) compared to the Pure AS patients. Those patients with a baseline LV ejection fraction (LVEF) &gt;55% continued to demonstrate preserved contractility compared to patients with an LVEF ≤55% at baseline (<em>P</em> &lt; .0001). No significant difference in mean gradient (<em>P</em> = .07) or effective orifice area (<em>P</em> = .96) at 5 years was evident between the groups.</div></div><div><h3>Conclusions</h3><div>Patients with Pure AR + MAVD demonstrated similar clinical safety and freedom from SVD at 5 years compared to those with Pure AS. There was a significant difference in LV reverse remodeling in the Pure AR + MAVD group compared to the Pure AS group at 5 years. These favorable outcomes in patients with AR may reinforce the need for treatment before irreversible changes occur.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 160-173"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960018","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":"Intraoperative right ventricular end-systolic pressure–volume loop analysis in patients undergoing cardiac surgery: A proof-of-concept methodology","authors":"Vahid Kiarad MD, MPH ,&nbsp;Feroze Mahmood MD, FASE ,&nbsp;Mona Hedayat MD ,&nbsp;Rayaan Yunus MPH ,&nbsp;Alina Nicoara MD ,&nbsp;David Liu MD ,&nbsp;Louis Chu MD ,&nbsp;Vankatachalam Senthilnathan MD ,&nbsp;Masashi Kai MD ,&nbsp;Kamal Khabbaz MD","doi":"10.1016/j.xjon.2024.09.020","DOIUrl":"10.1016/j.xjon.2024.09.020","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative right ventricular (RV) dysfunction is associated with increased morbidity and mortality in cardiac surgery patients. This study aimed to demonstrate proof of concept in generating intraoperative RV pressure–volume (PV) loops and conducting an end-systolic PV relationship (ESPVR) analysis using data obtained from routinely used intraoperative monitors.</div></div><div><h3>Methods</h3><div>Adult patients undergoing cardiac surgery with the placement of a pulmonary artery catheter (PAC) between May 2023 and March 2024 were included prospectively. The PV loops were generated using 3-dimensional echocardiographic RV volume data and continuous RV pressure data obtained from a PAC. The volume–time and pressure–time curves were digitized using the semiautomatic WebPlotDigitizer program and synchronized to reconstruct an RV PV loop and analyze ESPVR using the previously validated single-beat method.</div></div><div><h3>Results</h3><div>Intraoperative RV PV loops were generated for 25 patients, including 17 patients with preserved RV systolic function (group 1) and 8 patients with reduced systolic function (group 2). Mean E_es, E_a, and E_es/E_a ratio were 0.63 ± 0.25 mm Hg/mL, 0.60 ± 0.23 mm Hg/mL, and 1.0 8 ± 0.31 mm Hg/mL, respectively, by the P_max method and 0.56 ± 0.32 mm Hg/mL, 0.60 ± 0.23 mm Hg/mL, and 0.91 ± 0.21 mm Hg/mL, respectively, by the V₀ method. Group 1 had a significantly higher E_es compared to group 2 regardless of the calculation method and a larger E_es/E_a ratio calculated by the V₀ method.</div></div><div><h3>Conclusions</h3><div>It is clinically feasible to derive RV PV loops from routine hemodynamic and echocardiographic data. With further validation and technological support, this can be a potential real-time intraoperative RV function monitoring tool.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 225-234"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960074","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":"Is concomitant tricuspid valve repair in patients undergoing robotic mitral valve repair safe and effective?","authors":"Phillip G. Rowse MD ,&nbsp;Yazan AlJamal MBBS ,&nbsp;Richard C. Daly MD ,&nbsp;Austin Todd MS ,&nbsp;Arman Arghami MD, MPH ,&nbsp;Juan A. Crestanello MD ,&nbsp;Joseph A. Dearani MD","doi":"10.1016/j.xjon.2024.09.021","DOIUrl":"10.1016/j.xjon.2024.09.021","url":null,"abstract":"<div><h3>Objectives</h3><div>Robotic-assisted mitral valve repair (MVr) is a well-established procedure for management of degenerative mitral valve disease. Limited data regarding concomitant robotic-assisted tricuspid valve repair (TVr) is available. This review investigates prevalence and outcomes of concomitant robotic-assisted mitral and tricuspid valve repair.