{"title":"Machine Learning-Based Random Forest to Predict 3-Year Survival after Endovascular Aneurysm Repair.","authors":"Toshiya Nishibe, Tsuyoshi Iwasa, Seiji Matsuda, Masaki Kano, Shinobu Akiyama, Shoji Fukuda, Masayasu Nishibe","doi":"10.5761/atcs.oa.25-00036","DOIUrl":"10.5761/atcs.oa.25-00036","url":null,"abstract":"<p><strong>Purpose: </strong>Endovascular aneurysm repair (EVAR) is widely used to treat abdominal aortic aneurysms (AAAs), but mid-term survival remains a concern. This study aims to develop a machine learning-based random forest model to predict 3-year survival after EVAR.</p><p><strong>Methods: </strong>A random forest model was trained using data from 176 EVAR patients, of whom 169 patients were retained for analysis, incorporating 23 preoperative and perioperative variables. Model performance was evaluated using 5-fold cross-validation.</p><p><strong>Results: </strong>The model achieved an area under the receiver-operating characteristic curve (AUC) of 0.91, with an accuracy of 81.1%, a sensitivity of 81.6%, a specificity of 80.9%, and an F1 score of 0.66. Feature importance analysis identified poor nutritional status (geriatric nutritional risk index <101.4), compromised immunity (neutrophil-to-lymphocyte ratio >3.19), chronic kidney disease (CKD), octogenarian status, chronic obstructive pulmonary disease (COPD), small aneurysm size, and statin use as the top predictors of 3-year mortality. The average values of the AUC, accuracy, sensitivity, specificity, and F1 score across the 5-folds were 0.76 ± 0.10, 73.9 ± 5.8%, 60.4 ± 1.9%, 77.8 ± 0.7%, and 0.59 ± 0.17, indicating consistent performance across different data subsets.</p><p><strong>Conclusions: </strong>The random forest model effectively predicts 3-year survival after EVAR, indicating key factors such as poor nutritional status, compromised immunity, CKD, octogenarian status, COPD, small aneurysm size, and statin use.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082776","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}
Fei Li, Yuetang Wang, Donghui Xu, Xu Wang, Wei Wang
{"title":"Eight-Year Clinical Outcomes of Transcatheter Aortic Valve Replacement with J-Valve System.","authors":"Fei Li, Yuetang Wang, Donghui Xu, Xu Wang, Wei Wang","doi":"10.5761/atcs.oa.24-00152","DOIUrl":"https://doi.org/10.5761/atcs.oa.24-00152","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to summarize 8-year clinical outcomes for patients who underwent transcatheter aortic valve replacement (TAVR) with the J-Valve system and evaluate the long-term durability and hemodynamic performance of the valve.</p><p><strong>Methods: </strong>Between July 2014 and June 2015, 21 patients underwent transapical TAVR with the J-Valve system. Systematic clinical and echocardiographic follow-up was conducted on 18 patients for up to 8 years.</p><p><strong>Results: </strong>Eight years post-TAVR with the J-Valve system, the all-cause mortality rate was 16.7%, with no prosthesis failures or thrombosis. Moderate to severe valve deterioration was observed in 50% of patients with aortic stenosis (AS), whereas no such deterioration was noted in patients with pure aortic regurgitation (PAR). At 8 years following TAVR, the effective orifice area measured 2.27 ± 0.50 cm<sup>2</sup> in patients with PAR and 1.35 ± 0.38 cm<sup>2</sup> in those with AS. Additionally, patients with AS exhibited a mean pressure gradient of 17.90 ± 10.61 mmHg. Over 8 years, PAR patients experienced a significant reduction in left ventricular end-diastolic diameter from 61.50 ± 2.08 mm to 48.67 ± 7.23 mm (p < 0.001), whereas AS patients showed no significant change.</p><p><strong>Conclusion: </strong>The J-Valve system demonstrates favorable long-term outcomes in TAVR, with excellent durability and hemodynamic performance in PAR patients.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043826","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":"Left Atrial Mitral Valve Chordae Which Disturbed the Mitral Leaflet Motion and Induced Mitral Regurgitation.","authors":"Toru Kameda, Tomohiro Mizuno, Kota Kawada, Tsubasa Yoshikawa, Koichi Sugiyama, Yuzo Katayama, Takeshiro Fujii","doi":"10.5761/atcs.cr.25-00030","DOIUrl":"10.5761/atcs.cr.25-00030","url":null,"abstract":"<p><p>Left atrial mitral valve chorda (LAMVC) is a rare congenital cardiac anomaly. The abnormal tissue band, like a mitral valve chorda, is attached to the left atrial wall on one side and mostly to the mitral valve leaflet on the other side and the band sometimes disturbs the mitral leaflet motion, followed by mitral regurgitation (MR). We encountered a case with a LAMVC which originated from a papillary muscle and attached to the posterior mitral annulus over the posterior leaflet and caused MR due to restricted mitral leaflet motion.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569278","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}
