Journal of Thoracic and Cardiovascular Surgery最新文献

Objective: Controlled hypothermic storage of donor organs at 10°C is an emergent clinical standard in lung transplantation due to its superior graft protective effects. Itaconate, a known regulator of cell immunometabolism, has been shown to be upregulated in donor lungs preserved at 10°C for extended periods of static storage versus on ice. We hypothesized that itaconate may be an active agent in donor graft protection against ischemia-reperfusion injury, rather than a byproduct of 10°C graft metabolism.

Methods: We conducted cell-based screening of multiple formulations and concentrations of itaconate and its derivatives and identified 0.25 mM dimethyl itaconate as the most promising candidate for lung preservation. Lungs from Yorkshire pigs (n = 4/group) were randomized to be flushed with low potassium dextran solution ± 0.25 mM dimethyl itaconate, stored at 4°C for 36 hours to limit endogenous itaconate production, then assessed using ex-vivo lung perfusion.

Results: Lungs preserved with dimethyl itaconate had better function, as indicated by lower airway pressures, higher lung compliances, improved perfusate oxygenation, and less edema formation than controls. Perfusate pro-inflammatory cytokines were significantly lower with dimethyl itaconate. Tissue IκBζ levels declined, and dimethyl itaconate prevented tissue oxidative stress after reperfusion. High resolution respirometry indicated no inhibition of succinate dehydrogenase with dimethyl itaconate at 0.25 mM at either hypothermic or normothermic conditions.

Conclusions: Dimethyl itaconate safely modulated inflammation and improved lung physiologic performance upon reperfusion, supporting itaconate's protective role in donor-lung preservation.

Objective: Children undergoing high-risk cardiac surgery face significant postoperative morbidity and mortality risk, and early recognition of impaired systemic perfusion is critical. Current monitoring modalities, such as lactate, central venous oxygen saturation, and near-infrared spectroscopy (NIRS) are indirect surrogates of cardiac output and either invasive or limited in predictive value. Perfusion index (PI) is a continuous, non-invasive measure derived from pulse oximetry that has shown promise in adult critical care but remains underexplored in pediatric cardiac surgery. We sought to determine whether postoperative PI is associated with morbidity and mortality in this high-risk population.

Methods: We conducted a retrospective cohort study of children (aged 0-18 years) who underwent STAT 4-5 surgeries between 2021-2024. High-resolution PI data from the first twenty-four postoperative hours were analyzed. Multivariable logistic regression was used to determine associations with mortality and secondary outcomes.

Results: Of 223 patients, 33 (14.8%) died before discharge and demonstrated significantly lower PI values across all time points. Higher median PI during the first six postoperative hours was associated with reduced mortality (aOR: 0.49, p = 0.042). An abnormal PI (<0.7) in the first six postoperative hours was associated with a threefold increase in mortality risk (aOR: 3.7, p=0.004). Higher median PI over the first six hours was also linked to lower odds of dialysis, ECMO, or low cardiac output syndrome, as well as shorter ICU and hospital stays.

Conclusions: PI may be a useful early biomarker of adverse outcomes after high-risk pediatric cardiac surgery. Its continuous, non-invasive nature offers practical advantages over traditional measures and is complementary to other indirect measures. Multicenter prospective studies are needed.

Objectives: Induction immunochemotherapy is the standard of care for resectable stage II-III non-small cell lung cancer (NSCLC). However, the comparative effectiveness of subsequent definitive surgery versus radiotherapy remains uncertain. We aimed to compare outcomes between these two strategies in routine clinical practice.

Methods: This multicenter, retrospective cohort study included patients with stage II-III NSCLC who received induction immunochemotherapy followed by surgery or definitive radiotherapy across 12 centers in China. Propensity score matching (1:2) was used to balance clinicopathological characteristics. The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS) and recurrence patterns.

Results: Among 967 patients (683 surgery; 284 radiotherapy), the matched intent-to-treat cohort included 548 patients (365 surgery; 183 radiotherapy). Compared to radiotherapy, surgery was associated with significantly longer PFS (HR 0.32; 95% CI: 0.23-0.44; P<0.001) and OS (HR 0.41; 95% CI: 0.26-0.66; P<0.001). Surgery reduced overall recurrence (-21.3%; 95% CI: -31.1% to -11.3%) and local recurrence (-17.5%; 95% CI: -25.0% to -9.9%), but did not affect distant metastasis. In the subgroup of patients for whom pneumonectomy was indicated, surgery improved PFS (HR 0.47; 95% CI: 0.26-0.85; P=0.013) but did not confer an OS benefit (HR 1.14; 95% CI: 0.48-2.70; P=0.76). Among patients who achieved a clinical complete response (cCR), outcomes were similar between the two groups.

Conclusions: Definitive surgery following induction immunochemotherapy offers superior PFS and OS compared to definitive radiotherapy, primarily driven by improved local control. For patients requiring pneumonectomy or achieving a cCR, treatment should be individualized, and prospective trials are warranted.

Objective: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated mortality and heart failure hospitalization benefits across cardiovascular populations. However, their impact on patients with severe aortic stenosis (AS) undergoing surgical aortic valve replacement (AVR), with or without concomitant coronary artery bypass grafting (CABG), remains unclear. This study evaluated clinical outcomes associated with SGLT2i use in a real-world SAVR population.

Methods: Patients who underwent SAVR or combined SAVR and CABG between 2014 and 2025 were reviewed. The inclusion criteria were consistent with contemporary trials including severe AS with left ventricular ejection fraction ≤40%, estimated glomerular filtration rate (eGFR) 25-75 mL/min/1.73 m², or type 2 diabetes mellitus. Propensity score matching was used to adjust for baseline differences. The primary outcome was all-cause mortality, secondary outcomes included stroke, heart failure hospitalization, atrial fibrillation admission, and all-cause rehospitalization.

Results: A total of 2,930 patients (76 [69-83] years, 40.3% female) were included, of whom 85 (2.9%) received SGLT2i therapy. In the overall cohort, SGLT2i use was associated with significantly lower 5-year all-cause mortality compared with non-use (13.6% vs 33.5%, log-rank p=0.022). After matching, mortality remained lower among SGLT2i users (13.8% vs 25.8%, p=0.012), with reduced stroke incidence (2.0% vs 19.3%; p=0.046) and no significant differences in atrial fibrillation or rehospitalization.

Conclusions: In patients undergoing surgical AVR, perioperative SGLT2 inhibitor therapy was associated with improved 5-year survival and reduced stroke risk. These observational findings are hypothesis-generating and support further investigation of SGLT2i in prospective, randomized studies in the surgical valve population.