Pub Date : 2025-05-19DOI: 10.1053/j.semtcvs.2025.05.003
Rajika Jindani, Kyle G Mitchell, Mara B Antonoff
Oligometastatic non-small cell lung cancer (NSCLC) constitutes a distinct form of disease with limited metastatic burden, which may benefit in terms of disease control and overall survival from local consolidative therapy (LCT). Pulmonary resection has emerged as a valuable component of LCT, demonstrating improvements in progression-free and overall survival for appropriately selected patients. This review examines the evolving role of surgery in the management of oligometastatic NSCLC, emphasizing survival benefits, biological rationale, surgical complexities, disparities in care, and ongoing trials. Emerging research integrating biomarkers, novel pharmacotherapy, and advanced surgical techniques offers new opportunities to refine patient selection and improve outcomes. Addressing barriers and advancing multidisciplinary approaches will be critical to fully realize the benefits of surgery in this context.
{"title":"The Role of Surgery for Local Consolidative Therapy in the Management of Oligometastatic Disease.","authors":"Rajika Jindani, Kyle G Mitchell, Mara B Antonoff","doi":"10.1053/j.semtcvs.2025.05.003","DOIUrl":"10.1053/j.semtcvs.2025.05.003","url":null,"abstract":"<p><p>Oligometastatic non-small cell lung cancer (NSCLC) constitutes a distinct form of disease with limited metastatic burden, which may benefit in terms of disease control and overall survival from local consolidative therapy (LCT). Pulmonary resection has emerged as a valuable component of LCT, demonstrating improvements in progression-free and overall survival for appropriately selected patients. This review examines the evolving role of surgery in the management of oligometastatic NSCLC, emphasizing survival benefits, biological rationale, surgical complexities, disparities in care, and ongoing trials. Emerging research integrating biomarkers, novel pharmacotherapy, and advanced surgical techniques offers new opportunities to refine patient selection and improve outcomes. Addressing barriers and advancing multidisciplinary approaches will be critical to fully realize the benefits of surgery in this context.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121099","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 : 2025-05-19DOI: 10.1053/j.semtcvs.2025.04.008
Syed M. Ali Hassan MD , Shubh K. Patel , Miriam S. Badross , Nitish K. Dhingra MD , Raj Verma , Meena Verma , Ryuta Seguchi MD, PhD , Bobby Yanagawa MD, PhD , Jessica Spence MD, PhD , C. David Mazer MD , Ahmad Alli MD, Mmed , Subodh Verma MD, PhD , Rakesh C. Arora MD, PhD
This review examines the prevention and management of postoperative delirium in cardiac surgery patients, a frequent complication linked with significant mortality, morbidity, prolonged hospitalization, and cognitive decline. The aim was to consolidate current evidence on postoperative delirium pathophysiology, risk factors, diagnostic approaches, and pharmacologic and non-pharmacologic interventions. A PubMed/MEDLINE database review was conducted through October 2024, identifying studies that evaluated the relationship between cardiac surgery and the occurrence of postoperative delirium. The pathogenesis of postoperative delirium is complex, involving neuroinflammation, neurotransmitter imbalance, and endothelial dysfunction, compounded by baseline vulnerabilities and perioperative stressors. Early screening using tools like the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) aid in timely detection. Prevention emphasizes non-pharmacologic interventions, such as the Hospital Elder Life Program and the ABCDEF bundle, alongside pharmacologic strategies to minimize high-risk sedatives. Emerging technologies, including intraoperative neurophysiologic monitoring modalities and machine learning models, enhance postoperative delirium risk assessment and enable targeted interventions. Effective postoperative delirium management in cardiac surgery requires a balanced approach incorporating non-pharmacologic and pharmacologic methods. Integration of evidence-based practices and innovative technologies into routine care holds promise for improving patient outcomes. Ongoing research is essential to optimize postoperative delirium management and standardize practices in high-risk populations.
