Pub Date : 2024-12-08DOI: 10.1053/j.semtcvs.2024.11.005
Gardner Yost, Bo Yang
Aortic malperfusion occurs in a significant percentage of patients with acute aortic dissection, and causes malperfusion syndrome, the clinical entity defined by end organ ischemia, in 10-33% of patients. Malperfusion syndrome can be rapidly lethal and can involve the coronary, cerebral, visceral, or lower extremity vessels. Depending on presentation, it may be appropriately and well treated with endovascular fenestration prior to definitive central aortic repair.
{"title":"Malperfusion, Malperfusion Syndrome, and Mesenteric Ischemia in Aortic Dissection.","authors":"Gardner Yost, Bo Yang","doi":"10.1053/j.semtcvs.2024.11.005","DOIUrl":"10.1053/j.semtcvs.2024.11.005","url":null,"abstract":"<p><p>Aortic malperfusion occurs in a significant percentage of patients with acute aortic dissection, and causes malperfusion syndrome, the clinical entity defined by end organ ischemia, in 10-33% of patients. Malperfusion syndrome can be rapidly lethal and can involve the coronary, cerebral, visceral, or lower extremity vessels. Depending on presentation, it may be appropriately and well treated with endovascular fenestration prior to definitive central aortic repair.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.semtcvs.2023.05.001
Christopher W. Jensen MD MS , Lillian Kang MD , Mary E. Moya-Mendez MS MHS , Kristen E. Rhodin MD MHS , Andrew M. Vekstein MD , W. Schuyler Jones MD , Jennifer A. Rymer MD MBA MHS , Brittany A. Zwischenberger MD , Adam R. Williams MD
Spontaneous coronary artery dissection (SCAD) is a rare but important nonatherosclerotic cause of acute coronary syndrome. Indications for revascularization and long-term outcomes of SCAD remain areas of active investigation. We report our experience with initial management strategy and long-term outcomes in SCAD. We reviewed all patients treated at our institution from 1996-2021 with a SCAD diagnosis. Demographics, comorbidities, clinical presentations, angiography findings, and management strategies were obtained by chart review. The primary outcome was a composite of cardiac death, recurrent/progressive SCAD, subsequent diagnosis of congestive heart failure, or subsequent/repeat revascularization after the initial management. Unadjusted Kaplan-Meier survival analysis was performed. Of 186 patients with a SCAD diagnosis treated at our institution, 149 (80%) were female. Medical management was the initial treatment in 134 (72.0%) patients, percutaneous coronary intervention (PCI) in 43 (23.1%), and coronary artery bypass grafting in 9 (4.8%). Surgery/PCI intervention was associated with younger age (38.8 vs 47.7 years, P = 0.01), ST elevation myocardial infarction on presentation (67.0% vs 34.0%, P < 0.001), lower ejection fraction (45.0% vs 55.0%, P = 0.002), and left anterior descending coronary artery dissection (75.0% vs 51.0%, P = 0.006). Ten-year freedom from our composite outcome was similar between revascularized patients and those managed with medical therapy (P = 0.36). Median follow-up time was 4.5 years. SCAD in the setting of ST elevation myocardial infarction, left anterior descending coronary artery involvement, or decreased cardiac function suggests greater ischemic insult and was associated with initial percutaneous or surgical revascularization. Despite worse disease on initial presentation, long-term outcomes of patients undergoing revascularization are similar to medically managed patients with SCAD.
