Pub Date : 2024-10-24DOI: 10.1016/j.jtcvs.2024.10.035
Hanghang Wang, Chen Dun, Martin A Makary, Christi Walsh, Yi Fan, Emily Rodriguez, Deven Patel, Alice Zhou, Armaan Akbar, Glenn Whitman, James S Gammie
Objective: Mitral valve repair is the preferred treatment for primary mitral regurgitation, offering significant short- and long-term advantages over valve replacement. This study was designed to evaluate the contemporary national mitral valve surgery practice patterns, focusing on the impact of surgeon-specific factors, such as operative volume and years of practice, on repair rates.
Methods: A retrospective analysis was conducted using 100% Medicare fee-for-service claims data over a 3-year period (January 2020 to December 2022). Mitral valve procedures were identified using specific CPT codes. We excluded patients with active infective endocarditis, mitral stenosis, or a history of prior mitral valve repair or replacement. Multivariable binomial regression was used to assess the impact of surgeon-specific factors on repair rates.
Results: We identified 2,072 surgeons in 770 hospitals who performed 12,339 mitral valve operations, with an overall repair rate of 68.8%. The median number of mitral valve operations performed per surgeon during the three-year study period was 3 (IQR 2 - 7), and the median number of mitral valve repairs was 2 (IQR 1 - 5). A subset of 312 surgeons (15%) performed more than 10 mitral valve procedures each and over half (57%) of all repairs nationally. This subgroup's median repair rate was 77%, with significant variability within the group: 17% of surgeons had a repair rate below 50%, 59% had a repair rate between 50 - 90%, and 24% had a repair rate above 90%. Multivariable regression analysis indicated significant associations between repair rates and surgeon-specific factors, including surgical volume, years of practice, and region of practice. Each additional procedure was associated with a 1.5% average increase in repair rate likelihood (95% CI 1.2 - 1.8%, p < 0.001), and each additional year of practice was associated with a 1.4% average increase (95% CI 0.8 - 2%, p < 0.001). Regional differences were notable: surgeons in the South demonstrating lower repair rates (median 71%, IQR 55% - 85%) compared to those in the Northeast (median 78%, IQR 68% - 91%, p = 0.02) and Midwest (median 86%, IQR 63% - 92%, p = 0.04).
Conclusions: This study has identified significant variability in mitral valve repair rates among surgeons treating Medicare beneficiaries. Notably, even among the surgeons responsible for most of these procedures, the variability in repair rates is pronounced. These findings suggest substantial opportunities to improve outcomes for patients undergoing mitral valve operations in North America.
{"title":"Wide Variation in Mitral Valve Repair Rates Among U.S. Surgeons: Analysis of Medicare Claims Data.","authors":"Hanghang Wang, Chen Dun, Martin A Makary, Christi Walsh, Yi Fan, Emily Rodriguez, Deven Patel, Alice Zhou, Armaan Akbar, Glenn Whitman, James S Gammie","doi":"10.1016/j.jtcvs.2024.10.035","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.035","url":null,"abstract":"<p><strong>Objective: </strong>Mitral valve repair is the preferred treatment for primary mitral regurgitation, offering significant short- and long-term advantages over valve replacement. This study was designed to evaluate the contemporary national mitral valve surgery practice patterns, focusing on the impact of surgeon-specific factors, such as operative volume and years of practice, on repair rates.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using 100% Medicare fee-for-service claims data over a 3-year period (January 2020 to December 2022). Mitral valve procedures were identified using specific CPT codes. We excluded patients with active infective endocarditis, mitral stenosis, or a history of prior mitral valve repair or replacement. Multivariable binomial regression was used to assess the impact of surgeon-specific factors on repair rates.