首页 > 最新文献

Journal of Thoracic and Cardiovascular Surgery最新文献

英文 中文
Wide Variation in Mitral Valve Repair Rates Among U.S. Surgeons: Analysis of Medicare Claims Data. 美国外科医生二尖瓣修复率的巨大差异:医疗保险索赔数据分析》。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-24 DOI: 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.

目的:二尖瓣修复术是治疗原发性二尖瓣反流的首选方法,与瓣膜置换术相比具有显著的短期和长期优势。本研究旨在评估当代全国二尖瓣手术的实践模式,重点关注外科医生的特定因素(如手术量和从业年限)对修复率的影响:方法: 使用三年内(2020 年 1 月至 2022 年 12 月)100% 的医疗保险付费服务报销数据进行回顾性分析。二尖瓣手术使用特定的 CPT 代码进行识别。我们排除了患有活动性感染性心内膜炎、二尖瓣狭窄或既往二尖瓣修复或置换史的患者。采用多变量二项式回归评估外科医生特异性因素对修复率的影响:我们确定了 770 家医院的 2072 名外科医生,他们共实施了 12339 例二尖瓣手术,总修复率为 68.8%。在为期三年的研究期间,每位外科医生进行二尖瓣手术的中位数为 3 例(IQR 2 - 7),二尖瓣修复的中位数为 2 例(IQR 1 - 5)。在 312 名外科医生(15%)中,有一个子集每人进行了 10 次以上的二尖瓣手术,占全国所有修复手术的一半以上(57%)。该分组的修复率中位数为 77%,组内差异显著:17%的外科医生的修复率低于 50%,59%的外科医生的修复率介于 50 - 90% 之间,24%的外科医生的修复率高于 90%。多变量回归分析表明,修复率与外科医生的特定因素(包括手术量、执业年限和执业地区)之间存在显著关联。每增加一次手术,修复率平均增加 1.5%(95% CI 1.2 - 1.8%,p < 0.001),每增加一年执业时间,修复率平均增加 1.4%(95% CI 0.8 - 2%,p < 0.001)。地区差异显著:与东北部(中位数为 78%,IQR 为 68% - 91%,p = 0.02)和中西部(中位数为 86%,IQR 为 63% - 92%,p = 0.04)的外科医生相比,南部外科医生的修复率较低(中位数为 71%,IQR 为 55% - 85%):本研究发现,在治疗医保受益人的外科医生中,二尖瓣修复率存在很大差异。值得注意的是,即使在负责大部分手术的外科医生中,修复率的差异也非常明显。这些研究结果表明,在北美接受二尖瓣手术的患者有很大机会改善治疗效果。
{"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}
引用次数: 0
Surgical anatomy of aortic root: Toward precise and durable aortic, neo-aortic, and truncal valve repairs. 主动脉根部的手术解剖:实现精确、持久的主动脉瓣、新主动脉瓣和截断瓣修复。
IF 5.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-22 DOI: 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}
引用次数: 0
Durability of right ventricular conduits in the Ross procedure. 罗斯手术中右心室导管的耐久性。
IF 5.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-22 DOI: 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.

