Journal of Thoracic and Cardiovascular Surgery最新文献

英文中文

Reassessing outcomes of coronary artery bypass grafting in the presence of chronic total occlusions 慢性全闭塞的冠状动脉旁路移植术的再评估结果。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.07.004

Khaled Ebrahim Al Ebrahim FRCSC

引用次数: 0

Reply: No matter good or ugly: Always the best for the patient 回答：不管是好是坏：永远是对病人最好的。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.07.010

Youngkern Kwon MD, Ho Jin Kim MD

引用次数: 0

Automated and explainable coronary angiogram interpretation for selection of coronary artery bypass grafting candidates using artificial intelligence 利用人工智能对冠状动脉搭桥术候选者选择的自动和可解释的冠状动脉造影解释。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.08.005

Tom X. Liu MD , Patrick M. McCarthy MD , Adwaiy Manerikar MD , Daniel Won BS , Eric Cantey MD , Daniel Schimmel MD , Christopher K. Mehta MD , Adrienne Kline MD, PhD , Douglas R. Johnston MD

Objectives

Visual estimation of coronary artery stenosis on angiography is subject to human error. Although machine learning may facilitate more accurate interpretation, clinical utility has been limited by lack of human interpretable models. We developed an automated computer vision model to identify candidates for coronary artery bypass (CABG) from coronary angiograms.

Methods

Medical records for primary CABG between 2018 and 2023 were screened for coronary angiogram video with angiographic and operative reports. A clinically determined reference group of angiographically normal, single-, and double-vessel disease was compared with automated angiogram reports to identify patients with indications for CABG per American Heart Association/American College of Cardiology 2021 guidelines.

Results

A total of 4472 angiographic video clips from 349 patients were analyzed identifying 682 lesions. Mean analysis was 51.1 seconds/study, or 4.6 seconds/video clip. Detection algorithm results were compared with original reports/images in cases where the model differed in recommendation. The model detected stenotic lesions in the left main, left anterior descending, circumflex, and right coronary arteries and calculated whether multivessel disease met criteria for CABG (accuracy: 74%, positive predicted value: 61%, and negative predictive value: 87%) compared with lesions documented in angiogram reports. Incorrect angiographically normal prediction occurred in 20 cases (6%) due to the selection of an incorrect maximum contrast frame. Prediction of percutaneous intervention when bypass was recommended (n = 31) was due to underrecognition of a left main or circumflex lesion.

Conclusions

With future improvements, automated identification of CABG candidates could augment visual reading at the time of angiography to improve quality control and guideline-directed revascularization strategies.

目的：冠状动脉造影中冠状动脉狭窄的视觉估计容易受到人为错误的影响。虽然机器学习可以促进更准确的解释，但由于缺乏人类可解释的模型，临床应用受到限制。我们开发了一个自动计算机视觉模型，从冠状动脉造影中识别冠状动脉搭桥术（CABG）的候选者。方法：对2018 - 2023年原发性冠脉搭桥患者的医疗记录进行冠脉造影视频、血管造影和手术报告筛选。根据AHA/ACC 2021指南，将血管造影正常、单血管和双血管疾病的临床确定参照组与自动血管造影报告进行比较，以确定有CABG适应症的患者。结果：共分析了来自349例患者的4472个血管造影视频片段，确定了682个病变。平均分析时间为51.1秒/项研究，或4.6秒/段视频。在模型推荐不同的情况下，将检测算法结果与原始报告/图像进行比较。该模型检测左主干、左前降支、旋支和右冠状动脉狭窄病变，并计算多血管病变是否符合冠脉搭桥标准(准确率：74%；阳性预测值：61%；阴性预测值：87%)，与血管造影报告中记录的病变相比。由于选择不正确的最大对比框，20例（6%）发生了不正确的血管造影正常预测。当建议行旁路手术时（n=31），经皮介入治疗的预测是由于对左主干或旋回病变的识别不足。结论：随着未来的改进，CABG候选者的自动识别可以增加血管造影时的视觉读数，以提高质量控制和指导指导的血运重建策略。