</p><p><strong>Results: </strong>We identified 2,072 surgeons in 770 hospitals who performed 12,339 mitral valve operations, with an overall repair rate of 68.8%. The median number of mitral valve operations performed per surgeon during the three-year study period was 3 (IQR 2 - 7), and the median number of mitral valve repairs was 2 (IQR 1 - 5). A subset of 312 surgeons (15%) performed more than 10 mitral valve procedures each and over half (57%) of all repairs nationally. This subgroup's median repair rate was 77%, with significant variability within the group: 17% of surgeons had a repair rate below 50%, 59% had a repair rate between 50 - 90%, and 24% had a repair rate above 90%. Multivariable regression analysis indicated significant associations between repair rates and surgeon-specific factors, including surgical volume, years of practice, and region of practice. Each additional procedure was associated with a 1.5% average increase in repair rate likelihood (95% CI 1.2 - 1.8%, p < 0.001), and each additional year of practice was associated with a 1.4% average increase (95% CI 0.8 - 2%, p < 0.001). Regional differences were notable: surgeons in the South demonstrating lower repair rates (median 71%, IQR 55% - 85%) compared to those in the Northeast (median 78%, IQR 68% - 91%, p = 0.02) and Midwest (median 86%, IQR 63% - 92%, p = 0.04).</p><p><strong>Conclusions: </strong>This study has identified significant variability in mitral valve repair rates among surgeons treating Medicare beneficiaries. Notably, even among the surgeons responsible for most of these procedures, the variability in repair rates is pronounced. These findings suggest substantial opportunities to improve outcomes for patients undergoing mitral valve operations in North America.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512047","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}
Pub Date : 2024-10-22DOI: 10.1016/j.jtcvs.2024.10.010
Hans-Joachim Schäfers, Igor E Konstantinov
{"title":"Surgical anatomy of aortic root: Toward precise and durable aortic, neo-aortic, and truncal valve repairs.","authors":"Hans-Joachim Schäfers, Igor E Konstantinov","doi":"10.1016/j.jtcvs.2024.10.010","DOIUrl":"10.1016/j.jtcvs.2024.10.010","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512043","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}
Pub Date : 2024-10-22DOI: 10.1016/j.jtcvs.2024.10.023
Karen B Abeln, Lennart Froede, Christian Giebels, Hans-Joachim Schäfers
Background: Right ventricular (RV) conduit availability and degeneration are potential limitations of the Ross procedure. Pulmonary homografts are the gold standard, but their limited availability drives the need for alternatives. The aim of this study was to compare results of different RV conduits.
Methods: Between 1995 and 2023, 315 consecutive patients (73% males; mean age, 37 ± 12 years) underwent a Ross procedure using a homograft (n = 211), bovine jugular vein (BJV) (n = 34), or xenograft (n = 70) as the RV conduit. The mean follow-up was 5.7 ± 6.7 years and was 96% complete (1631 patient-years).
Results: Twelve patients (homograft, n = 8; BJV. n = 3; xenograft, n = 1) required RV conduit reintervention, including 4 patients within 4 years (all with homografts). Indications for reintervention were degeneration in 8 patients and active endocarditis in 4 patients. Reinterventions included RV conduit replacement (homograft, n = 3; xenograft, n = 1; BJV, n = 2) and transcatheter valve implantation (homograft n = 5; BJV, n = 1). At 15 years, freedom from RV conduit reintervention was 88%, and freedom from reoperation was 93%. Freedom from reintervention at 15 years was similar in the homograft (89%), BJV (89%), and xenograft (100%) groups (P = .812). Progression of mean RV conduit gradient was lowest for the BJV group (1.45 mm Hg/year) and similar in the homograft (2.6 mm Hg/year) and xenograft (2.9 mm Hg/year) groups. Age at <18 years at surgery (hazard ratio [HR], 1.9; P < .001) was a predictive risk factor for reintervention. There was no difference among the RV conduit groups (HR, 1.198; P = .606).