</div></div><div><h3>Methods</h3><div>From 2014 to 2022, 839 patients underwent robotic-assisted MVr, including 76 patients with moderate or greater tricuspid regurgitation and/or tricuspid annular dilatation ≥40 mm. Among the 76 patients, 19 (25%) underwent isolated MVr and 57 (75%) had concomitant mitral and tricuspid valve repair. Outcome data between the 2 groups were analyzed.</div></div><div><h3>Results</h3><div>In the MVr/TVr group, tricuspid regurgitation grades were mild in 4 (7%) patients, moderate in 44 (77%) and severe in 9 (15.7%). Significant tricuspid annular dilatation ≥40 mm was present in all patients. In the isolated MVr group, 3 (15.7%) patients had mild tricuspid regurgitation and 16 (84.2%) had moderate tricuspid regurgitation with significant tricuspid annular dilatation present in only 6 patients. Cardiopulmonary bypass and crossclamp time were 130.6 and 91 minutes versus 85 and 55.4 minutes for robotic MVr/TVr group versus MVr group, respectively (<em>P</em> &lt; .05). The intensive care unit and hospital length of stay were similar: 27.7 versus 27.7 hours and 4.4 versus 4.2 days for MVr/TVr versus MVr (<em>P</em> = .24), respectively. There were no perioperative deaths or heart block in either group. Survival and freedom from reoperation with median follow-up of 16 and 46 months for MVr/TVr and MVr groups, respectively were 100%.</div></div><div><h3>Conclusions</h3><div>Concomitant robotic-assisted tricuspid valve repair for functional regurgitation can be safely and effectively performed at the time of mitral valve repair with excellent short-term morbidity and mortality results.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 214-221"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960075","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 between the proportionality of functional mitral regurgitation and survival after mitral valve operation","authors":"Makoto Mori MD, PhD ,&nbsp;Christina Waldron BS ,&nbsp;Sigurdur Ragnarsson MD ,&nbsp;Soh Hosoba MD, PhD ,&nbsp;Mina Zaky MD ,&nbsp;Dustin Lieu MD ,&nbsp;Markus Krane MD ,&nbsp;Arnar Geirsson MD","doi":"10.1016/j.xjon.2024.06.006","DOIUrl":"10.1016/j.xjon.2024.06.006","url":null,"abstract":"<div><h3>Objective</h3><div>The concept of proportionate and disproportionate functional mitral regurgitation suggests that transcatheter edge-to-edge mitral repair may benefit patients with a smaller left ventricle relative to a higher regurgitant burden. The clinical relevance of proportionality remains unknown in mitral operations for ischemic mitral regurgitation. We aimed to characterize the association between mitral regurgitation proportionality and outcomes after mitral valve operations.</div></div><div><h3>Methods</h3><div>By using the Cardiothoracic Surgery Trial Network's severe ischemic mitral regurgitation trial, we first identified the inflection point at which the risk of 2-year mortality changed along the spectrum of the mitral regurgitation proportionality (defined as effective regurgitant orifice area/left ventricular end-diastolic volume index) using a splined multivariable Cox proportional hazards model. Patients were dichotomized by the mitral regurgitation proportionality value. The Cox model evaluated the hazard of 2-year all-cause mortality between proportionate and disproportionate mitral regurgitation.</div></div><div><h3>Results</h3><div>Among the 240 patients, the median age was 69 years (interquartile range, 62-75), and 38% (n = 90) were women. Patients with effective regurgitant orifice/left ventricular end-diastolic volume index proportion greater than 0.40 (more disproportionate mitral regurgitation) had a higher hazard of death compared with those with more proportionate mitral regurgitation. The 90-day and 1-year mortality were higher in patients with disproportionate mitral regurgitation (13% vs 6.2% for 90 days and 19% vs 12% for 1 year). In a multivariable Cox model, the disproportionate mitral regurgitation group had a statistically significantly higher hazard of death compared with the proportionate mitral regurgitation group (hazard ratio, 2.15, 95% CI, 1.16-3.98, <em>P</em> = .015).