{"title":"Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection","authors":"Christopher W. Jensen MD MS , Lillian Kang MD , Mary E. Moya-Mendez MS MHS , Kristen E. Rhodin MD MHS , Andrew M. Vekstein MD , W. Schuyler Jones MD , Jennifer A. Rymer MD MBA MHS , Brittany A. Zwischenberger MD , Adam R. Williams MD","doi":"10.1053/j.semtcvs.2023.05.001","DOIUrl":"10.1053/j.semtcvs.2023.05.001","url":null,"abstract":"<div><div><span><span>Spontaneous coronary artery dissection<span> (SCAD) is a rare but important nonatherosclerotic cause of acute coronary syndrome<span><span>. Indications for revascularization<span> and long-term outcomes of SCAD remain areas of active investigation. We report our experience with initial management strategy and long-term outcomes in SCAD. We reviewed all patients treated at our institution from 1996-2021 with a SCAD diagnosis. Demographics, comorbidities, clinical presentations, angiography findings, and management strategies were obtained by chart review. The primary outcome was a composite of cardiac death, recurrent/progressive SCAD, subsequent diagnosis of </span></span>congestive heart failure, or subsequent/repeat revascularization after the initial management. Unadjusted Kaplan-Meier survival analysis was performed. Of 186 patients with a SCAD diagnosis treated at our institution, 149 (80%) were female. Medical management was the initial treatment in 134 (72.0%) patients, percutaneous coronary intervention (PCI) in 43 (23.1%), and </span></span></span>coronary artery bypass grafting in 9 (4.8%). Surgery/PCI intervention was associated with younger age (38.8 vs 47.7 years, </span><em>P</em><span> = 0.01), ST elevation myocardial infarction on presentation (67.0% vs 34.0%, </span><em>P</em><span> < 0.001), lower ejection fraction (45.0% vs 55.0%, </span><em>P</em><span> = 0.002), and left anterior descending coronary artery dissection (75.0% vs 51.0%, </span><em>P</em> = 0.006). Ten-year freedom from our composite outcome was similar between revascularized patients and those managed with medical therapy (<em>P</em><span> = 0.36). Median follow-up time was 4.5 years. SCAD in the setting of ST elevation myocardial infarction, left anterior descending coronary artery involvement, or decreased cardiac function suggests greater ischemic insult and was associated with initial percutaneous or surgical revascularization. Despite worse disease on initial presentation, long-term outcomes of patients undergoing revascularization are similar to medically managed patients with SCAD.</span></div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 387-397"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10532280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.semtcvs.2024.08.004
Tracy R. Geoffrion MD, MPH , David M. Overman MD , Carl L. Backer MD , Christopher A. Caldarone MD
{"title":"Discussions in Cardiothoracic Treatment and Care: Organization of Centers Performing Congenital Heart Surgery","authors":"Tracy R. Geoffrion MD, MPH , David M. Overman MD , Carl L. Backer MD , Christopher A. Caldarone MD","doi":"10.1053/j.semtcvs.2024.08.004","DOIUrl":"10.1053/j.semtcvs.2024.08.004","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 428-434"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.semtcvs.2024.08.002
Jacob A. Klapper MD, FACS , Chadrick Denlinger MD , Matthew G. Hartwig MD, MHS , Stephanie H. Chang MD, MSCI
{"title":"Discussions in Cardiothoracic Treatment and Care: Implications for the Composite Allocation Score System for Organ Distribution in the United States","authors":"Jacob A. Klapper MD, FACS , Chadrick Denlinger MD , Matthew G. Hartwig MD, MHS , Stephanie H. Chang MD, MSCI","doi":"10.1053/j.semtcvs.2024.08.002","DOIUrl":"10.1053/j.semtcvs.2024.08.002","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 450-456"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.semtcvs.2024.08.003
Faisal G. Bakaeen MD , Joseph F. Sabik MD , Patrick O. Myers MD , Dawn S. Hui MD , Milan Milojevic MD, PhD
{"title":"Discussions in Cardiothoracic Treatment and Care: Towards Robust and Trustworthy Coronary Guidelines","authors":"Faisal G. Bakaeen MD , Joseph F. Sabik MD , Patrick O. Myers MD , Dawn S. Hui MD , Milan Milojevic MD, PhD","doi":"10.1053/j.semtcvs.2024.08.003","DOIUrl":"10.1053/j.semtcvs.2024.08.003","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 411-417"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.semtcvs.2022.11.001
