首页 > 最新文献

Journal of Thoracic and Cardiovascular Surgery最新文献

英文 中文
Discussion to: Valve-sparing aortic root replacement-for all patients? 讨论:所有患者都可以进行保留瓣膜的主动脉根部置换术?
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-11-04 DOI: 10.1016/j.jtcvs.2023.10.014
{"title":"Discussion to: Valve-sparing aortic root replacement-for all patients?","authors":"","doi":"10.1016/j.jtcvs.2023.10.014","DOIUrl":"10.1016/j.jtcvs.2023.10.014","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lung Transplantation After Ex Vivo Lung Perfusion in High-Risk Recipients: A Propensity Matched Analysis of a National Database. 高风险受者体内肺灌注后的肺移植:全国数据库倾向匹配分析》。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.10.041
Ernest G Chan, Rachel L Deitz, Jack K Donohue, John P Ryan, Yota Suzuki, Masashi Furukawa, Kentaro Noda, Pablo G Sanchez

Purpose: We report outcomes associated with EVLP lungs in high-risk lung transplant recipients utilizing a national database.

Methods: We performed a retrospective analysis of the UNOS Database (1/1/2018-3/31/2024). High-risk status was defined as mean pulmonary arterial pressure > 35 mmHg, lung retransplantation, or bridge to transplant. In addition to univariable analysis, propensity score matched analysis was performed on predictors of donor and recipient characteristics.

Results: Risk of dying on the waitlist was significantly higher for high-risk candidates (HR: 1.69 [1.51 - 1.89], p < 0.001). Following matching, 203 EVLP cases were matched to 609 standard procurement recipients. The EVLP group was associated with higher rates of postoperative acute kidney injury requiring renal replacement therapy (27% vs 16%, p < 0.001), higher mortality on index admission (13% vs. 8%, p = 0.04), and longer length of stay (29 vs 25 days, p = 0.006). EVLP modality was associated with survival time (p < 0.001) with portable EVLP having significantly shorter survival (2.7 years) relative to standard cases (4.7 years, p < 0.02). A subgroup analysis found that this survival effect was limited to bridge and retransplant recipients.

Conclusions: EVLP lungs were associated with higher rates of postoperative AKI and portable EVLP was associated with shorter survival in high-risk lung transplant recipients. However, given the high waitlist mortality in this candidate population, EVLP lungs should still be considered an alternative.

目的:我们利用国家数据库报告了高风险肺移植受者EVLP肺的相关结果:我们对 UNOS 数据库(1/1/2018-3/31/2024)进行了回顾性分析。高风险状态定义为平均肺动脉压> 35 mmHg、肺再移植或移植桥。除了单变量分析外,还对供体和受体特征的预测因素进行了倾向得分匹配分析:结果:高风险候选者在等待名单上死亡的风险明显更高(HR:1.69 [1.51 - 1.89],P < 0.001)。经过配对,203 个 EVLP 病例与 609 个标准接受者进行了配对。EVLP组需要肾脏替代治疗的术后急性肾损伤发生率较高(27% vs. 16%,p < 0.001),入院时死亡率较高(13% vs. 8%,p = 0.04),住院时间较长(29天 vs. 25天,p = 0.006)。EVLP模式与存活时间相关(p < 0.001),便携式EVLP的存活时间(2.7年)明显短于标准病例(4.7年,p < 0.02)。亚组分析发现,这种存活率影响仅限于桥接和再移植受者:结论:EVLP肺与较高的术后AKI发生率有关,便携式EVLP与高风险肺移植受者较短的生存期有关。然而,考虑到这一候选人群的高等待死亡率,EVLP肺仍应被视为一种替代方案。
{"title":"Lung Transplantation After Ex Vivo Lung Perfusion in High-Risk Recipients: A Propensity Matched Analysis of a National Database.","authors":"Ernest G Chan, Rachel L Deitz, Jack K Donohue, John P Ryan, Yota Suzuki, Masashi Furukawa, Kentaro Noda, Pablo G Sanchez","doi":"10.1016/j.jtcvs.2024.10.041","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.041","url":null,"abstract":"<p><strong>Purpose: </strong>We report outcomes associated with EVLP lungs in high-risk lung transplant recipients utilizing a national database.</p><p><strong>Methods: </strong>We performed a retrospective analysis of the UNOS Database (1/1/2018-3/31/2024). High-risk status was defined as mean pulmonary arterial pressure > 35 mmHg, lung retransplantation, or bridge to transplant. In addition to univariable analysis, propensity score matched analysis was performed on predictors of donor and recipient characteristics.</p><p><strong>Results: </strong>Risk of dying on the waitlist was significantly higher for high-risk candidates (HR: 1.69 [1.51 - 1.89], p < 0.001). Following matching, 203 EVLP cases were matched to 609 standard procurement recipients. The EVLP group was associated with higher rates of postoperative acute kidney injury requiring renal replacement therapy (27% vs 16%, p < 0.001), higher mortality on index admission (13% vs. 8%, p = 0.04), and longer length of stay (29 vs 25 days, p = 0.006). EVLP modality was associated with survival time (p < 0.001) with portable EVLP having significantly shorter survival (2.7 years) relative to standard cases (4.7 years, p < 0.02). A subgroup analysis found that this survival effect was limited to bridge and retransplant recipients.</p><p><strong>Conclusions: </strong>EVLP lungs were associated with higher rates of postoperative AKI and portable EVLP was associated with shorter survival in high-risk lung transplant recipients. However, given the high waitlist mortality in this candidate population, EVLP lungs should still be considered an alternative.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Valve-sparing aortic root replacement-for all patients? 所有患者均采用保留瓣膜的主动脉根部置换术?
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-09-09 DOI: 10.1016/j.jtcvs.2023.08.055
Tristan Ehrlich, Karen B Abeln, Lennart Froede, Christian Burgard, Christian Giebels, Hans-Joachim Schäfers

Background: Valve-sparing root replacement (VSRR) has been associated with good survival and low rates of valve-related complications (VRCs). Whether these advantages are present irrespective of patient comorbidity or age is unclear. The aim of this study was to analyze survival and frequency of VRCs in relation to patient comorbidity and age.