目的:右心室(RV)导管的可用性和退化是罗斯手术的潜在限制因素。肺动脉同种移植是黄金标准,但其可用性有限,因此需要替代方案。本研究旨在比较不同 RV 导管的效果:1995年至2023年间,315名连续患者(平均年龄:37±12岁,73%为男性)接受了Ross手术,使用同种移植物(n=211)、牛颈静脉('BJV')(n=34)或异种移植物(n=70)作为RV导管。平均随访时间为(5.7±6.7)年,随访完成率为 96%(1631 患者年):结果:12名患者(同种移植8/211,BJV 3/34,异种移植1/70)需要进行RV导管再介入,其中4名患者(同种移植)在4年内进行了再介入。重新介入的指征是变性(8 例)和活动性心内膜炎(4 例)。再介入包括 RV 导管置换(6 人,同种移植 3 人,异种移植 1 人,BJV 2 人)和经导管瓣膜植入(6 人,同种移植 5 人,BJV 1 人)。15年后,RV导管再介入的自由度为88%;再手术的自由度为93%。同种移植物(89%)、BJV(89%)和异种移植物(100%)的15年免再介入率相似(P=0.812)。BJV的平均RV导管梯度进展最小(1.45mmHg/年),同种移植(2.6mmHg/年)和异种移植(2.9mmHg/年)的平均RV导管梯度进展相似。手术年龄(结论:同种移植物、异种移植物和 BJV 15 年后再次介入的发生率相似。有趣的是,同种移植可能会在最初几年失败,这可能与炎症现象有关。因此,如果没有同种移植物,可以选择使用异种移植物。
{"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}
引用次数: 0
Effects of Mitral Calcification in Severe Aortic Stenosis with Severe Mitral Regurgitation on Left Heart Remodeling, Surgical Strategy, and Outcomes. 严重主动脉瓣狭窄伴严重二尖瓣反流的二尖瓣钙化对左心重塑、手术策略和预后的影响
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-21 DOI: 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}
引用次数: 0
Commentary: Chest wall resection for sarcoma: Evolution in thoracic park. 评论:胸壁肉瘤切除术:胸腔公园的演变。
IF 5.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-18 DOI: 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}
引用次数: 0
Commentary: Heroic hearts made weak by time and fate. 评论:被时间和命运削弱的英雄之心
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-18 DOI: 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}
引用次数: 0
Commentary: Once again, we should only do good Fontans! Plastic bronchitis is not caused by bad luck. 评论:再次强调,我们只应做好丰坦!塑料支气管炎不是因为运气不好。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-18 DOI: 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}
引用次数: 0
Multiarterial grafting in redo coronary artery bypass grafting: Type of arterial conduit and patient sex determine benefit. 重做 CABG 时的多动脉移植:动脉导管类型和患者性别决定获益情况。
IF 5.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-18 DOI: 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.

目的评估在孤立的再做 CABG 手术中,多动脉移植是否比单动脉移植带来更多益处:从1980年1月1日至2020年7月7日,6559名成人接受了6693例孤立的CABG再手术。接受多动脉移植术的患者与接受单动脉移植术的患者进行了倾向得分匹配,无论是否进行了额外的静脉移植,结果有2005对患者匹配成功。终点是院内术后并发症、住院死亡率和长期死亡率。中位随访时间为10年,25%的随访时间超过17年。多变量多相危险模型和非参数随机生存森林用于确定多动脉移植对哪些患者最有利:在倾向匹配的患者中,多动脉移植与单动脉移植的术后并发症分别为:再次手术50例(2.5%)对65例(3.2%);肾功能衰竭73例(3.6%)对55例(2.7%);中风44例(2.2%)对38例(1.9%);胸骨深部感染36例(1.8%)对25例(1.2%)。住院死亡率为1.7%(35人)对2.8%(56人)(P=0.03)。多动脉移植与单动脉移植相比,1 年和 3 年的存活率分别为 95% 对 94% 和 92% 对 88%,5 年、15 年和 20 年的存活率分别为 87%、49% 和 31% 对 82%、42% 和 25%。多动脉移植后存活率较高的患者仅限于胸内动脉移植2处通畅的男性(PConclusions:与单动脉移植术相比,多动脉移植术可降低院内死亡率和主要发病率。长期存活率较高,尤其是使用 2 条胸内动脉移植物的男性患者。
{"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}
引用次数: 0
Commentary: Ask yourself always: How can this be done better? 评论:经常问问自己如何才能做得更好?
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-18 DOI: 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}
引用次数: 0
Commentary: Getting to the root of the matter when managing the trunk. 评论:在管理树干时要从根本上解决问题。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-18 DOI: 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}
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