Conclusions: The incidence of reintervention after 15 years is similar in recipients of homografts, xenografts, and BJV grafts. Interestingly, homografts may fail in the first few years, possibly related to inflammatory phenomena. Thus, the use of xenografts may be an option if homografts are not available.
{"title":"Durability of right ventricular conduits in the Ross procedure.","authors":"Karen B Abeln, Lennart Froede, Christian Giebels, Hans-Joachim Schäfers","doi":"10.1016/j.jtcvs.2024.10.023","DOIUrl":"10.1016/j.jtcvs.2024.10.023","url":null,"abstract":"<p><strong>Background: </strong>Right ventricular (RV) conduit availability and degeneration are potential limitations of the Ross procedure. Pulmonary homografts are the gold standard, but their limited availability drives the need for alternatives. The aim of this study was to compare results of different RV conduits.</p><p><strong>Methods: </strong>Between 1995 and 2023, 315 consecutive patients (73% males; mean age, 37 ± 12 years) underwent a Ross procedure using a homograft (n = 211), bovine jugular vein (BJV) (n = 34), or xenograft (n = 70) as the RV conduit. The mean follow-up was 5.7 ± 6.7 years and was 96% complete (1631 patient-years).</p><p><strong>Results: </strong>Twelve patients (homograft, n = 8; BJV. n = 3; xenograft, n = 1) required RV conduit reintervention, including 4 patients within 4 years (all with homografts). Indications for reintervention were degeneration in 8 patients and active endocarditis in 4 patients. Reinterventions included RV conduit replacement (homograft, n = 3; xenograft, n = 1; BJV, n = 2) and transcatheter valve implantation (homograft n = 5; BJV, n = 1). At 15 years, freedom from RV conduit reintervention was 88%, and freedom from reoperation was 93%. Freedom from reintervention at 15 years was similar in the homograft (89%), BJV (89%), and xenograft (100%) groups (P = .812). Progression of mean RV conduit gradient was lowest for the BJV group (1.45 mm Hg/year) and similar in the homograft (2.6 mm Hg/year) and xenograft (2.9 mm Hg/year) groups. Age at <18 years at surgery (hazard ratio [HR], 1.9; P < .001) was a predictive risk factor for reintervention. There was no difference among the RV conduit groups (HR, 1.198; P = .606).</p><p><strong>Conclusions: </strong>The incidence of reintervention after 15 years is similar in recipients of homografts, xenografts, and BJV grafts. Interestingly, homografts may fail in the first few years, possibly related to inflammatory phenomena. Thus, the use of xenografts may be an option if homografts are not available.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512041","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}
Pub Date : 2024-10-21DOI: 10.1016/j.jtcvs.2024.10.022
Abigail Snyder, Monica Isabella, Leonardo Rodriguez, Paul Bishop, Nicholas G Smedira, Jeevanantham Rajeswaran, Benjamin P Kramer, Ashley M Lowry, Eugene H Blackstone, Eric E Roselli
Objectives: To localize and quantify mitral calcification associated with severe aortic stenosis and severe mitral regurgitation and determine its association with cardiac remodeling, operative management, and long-term survival.
Methods: From July 1998 to July 2010, 158 patients with severe aortic stenosis, severe mitral regurgitation, and mitral calcification underwent surgical aortic valve replacement (SAVR, n=49) or SAVR plus mitral valve repair (SAVR+MVr, n=67) or replacement (SAVR+MVR, n=42). Mitral calcium was localized and quantified on preoperative computed tomography. Random forest methodology was used to correlate calcium volume with cardiac morphology and function. Median follow-up for survival was 4.1 years; 25% were followed ≥14 years.