Methods: Between October 1995 and December 2021, 1156 patients with a bicuspid or tricuspid aortic valve were treated by root remodeling. The mean patient age was 53.3 ± 14 years, and 973 (84%) were male. The mean duration of follow-up was 6.7 ± 5.5 years (median, 5.9 years), and follow-up was 95% complete (7746 patient-years). We analyzed the population according to comorbidity and age at surgery. A discriminating cutoff for the effect of age was determined using receiver operating characteristic curve (ROC) analysis.

Results: Mean survival at 15 years was 74.7 ± 2.5%. Deceased patients were older (mean, 65.3 ± 12 years vs 51.6 ± 14.1 years; P < .001) at the time of surgery and had more comorbidities (coronary artery disease [CAD], 28.4% vs 9.8%; P < .001). The sole significant adjusted predictor was age (P < .001). By ROC analysis (area under the curve, 0.780), the optimal cutoff for age was 61 years. Survival was 87.1 ± 2.8% at 15 years in patients age <61 years, compared to 55.3 ± 4.3% in patients age >61 years (P < .0001). Using competing risk analysis, VRC-free survival at 15 years was 66.8% at 15 years, including 76.7% in patients age <61 years and 52.4% in those age >61 years (P < .0001).

Conclusions: VSRR is associated with a low incidence of VRC and excellent durability. Survival is decreased in the presence of comorbidities, mainly CAD, and patient age >61 years. Despite lower survival, freedom from VRC is good.

背景:保留瓣膜根部置换术(VSRR)具有良好的生存率和较低的瓣膜相关并发症(VRCs)发生率。无论患者合并症或年龄如何,这些优势是否存在尚不清楚。本研究的目的是分析VRCs的生存率和频率与患者共病和年龄的关系。方法:1995年10月至2021年12月,1156例二尖瓣或三尖瓣主动脉瓣患者接受了根部重建治疗。患者平均年龄为53.3±14岁,男性973例(84%)。平均随访时间为6.7±5.5年(中位数5.9年),随访完成率为95%(7746患者年)。我们根据合并症和手术年龄对人群进行了分析。使用受试者工作特性曲线(ROC)分析确定年龄影响的判别临界值。结果:15年的平均生存率为74.7±2.5%。死亡患者年龄较大(平均65.3±12岁vs 51.6±14.1岁;P 61岁(P 61岁(P结论:VSRR与VRC的发生率低和良好的耐久性有关。存在合并症(主要是CAD)和患者年龄>61岁时,生存率会降低。尽管生存率较低,但无VRC是好的。
{"title":"Valve-sparing aortic root replacement-for all patients?","authors":"Tristan Ehrlich, Karen B Abeln, Lennart Froede, Christian Burgard, Christian Giebels, Hans-Joachim Schäfers","doi":"10.1016/j.jtcvs.2023.08.055","DOIUrl":"10.1016/j.jtcvs.2023.08.055","url":null,"abstract":"<p><strong>Background: </strong>Valve-sparing root replacement (VSRR) has been associated with good survival and low rates of valve-related complications (VRCs). Whether these advantages are present irrespective of patient comorbidity or age is unclear. The aim of this study was to analyze survival and frequency of VRCs in relation to patient comorbidity and age.</p><p><strong>Methods: </strong>Between October 1995 and December 2021, 1156 patients with a bicuspid or tricuspid aortic valve were treated by root remodeling. The mean patient age was 53.3 ± 14 years, and 973 (84%) were male. The mean duration of follow-up was 6.7 ± 5.5 years (median, 5.9 years), and follow-up was 95% complete (7746 patient-years). We analyzed the population according to comorbidity and age at surgery. A discriminating cutoff for the effect of age was determined using receiver operating characteristic curve (ROC) analysis.</p><p><strong>Results: </strong>Mean survival at 15 years was 74.7 ± 2.5%. Deceased patients were older (mean, 65.3 ± 12 years vs 51.6 ± 14.1 years; P < .001) at the time of surgery and had more comorbidities (coronary artery disease [CAD], 28.4% vs 9.8%; P < .001). The sole significant adjusted predictor was age (P < .001). By ROC analysis (area under the curve, 0.780), the optimal cutoff for age was 61 years. Survival was 87.1 ± 2.8% at 15 years in patients age <61 years, compared to 55.3 ± 4.3% in patients age >61 years (P < .0001). Using competing risk analysis, VRC-free survival at 15 years was 66.8% at 15 years, including 76.7% in patients age <61 years and 52.4% in those age >61 years (P < .0001).</p><p><strong>Conclusions: </strong>VSRR is associated with a low incidence of VRC and excellent durability. Survival is decreased in the presence of comorbidities, mainly CAD, and patient age >61 years. Despite lower survival, freedom from VRC is good.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10203618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Percent predicted peak oxygen uptake is superior to weight-indexed peak oxygen uptake in risk stratification before lung cancer lobectomy. 在肺癌肺叶切除术前的风险分层中,预测峰值摄氧量百分比优于体重指数峰值摄氧量百分比。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-03-05 DOI: 10.1016/j.jtcvs.2024.02.021
Karolina Kristenson, Kristofer Hedman

Objective: To improve preoperative risk stratification in lung cancer lobectomy by identifying and comparing optimal thresholds for peak oxygen uptake (VO2peak) presented as weight-indexed and percent of predicted values, respectively.

Methods: This was a longitudinal cohort study including national registry data on patients scheduled for cancer lobectomy that used available data from preoperative cardiopulmonary exercise testing. The measured VO2peak was indexed by body mass (mL/kg/min) and also compared with 2 established reference equations (Wasserman-Hansen and Study of Health in Pomerania, respectively). By receiver operating characteristic analysis, a lower 90% specificity and an upper 90% sensitivity threshold were determined for each measure, in relation to the outcome of any major complication or death. For each measure and based on these thresholds, patients were categorized as low risk, intermediate risk, or high risk. The frequency of complications was compared between groups using χ2.

