Journal of Thoracic and Cardiovascular Surgery最新文献

英文中文

Rethinking international collaboration in cardiac surgery in Africa: From dependency to sustainable empowerment 重新思考非洲心脏外科的国际合作：从依赖到可持续赋权。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.07.022

Valdano Manuel MD, PhD

引用次数: 0

Predicting and diagnosing pneumonia in patients undergoing elective cardiac surgery via machine learning analysis of exhaled volatile carbonyl compounds 通过呼气挥发性羰基化合物的机器学习分析预测和诊断选择性心脏手术患者的肺炎。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.06.028

Toyokazu Endo MD , Kevin Tran MS , Dylan A. Goodin PhD , Gianna Katsaros MD , Zhenzhen Xie PhD , Xiao-An Fu PhD , George Pantalos PhD , Hermann B. Frieboes PhD , Victor van Berkel MD, PhD

Objective

Pneumonia remains one of the most common postoperative complications after elective cardiac surgery. Early intervention could lead to improved patient outcomes, including lower rates of intensive care unit admissions, and shorter hospital stays. Volatile organic compounds (VOCs) in exhaled breath have shown promise in diagnosis and classification for various lung-related conditions. The study aims to diagnose and predict the onset of pneumonia in patients undergoing elective cardiac surgery via machine learning (ML) analysis of VOCs.

Methods

Patients undergoing elective cardiac surgery (n = 75) were enrolled in the study (March 2023 to July 2024). Each patient's breath was collected in a 600-mL Tedlar bag preoperatively, within 24 hours, and every 3 days. The pneumonia group consisted of those who developed clinical signs of pneumonia postoperatively. Carbonyl compounds in the breath were captured on a microchip and identified using mass spectrometry. An ML workflow was implemented to build a model for pneumonia diagnosis (trained on pre- and postoperative VOC samples) and to build a prediction model of pneumonia development (trained on preoperative samples) (alpha 0.05).

Results

Of the 75 patients enrolled during the study period, 10 developed clinical signs of pneumonia. The majority of patients had undergone coronary artery bypass grafting (50.1%), followed by aortic valve/root replacement (22.7%), concomitant coronary artery bypass grafting and valve (16%), and mitral valve repair/replacement (8%). Twenty-four carbonyls were selected by the pneumonia diagnosis model, including formaldehyde, hexanal, C₁₀H₂₀O, C₁₁H₂₂O, hexanone, and hydroxy-butanal. The proposed pneumonia diagnosis model had an area under the receiver operating characteristic of 0.833 and an area under the precision-recall curve of 0.818 on the test set. In contrast, 4 carbonyls (heptanal, octenone, C₁₂H₂₄O, and acetone) were selected by the model to predict the onset of pneumonia using preoperative breath samples (area under the receiver operating characteristic of 0.833 and area under the precision-recall curve of 0.818 on the test set).

Conclusions

This pilot study demonstrates that VOCs captured from breath can be used to train and test ML models for diagnosis and prediction of pneumonia onset in patients undergoing elective cardiac surgery. This finding has implications for guiding perioperative and postoperative strategies for preventing pneumonia.