</div></div><div><h3>Conclusions</h3><div>The clinical relevance of the proportionality of functional mitral regurgitation proposed in the transcatheter edge-to-edge mitral repair population may not generalize to surgical patient populations.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 176-188"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959319","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":"Rapid-recovery protocol for minimally invasive mitral valve repair","authors":"Amy Brown MD, MPH ,&nbsp;Ali Fatehi Hassanabad MD ,&nbsp;Jolene Moen RN ,&nbsp;Karen Wiens RN ,&nbsp;Alexander J. Gregory MD ,&nbsp;Ken Kuljit S. Parhar MD ,&nbsp;Corey Adams MD ,&nbsp;William D.T. Kent MD","doi":"10.1016/j.xjon.2024.08.006","DOIUrl":"10.1016/j.xjon.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Minimally invasive mitral valve repair (MIMVR), often performed within specialized care pathways, has been shown to reduce hospital length of stay and improve patient recovery. The relative value of rapid-recovery protocols as a component of care pathways, including enhanced recovery programs (ERPs), has not been well described. This study compared clinical outcomes following implementation of a new, comprehensive rapid-recovery protocol within a previously established, mature ERP for patients undergoing MIMVR.</div></div><div><h3>Methods</h3><div>The rapid-recovery protocol was developed and implemented by a multidisciplinary team to further optimize patient recovery within an existing ERP. The protocol was applied to 75 consecutive patients undergoing MIMVR between September 2022 and December 2023. Outcomes were compared retrospectively to 75 ERP control patients who did not receive the rapid-recovery protocol but experienced the ERP. The primary outcome was a composite of discharge from the intensive care unit (ICU) by postoperative day (POD) 1, discharge to home by POD 4, and no all-cause hospital readmission by 30 days.</div></div><div><h3>Results</h3><div>Baseline characteristics were similar in the 2 groups. Patients in the rapid-recovery group achieved the primary composite outcome significantly more often compared to the control group (60% vs 40%, respectively). There was no between-group difference in postoperative complications. Multivariable logistic regression showed that age ≤60 years was significantly associated with rapid-recovery protocol success. Clinical barriers to achieving individual components of the primary outcome were described.</div></div><div><h3>Conclusions</h3><div>A rapid-recovery protocol for MIMVR was associated with early ICU and hospital discharge. These benefits were safely achieved without any increase in hospital readmission, morbidity, or mortality up to 30 days postoperatively.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 49-60"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959781","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":"Predicting operative mortality in patients who undergo elective open thoracoabdominal aortic aneurysm repair","authors":"Kyle W. Blackburn BS ,&nbsp;Susan Y. Green MPH ,&nbsp;Allen Kuncheria BA ,&nbsp;Meng Li PhD ,&nbsp;Adel M. Hassan BA ,&nbsp;Brittany Rhoades PhD ,&nbsp;Scott A. Weldon MA ,&nbsp;Subhasis Chatterjee MD ,&nbsp;Marc R. Moon MD ,&nbsp;Scott A. LeMaire MD ,&nbsp;Joseph S. Coselli MD","doi":"10.1016/j.xjon.2024.09.002","DOIUrl":"10.1016/j.xjon.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>We have developed a model aimed at identifying preoperative predictors of operative mortality in patients who undergo elective, open thoracoabdominal aortic aneurysm (TAAA) repair. We converted this model into an intuitive nomogram to aid preoperative counseling.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from 2884 elective, open TAAA repairs performed between 1986 and 2023 in a single practice. Using clinical and selected operative variables, we built 4 predictive models: multivariable logistic regression (MLR), random forest, support vector machine, and gradient boosting machine. Each model’s predictive effectiveness was evaluated with the C-statistic. Test C-statistics were computed using an 80:20 cross-validation scheme with 1000 iterations.