Results: The frequency of complications differed significantly between the proposed low-, intermediate-, and high-risk groups when using % predicted Study of Health in Pomerania (5%, 21%, 35%, P = .007) or % predicted Wasserman-Hansen (5%, 25%, 35%, P = .002) but not when using the weight-indexed VO2peak groups (7%, 23%, 15%, P = .08). Nonsignificant differences were found using the threshold <15 mL/kg/min (P = .34).

Conclusions: This study showed that weight-indexed VO2peak was of less use as a marker of risk at the lower range of exercise capacity, whereas % predicted VO2peak was associated with a continuously increasing risk of major complications, also at the lower end of exercise capacity. As identifying subjects at high risk of complications is important, % predicted VO2peak is therefore preferable.

目的通过识别和比较分别以体重指数值和预测值百分比表示的摄氧量峰值(VO2peak)的最佳阈值,改进肺癌肺叶切除术的术前风险分层:方法:纵向队列研究,包括国家登记数据,针对计划进行肺叶切除术的患者,使用术前心肺运动测试的可用数据。测得的 VO2 峰值以体重(毫升/千克/分钟)为指标,并与两个既定参考方程(分别为 Wasserman-Hansen 和 SHIP-study)进行比较。通过接收器操作特性分析,确定了每种测量方法与任何重大并发症或死亡结果相关的 90% 灵敏度下限和 90% 特异性上限。根据这些阈值,每项指标都将患者分为低风险、中风险和高风险。采用 Chi2 方法比较各组间并发症的发生频率:在使用 SHIP 预测百分比(5%、21%、35%,P=0.007)或 Wasserman-Hansen 预测百分比(5%、25%、35%,P=0.002)时,拟议的低、中、高风险组之间的并发症发生率存在显著差异,但在使用体重指数 VO2peak 组时,并发症发生率没有显著差异(7%、23%、15%,P=0.08)。使用阈值时发现差异不显著:这项研究表明,在运动能力较低的情况下,体重指数 VO2peak 作为风险指标的作用较小,而预测 VO2peak 百分比与主要并发症风险的持续增加有关,同样在运动能力较低的情况下也是如此。由于识别并发症高风险受试者非常重要,因此预测 VO2peak 百分比更为可取。
{"title":"Percent predicted peak oxygen uptake is superior to weight-indexed peak oxygen uptake in risk stratification before lung cancer lobectomy.","authors":"Karolina Kristenson, Kristofer Hedman","doi":"10.1016/j.jtcvs.2024.02.021","DOIUrl":"10.1016/j.jtcvs.2024.02.021","url":null,"abstract":"<p><strong>Objective: </strong>To improve preoperative risk stratification in lung cancer lobectomy by identifying and comparing optimal thresholds for peak oxygen uptake (VO<sub>2peak</sub>) presented as weight-indexed and percent of predicted values, respectively.</p><p><strong>Methods: </strong>This was a longitudinal cohort study including national registry data on patients scheduled for cancer lobectomy that used available data from preoperative cardiopulmonary exercise testing. The measured VO<sub>2peak</sub> was indexed by body mass (mL/kg/min) and also compared with 2 established reference equations (Wasserman-Hansen and Study of Health in Pomerania, respectively). By receiver operating characteristic analysis, a lower 90% specificity and an upper 90% sensitivity threshold were determined for each measure, in relation to the outcome of any major complication or death. For each measure and based on these thresholds, patients were categorized as low risk, intermediate risk, or high risk. The frequency of complications was compared between groups using χ<sup>2</sup>.</p><p><strong>Results: </strong>The frequency of complications differed significantly between the proposed low-, intermediate-, and high-risk groups when using % predicted Study of Health in Pomerania (5%, 21%, 35%, P = .007) or % predicted Wasserman-Hansen (5%, 25%, 35%, P = .002) but not when using the weight-indexed VO<sub>2peak</sub> groups (7%, 23%, 15%, P = .08). Nonsignificant differences were found using the threshold <15 mL/kg/min (P = .34).</p><p><strong>Conclusions: </strong>This study showed that weight-indexed VO<sub>2peak</sub> was of less use as a marker of risk at the lower range of exercise capacity, whereas % predicted VO<sub>2peak</sub> was associated with a continuously increasing risk of major complications, also at the lower end of exercise capacity. As identifying subjects at high risk of complications is important, % predicted VO<sub>2peak</sub> is therefore preferable.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of thoracic endovascular aortic repair following blunt traumatic thoracic aortic injury on blood pressure. 钝性创伤性胸主动脉损伤后胸腔内血管主动脉修补术对血压的影响。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-07-23 DOI: 10.1016/j.jtcvs.2023.07.018
Andrea Guala, Daniel Gil-Sala, Marvin E Garcia Reyes, Maria A Azancot, Lydia Dux-Santoy, Nicolas Allegue Allegue, Gisela Teixido-Turà, Gabriela Goncalves Martins, Laura Galian-Gay, Juan Garrido-Oliver, Ivan Constenla García, Arturo Evangelista, Cristina Tello Díaz, Alejandro Carrasco-Poves, Alberto Morales-Galán, Ignacio Ferreira-González, Jose Rodríguez-Palomares, Sergi Bellmunt Montoya

Background: Blunt traumatic thoracic aortic injuries (BTAIs) are associated with a high mortality rate. Thoracic endovascular aortic repair (TEVAR) is the most frequently used surgical strategy in patients with BTAI, as it offers good short- and middle-term results. Previous studies have reported an abnormally high prevalence of hypertension (HT) in these patients. This work aimed to describe the long-term prevalence of HT and provide a comprehensive evaluation of the biomechanical, clinical, and functional factors involved in HT development.

Methods: Twenty-six patients treated with TEVAR following BTAI with no history of HT at the time of trauma were enrolled. They were matched with 37 healthy volunteers based on age, sex, and body surface area and underwent a comprehensive follow-up study, including cardiovascular magnetic resonance, 24-hour ambulatory blood pressure monitoring, and assessment of carotid-femoral pulse wave velocity (cfPWV, a measure of aortic stiffness) and flow-mediated vasodilation.