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引用次数: 0

Transcatheter edge-to-edge repair versus mitral valve surgery in octogenarians: Comparative analysis of safety, durability, and survival 经导管边缘对边缘修复与二尖瓣手术在八十多岁患者中的应用：安全性、耐久性和生存率的比较分析。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.08.016

Sina Danesh MD , Hartzell V. Schaff MD , Kimberly A. Holst MD , Paul C. Tang MD, PhD , Tedy Sawma MD , Joseph A. Dearani MD , Austin Todd MS , Agata Sularz MB, BChir , Kevin L. Greason MD , Juan A. Crestanello MD , Mohamad Alkhouli MD , Arman Arghami MD, MPH

Objective

To investigate the short- and long-term outcomes of surgical and transcatheter interventions for treating mitral regurgitation (MR) in patients age ≥80 years.

Methods

Between 2014 and 2024, 744 patients age ≥80 years underwent mitral valve (MV) surgery (n = 390) or transcatheter edge-to-edge repair (TEER; n = 354) at our institution. Of these, 466 patients without additional procedures or MV stenosis met the inclusion criteria. Application of 1:1 propensity score matching yielded a final matched cohort of 252 patients.

Results

After matching, baseline characteristics were comparable between the TEER and MV surgery groups. In the entire study cohort, the median patient age was 83.5 years (interquartile range, 81.7-85.9 years), and 78.2% had degenerative MR. Thirty-day mortality was similar in the 2 groups (MV surgery, 1.6%; TEER, 0.8%; P = .561). Postoperatively, the MV surgery group had higher rates of atrial fibrillation, prolonged mechanical ventilation, and longer intensive care unit and hospital stays (P < .001 for all). Predischarge echocardiography showed less residual MR (2.4% vs 8%; P < .001), less tricuspid regurgitation (10.5% vs 50%, P < .001), and lower right ventricular systolic pressure (37.5 mm Hg vs 44 mm Hg; P < .001) in the MV surgery group. Over a median 3.9-year follow-up, the incidence of recurrent MR remained lower (6.4% vs 33.3%; P < .001), and 5-year survival was superior (68% vs 56%; P = .019) in the MV surgery group.

Conclusions

Both surgical correction of MR and TEER can be performed relatively safely in octogenarians. Although TEER is associated with shorter hospital stays and fewer procedure-related complications, MV surgery results in a lower rate of recurrent MR and better late survival.

目的：很少有经导管边缘到边缘修复（TEER）和二尖瓣（MV）手术在老年患者中的实际比较。我们研究了手术和经导管介入治疗80岁及以上患者二尖瓣反流（MR）的短期和长期结果。方法：2014 - 2024年，我院80岁及以上患者744例（390例）行MV手术或TEER手术（354例）。466例未接受额外手术或中动脉狭窄的患者符合纳入标准；然后应用1:1的倾向评分匹配，得到252例患者的最终匹配队列。结果：匹配后，基线特征具有可比性；中位年龄为83.5岁（IQR: 81.7 ~ 85.9）， 78.2%有退行性mr，手术（1.6%）和TEER（0.8%）的30天死亡率相似（P = 0.561）。术后患者房颤发生率较高，机械通气时间延长，ICU和住院时间延长（P < 0.001）。出院前超声心动图显示手术后残余MR减少（2.4%比8%，P < 0.001），三尖瓣反流减少（10.5%比50%，P < 0.001），右心室收缩压降低（37.5比44 mmHg， P < 0.001）。在中位3.9年的随访中，复发性MR仍然较低（6.4%对33.3%,P < 0.001），手术后5年生存率更高（68%对56%，P = 0.019）。结论：80岁老人MR和TEER的手术矫正都可以相对安全的进行。虽然TEER与更短的住院时间和更少的手术相关并发症相关，但MV手术导致更少的复发性MR和更好的晚期生存。

