Seminars in Thoracic and Cardiovascular Surgery最新文献

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AATS 2022 Annual Meeting AATS 2022年会。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semtcvs.2023.05.004

引用次数: 0

Discussions in Cardiothoracic Treatment and Care: Implications for the Composite Allocation Score System for Organ Distribution in the United States 心胸治疗和护理的讨论：CAS 系统对美国器官分配的影响。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 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

引用次数: 0

Discussions in Cardiothoracic Treatment and Care: Towards Robust and Trustworthy Coronary Guidelines 心胸治疗与护理讨论：可靠可信的冠心病指南的特点。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 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

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Overly Selective Offer Acceptance is Associated With High Waitlist Mortality for the Most Ill Lung Transplant Candidates 对于病情最严重的肺移植候选者来说，过度选择性接受允诺与较高的候选死亡率有关。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 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.

肺移植（LTx）对器官的需求仍然供不应求。然而，近 75% 的捐献肺从未移植。人们对肺移植的接受方式以及候选者临床敏锐度对等待名单/移植后结果的影响研究不足。UNOS 用于识别 2005 年至 2019 年的所有 LTx 候选人、捐献者和提议。候选者按肺分配评分（LAS；适用于2005年后，年龄≥12岁）分组：LAS80。比较了供体接受模式、等待者死亡/代偿以及移植后存活率（PTS）。"可接受器官供体 "是指器官被接受移植的捐献者。审查了向 34,531 名候选人提供的约 300 万个器官。等待时间的中位数为9天-（LAS>80）、17天-（LAS 61-80）、42天-（LAS 40-60）、125天-（LAS80）、0.7/天-（LAS 61-80）、0.6/天-（LAS 40-60）、0.4/天-（LAS80）、0.32/天-（LAS 61-80），0.24/天-（LAS 40-60），0.15/天-（LAS 80，LAS 61-80 为 88%，LAS 40-60 为 93%，LAS 80 为 96%），24%-（LAS 61-80），5%-（LAS 40-60），0.4）。几乎所有候选人都拒绝了 LTx 候选人收到的第一份录取通知（包括可接受的器官）。较健康的候选者可以承受选择性报价，但病情较重的患者（LAS>60）则无法承受，他们的 30 天等待死亡率极高。

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引用次数: 0

Aortic Valve Surgery in Children With Infective Endocarditis 儿童感染性心内膜炎的主动脉瓣手术治疗

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 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.

关于接受主动脉瓣感染性心内膜炎（IE）手术治疗的儿童的预后数据有限，最佳手术方法仍然存在争议。我们调查了儿童主动脉瓣IE手术的长期结果，特别关注Ross手术。在同一机构对所有接受主动脉瓣IE手术的儿童进行回顾性研究。1989年至2020年间，41名儿童接受了主动脉瓣IE手术，其中16名（39.0%）接受了瓣膜修复，13名（31.7%）接受了Ross手术，9名（21.9%）接受了同种移植物根置换，3名（7.3%）接受了机械瓣膜置换。中位年龄为10.1岁（四分位数范围为5.4-14.1）。绝大多数患儿（82.9%,34/41）有先天性心脏病，39.0%（16/41）既往有心脏手术史。修复手术死亡率为0.0% (0/16)，Ross手术死亡率为15.4%(2/13)，同种移植物根置换术死亡率为33.3%(3/9)，机械置换术死亡率为33.3%（1/3）。修复组的10年生存率为87.5%，Ross组为74.1%，同种移植组为66.7% (P >；0.05)。修复组的10年再手术率为30.8%，Ross组为63.0%，同种移植物组为26.3% （Ross vs修复组P = 0.15， Ross vs同种移植物组P = 0.002）。接受主动脉瓣IE手术的儿童有可接受的长期生存率，尽管长期再干预的必要性是显著的。当修复不可行时，Ross手术似乎是最佳选择。

{"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}

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Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection AATS 2022年会手稿。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semtcvs.2023.05.003

引用次数: 0

Recent Articles in AATS Journals AATS期刊近期文章

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semtcvs.2024.10.001

引用次数: 0

Masthead (copyright and information page) 报头（版权及信息页）

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/S1043-0679(24)00089-3

引用次数: 0

Making the Transition From Cardiac Missions to Autonomous Heart Surgery at a Nigerian Teaching Hospital: Challenges and Lessons Learned 尼日利亚教学医院从心脏任务到自主心脏手术的转变：挑战和经验教训。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semtcvs.2023.05.002

Bode Falase FRCS CTh , Setemi Olufemi FWACS CTh , Funmilayo Ikotun FWACS , Folasade Daniel FMCP , Ariyo Idowu PGCert Perfusion , Reza Khodaverdian MD , Emily Farkas MD