Results: The mean patient age was 43.5 ± 12.9 years, and the majority were male (23 of 26; 88.5%). At a mean of 120.2 ± 69.7 months after intervention, 17 patients (65%) presented with HT, 14 (54%) had abnormal nighttime blood pressure dipping, and 6 (23%) high cfPWV. New-onset HT was related to a more proximal TEVAR landing zone and greater distal oversizing. Abnormal nighttime blood pressure was related to high cfPWV, which in turn was associated with TEVAR length and premature arterial aging.

Conclusions: HT frequently occurs otherwise healthy subjects undergoing TEVAR implantation after BTAI. TEVAR stiffness and length, the proximal landing zone, and distal oversizing are potentially modifiable surgical characteristics related to abnormal blood pressure.

背景:钝性创伤性胸主动脉损伤(BTAI)死亡率很高。胸腔内血管主动脉修复术(TEVAR)是胸主动脉损伤患者最常用的手术策略,因为它能提供良好的短期和中期效果。以往的研究报告显示,这些患者的高血压(HT)发病率异常高。本研究旨在描述高血压的长期发病率,并对高血压发生所涉及的生物力学、临床和功能因素进行全面评估:方法:纳入了 26 例在 BTAI 后接受 TEVAR 治疗的患者,这些患者在创伤时没有 HT 病史。他们与 37 名健康志愿者根据年龄、性别和体表面积进行了配对,并接受了全面的随访研究,包括心血管磁共振、24 小时非卧床血压监测以及颈动脉-股动脉脉搏波速度(cfPWV,主动脉僵硬度的测量指标)和血流介导的血管舒张评估:患者平均年龄为(43.5 ± 12.9)岁,大多数为男性(26 人中有 23 名男性,占 88.5%)。干预后平均 120.2 ± 69.7 个月,17 名患者(65%)出现高血压,14 名患者(54%)夜间血压下降异常,6 名患者(23%)cfPWV 偏高。新发 HT 与更近端 TEVAR 着床区和更远端尺寸过大有关。夜间血压异常与高cfPWV有关,而高cfPWV又与TEVAR长度和动脉过早老化有关:结论:高血压经常发生在BTAI后接受TEVAR植入术的健康受试者身上。TEVAR的硬度和长度、近端着陆区和远端过大都是与血压异常相关的潜在可修正手术特征。
{"title":"Impact of thoracic endovascular aortic repair following blunt traumatic thoracic aortic injury on blood pressure.","authors":"Andrea Guala, Daniel Gil-Sala, Marvin E Garcia Reyes, Maria A Azancot, Lydia Dux-Santoy, Nicolas Allegue Allegue, Gisela Teixido-Turà, Gabriela Goncalves Martins, Laura Galian-Gay, Juan Garrido-Oliver, Ivan Constenla García, Arturo Evangelista, Cristina Tello Díaz, Alejandro Carrasco-Poves, Alberto Morales-Galán, Ignacio Ferreira-González, Jose Rodríguez-Palomares, Sergi Bellmunt Montoya","doi":"10.1016/j.jtcvs.2023.07.018","DOIUrl":"10.1016/j.jtcvs.2023.07.018","url":null,"abstract":"<p><strong>Background: </strong>Blunt traumatic thoracic aortic injuries (BTAIs) are associated with a high mortality rate. Thoracic endovascular aortic repair (TEVAR) is the most frequently used surgical strategy in patients with BTAI, as it offers good short- and middle-term results. Previous studies have reported an abnormally high prevalence of hypertension (HT) in these patients. This work aimed to describe the long-term prevalence of HT and provide a comprehensive evaluation of the biomechanical, clinical, and functional factors involved in HT development.</p><p><strong>Methods: </strong>Twenty-six patients treated with TEVAR following BTAI with no history of HT at the time of trauma were enrolled. They were matched with 37 healthy volunteers based on age, sex, and body surface area and underwent a comprehensive follow-up study, including cardiovascular magnetic resonance, 24-hour ambulatory blood pressure monitoring, and assessment of carotid-femoral pulse wave velocity (cfPWV, a measure of aortic stiffness) and flow-mediated vasodilation.</p><p><strong>Results: </strong>The mean patient age was 43.5 ± 12.9 years, and the majority were male (23 of 26; 88.5%). At a mean of 120.2 ± 69.7 months after intervention, 17 patients (65%) presented with HT, 14 (54%) had abnormal nighttime blood pressure dipping, and 6 (23%) high cfPWV. New-onset HT was related to a more proximal TEVAR landing zone and greater distal oversizing. Abnormal nighttime blood pressure was related to high cfPWV, which in turn was associated with TEVAR length and premature arterial aging.</p><p><strong>Conclusions: </strong>HT frequently occurs otherwise healthy subjects undergoing TEVAR implantation after BTAI. TEVAR stiffness and length, the proximal landing zone, and distal oversizing are potentially modifiable surgical characteristics related to abnormal blood pressure.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10045746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
New perspectives on tracheal resection for COVID-19-related stenosis: A propensity score matching analysis. 气管切除治疗 COVID-19 相关狭窄的新视角:倾向得分匹配分析。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-03-30 DOI: 10.1016/j.jtcvs.2024.03.028
Cecilia Menna, Silvia Fiorelli, Beatrice Trabalza Marinucci, Domenico Massullo, Antonio D'Andrilli, Anna Maria Ciccone, Claudio Andreetti, Giulio Maurizi, Camilla Vanni, Alessandra Siciliani, Matteo Tiracorrendo, Massimiliano Mancini, Federico Venuta, Erino Angelo Rendina, Mohsen Ibrahim

Objective: The large number of patients with COVID-19 subjected to prolonged invasive mechanical ventilation has been expected to result in a significant increase in tracheal stenosis in the next years. The aim of this study was to evaluate and compare postoperative outcomes of patients who survived COVID-19 critical illness and underwent tracheal resection for postintubation/posttracheostomy tracheal stenosis with those of non-COVID-19 patients.