Results: Larger calcium volume was associated with degenerative mitral disease, higher ejection fraction, smaller left ventricular end-systolic volume, and SAVR+MVR (median calcium volume 3.4 cm3) versus SAVR (median calcium volume 1.0 cm3) or SAVR+MVr (median calcium volume 0.41 cm3). Ten-year mortality was higher in patients with more mitral calcification (terciles: 7.1% vs 16% vs 25%), subvalvular involvement (8.1% vs 18%), and SAVR+MVR (5.4% vs SAVR=13% vs SAVR+MVr=26%). Multivariable analysis demonstrated early postoperative mortality was strongly associated with subvalvular mitral calcification, but late mortality was not associated with calcium volume or location.
Conclusions: Larger mitral calcium volume is a marker of late-stage cardiac remodeling associated with more extensive mitral valve intervention, but it is not associated with long-term mortality. Quantitative analysis of mitral calcification with computed tomography can aid in patient selection and surgical management decisions in this complex patient population.
目的定位和量化与重度主动脉瓣狭窄和重度二尖瓣反流相关的二尖瓣钙化,并确定其与心脏重塑、手术治疗和长期生存的关系:1998年7月至2010年7月,158名患有重度主动脉瓣狭窄、重度二尖瓣反流和二尖瓣钙化的患者接受了主动脉瓣置换术(SAVR,49人)或SAVR加二尖瓣修复术(SAVR+MVr,67人)或置换术(SAVR+MVR,42人)。二尖瓣钙化是通过术前计算机断层扫描定位和量化的。采用随机森林方法将钙量与心脏形态和功能相关联。中位生存随访时间为4.1年;25%的随访时间≥14年:较大的钙容量与二尖瓣退化性疾病、较高的射血分数、较小的左心室收缩末期容积以及SAVR+MVR(中位钙容量为3.4立方厘米)与SAVR(中位钙容量为1.0立方厘米)或SAVR+MVr(中位钙容量为0.41立方厘米)相关。二尖瓣钙化较多(三等分:7.1% vs 16% vs 25%)、瓣下受累(8.1% vs 18%)和SAVR+MVR(5.4% vs SAVR=13% vs SAVR+MVr=26%)的患者十年死亡率较高。多变量分析表明,术后早期死亡率与瓣下二尖瓣钙化密切相关,但晚期死亡率与钙量或位置无关:结论:较大的二尖瓣钙化体积是后期心脏重塑的标志,与更广泛的二尖瓣介入治疗有关,但与长期死亡率无关。通过计算机断层扫描对二尖瓣钙化进行定量分析,有助于对这一复杂患者群体进行患者选择和手术管理决策。
{"title":"Effects of Mitral Calcification in Severe Aortic Stenosis with Severe Mitral Regurgitation on Left Heart Remodeling, Surgical Strategy, and Outcomes.","authors":"Abigail Snyder, Monica Isabella, Leonardo Rodriguez, Paul Bishop, Nicholas G Smedira, Jeevanantham Rajeswaran, Benjamin P Kramer, Ashley M Lowry, Eugene H Blackstone, Eric E Roselli","doi":"10.1016/j.jtcvs.2024.10.022","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.022","url":null,"abstract":"<p><strong>Objectives: </strong>To localize and quantify mitral calcification associated with severe aortic stenosis and severe mitral regurgitation and determine its association with cardiac remodeling, operative management, and long-term survival.</p><p><strong>Methods: </strong>From July 1998 to July 2010, 158 patients with severe aortic stenosis, severe mitral regurgitation, and mitral calcification underwent surgical aortic valve replacement (SAVR, n=49) or SAVR plus mitral valve repair (SAVR+MVr, n=67) or replacement (SAVR+MVR, n=42). Mitral calcium was localized and quantified on preoperative computed tomography. Random forest methodology was used to correlate calcium volume with cardiac morphology and function. Median follow-up for survival was 4.1 years; 25% were followed ≥14 years.</p><p><strong>Results: </strong>Larger calcium volume was associated with degenerative mitral disease, higher ejection fraction, smaller left ventricular end-systolic volume, and SAVR+MVR (median calcium volume 3.4 cm<sup>3</sup>) versus SAVR (median calcium volume 1.0 cm<sup>3</sup>) or SAVR+MVr (median calcium volume 0.41 cm<sup>3</sup>). Ten-year mortality was higher in patients with more mitral calcification (terciles: 7.1% vs 16% vs 25%), subvalvular involvement (8.1% vs 18%), and SAVR+MVR (5.4% vs SAVR=13% vs SAVR+MVr=26%). Multivariable analysis demonstrated early postoperative mortality was strongly associated with subvalvular mitral calcification, but late mortality was not associated with calcium volume or location.</p><p><strong>Conclusions: </strong>Larger mitral calcium volume is a marker of late-stage cardiac remodeling associated with more extensive mitral valve intervention, but it is not associated with long-term mortality. Quantitative analysis of mitral calcification with computed tomography can aid in patient selection and surgical management decisions in this complex patient population.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512042","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}