Shunsuke Sato, Takashi Azami, Jun Fujisue, Kyozo Inoue, Kenji Okada
{"title":"Usefulness of Artificial Pneumothorax during Totally Endoscopic Off-Pump Left Atrial Appendage Closure and Surgical Ablation.","authors":"Shunsuke Sato, Takashi Azami, Jun Fujisue, Kyozo Inoue, Kenji Okada","doi":"10.5761/atcs.oa.24-00156","DOIUrl":"10.5761/atcs.oa.24-00156","url":null,"abstract":"<p><strong>Purpose: </strong>In totally endoscopic off-pump left atrial appendage (LAA) closure and surgical ablation, securing the operative field is sometimes difficult in some patients because of a narrow working space caused by an elevated diaphragm or ventricles. In this study, we aimed to investigate the effectiveness of a method that facilitates securing the operative field using an artificial pneumothorax.</p><p><strong>Methods: </strong>We analyzed 71 consecutive patients who underwent totally endoscopic off-pump LAA closure and bilateral pulmonary vein isolation. The factors contributing to the reduction in operative time were examined. The patients were divided into the following 2 groups according to whether or not an artificial pneumothorax was used: Group C comprised 24 patients without an artificial pneumothorax and Group A comprised 47 patients with an artificial pneumothorax.</p><p><strong>Results: </strong>There were no hospital deaths or major complications. The operative time was significantly shorter in Group A (108 ± 26 minutes) than in Group C (198 ± 77 minutes) (p <0.0001).</p><p><strong>Conclusions: </strong>In totally endoscopic off-pump LAA closure and surgical ablation, an artificial pneumothorax may be useful in reducing the operative time.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070300","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":"Posterior Leaflet Overlay Patch Reinforcement for Mitral Valve Posterior Tethering: The Elbow Patch Repair.","authors":"Hyeon A Kim, Jae Suk Yoo","doi":"10.5761/atcs.nm.25-00068","DOIUrl":"https://doi.org/10.5761/atcs.nm.25-00068","url":null,"abstract":"<p><p>The scarcity of leaflet tissue and restricted systolic motion remain challenges in mitral valve repair. In addition to functional or secondary mitral regurgitation, atrial functional mitral regurgitation, characterized by chronic atrial fibrillation, preserved left ventricular function, and atriogenic leaflet tethering, exacerbates leaflet scarcity, complicating mitral valve repair. To address this, we introduce the \"elbow patch repair,\" a novel technique using an autologous pericardium overlay patch to reinforce the posterior mitral valve leaflet. A 65-year-old male patient with chronic atrial fibrillation and severe mitral regurgitation consistent with atrial functional mitral regurgitation underwent the \"elbow patch repair\" combined with annuloplasty and neochordae placement. This approach effectively managed posterior mitral valve leaflet deficiency and restored the coaptation surface. The \"elbow patch repair\" offers a straightforward and effective solution for leaflet shortage in atrial functional mitral regurgitation and select cases of Carpentier Class IIIb. Further studies are needed to assess its long-term durability.