目的：肺炎仍然是择期心脏手术后最常见的并发症之一。早期干预可以改善患者的预后，包括降低ICU住院率和缩短住院时间。呼出气体中的挥发性有机化合物（VOCs）在各种肺部相关疾病的诊断和分类中显示出了希望。该研究旨在通过对VOCs的机器学习（ML）分析来诊断和预测接受选择性心脏手术的患者的肺炎发作。方法：接受择期心脏手术的患者（n=75）被纳入研究（2023年3月- 2024年7月）。术前、24小时内、每3天用600mL泰德勒气囊采集患者呼吸。肺炎组包括术后出现肺炎临床症状的患者。呼吸中的羰基化合物被微芯片捕获，并用质谱法进行鉴定。采用机器学习（ML）工作流构建肺炎诊断模型（术前和术后VOC样本训练）和肺炎发展预测模型（术前样本训练）（alpha 0.05）。结果：在研究期间纳入的75名患者中，有10名出现了肺炎的临床症状。大多数患者接受了冠状动脉旁路移植术（CABG）（50.1%），其次是主动脉瓣/根置换术（22.7%）、冠状动脉旁路移植术和瓣膜合并（16%）、二尖瓣修复/置换术（8%）。肺炎诊断模型选取24种羰基，包括甲醛、己醛、c10h2o、c11h2o、己酮、羟基丁醛。所提出的肺炎诊断模型在测试集上的receiver operating characteristic （AUROC）下面积为0.833,precision-recall curve （PRAUC）下面积为0.818。模型选择庚醛、辛烯酮、C12H24O和丙酮四种羰基作为术前呼吸样本预测肺炎发病的指标（AUROC为0.833，PRAUC为0.818）。结论：本初步研究表明，从呼吸中捕获的挥发性有机化合物可用于训练和测试ML模型，用于择期心脏手术患者肺炎发作的诊断和预测。这一发现对指导围手术期和术后预防肺炎的策略具有重要意义。

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引用次数: 0

Calcium/calmodulin-dependent protein kinase II inhibition using tatCN19o ameliorates spinal cord ischemia associated with aortic surgery 使用tatCN19o抑制CaMKII可改善主动脉手术相关的脊髓缺血

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.08.021

Bo Chang Brian Wu MD , Linling Cheng BS , Nicolas Chanes MD , Adam M. Carroll MD, MPH , Muhammad Aftab MD , Karl Ulrich Bayer PhD , T. Brett Reece MD, MBA

Objective

Paraplegia from spinal cord ischemia (SCI) is a life-altering complication of aortic surgery. Although various strategies have been employed to enhance spinal cord perfusion, no pharmaceutical agents have been used clinically to mitigate the risk of SCI. Inhibition of calcium/calmodulin-dependent protein kinase II (CaMKII) pathway has shown neuroprotective effects in rodent cerebral ischemia; however, its role in spinal cord ischemia-reperfusion injury has yet to be investigated. This study aims to evaluate the potential of CaMKII inhibition with tatCN19o in preventing SCI in a mouse model.

Methods

Male C57BL/6 mice (aged 7-9 weeks) were used. Both treatment and control groups underwent aortic cross-clamping to induce SCI. The aorta (distal to left carotid artery) and the left subclavian were clamped for 4 minutes. Sham mice had aortic exposure without clamping. tatCN19o (0.1 mg/kg) or placebo was administered intraperitoneally 10 minutes before and 24 hours after SCI. Sham mice received placebo at the same time points. Postoperative motor function was assessed during the first hour and every 12 hours for 48 hours using the Basso Motor Scale (0-9, from no to full function). Mice not surviving until 48 hours were excluded. Spinal cord histological analysis was performed. A blinded motor neuron cell count of lumbar anterior horn was conducted using 20× imaging by 2 reviewers.

Results

Based on behavioral scores, sham mice (n = 3) regained full motor function within 30 minutes after surgery. All tatCN19o mice (n = 12) recovered faster with full motor scores by 12 hours postoperatively (9 ± 0 vs 7 ± 0.7; P = .02), compared with controls (n = 11). Motor function declined in both groups after 24 hours. At 48 hours, tatCN19o mice had significantly improved motor function (8.2 ± 0.8 vs 3.1 ± 1.3; P = .004) that did not differ significantly from sham (P = .288). In contrast to sham and tatCN19o-treated mice, the lumbar anterior horn of untreated SCI mice showed minimal surviving motor neurons, with vacuolization and pyknosis, suggesting both necrosis and apoptosis. Motor neuron counts were higher in tatCN19o mice than controls (13.2 ± 1.1 vs 7.2 ± 1.6 cells/1200px diameter area; P = .01).