Pub Date : 2024-10-18DOI: 10.1016/j.jtcvs.2024.10.019
Samine Ravanbakhsh, Jonathan D'Cunha
{"title":"Commentary: Chest wall resection for sarcoma: Evolution in thoracic park.","authors":"Samine Ravanbakhsh, Jonathan D'Cunha","doi":"10.1016/j.jtcvs.2024.10.019","DOIUrl":"10.1016/j.jtcvs.2024.10.019","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479276","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}
Pub Date : 2024-10-18DOI: 10.1016/j.jtcvs.2024.10.020
Ashish S Shah
{"title":"Commentary: Heroic hearts made weak by time and fate.","authors":"Ashish S Shah","doi":"10.1016/j.jtcvs.2024.10.020","DOIUrl":"10.1016/j.jtcvs.2024.10.020","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479278","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}
Pub Date : 2024-10-18DOI: 10.1016/j.jtcvs.2024.10.021
Alyssia Venna, Yves d'Udekem
{"title":"Commentary: Once again, we should only do good Fontans! Plastic bronchitis is not caused by bad luck.","authors":"Alyssia Venna, Yves d'Udekem","doi":"10.1016/j.jtcvs.2024.10.021","DOIUrl":"10.1016/j.jtcvs.2024.10.021","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479280","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}
Pub Date : 2024-10-18DOI: 10.1016/j.jtcvs.2024.10.018
Gabriele M Iacona, Jules J Bakhos, Penny L Houghtaling, Aaron E Tipton, Richard Ramsingh, Nicholas G Smedira, Marc Gillinov, Kenneth R McCurry, Edward G Soltesz, Eric E Roselli, Michael Z Tong, Shinya G Unai, Haytham J Elgharably, Marijan J Koprivanac, Lars G Svensson, Eugene H Blackstone, Faisal G Bakaeen
Objective: To evaluate whether multiarterial grafting provides an incremental benefit above single arterial grafting in isolated redo coronary artery bypass grafting (CABG).
Methods: From January 1980 to July 2020, 6559 adults underwent a total of 6693 isolated CABG reoperations. Patients undergoing multiarterial grafting were propensity score-matched with those undergoing single arterial grafting with or without additional vein grafts, yielding 2005 well-matched pairs. Endpoints were in-hospital postoperative complications, hospital mortality, and long-term mortality. The median follow-up was 10 years, with 25% of patients followed for >17 years. Multivariable multiphase hazard models and nonparametric random survival forest models for survival were used to identify patients for whom multiarterial grafting was most beneficial.
Results: Among propensity score-matched patients, postoperative complications in multiarterial versus single arterial grafting included any reoperation (50 [2.5%] vs 65 [3.2%]); renal failure (73 [3.6%] vs 55 [2.7%]), stroke (44 [2.2%] vs 38 [1.9%]), and deep sternal infection (36 [1.8%] vs 25 [1.2%]). In-hospital mortality was 1.7% (n = 35) in multiarterial grafting versus 2.8% (n = 56) in single arterial grafting (P = .03). Comparing multiarterial to single arterial grafting, overall survival was 95% versus 94% at 1 year, 92% versus 88% at 3 years, 87% versus 82% at 5 years, 49% versus 42% at 15 years, and 31% versus 25% at 20 years. Better survival after multiarterial grafting was confined to males with 2 patent internal thoracic artery grafts (P < .0001).