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144904","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":"Case Series of Blowhole Creation with or without Negative Pressure Wound Therapy for Severe Subcutaneous Emphysema.","authors":"Toshiko Kamata, Shigetoshi Yoshida, Yuki Hirai, Ryo Karita, Yuki Onozato, Hironobu Wada, Takashi Anayama","doi":"10.5761/atcs.cr.25-00034","DOIUrl":"https://doi.org/10.5761/atcs.cr.25-00034","url":null,"abstract":"<p><p>Severe subcutaneous emphysema that is refractory to chest tube drainage can result in significant patient discomfort, airway compromise, and hemodynamic instability. Various interventional approaches, including subcutaneous drain insertion and the blowhole technique, with or without negative pressure wound therapy (NPWT), have been proposed to manage this condition. In this case series, we describe 10 patients who developed severe subcutaneous emphysema following surgery or pneumothorax and were treated using the blowhole technique, with or without NPWT. A Wound Protector/Retractor XXS or LapProtector was used to maintain the patency of the blowhole, facilitating continuous decompression. In cases with more extensive emphysema, the application of NPWT led to rapid respiratory improvement, thereby enabling additional invasive interventions to address the underlying pulmonary air leak. These findings highlight the potential utility of a structured approach incorporating NPWT for the management of severe subcutaneous emphysema, particularly in cases refractory to conventional chest tube drainage.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176358","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":"\"A Bridge-over-the Bar\": A Novel Strategy to Prevent Paravalvular Regurgitation during Mitral Valve Replacement for Severe Mitral Annular Calcifications.","authors":"Khaled F Salhab, Sameh M Said","doi":"10.5761/atcs.nm.24-00081","DOIUrl":"10.5761/atcs.nm.24-00081","url":null,"abstract":"<p><p>Mitral annular calcifications have been known to increase complexity during mitral valve replacement (MVR). Standard procedure requires decalcification followed by reconstruction of the mitral annulus prior to placing the prosthesis. While this is the ideal technique, it is not feasible in every patient due to the associated risks. The mere attempt at valve replacement without proper annular decalcification has been associated with a high incidence of periprosthetic leak which complicates the postoperative course and has been associated with increased morbidity and mortality. With the advances in transcatheter therapy, postoperative periprosthetic regurgitation can be managed with devices and primary transcatheter valve implantation could be alternative to standard valve replacement; however, these alternate strategies are not without its own limitations and drawbacks. In the current report, we present a novel strategy to be used in a select group of patients with severe but non-circumferential annular calcifications to prevent/minimize periprosthetic regurgitation during MVR. This involves placing a patch over the posteriorly located calcium bar, thus minimizing tension on the posterior suture line and contain any periprosthetic regurgitation if to develop. This modification has been performed in a total of nine cases with acceptable early results.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980999","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}
Jasmin H Shahinian, Harry Lappiere, Juan Grau, David Glineur
{"title":"Total Arterial Revascularization: Evaluating the Length of the Radial Artery in a Composite Graft Configuration.","authors":"Jasmin H Shahinian, Harry Lappiere, Juan Grau, David Glineur","doi":"10.5761/atcs.oa.23-00084","DOIUrl":"10.5761/atcs.oa.23-00084","url":null,"abstract":"<p><strong>Purpose: </strong>Reimplanting the radial artery in the left internal thoracic artery as a composite graft allows total arterial revascularization (TAR) without aortic manipulation. The limitation of this strategy is the length of the radial artery required to reach distal right coronary artery (RCA) branches. Our analysis focuses on the feasibility of this strategy.</p><p><strong>Methods: </strong>A total of 169 patients underwent TAR using the radial artery in a composite grafting configuration. Length of the radial artery, number of sequential anastomoses, heart size, target location, length of the arm, patient height, body surface area, and flow in the composite graft were prospectively collected.</p><p><strong>Results: </strong>The mean length of the radial artery was 18.02 cm. Patients with a mean length of the radial artery of 15.9 cm needed an extension of the radial artery with another conduit to reach the RCA distal branches. When T-configuration is used, the length of the radial artery should be 0.53 cm per sequential anastomosis to reach the RCA distal branches.