Open-Heart Surgery at the Lagos State University Teaching Hospital commenced in 2004. Early years were based on a Cardiac Mission Model, but since 2017 the focus was on the transition to a Local Team Model with autonomous Open-Heart Surgery. The aim of this study is to describe our progress in making this transition, highlight lessons learned, and detail the outstanding challenges to be overcome. This study is a retrospective analysis of prospectively maintained data from the Lagos State University Teaching Hospital cardiothoracic database and Nigeria Open-Heart Surgery Registry between November 2004 and December 2021. Data extracted included patient demographics, EuroSCORE II, operative procedure, operative category, lead surgeon, complications, and outcomes. Over the study period, 100 operations were done over 2 time periods, 51 operations between 2004 and 2011 (Cardiac Mission Period) and 49 operations between 2017 and 2021 (Transition Period). In the Cardiac Mission Period, 21.6% of the operations were done by the Local Team and in the Transition Period this increased to 85.7% of the operations completed. Overall mortality was 14%, dropping from 17.6% in the Cardiac Mission Period to 10.2% in the Transition Period. The Local Team is now gradually taking on more diverse cases while striving to maintain good outcomes. Our institution has successfully made the transition from Cardiac Missions to Autonomous Open-Heart Surgery without an increase in mortality and a gradual increase in surgical volumes. Lessons learned included a strategy to focus on adult surgery, avoidance of high-risk cases, and moving from free surgery toward an appropriate cost structure for program sustainability. Contributory factors to the successful transition include the active support of the hospital management (provision of appropriate infrastructure and equipment, investment in training of the Local Team), continued humanitarian international collaborations focused on skill transfer, and maintenance of Local Team skills by collaborations with other active cardiac centers in Nigeria. Remaining challenges include financing to bridge equipment gaps, maintenance and replacement of equipment as well as the evolution of a national health insurance schema that would ideally support Open-Heart Surgery for Nigerian patients. Until that time, patients and programs must rely on supplemental funding of surgery to increase surgical volumes.

拉各斯州立大学教学医院的心脏直视手术于2004年开始。早期是基于心脏任务模型，但自2017年以来，重点是向具有自主心脏直视手术的本地团队模型过渡。本研究的目的是描述我们在实现这一转变方面的进展，强调所吸取的教训，并详细说明需要克服的突出挑战。本研究对2004年11月至2021年12月期间拉各斯州立大学教学医院心胸数据库和尼日利亚心脏直视手术注册中心的前瞻性数据进行了回顾性分析。提取的数据包括患者人口统计、EuroSCORE II、手术程序、手术类别、主刀医生、并发症和结果。在研究期间，在2个时间段内进行了100次手术，2004年至2011年（心脏任务期）进行了51次手术，2017年至2021年（过渡期）进行49次手术。在心脏任务期，21.6%的手术由当地团队完成，在过渡期，这一比例增至85.7%。总死亡率为14%，从心脏任务期的17.6%下降到过渡期的10.2%。当地团队现在正在逐步处理更多样化的案件，同时努力保持良好的结果。我们的机构已经成功地从心脏任务过渡到自主心脏直视手术，死亡率没有增加，手术量也没有逐渐增加。经验教训包括专注于成人手术的策略，避免高风险病例，以及从免费手术转向适当的成本结构，以实现项目的可持续性。成功过渡的因素包括医院管理层的积极支持（提供适当的基础设施和设备，投资培训当地团队），持续的以技能转移为重点的人道主义国际合作，以及通过与尼日利亚其他活跃的心脏病中心合作来保持当地团队的技能。剩余的挑战包括弥补设备缺口的资金、设备的维护和更换，以及国家医疗保险计划的发展，该计划将理想地支持尼日利亚患者的心脏直视手术。在此之前，患者和项目必须依靠手术的补充资金来增加手术量。

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Lung Transplantation for COVID-19 Acute Respiratory Distress Syndrome: The British Columbian Experience With New Disease Pathology 肺移植治疗 COVID-19 急性呼吸窘迫综合征：不列颠哥伦比亚省的新病理经验。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.semtcvs.2022.12.004

Roy Avraham Hilzenrat MD, MHSc , John C. English MD , Anna McGuire MD, MSc , Gordon Finlayson MD , James Choi MD, MPH , John Yee MD

Lung transplantation is a life-saving treatment for patients with end-stage lung disease. COVID-19 has been associated with a severe and rapid decline in pulmonary function, in which case lung transplantation has been described to be effective. We herein describe 9 patients who underwent lung transplantation for COVID-19 acute respiratory distress syndrome, of whom 6 were bridged with extracorporeal membrane oxygenation (ECMO). The median time of pre-operative observation periods was 54 days to ensure no lung function recovery and the time to wean off extracorporeal membrane oxygenation was 3 days. Patients had comparable short-term survival outcomes to non-COVID-19 lung transplant recipients at our institution during the same time period. Lung transplantation for COVID-19-associated lung disease is feasible with comparable short-term outcomes and may liberate patients from extracorporeal supports.

肺移植是挽救终末期肺病患者生命的一种治疗方法。COVID-19 与肺功能严重急剧下降有关，在这种情况下，肺移植被认为是有效的。我们在本文中描述了 9 名因 COVID-19 急性呼吸窘迫综合征而接受肺移植的患者，其中 6 人接受了体外膜肺氧合（ECMO）。为确保肺功能不恢复，术前观察期的中位时间为 54 天，脱离体外膜氧合的时间为 3 天。在同一时期，患者的短期生存结果与本院非 COVID-19 肺移植受者相当。COVID-19相关肺病的肺移植手术是可行的，短期疗效相当，而且可以让患者摆脱体外支持。

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