Conclusions

Inhibiting CaMKII with tatCN19o significantly preserved lower extremity motor function in a mouse SCI model. As in brain tissues, the CaMKII pathway is critical in spinal cord ischemia-reperfusion injury. Further studies are needed to explore CaMKII signaling in SCI and optimize tatCN19o dosing and timing.

目的：脊髓缺血截瘫是主动脉手术后改变患者生活的并发症。虽然已经采用了各种策略来增强脊髓灌注，但临床上还没有使用药物来降低脊髓损伤的风险。抑制钙/钙调素依赖性蛋白激酶II （CaMKII）通路在啮齿动物脑缺血中显示出神经保护作用然而，其在脊髓缺血再灌注损伤中的作用尚未被研究。本研究旨在评估tatCN19o抑制CaMKII在小鼠模型中预防脊髓损伤的潜力。方法：雄性C57BL/6小鼠（7 ~ 9周龄）。治疗组和对照组均行主动脉交叉夹紧术诱导脊髓损伤。主动脉（左颈动脉远端）和左锁骨下夹持4分钟。假手术小鼠主动脉暴露，但未夹持。在脊髓损伤前10分钟和后24小时腹腔注射tatCN19o （0.1mg/kg）或安慰剂。假药小鼠在同一时间点接受安慰剂治疗。术后第1小时及48小时内每12小时使用Basso运动量表（0 - 9，从无功能到完全功能）评估运动功能。未存活至48小时的小鼠被排除在外。进行脊髓组织学分析。采用20倍显像对腰椎前角进行盲法运动神经元细胞计数。结果：行为评分，Sham小鼠（n = 3）在术后30分钟内恢复了完全的运动功能。术后12小时，所有tatCN19o小鼠（n = 12）与对照组（n = 11）相比，恢复速度更快（9±0比7±0.7,p=0.02）。24小时后，两组的运动功能均有所下降。48小时时，tatCN19o小鼠的运动功能显著改善（8.2±0.8比3.1±1.3,p = 0.004），与假手术相比无显著差异（p = 0.288）。组织学变化：与假手术和tatcn19治疗的小鼠相比，未治疗的脊髓损伤小鼠腰前角显示存活的运动神经元极少，空泡化和固缩，提示坏死和凋亡。细胞计数：tatCN19o小鼠运动神经元计数高于对照组（13.2±1.1 vs. 7.2±1.6细胞/1200px直径面积，p = 0.01）。结论：用tatCN19o抑制CaMKII可显著保护小鼠脊髓损伤模型的下肢运动功能。与脑组织一样，CaMKII通路在脊髓缺血/再灌注损伤中起关键作用。需要进一步的研究来探索CaMKII在SCI中的信号传导，并优化tatCN19o的剂量和时间。

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引用次数: 0

Reply: Toward personalized, surgeon-level prediction in mitral valve repair 回复：二尖瓣修复的个性化、外科水平预测。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.08.001

Mohsyn Imran Malik MD, MSc, Rashmi Nedadur MD, MSc, Michael W.A. Chu MD, MEd

引用次数: 0

When the gold standard fails: Propensity-matched comparison of peroral endoscopic myotomy after Heller myotomy versus index peroral endoscopic myotomy 当金标准失败时：Heller肌切开术后的经口内窥镜肌切开术与指数经口内窥镜肌切开术的倾向匹配比较。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.10.012

Andrew Conner MD , Nethra Jain MBBS , John O. Barron MD , Andrew J. Toth MS , Andrew Tang MD , Feredun Azari MD , Monisha Sudarshan MD , Sudish C. Murthy MD, PhD , Eugene H. Blackstone MD , Siva Raja MD, PhD

Objective

Symptoms of achalasia can recur after Heller myotomy (HM), which is considered the gold standard therapy. Although peroral endoscopic myotomy (POEM) has been used as salvage therapy after failed HM, limited data exist comparing long-term outcomes of POEM after HM versus POEM as index myotomy. We compared physiologic and patient-reported outcomes of salvage versus initial POEM for achalasia.