Methods: It was single-center, retrospective study. All consecutive patients with post-intubation/posttracheostomy tracheal stenosis who underwent tracheal resection from February 2020 to March 2022 were enrolled. A total of 147 tracheal resections were performed: 24 were in post-COVID-19 patients and 123 were in non-COVID-19 patients. A 1:1 propensity score matching analysis was performed, considering age, gender, body mass index, and length of stenosis. After matching, 2 groups of 24 patients each were identified: a post-COVID-19 group and a non-COVID group.

Results: No mortality after surgery was registered. Posttracheostomy etiology of stenosis resulted more frequently in post-COVID-19 patients (n = 20 in the post-COVID-19 group vs n = 11 in the non-COVID-19 group; P = .03), as well as intensive care unit admissions during the postoperative period (16 vs 9 patients; P = .04). Need for postoperative reintubation for glottic edema and respiratory failure was higher in the post-COVID-19 group (7 vs 2 postoperative reintubation procedures; P = .04). Postoperative dysphonia was observed in 11 (46%) patients in the post-COVID-19 group versus 4 (16%) patients in the non-COVID-19 group (P = .03).

Conclusions: Tracheal resection continues to be safe and effective in COVID-19-related tracheal stenosis scenarios. Intensive care unit admission rates and postoperative complications seem to be higher in post-COVID-19 patients who underwent tracheal resection compared with non-COVID-19 patients.

目的:大量 COVID-19 危重症患者长期接受有创机械通气,预计未来几年气管狭窄患者将大幅增加。本研究旨在评估和比较因插管后/气管造口术后气管狭窄而接受气管切除术的 COVID-19 危重症存活患者与非 COVID 患者的术后效果:这是一项单中心回顾性研究。方法:这是一项单中心回顾性研究,纳入了所有在 2020 年 2 月至 2022 年 3 月期间接受气管切除术的插管后/气管造口术后气管狭窄患者。共进行了 N=147 例气管切除术:N=24 例为后 COVID 患者,N=123 例为非 COVID 患者。考虑到年龄、性别、BMI(体重指数)和狭窄长度,进行了 1:1 倾向评分匹配分析。匹配后,确定了两组患者,每组 24 人:结果:结果:手术后无死亡病例。气管切开术后导致狭窄的病因在后 COVID 组患者中更常见(后 COVID 组 20 人 vs 非 COVID 组 11 人,P=0.03),术后入住 ICU 的患者也更常见(16 人 vs 9 人,P=0.04)。术后因声门水肿和呼吸衰竭需要再次插管的患者在术后 COVID 组更多(7 对 2,P=0.04)。COVID术后组中有11例(46%)患者术后出现发音障碍,而非COVID组中有4例(16%)患者术后出现发音障碍(P=0.03):结论:在COVID-19相关气管狭窄患者中,气管切除术仍然安全有效。与非 COVID-19 患者相比,接受气管切除术的 COVID-19 后患者的 ICU 入院率和术后并发症似乎更高。
{"title":"New perspectives on tracheal resection for COVID-19-related stenosis: A propensity score matching analysis.","authors":"Cecilia Menna, Silvia Fiorelli, Beatrice Trabalza Marinucci, Domenico Massullo, Antonio D'Andrilli, Anna Maria Ciccone, Claudio Andreetti, Giulio Maurizi, Camilla Vanni, Alessandra Siciliani, Matteo Tiracorrendo, Massimiliano Mancini, Federico Venuta, Erino Angelo Rendina, Mohsen Ibrahim","doi":"10.1016/j.jtcvs.2024.03.028","DOIUrl":"10.1016/j.jtcvs.2024.03.028","url":null,"abstract":"<p><strong>Objective: </strong>The large number of patients with COVID-19 subjected to prolonged invasive mechanical ventilation has been expected to result in a significant increase in tracheal stenosis in the next years. The aim of this study was to evaluate and compare postoperative outcomes of patients who survived COVID-19 critical illness and underwent tracheal resection for postintubation/posttracheostomy tracheal stenosis with those of non-COVID-19 patients.</p><p><strong>Methods: </strong>It was single-center, retrospective study. All consecutive patients with post-intubation/posttracheostomy tracheal stenosis who underwent tracheal resection from February 2020 to March 2022 were enrolled. A total of 147 tracheal resections were performed: 24 were in post-COVID-19 patients and 123 were in non-COVID-19 patients. A 1:1 propensity score matching analysis was performed, considering age, gender, body mass index, and length of stenosis. After matching, 2 groups of 24 patients each were identified: a post-COVID-19 group and a non-COVID group.</p><p><strong>Results: </strong>No mortality after surgery was registered. Posttracheostomy etiology of stenosis resulted more frequently in post-COVID-19 patients (n = 20 in the post-COVID-19 group vs n = 11 in the non-COVID-19 group; P = .03), as well as intensive care unit admissions during the postoperative period (16 vs 9 patients; P = .04). Need for postoperative reintubation for glottic edema and respiratory failure was higher in the post-COVID-19 group (7 vs 2 postoperative reintubation procedures; P = .04). Postoperative dysphonia was observed in 11 (46%) patients in the post-COVID-19 group versus 4 (16%) patients in the non-COVID-19 group (P = .03).</p><p><strong>Conclusions: </strong>Tracheal resection continues to be safe and effective in COVID-19-related tracheal stenosis scenarios. Intensive care unit admission rates and postoperative complications seem to be higher in post-COVID-19 patients who underwent tracheal resection compared with non-COVID-19 patients.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Follow-up of bioprosthesis recipients: How long should a long-term be? 生物假体接受者的随访:长期随访应持续多久?
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-05-30 DOI: 10.1016/j.jtcvs.2024.04.032
Igor Vendramin, Uberto Bortolotti, Ugolino Livi
{"title":"Follow-up of bioprosthesis recipients: How long should a long-term be?","authors":"Igor Vendramin, Uberto Bortolotti, Ugolino Livi","doi":"10.1016/j.jtcvs.2024.04.032","DOIUrl":"10.1016/j.jtcvs.2024.04.032","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141181137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Volume-failure-to-rescue relationship in acute type A aortic dissections: An analysis of The Society of Thoracic Surgeons Database. 急性A型主动脉夹层体积衰竭与抢救的关系:胸外科医师学会数据库分析。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-08-30 DOI: 10.1016/j.jtcvs.2023.08.037
Carlos E Diaz-Castrillon, Derek Serna-Gallegos, George Arnaoutakis, Joshua Grimm, Wilson Y Szeto, Danny Chu, Ahmet Sezer, Ibrahim Sultan

Objective: To determine the relationship between volume of cases and failure-to-rescue (FTR) rate after surgery for acute type A aortic dissection (ATAAD) across the United States.