</p><p><strong>Conclusions: </strong>Our study shows that an average length of 18.02 cm of radial artery is needed to reach targets on the RCA distal branches in composite grafting. In T-configuration, we need 0.53 cm more length per anastomosis to achieve TAR.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10902649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415902","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 Simple Endovascular Aneurysm Repair Based on the Initial Aortic Diameter.","authors":"Yuki Orimoto, Hiroyuki Ishibashi, Takahiro Arima, Yusuke Imaeda, Yuki Maruyama, Hiroki Mitsuoka, Akio Kodama","doi":"10.5761/atcs.oa.23-00098","DOIUrl":"10.5761/atcs.oa.23-00098","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to investigate the effects of initial abdominal aortic aneurysm (AAA) diameter on aneurysmal sac expansion/shrinkage, endoleaks, and reintervention postelective simple endovascular aneurysm repair (EVAR).</p><p><strong>Methods: </strong>Overall, 228 patients monitored for >1 year after EVAR were analyzed. Male and female participants with initial AAA diameters <55 mm and <50 mm, respectively, composed the small group (group S), while those with initial AAA diameters ≥55 mm (men) and ≥50 mm (women) composed the large group (group L). Aneurysmal sac expansion of 10 mm and/or reintervention during follow-up (composite event) and its related factors were evaluated.</p><p><strong>Results: </strong>The 5-year freedom from composite event rate was significantly higher in group S (92.4 ± 2.8%) than that in group L (79.1 ± 4.9%; P <0.01). Multivariate analysis revealed AAA diameters before EVAR in group S (hazard ratio, 0.38; 95% confidence interval, 0.18-0.81; P = 0.01) and type II endoleak (T2EL) at discharge (hazard ratio, 2.83; 95% confidence interval, 1.29-6.20; P <0.01) as factors associated with the composite event. The freedom from composite event rate decreased to 51 ± 13% at 5 years in group L with T2EL.</p><p><strong>Conclusions: </strong>Group S had high freedom from composite event rate; in group L, the rate decreased to 51% at 5 years with T2EL at discharge.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10902653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50164114","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":"Lateral Dorsal Basal Lung Resection Based on Functional Preserving Sublobectomy Method: Single-Center Experience.","authors":"Bing Han, Zheng Qin, Peirui Chen, Liqiang Yuan, Mingqiang Diao","doi":"10.5761/atcs.oa.23-00025","DOIUrl":"10.5761/atcs.oa.23-00025","url":null,"abstract":"<p><strong>Purpose: </strong>Functional preserving sublobectomy (FPSL), a novel balancing strategy for segmentectomy and wedge resection, allows rapid and accurate removal of invisible nodules without the use of any preoperative localization markers. This study aimed to share single-center experience of lateral dorsal basal lung resection based on FPSL, so as to provide new surgical options for thoracic surgeons.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 13 patients who underwent thoracoscopic basal lung resection after FPSL at XX hospital from January 2021 to August 2022.</p><p><strong>Results: </strong>The operation was successfully performed in 13 patients by using FPSL, including 12 patients with malignant tumors. The mean operating time was 107.5 ± 25.6 min. The mean postoperative hospital stay was 3.7 ± 2.4 days. None of the patients needed extended excision, such as an entire basal or inferior lobectomy.</p><p><strong>Conclusion: </strong>Our single-center experience showed that the FPSL method only dealt with the target vessels, which greatly reduced the technical difficulty of surgery. In addition, both arteries and veins could be used as target vessels, and in particular cases such as undeveloped interlobar fissure, the operation could still be completed successfully. Lateral dorsal basal lung resection based on FPSL may be a new surgical option for surgeons.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10902666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164780","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}