Methods

From April 2014 to January 2023, 381 patients underwent POEM for achalasia at Cleveland Clinic; 84 had previous HM (POEM-after-HM group) and 297 had not (index-POEM group). Propensity-score matching generated 62 pairs with median follow-up of 3 years. Longitudinal trends in symptom palliation (Eckardt score), esophageal emptying (timed barium esophagram), esophagitis, and reinterventions were evaluated.

Results

Operative time, length of stay, and complications were comparable between groups. Longitudinal symptom palliation differed: 67% in the POEM-after-HM group and 80% in the index-POEM group had Eckardt score ≤3 at 5 years (P = .028). Complete esophageal emptying at 5 years was 20% in the POEM-after-HM group versus 24% in the index-POEM group (P = .61). Longitudinal esophagitis trends and postoperative pH testing were similar between groups, despite fundoplication in 89% of the POEM-after-HM group. By 5 years, 10 reinterventions were performed after POEM-after-HM versus 4 after index-POEM (P = .24).

Conclusions

Salvage POEM provides durable palliation for recurrent achalasia symptoms after HM but with less favorable outcomes than index POEM. Factors inherent to previous HM (fibrosis, narrow crural closure, tight fundoplication) may limit the effectiveness of salvage POEM. Previous fundoplication does not protect against post-POEM reflux esophagitis. We recommend closer follow-up for patients undergoing POEM after failed HM.

目的：贲门失弛缓症症状可在海勒肌切开术后复发，被认为是金标准疗法。虽然经口内窥镜下肌切开术（POEM）已被用作HM失败后的挽救性治疗，但比较POEM与POEM作为指数肌切开术后的长期结果的数据有限。我们比较了失弛缓症抢救与初始POEM的生理和患者报告的结果。方法：2014年4月至2023年1月，克利夫兰诊所381例贲门失弛缓症患者行POEM治疗；84例既往HM组（经HM组），297例既往无HM组（经index-POEM组）。倾向得分匹配产生62对，中位随访3年。评估了症状缓解（Eckardt评分）、食管排空（定时钡餐食管造影）、食管炎和再干预的纵向趋势。结果：两组间手术时间、住院时间、并发症均具有可比性。纵向症状缓解有差异：在hm后进行poem治疗组，有67%的患者5年时Eckardt评分≤3分，而index-POEM治疗组有80%的患者5年时Eckardt评分≤3分（P= 0.028）。5年食管完全排空率在hm后poem组为20%，而index-POEM组为24% （P= 0.61）。纵向食管炎趋势和术后pH值检测在两组之间相似，尽管在hm后poem组中有89%的患者出现了基底重复。5年后，再干预10例，再干预4例（P= 0.24）。结论：补救性POEM为HM后复发性贲门失弛缓症症状提供了持久的缓解，但其预后不如指数POEM。先前HM的固有因素（纤维化、脚闭合狭窄、基底闭合紧密）可能限制挽救性POEM的有效性。先前的复底不能预防poem后反流性食管炎。我们建议对HM失败后接受POEM的患者进行更密切的随访。

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引用次数: 0

One thousand cases of ex vivo lung perfusion for lung transplantation: A single-center experience 1000例体外肺灌注用于肺移植：单中心经验。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.08.036

Shaf Keshavjee MD , Andrew T. Sage PhD , Thomas Borrillo MHSc , Jonathan C. Yeung MD , Deween Piyasena BHSc , Elliot Wakeam MD , Laura Donahoe MD , Thomas K. Waddell MD, MSc, PhD , Marc de Perrot MD , Andrew Pierre MD , Sharaniyaa Balachandran , Rasheed Ghany MSc , Aadil Ali PhD , Kazuhiro Yasufuku MD , Marcelo Cypel MD

Objectives

The study objectives were to report the impact of ex vivo lung perfusion on lung transplantation practices and clinical outcomes. This study presents the largest single-center ex vivo lung perfusion experience to date, highlighting how ex vivo lung perfusion has transformed clinical lung transplantation with expansion of donor access, program growth, and the safe use of extended criteria donor lungs.