Jason W. Greenberg MD, David L.S. Morales MD, Hosam F. Ahmed MD, Mallika V. Desai, Kyle W. Riggs MD, Don Hayes Jr MD, MS, MEd, David G. Lehenbauer MD, Md. M. Hossain PhD, MSc, Farhan Zafar MD, MS
The demand for organs for lung transplantation (LTx) continues to outweigh supply. However, nearly 75% of donor lungs are never transplanted. LTx offer acceptance practices and the effects on waitlist/post-transplant outcomes by candidate clinical acuity are understudied. UNOS was used to identify all LTx candidates, donors, and offers from 2005 to 2019. Candidates were grouped by Lung Allocation Score (LAS; applicable post-2005, ages ≥12 years): LAS<40, 40–60, 61–80, and >80. Offer acceptance patterns, waitlist death/decompensation, and post-transplant survival (PTS) were compared. “Acceptable organ offers” were those from donors whose organs were accepted for transplantation. Approximately 3 million offers to 34,531 candidates were reviewed. Median waitlist durations were: 9 days-(LAS>80), 17 days-(LAS 61–80), 42 days-(LAS 40–60), 125 days-(LAS<40) (P < 0.001 between all). Per waitlist-day, offer rates were: total offers – 0.8/day-(LAS>80), 0.7/day-(LAS 61–80), 0.6/day-(LAS 40–60), 0.4/day-(LAS<40); acceptable offers – 0.34/day-(LAS>80), 0.32/day-(LAS 61–80), 0.24/day-(LAS 40–60), 0.15/day-(LAS<40) (both P < 0.001 between all LAS). Among patients who experienced waitlist mortality/decompensation, ≥1 acceptable offer was declined in 92% (3939/4270) of patients – 78% for LAS >80, 88% for LAS 61–80, 93% for LAS 40–60, and 96% for LAS <40. Thirty-day waitlist mortality/decompensation rates were: 46%-(LAS>80), 24%-(LAS 61–80), 5%-(LAS 40–60), <1%-(LAS<40) (P < 0.001 between all). PTS was equivalent between patients for whom the first/second offer vs later offers were accepted (all LAS P > 0.4). The first offers that LTx candidates receive (including acceptable organs) are declined for nearly all candidates. Healthier candidates can afford offer selectivity but more ill patients (LAS>60) cannot, experiencing exceedingly high 30-day waitlist mortality.
{"title":"Overly Selective Offer Acceptance is Associated With High Waitlist Mortality for the Most Ill Lung Transplant Candidates","authors":"Jason W. Greenberg MD, David L.S. Morales MD, Hosam F. Ahmed MD, Mallika V. Desai, Kyle W. Riggs MD, Don Hayes Jr MD, MS, MEd, David G. Lehenbauer MD, Md. M. Hossain PhD, MSc, Farhan Zafar MD, MS","doi":"10.1053/j.semtcvs.2022.11.001","DOIUrl":"10.1053/j.semtcvs.2022.11.001","url":null,"abstract":"<div><div><span>The demand for organs for lung transplantation (LTx) continues to outweigh supply. However, nearly 75% of donor lungs are never transplanted. LTx offer acceptance practices and the effects on waitlist/post-transplant outcomes by candidate clinical acuity are understudied. UNOS was used to identify all LTx candidates, donors, and offers from 2005 to 2019. Candidates were grouped by Lung Allocation Score (LAS; applicable post-2005, ages ≥12 years): LAS<40, 40–60, 61–80, and >80. Offer acceptance patterns, waitlist death/decompensation, and post-transplant survival (PTS) were compared. “Acceptable organ offers” were those from donors whose organs were accepted for transplantation. Approximately 3 million offers to 34,531 candidates were reviewed. Median waitlist durations were: 9 days-(LAS>80), 17 days-(LAS 61–80), 42 days-(LAS 40–60), 125 days-(LAS<40) (</span><em>P</em> < 0.001 between all). Per waitlist-day, offer rates were: <em>total offers</em> – 0.8/day-(LAS>80), 0.7/day-(LAS 61–80), 0.6/day-(LAS 40–60), 0.4/day-(LAS<40); <em>acceptable offers</em> – 0.34/day-(LAS>80), 0.32/day-(LAS 61–80), 0.24/day-(LAS 40–60), 0.15/day-(LAS<40) (both <em>P</em> < 0.001 between all LAS). Among patients who experienced waitlist mortality/decompensation, ≥1 acceptable offer was declined in 92% (3939/4270) of patients – 78% for LAS >80, 88% for LAS 61–80, 93% for LAS 40–60, and 96% for LAS <40. Thirty-day waitlist mortality/decompensation rates were: 46%-(LAS>80), 24%-(LAS 61–80), 5%-(LAS 40–60), <1%-(LAS<40) (<em>P</em> < 0.001 between all). PTS was equivalent between patients for whom the first/second offer vs later offers were accepted (all LAS <em>P</em> > 0.4). The first offers that LTx candidates receive (including acceptable organs) are declined for nearly all candidates. Healthier candidates can afford offer selectivity but more ill patients (LAS>60) cannot, experiencing exceedingly high 30-day waitlist mortality.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 435-444"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10373926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.semtcvs.2023.02.004