Methods: The Society of Thoracic Surgeons adult cardiac surgery database was used to review outcomes of surgery after ATAAD between June 2017 and December 2021. Mixed-effect models and restricted cubic splines were used to determine the risk-adjusted relationships between ATAAD average volume and FTR rate. FTR calculation was based on deaths associated with the following complications: venous thromboembolism/deep venous thrombosis, stroke, renal failure, mechanical ventilation >48 hours, sepsis, gastrointestinal complications, cardiopulmonary resuscitation, and unplanned reoperation.

Results: In total, 18,192 patients underwent surgery for ATAAD in 832 centers. The included hospitals' median volume was 2.2 cases/year (interquartile range [IQR], 0.9-5.8). Quartiles' distribution was 615 centers in the first (1.3 cases/year, IQR, 0.4-2.9); 123 centers in the second (8 cases/year, IQR, 6.7-10.2); 66 centers in the third (15.6 cases/year, IQR, 14.2-18); and 28 centers in the fourth quartile (29.3 cases/year, IQR, 28.8-46.0). Fourth-quartile hospitals performed more extensive procedures. Overall complication, mortality, and FTR rates were 52.6%, 14.2%, and 21.7%, respectively. Risk-adjusted analysis demonstrated increased odds of FTR when the average volume was fewer than 10 cases per year.

Conclusions: Although high-volume centers performed more complex procedures than low-volume centers, their operative mortality was lower, perhaps reflecting their ability to rescue patients and mitigate complications. An average of fewer than 10 cases per year at an institution is associated with increased odds of failure to rescue patients after ATAAD repair.

目的:确定美国急性A型主动脉夹层(ATAAD)术后病例数与抢救失败率(FTR)之间的关系。混合效应模型和限制三次样条用于确定ATAAD平均体积和FTR率之间的风险调整关系。FTR的计算基于与以下并发症相关的死亡:静脉血栓栓塞/深静脉血栓形成、中风、肾衰竭、机械通气>48小时、败血症、胃肠道并发症、心肺复苏和计划外再次手术。结果:832个中心共有18192名患者接受了ATAAD手术。纳入医院的中位容量为2.2例/年(四分位间距[IQR],0.9-5.8)。第一个四分位的分布为615个中心(1.3例/年,IQR,0.4-2.9);第二组123个中心(8例/年,IQR,6.7-10.2);第三组66个中心(15.6例/年,IQR,14.2-18);第四分位数有28个中心(29.3例/年,IQR,28.8-46.0)。第四分位医院进行了更广泛的手术。总并发症、死亡率和FTR率分别为52.6%、14.2%和21.7%。风险调整分析表明,当平均每年病例数少于10例时,FTR的几率增加。结论:尽管高容量中心比低容量中心进行更复杂的手术,但它们的手术死亡率较低,这可能反映了它们抢救患者和减轻并发症的能力。一家机构平均每年少于10例病例与ATAAD修复后患者抢救失败的几率增加有关。
{"title":"Volume-failure-to-rescue relationship in acute type A aortic dissections: An analysis of The Society of Thoracic Surgeons Database.","authors":"Carlos E Diaz-Castrillon, Derek Serna-Gallegos, George Arnaoutakis, Joshua Grimm, Wilson Y Szeto, Danny Chu, Ahmet Sezer, Ibrahim Sultan","doi":"10.1016/j.jtcvs.2023.08.037","DOIUrl":"10.1016/j.jtcvs.2023.08.037","url":null,"abstract":"<p><strong>Objective: </strong>To determine the relationship between volume of cases and failure-to-rescue (FTR) rate after surgery for acute type A aortic dissection (ATAAD) across the United States.</p><p><strong>Methods: </strong>The Society of Thoracic Surgeons adult cardiac surgery database was used to review outcomes of surgery after ATAAD between June 2017 and December 2021. Mixed-effect models and restricted cubic splines were used to determine the risk-adjusted relationships between ATAAD average volume and FTR rate. FTR calculation was based on deaths associated with the following complications: venous thromboembolism/deep venous thrombosis, stroke, renal failure, mechanical ventilation >48 hours, sepsis, gastrointestinal complications, cardiopulmonary resuscitation, and unplanned reoperation.</p><p><strong>Results: </strong>In total, 18,192 patients underwent surgery for ATAAD in 832 centers. The included hospitals' median volume was 2.2 cases/year (interquartile range [IQR], 0.9-5.8). Quartiles' distribution was 615 centers in the first (1.3 cases/year, IQR, 0.4-2.9); 123 centers in the second (8 cases/year, IQR, 6.7-10.2); 66 centers in the third (15.6 cases/year, IQR, 14.2-18); and 28 centers in the fourth quartile (29.3 cases/year, IQR, 28.8-46.0). Fourth-quartile hospitals performed more extensive procedures. Overall complication, mortality, and FTR rates were 52.6%, 14.2%, and 21.7%, respectively. Risk-adjusted analysis demonstrated increased odds of FTR when the average volume was fewer than 10 cases per year.</p><p><strong>Conclusions: </strong>Although high-volume centers performed more complex procedures than low-volume centers, their operative mortality was lower, perhaps reflecting their ability to rescue patients and mitigate complications. An average of fewer than 10 cases per year at an institution is associated with increased odds of failure to rescue patients after ATAAD repair.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10140762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Heterogeneous treatment effects of coronary artery bypass grafting in ischemic cardiomyopathy: A machine learning causal forest analysis. 缺血性心肌病冠状动脉搭桥术的异质性治疗效果:机器学习因果森林分析。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-09-15 DOI: 10.1016/j.jtcvs.2023.09.021
Zhuoming Zhou, Bohao Jian, Xuanyu Chen, Menghui Liu, Shaozhao Zhang, Guangguo Fu, Gang Li, Mengya Liang, Ting Tian, Zhongkai Wu

Objectives: We aim to evaluate the heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy and to identify a group of patients to have greater benefits from coronary artery bypass grafting compared with medical therapy alone.