Methods

We conducted a retrospective analysis of 1000 consecutive ex vivo lung perfusion procedures performed between 2008 and 2024 at University Health Network's Toronto General Hospital. Donor lungs were evaluated using the standardized normothermic acellular Toronto ex vivo lung perfusion technique. We analyzed donor and recipient demographics, procedural characteristics, transplant rates, and post-transplant outcomes.

Results

Of 1000 ex vivo lung perfusion procedures, approximately 65% of lungs were accepted for transplant. These grafts accounted for 659 lung transplants, representing 29% of all transplants performed during the study period. Ex vivo lung perfusion volume grew steadily and contributed to an overall increase in transplant activity. The use of moderate- and high-risk donor lungs, including those after circulatory death, increased over time. In concordance with these shifts, median ischemia time increased from 224 to 414 minutes, and the proportion of cases achieving a final ΔpO₂ 400 mm Hg or greater on ex vivo lung perfusion declined from 68% to 52%. Post-transplant outcomes including intensive care unit duration, time to extubation, primary graft dysfunction, and overall survival were not significantly different between ex vivo lung perfusion and non–ex vivo lung perfusion lung recipients.

Conclusions

Ex vivo lung perfusion has emerged as a safe, effective, and scalable platform for donor lung evaluation. Its integration into clinical practice has supported broader donor organ use and excellent patient outcomes, while laying the foundation for continued innovation in lung transplantation.

目的：报道体外肺灌注（EVLP）对肺移植实践和临床结果的影响。本研究展示了迄今为止最大的单中心EVLP经验，强调了EVLP如何通过扩大供体获取、项目增长和安全使用扩展标准供体肺来改变临床肺移植。方法：我们对2008年至2024年在多伦多综合医院大学健康网络进行的1000例连续EVLP手术进行了回顾性分析。使用标准化的正常无细胞多伦多EVLP技术评估供体肺。我们分析了供体和受体的人口统计学特征、手术特点、移植率和移植后结果。结果：在1000例EVLP手术中，约65%的肺接受移植。这些移植占659例肺移植，占研究期间所有移植的29%。EVLP数量稳步增长，并促进了移植活动的总体增加。随着时间的推移，使用中等和高风险的供体肺，包括那些循环死亡后的供体肺。与这些变化相一致，中位缺血时间从224分钟增加到414分钟，EVLP最终达到ΔpO2≥400 mmHg的病例比例从68%下降到52%。EVLP和非EVLP肺受者的移植后预后包括ICU时间、拔管时间、原发性移植物功能障碍和总生存率无显著差异。结论：EVLP已成为一种安全、有效和可扩展的供肺评估平台。它与临床实践的结合支持了更广泛的供体器官利用和良好的患者预后，同时为肺移植的持续创新奠定了基础。

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引用次数: 0

Reply: Discrete subaortic membrane—simple in appearance, complex in reality 回答：离散的主动脉下膜，表面简单，实际复杂。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.08.026

Jie Dong MD , Keming Yang MD, PhD , Shuo Dong MD, PhD

引用次数: 0

Redo coronary artery bypass grafting in patients with patent bilateral internal thoracic artery grafts: Exceptions to a lifetime warranty 双侧胸椎内动脉移植术患者重做冠状动脉旁路移植术：终身保证的例外。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.07.018

Mahmoud Alshneikat MD , Richard Ramsingh MD , Ahmed K. Awad MD , Penny L. Houghtaling MS , Shinya G. Unai MD , Marijan J. Koprivanac MD, MS , Michael Z. Tong MD , Haytham J. Elgharably MD , Kenneth R. McCurry MD , Patrick R. Vargo MD , Edward G. Soltesz MD, MPH , Nicholas G. Smedira MD , Gösta B. Pettersson MD , Eric E. Roselli MD , A. Marc Gillinov MD , Lars G. Svensson MD, PhD , Eugene H. Blackstone MD , Faisal G. Bakaeen MD

Objective

To undertake an in-depth review of patients undergoing redo coronary artery bypass grafting (CABG) despite patent bilateral internal thoracic artery (BITA) grafts.