</div></div><div><h3>Results</h3><div>Operative death occurred in 200 patients (6.9%). Test set C-statistics showed that the MLR model (median, 0.68; interquartile range [IQR], 0.65-0.71) outperformed the machine learning models (0.61 [IQR, 0.59-0.64] for random forest; 0.61 [IQR, 0.58-0.64] for support vector machine; 0.65 [IQR, 0.62-0.67] for gradient boosting machine). The final MLR model was based on 7 characteristics: increasing age (odds ratio [OR], 1.04/y; <em>P</em> &lt; .001), cerebrovascular disease (OR, 1.54; <em>P</em> = .01), chronic kidney disease (OR, 1.53; <em>P</em> = .008), symptomatic aneurysm (OR, 1.42; <em>P</em> = .02), and Crawford extent I (OR, 0.66; <em>P</em> = .08), extent II (OR, 1.61; <em>P</em> = .01), and extent IV (OR, 0.41; <em>P</em> = .002). We converted this model into a nomogram.</div></div><div><h3>Conclusions</h3><div>Using institutional data, we evaluated several models to predict operative mortality in elective TAAA repair, using information available to surgeons preoperatively. We then converted the best predictive model, the MLR model, into an intuitive nomogram to aid patient counseling.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 95-103"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959855","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 management of atrioesophageal fistula after catheter ablation of atrial fibrillation: A French nationwide study","authors":"Ludovic Dupautet MD ,&nbsp;Guillaume Lebreton MD, PhD ,&nbsp;Gabriel Saiydoun MD ,&nbsp;Thierry Bourguignon MD, PhD ,&nbsp;Sébastien Frey MD ,&nbsp;Christophe Beaufreton MD, PhD ,&nbsp;Géraud Galvaing MD, MSc ,&nbsp;Sébastien Cambier MD, MSc ,&nbsp;Marc Filaire MD, PhD ,&nbsp;Laura Filaire MD, MSc","doi":"10.1016/j.xjon.2024.09.010","DOIUrl":"10.1016/j.xjon.2024.09.010","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to assess the efficacity of different surgical strategies for atrioesophageal fistula after catheter ablation of atrial fibrillation.</div></div><div><h3>Methods</h3><div>Between January 2010 and April 2023, all patients with a diagnosis of atrioesophageal fistula or pericardo-esophageal fistula after catheter ablation of atrial fibrillation were analyzed retrospectively from the French database EPITHOR. Patients without surgical management were excluded.</div></div><div><h3>Results</h3><div>Eighteen patients were included, 15 with atrioesophageal fistula and 3 with pericardo-esophageal fistula. Median follow-up was 89.5 days with an overall survival of 50%. Five patients underwent esophageal stenting, 2 as a bridge-to-esophagectomy with 50% of survival and 3 in association with esophagus and left atrial direct repair with 66% survival. Primary esophageal repair with flap coverage was performed in 8 patients with 25% survival, most of them with sepsis and neurological failure. Seven patients had an esophagectomy with 71% survival, only 2 of them having a neurological failure. Among them, 5 patients underwent a restorative surgery and are still alive. Four patients had a retrosternal colon interposition, and 1 patient had an esogastric anastomosis. Risk factors for death were neurological failure (hazard ratio [HR], 4.91, 95% CI, 0.95-25.22; <em>P</em> = .0057) in univariate analysis and sepsis (HR, 6.25, 95% CI, 1.17-33.3; <em>P</em> = .032) in multivariate analysis. Esophagectomy tended to offer a survival benefit (HR, 0.163, 95% CI, 0.019-1.340; <em>P</em> = .092). The use of cardiopulmonary bypass did not significantly impact survival (HR, 1.953, 95% CI, 0.392-9.719; <em>P</em> = .413).</div></div><div><h3>Conclusions</h3><div>Aggressive surgical strategies for managing atrioesophageal fistula are mandatory to offer the best chance of survival.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 476-484"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959862","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}