Methods: Machine learning causal forest modeling was performed to identify the heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy from the Surgical Treatment for Ischemic Heart Failure trial. The risks of death from any cause and death from cardiovascular causes between coronary artery bypass grafting and medical therapy alone were assessed in the identified subgroups.

Results: Among 1212 patients enrolled in the Surgical Treatment for Ischemic Heart Failure trial, left ventricular end-systolic volume index, serum creatinine, and age were identified by the machine learning algorithm to distinguish patients with heterogeneous treatment effects. Among patients with left ventricular end-systolic volume index greater than 84 mL/m2 and age 60.27 years or less, coronary artery bypass grafting was associated with a significantly lower risk of death from any cause (adjusted hazard ratio, 0.61; 95% CI, 0.45-0.84) and death from cardiovascular causes (adjusted hazard ratio, 0.63; 95% CI, 0.45-0.89). By contrast, the survival benefits of coronary artery bypass grafting no longer exist in patients with left ventricular end-systolic volume index 84 mL/m2 or less and serum creatinine 1.04 mg/dL or less, or patients with left ventricular end-systolic volume index greater than 84 mL/m2 and age more than 60.27 years.

Conclusions: The current post hoc analysis of the Surgical Treatment for Ischemic Heart Failure trial identified heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy. Younger patients with severe left ventricular enlargement were more likely to derive greater survival benefits from coronary artery bypass grafting.

目的:我们旨在评估缺血性心肌病患者冠状动脉搭桥术的异质性治疗效果,并确定一组患者与单纯药物治疗相比,冠状动脉搭桥手术具有更大的益处。方法:采用机器学习因果森林模型,从缺血性心力衰竭的外科治疗试验中确定冠状动脉搭桥术对缺血性心肌病患者的异质性治疗效果。在已确定的亚组中评估了冠状动脉搭桥术和单独药物治疗之间任何原因死亡和心血管原因死亡的风险。结果:在1212名参加缺血性心力衰竭外科治疗试验的患者中,通过机器学习算法识别左心室收缩末期容积指数、血清肌酐和年龄,以区分具有不同治疗效果的患者。在左心室收缩末期容积指数大于84 mL/m2且年龄在60.27岁或以下的患者中,冠状动脉搭桥术与任何原因死亡的风险(调整后的危险比,0.61;95%可信区间,0.45-0.84)和心血管原因死亡的危险(调整后危险比,0.62;95%置信区间,0.45-2.89)显著降低相关。相比之下,冠状动脉旁路移植术的生存益处在左心室收缩末期容积指数为84mL/m2或更低且血清肌酐为1.04mg/dL或更低的患者中不再存在,或左心室收缩末期容积指数大于84 mL/m2且年龄大于60.27岁的患者。结论:目前对缺血性心力衰竭手术治疗试验的事后分析发现,冠状动脉搭桥术对缺血性心肌病患者的治疗效果参差不齐。患有严重左心室增大的年轻患者更有可能从冠状动脉搭桥术中获得更大的生存益处。
{"title":"Heterogeneous treatment effects of coronary artery bypass grafting in ischemic cardiomyopathy: A machine learning causal forest analysis.","authors":"Zhuoming Zhou, Bohao Jian, Xuanyu Chen, Menghui Liu, Shaozhao Zhang, Guangguo Fu, Gang Li, Mengya Liang, Ting Tian, Zhongkai Wu","doi":"10.1016/j.jtcvs.2023.09.021","DOIUrl":"10.1016/j.jtcvs.2023.09.021","url":null,"abstract":"<p><strong>Objectives: </strong>We aim to evaluate the heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy and to identify a group of patients to have greater benefits from coronary artery bypass grafting compared with medical therapy alone.</p><p><strong>Methods: </strong>Machine learning causal forest modeling was performed to identify the heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy from the Surgical Treatment for Ischemic Heart Failure trial. The risks of death from any cause and death from cardiovascular causes between coronary artery bypass grafting and medical therapy alone were assessed in the identified subgroups.</p><p><strong>Results: </strong>Among 1212 patients enrolled in the Surgical Treatment for Ischemic Heart Failure trial, left ventricular end-systolic volume index, serum creatinine, and age were identified by the machine learning algorithm to distinguish patients with heterogeneous treatment effects. Among patients with left ventricular end-systolic volume index greater than 84 mL/m<sup>2</sup> and age 60.27 years or less, coronary artery bypass grafting was associated with a significantly lower risk of death from any cause (adjusted hazard ratio, 0.61; 95% CI, 0.45-0.84) and death from cardiovascular causes (adjusted hazard ratio, 0.63; 95% CI, 0.45-0.89). By contrast, the survival benefits of coronary artery bypass grafting no longer exist in patients with left ventricular end-systolic volume index 84 mL/m<sup>2</sup> or less and serum creatinine 1.04 mg/dL or less, or patients with left ventricular end-systolic volume index greater than 84 mL/m<sup>2</sup> and age more than 60.27 years.</p><p><strong>Conclusions: </strong>The current post hoc analysis of the Surgical Treatment for Ischemic Heart Failure trial identified heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy. Younger patients with severe left ventricular enlargement were more likely to derive greater survival benefits from coronary artery bypass grafting.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10635732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Should mitral valve replacement age guidelines be lowered due to better bioprosthetic mitral valve durability? 由于生物瓣膜的耐用性更好,是否应该降低二尖瓣置换年龄指南?
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-10-13 DOI: 10.1016/j.jtcvs.2023.10.012
Matthew Romano, Patrick M McCarthy, Abigail S Baldridge, Jane Kruse, Anna Huskin, China Green, Jessica Woodford, Heather Byrd, Steven F Bolling

Objective: Guideline recommendations for mechanical or bioprosthetic valve for mitral valve replacement by age remains controversial. We sought to determine bovine pericardial valve durability by age and risk of reintervention.