Methods

From January 1980 to July 2020, 91 of 8108 patients (1.1%) who underwent isolated redo CABG had patent BITAs. Mean age was 62 ± 8.7 years; 81 (89%) were male. Mean age at previous CABG was 52 ± 9.4 years, with reoperation occurring after a median of 10 years. Indications for reoperation, surgical strategies, and outcomes were analyzed.

Results

All patients had ischemic symptoms, most commonly unstable angina (65 [71%]). Anatomic drivers of reoperation included progression of native coronary atherosclerosis (63 [69%]), non-BITA graft failure (63 [69%]), and patent but diseased, atretic, or technically compromised internal thoracic artery grafts (ITAs) (34 [37%]; left: 12, right: 18, bilateral: 4). The left anterior descending artery (LAD) was previously bypassed with an ITA in 78 (86%). At reoperation, conduits used included saphenous vein (75 [82%]), radial artery (39 [43%]), and gastroepiploic artery (8 [8.8%]). Coronary targets included circumflex (58 [64%]), right coronary (54 [59%]), LAD (36 [40%]), and diagonal (28 [31%]) arteries. Operative mortality and median survival were 3.3% and 12 years, respectively.

Conclusions

Patients with patent BITAs represent a small subset of redo CABG cases, with native coronary disease progression and non-ITA graft failure being the most common reoperation indications. Most patients undergo multivessel grafting, with less than one half needing or requiring a bypass to the LAD. Outcomes are good at centers with experienced surgeons.

目的：深入回顾双侧胸内动脉（BITA）移植未通畅后再次行冠状动脉旁路移植术（CABG）的患者。方法：从1980年1月至2020年7月，8108例接受单独重做CABG的患者中有91例（1.1%）具有专利BITAs。平均年龄62±8.7岁；81例（89%）为男性。先前CABG的平均年龄为52±9.4岁，中位10年后再次手术。分析了再手术指征、手术策略和结果。结果：所有患者均有缺血性症状，最常见的是不稳定型心绞痛（65例[71%]）。再手术的解剖学驱动因素包括：原生冠状动脉粥样硬化进展（63例[69%]）、非bita移植物失败（63例[69%]）、未闭但病变、闭锁或技术上受损的胸内动脉移植物（ITAs）(34例[37%]；左：12，右：18，双侧：4)。78例（86%）患者曾行ITA旁路左前降支（LAD）。再次手术时使用的导管包括大隐静脉（75条[82%]）、桡动脉（39条[43%]）和胃大网膜动脉（8条[8.8%]）。冠状动脉靶动脉包括旋动脉（58条[64%]）、右冠状动脉（54条[59%]）、左冠状动脉（36条[40%]）和对角线动脉（28条[31%]）。手术死亡率和中位生存期分别为3.3%和12年。结论：未专利bita患者占再行CABG病例的一小部分，原生冠状动脉疾病进展和非ita移植物失败是最常见的再手术指征。大多数患者接受多血管移植，只有不到一半的患者需要或需要对LAD进行搭桥。在有经验的外科医生的中心，结果很好。

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引用次数: 0

Congenital Articles in AATS Journals 先天性文章在AATS期刊

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/S0022-5223(25)01085-2

引用次数: 0

Adult Articles in AATS Journals 成人文章在AATS期刊

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/S0022-5223(25)01087-6

引用次数: 0

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