{"title":"Contemporary Prevention and Management of Postoperative Delirium in Cardiac Surgery Patients","authors":"Syed M. Ali Hassan MD , Shubh K. Patel , Miriam S. Badross , Nitish K. Dhingra MD , Raj Verma , Meena Verma , Ryuta Seguchi MD, PhD , Bobby Yanagawa MD, PhD , Jessica Spence MD, PhD , C. David Mazer MD , Ahmad Alli MD, Mmed , Subodh Verma MD, PhD , Rakesh C. Arora MD, PhD","doi":"10.1053/j.semtcvs.2025.04.008","DOIUrl":"10.1053/j.semtcvs.2025.04.008","url":null,"abstract":"<div><div><span>This review examines the prevention and management of postoperative delirium<span><span> in cardiac surgery patients, a frequent complication linked with significant mortality, morbidity, prolonged hospitalization, and cognitive decline. The aim was to consolidate current evidence on postoperative delirium </span>pathophysiology, risk factors, </span></span>diagnostic<span><span> approaches, and pharmacologic and non-pharmacologic interventions. A PubMed/MEDLINE database review was conducted through October 2024, identifying studies that evaluated the relationship between cardiac surgery and the occurrence of postoperative delirium. The pathogenesis of postoperative delirium is complex, involving </span>neuroinflammation<span><span><span>, neurotransmitter imbalance, and </span>endothelial dysfunction<span>, compounded by baseline vulnerabilities and perioperative stressors. Early screening using tools like the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and </span></span>Intensive Care Delirium<span> Screening Checklist<span> (ICDSC) aid in timely detection. Prevention emphasizes non-pharmacologic interventions, such as the Hospital Elder Life Program and the ABCDEF bundle, alongside pharmacologic strategies to minimize high-risk sedatives. Emerging technologies, including intraoperative neurophysiologic monitoring modalities and machine learning models, enhance postoperative delirium risk assessment and enable targeted interventions. Effective postoperative delirium management in cardiac surgery requires a balanced approach incorporating non-pharmacologic and pharmacologic methods. Integration of evidence-based practices and innovative technologies into routine care holds promise for improving patient outcomes. Ongoing research is essential to optimize postoperative delirium management and standardize practices in high-risk populations.</span></span></span></span></div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 3","pages":"Pages 263-274.e3"},"PeriodicalIF":2.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121095","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 : 2025-04-23DOI: 10.1053/j.semtcvs.2025.04.006
Joon Chul Jung, Kay-Hyun Park
{"title":"Approach to Intramural Hematoma in South Korea.","authors":"Joon Chul Jung, Kay-Hyun Park","doi":"10.1053/j.semtcvs.2025.04.006","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.04.006","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991635","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 : 2025-04-23DOI: 10.1053/j.semtcvs.2025.04.004
Caitlin T. Demarest MD, PhD , Anil J. Trindade MD
{"title":"Debate: Implications for the Continuous Allocation System for Organ Distribution in the United States: Challenges and Controversies - CON","authors":"Caitlin T. Demarest MD, PhD , Anil J. Trindade MD","doi":"10.1053/j.semtcvs.2025.04.004","DOIUrl":"10.1053/j.semtcvs.2025.04.004","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 3","pages":"Pages 345-349"},"PeriodicalIF":2.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053384","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 : 2025-04-23DOI: 10.1053/j.semtcvs.2025.04.005
Lise N Tchouta, Lucy Nam, David A D'Alessandro
{"title":"Looking to the Right Ventricle After Heart Transplantation: Invited Expert Opinion.","authors":"Lise N Tchouta, Lucy Nam, David A D'Alessandro","doi":"10.1053/j.semtcvs.2025.04.005","DOIUrl":"10.1053/j.semtcvs.2025.04.005","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053544","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 : 2025-04-21DOI: 10.1053/j.semtcvs.2025.03.008
Anna K Gergen, Thomas Brett Reece
{"title":"Commentary: The Root of the Argument Is Are We Even Arguing About the Root?","authors":"Anna K Gergen, Thomas Brett Reece","doi":"10.1053/j.semtcvs.2025.03.008","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.03.008","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051339","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 : 2025-04-21DOI: 10.1053/j.semtcvs.2025.04.003
Tsuyoshi Kaneko, Thierry Carrel
{"title":"Commentary: Commando Operation - For the \"Elite\".","authors":"Tsuyoshi Kaneko, Thierry Carrel","doi":"10.1053/j.semtcvs.2025.04.003","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.04.003","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057748","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 : 2025-04-20DOI: 10.1053/j.semtcvs.2025.03.009
Giulio Folino, Raffaele Scaffa, Andrea Salica, Mario Torre, Ruggero De Paulis
{"title":"The Anatomy and Physiology of Aortic Root Repair.","authors":"Giulio Folino, Raffaele Scaffa, Andrea Salica, Mario Torre, Ruggero De Paulis","doi":"10.1053/j.semtcvs.2025.03.009","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.03.009","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035166","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 : 2025-04-18DOI: 10.1053/j.semtcvs.2025.04.002
Travis J Miles, Kyle W Blackburn, Marc R Moon, Subhasis Chatterjee
Low cardiac output syndrome (LCOS), a form of cardiogenic shock that occurs after cardiac surgery, is associated with an elevated risk of morbidity and mortality. Generally, LCOS is managed medically with inotropes and vasopressors to optimize hemodynamics. However, randomized data comparing the efficacy of individual inotropes in treating LCOS are limited. Consequently, there is little consensus regarding the optimal inotrope strategy, and practice patterns vary widely. This review synthesizes current evidence on pharmacologic, non-mechanical circulatory support strategies for managing LCOS, advocating for a personalized approach tailored to the individual patient's hemodynamic profile and inotropic requirements. Currently available vasoactive agents are discussed, and guidance is provided on their use across specific clinical contexts to support individualized treatment.
{"title":"Optimal Inotropic Support Strategy in Low Cardiac Output Syndrome.","authors":"Travis J Miles, Kyle W Blackburn, Marc R Moon, Subhasis Chatterjee","doi":"10.1053/j.semtcvs.2025.04.002","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.04.002","url":null,"abstract":"<p><p>Low cardiac output syndrome (LCOS), a form of cardiogenic shock that occurs after cardiac surgery, is associated with an elevated risk of morbidity and mortality. Generally, LCOS is managed medically with inotropes and vasopressors to optimize hemodynamics. However, randomized data comparing the efficacy of individual inotropes in treating LCOS are limited. Consequently, there is little consensus regarding the optimal inotrope strategy, and practice patterns vary widely. This review synthesizes current evidence on pharmacologic, non-mechanical circulatory support strategies for managing LCOS, advocating for a personalized approach tailored to the individual patient's hemodynamic profile and inotropic requirements. Currently available vasoactive agents are discussed, and guidance is provided on their use across specific clinical contexts to support individualized treatment.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057749","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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