Conclusions: Redo CABG with multiarterial grafting can be performed with lower in-hospital mortality and similar major morbidity to single arterial grafting. It is associated with better long-term survival, particularly in males when 2 internal thoracic artery grafts are used.
{"title":"Multiarterial grafting in redo coronary artery bypass grafting: Type of arterial conduit and patient sex determine benefit.","authors":"Gabriele M Iacona, Jules J Bakhos, Penny L Houghtaling, Aaron E Tipton, Richard Ramsingh, Nicholas G Smedira, Marc Gillinov, Kenneth R McCurry, Edward G Soltesz, Eric E Roselli, Michael Z Tong, Shinya G Unai, Haytham J Elgharably, Marijan J Koprivanac, Lars G Svensson, Eugene H Blackstone, Faisal G Bakaeen","doi":"10.1016/j.jtcvs.2024.10.018","DOIUrl":"10.1016/j.jtcvs.2024.10.018","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether multiarterial grafting provides an incremental benefit above single arterial grafting in isolated redo coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>From January 1980 to July 2020, 6559 adults underwent a total of 6693 isolated CABG reoperations. Patients undergoing multiarterial grafting were propensity score-matched with those undergoing single arterial grafting with or without additional vein grafts, yielding 2005 well-matched pairs. Endpoints were in-hospital postoperative complications, hospital mortality, and long-term mortality. The median follow-up was 10 years, with 25% of patients followed for >17 years. Multivariable multiphase hazard models and nonparametric random survival forest models for survival were used to identify patients for whom multiarterial grafting was most beneficial.</p><p><strong>Results: </strong>Among propensity score-matched patients, postoperative complications in multiarterial versus single arterial grafting included any reoperation (50 [2.5%] vs 65 [3.2%]); renal failure (73 [3.6%] vs 55 [2.7%]), stroke (44 [2.2%] vs 38 [1.9%]), and deep sternal infection (36 [1.8%] vs 25 [1.2%]). In-hospital mortality was 1.7% (n = 35) in multiarterial grafting versus 2.8% (n = 56) in single arterial grafting (P = .03). Comparing multiarterial to single arterial grafting, overall survival was 95% versus 94% at 1 year, 92% versus 88% at 3 years, 87% versus 82% at 5 years, 49% versus 42% at 15 years, and 31% versus 25% at 20 years. Better survival after multiarterial grafting was confined to males with 2 patent internal thoracic artery grafts (P < .0001).</p><p><strong>Conclusions: </strong>Redo CABG with multiarterial grafting can be performed with lower in-hospital mortality and similar major morbidity to single arterial grafting. It is associated with better long-term survival, particularly in males when 2 internal thoracic artery grafts are used.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479292","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}
Pub Date : 2024-10-18DOI: 10.1016/j.jtcvs.2024.10.015
Katherine E Sprouse, William L Holman
{"title":"Commentary: Ask yourself always: How can this be done better?","authors":"Katherine E Sprouse, William L Holman","doi":"10.1016/j.jtcvs.2024.10.015","DOIUrl":"10.1016/j.jtcvs.2024.10.015","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479275","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}
Pub Date : 2024-10-18DOI: 10.1016/j.jtcvs.2024.10.017
L Mac Felmly, Minoo N Kavarana
{"title":"Commentary: Getting to the root of the matter when managing the trunk.","authors":"L Mac Felmly, Minoo N Kavarana","doi":"10.1016/j.jtcvs.2024.10.017","DOIUrl":"10.1016/j.jtcvs.2024.10.017","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479277","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}