Damien M. Wu MD , Michael Z.L. Zhu MBBS , Edward Buratto MBBS, PhD, FRACS , Christian P. Brizard MD, MS , Igor E. Konstantinov MD, PhD, FRACS
There is limited data on the outcomes of children who undergo surgery for aortic valve infective endocarditis (IE), and the optimal surgical approach remains controversial. We investigated the long-term outcomes of surgery for aortic valve IE in children, with a particular focus on the Ross procedure. A retrospective review of all children who underwent surgery for aortic valve IE was performed at a single institution. Between 1989 and 2020, 41 children underwent surgery for aortic valve IE, of whom 16 (39.0%) underwent valve repair, 13 (31.7%) underwent the Ross procedure, 9 (21.9%) underwent a homograft root replacement, and 3 (7.3%) underwent a mechanical valve replacement. Median age was 10.1 years (interquartile range, 5.4–14.1). The majority of children (82.9%, 34/41) had underlying congenital heart disease, while 39.0% (16/41) had previous heart surgery. Operative mortality was 0.0% (0/16) for repair, 15.4% (2/13) for the Ross procedure, 33.3% (3/9) for homograft root replacement, and 33.3% (1/3) for mechanical replacement. Survival at 10 years was 87.5% for repair, 74.1% for Ross, and 66.7% for homograft (P > 0.05). Freedom from reoperation at 10 years was 30.8% for repair, 63.0% for Ross, and 26.3% for homograft (P = 0.15 for Ross vs repair, P = 0.002 for Ross vs homograft). Children undergoing surgery for aortic valve IE have acceptable long-term survival, although the need for long-term reintervention is significant. The Ross procedure appears to be the optimal choice when repair is not feasible.
{"title":"Aortic Valve Surgery in Children With Infective Endocarditis","authors":"Damien M. Wu MD , Michael Z.L. Zhu MBBS , Edward Buratto MBBS, PhD, FRACS , Christian P. Brizard MD, MS , Igor E. Konstantinov MD, PhD, FRACS","doi":"10.1053/j.semtcvs.2023.02.004","DOIUrl":"10.1053/j.semtcvs.2023.02.004","url":null,"abstract":"<div><div><span>There is limited data on the outcomes of children who undergo surgery for aortic valve<span><span> infective endocarditis (IE), and the optimal surgical approach remains controversial. We investigated the long-term outcomes of surgery for aortic valve IE in children, with a particular focus on the Ross procedure<span>. A retrospective review of all children who underwent surgery for aortic valve IE was performed at a single institution. Between 1989 and 2020, 41 children underwent surgery for aortic valve IE, of whom 16 (39.0%) underwent valve repair, 13 (31.7%) underwent the Ross procedure, 9 (21.9%) underwent a </span></span>homograft<span><span> root replacement, and 3 (7.3%) underwent a mechanical valve replacement. Median age was 10.1 years (interquartile range, 5.4–14.1). The majority of children (82.9%, 34/41) had underlying congenital heart disease, while 39.0% (16/41) had previous heart surgery. </span>Operative mortality was 0.0% (0/16) for repair, 15.4% (2/13) for the Ross procedure, 33.3% (3/9) for homograft root replacement, and 33.3% (1/3) for mechanical replacement. Survival at 10 years was 87.5% for repair, 74.1% for Ross, and 66.7% for homograft (</span></span></span><em>P</em><span> > 0.05). Freedom from reoperation at 10 years was 30.8% for repair, 63.0% for Ross, and 26.3% for homograft (</span><em>P</em> = 0.15 for Ross vs repair, <em>P</em> = 0.002 for Ross vs homograft). Children undergoing surgery for aortic valve IE have acceptable long-term survival, although the need for long-term reintervention is significant. The Ross procedure appears to be the optimal choice when repair is not feasible.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 418-427"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9620453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.semtcvs.2023.05.003
{"title":"Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection","authors":"","doi":"10.1053/j.semtcvs.2023.05.003","DOIUrl":"10.1053/j.semtcvs.2023.05.003","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 396-397"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.semtcvs.2024.10.001
{"title":"Recent Articles in AATS Journals","authors":"","doi":"10.1053/j.semtcvs.2024.10.001","DOIUrl":"10.1053/j.semtcvs.2024.10.001","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages e1-e3"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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