Methods: This retrospective study between 2 large university-based cardiac surgery programs examined patients who underwent bioprosthetic mitral valve replacement from 2004 to 2020. Follow-up was obtained through June 2022. Durability outcomes involving structural valve deterioration were compared by age decile.

Results: Of 1544 available patients, mean age was 66 ± 13 years and 652 (42%) were aged less than 65 years. Indications for mitral valve replacement were as follows: mitral regurgitation greater than 2+ in 53% (n = 813), mitral stenosis in 44% (n = 650), endocarditis in 18% (n = 277), and reoperation in 39% (n = 602). Concomitant procedures were aortic valve replacement in 28% (n = 426), tricuspid valve in 36% (n = 550), and coronary artery bypass in 19% (n = 290). Thirty-day mortality was 5.4%. In follow-up (clinical: median [interquartile range] 75 [25-129] months), reoperation for endocarditis and new stroke were low (0.30 and 1.06 per 100 patient/years, respectively). The cumulative incidence of mitral valve reintervention for structural valve deterioration among all patients was 6.2% at 10 years and 9.0% at 12 years with no statistical difference in structural valve deterioration in patients aged 40 to 70 years (P = .1). In 90 patients with mitral valve reintervention, 30-day mortality after reintervention was 4.7% (n = 2) for 43 with mitral valve-in-valve and 6.4% (n = 3) for 47 with reoperation.

Conclusions: Bovine pericardial mitral valve replacement is a durable option for younger patients. The opportunity to avoid anticoagulation and the associated risks with mechanical mitral valve replacement may be of benefit to patients. These insights may provide data needed to revise the current guidelines.

目的:按年龄划分的MVR机械或生物瓣膜(BP)指南建议仍存在争议。我们试图通过年龄和再干预风险来确定牛心包膜瓣膜的耐久性。方法:这项针对两个大型大学心脏外科项目的回顾性研究对2004年至2020年接受BP MVR的患者进行了检查。随访至2022年6月。按年龄十分位数比较涉及结构瓣膜退化(SVD)的耐久性结果。结果:1544例患者平均年龄66±13岁,652例(42%)<65岁。MVR的适应症为:MR>2+53%[n=813];二尖瓣狭窄44%[n=650];心内膜炎18%[n=277],再次手术39%[n=602]。伴随手术为AVR 28%[n=426];三尖瓣36%[n=550];CAB 19%[n=290]。30天死亡率为5.4%。在随访(临床:中位数[IQR]75[25-129]个月)中,心内膜炎和新发卒中的再次手术率较低(分别为0.30和1.06/100患者/年)。在所有患者中,MV再干预SVD的累积发生率在10年时为6.2%,在12年时为9.0%,在40岁和70岁之间的患者中SVD没有统计学差异(p=0.1)。在90名MV再干预患者中,43名MViV患者再干预后30天的死亡率为4.7%(n=2),47名再次手术患者的死亡率为6.4%(n=3)。结论:牛心包MVR是年轻患者的一种持久选择。避免抗凝的机会和机械MVR的相关风险可能对患者有益。这些见解可能会提供修订现行指南所需的数据。
{"title":"Should mitral valve replacement age guidelines be lowered due to better bioprosthetic mitral valve durability?","authors":"Matthew Romano, Patrick M McCarthy, Abigail S Baldridge, Jane Kruse, Anna Huskin, China Green, Jessica Woodford, Heather Byrd, Steven F Bolling","doi":"10.1016/j.jtcvs.2023.10.012","DOIUrl":"10.1016/j.jtcvs.2023.10.012","url":null,"abstract":"<p><strong>Objective: </strong>Guideline recommendations for mechanical or bioprosthetic valve for mitral valve replacement by age remains controversial. We sought to determine bovine pericardial valve durability by age and risk of reintervention.</p><p><strong>Methods: </strong>This retrospective study between 2 large university-based cardiac surgery programs examined patients who underwent bioprosthetic mitral valve replacement from 2004 to 2020. Follow-up was obtained through June 2022. Durability outcomes involving structural valve deterioration were compared by age decile.</p><p><strong>Results: </strong>Of 1544 available patients, mean age was 66 ± 13 years and 652 (42%) were aged less than 65 years. Indications for mitral valve replacement were as follows: mitral regurgitation greater than 2+ in 53% (n = 813), mitral stenosis in 44% (n = 650), endocarditis in 18% (n = 277), and reoperation in 39% (n = 602). Concomitant procedures were aortic valve replacement in 28% (n = 426), tricuspid valve in 36% (n = 550), and coronary artery bypass in 19% (n = 290). Thirty-day mortality was 5.4%. In follow-up (clinical: median [interquartile range] 75 [25-129] months), reoperation for endocarditis and new stroke were low (0.30 and 1.06 per 100 patient/years, respectively). The cumulative incidence of mitral valve reintervention for structural valve deterioration among all patients was 6.2% at 10 years and 9.0% at 12 years with no statistical difference in structural valve deterioration in patients aged 40 to 70 years (P = .1). In 90 patients with mitral valve reintervention, 30-day mortality after reintervention was 4.7% (n = 2) for 43 with mitral valve-in-valve and 6.4% (n = 3) for 47 with reoperation.</p><p><strong>Conclusions: </strong>Bovine pericardial mitral valve replacement is a durable option for younger patients. The opportunity to avoid anticoagulation and the associated risks with mechanical mitral valve replacement may be of benefit to patients. These insights may provide data needed to revise the current guidelines.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Thoracic and Cardiovascular Surgery
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1