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引用次数: 0

Challenging the transcatheter-first paradigm: Redo surgical aortic valve replacement after previous transcatheter or surgical aortic valve replacement 挑战经导管优先模式：在先前的经导管或手术主动脉瓣置换术后重新进行手术主动脉瓣置换术。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.08.014

Shinichi Fukuhara MD, Carol Ling MSc, Himanshu J. Patel MD, Barbara C.S. Hamilton MD, Robert B. Hawkins MD, MSc, Gorav Ailawadi MD, Bo Yang MD, PhD

Objective

Aortic valve reoperations after transcatheter aortic valve replacement (TAVR) are increasing. However, concerns persist regarding poor clinical outcomes, whereas high cohort heterogeneity has historically precluded meaningful comparative analyses.

Methods

We identified 1024 consecutive patients who underwent surgical aortic valve replacement (SAVR) after either TAVR (TAVR-SAVR; n = 127) or SAVR (SAVR-SAVR; n = 897) between 2011 and 2024. Among these, patients undergoing isolated SAVR ± coronary artery bypass grafting were included: 57 in the TAVR-SAVR group and 447 in the SAVR-SAVR group.

Results

The proportion of TAVR-SAVR among all aortic valve reoperations increased from 0% in 2011-2012 to 31.3% in 2024. Patients in the TAVR-SAVR group were older, exhibited greater comorbidity and heart failure burden, and had greater Society of Thoracic Surgeons Predicted Risk of Mortality. Despite 61.2% of TAVR-SAVR patients lacking previous sternotomy with shorter cardiopulmonary bypass and aortic crossclamp times, they demonstrated significantly greater operative mortality (12.3% vs 1.1%, P < .001). In contrast, the SAVR-SAVR cohort exhibited a remarkably low observed-to-expected mortality ratio of 0.33 (95% confidence interval, 0.11-0.76). After 1:2 propensity score matching (50 TAVR-SAVR vs 93 SAVR-SAVR patients), the TAVR-SAVR group continued to show greater operative mortality (12.0% vs 1.1%, P = .008) and greater composite complication rates.

Conclusions

TAVR-SAVR cases are increasing and may surpass SAVR-SAVR cases by 2029. Despite matching, patients undergoing SAVR ± coronary artery bypass grafting showed worse outcomes in TAVR-SAVR, whereas a SAVR-SAVR strategy was extremely safe. Reconsideration of the TAVR-first strategy is warranted for patients expected to outlive the durability of TAVR prostheses.

目的：经导管主动脉瓣置换术（TAVR）后主动脉瓣再手术越来越多。然而，对不良临床结果的担忧仍然存在，而高队列异质性历来阻碍了有意义的比较分析。方法：在2011年至2024年期间，我们确定了1,024例连续接受TAVR （TAVR-SAVR; n=127）或SAVR （SAVR-SAVR; n=897）手术主动脉瓣置换术（SAVR）的患者。其中，接受孤立SAVR +冠状动脉旁路移植术（CABG）的患者包括：TAVR-SAVR组57例，SAVR-SAVR组447例。结果：TAVR-SAVR占所有主动脉瓣再手术的比例从2011-2012年的0%上升到2024年的31.3%。TAVR-SAVR组患者年龄较大，表现出更大的合并症和心力衰竭负担，胸外科学会预测的死亡风险（STS-PROM）更高。尽管61.2%的TAVR-SAVR患者先前没有胸骨切开术并缩短体外循环和主动脉交叉夹夹时间，但他们的手术死亡率明显更高（12.3%对1.1%）。结论：TAVR-SAVR病例正在上升，到2029年可能超过SAVR-SAVR病例。尽管匹配，接受SAVR±CABG的患者在TAVR-SAVR中表现出较差的结果，而SAVR-SAVR策略是非常安全的。对于预期寿命超过TAVR假体耐久性的患者，重新考虑TAVR优先策略是有必要的。

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引用次数: 0

Information for readers 读者资讯

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/S0022-5223(25)00991-2

引用次数: 0

Quality of evidence: Randomized trials in coronary disease and moving the goalposts 证据质量：冠心病的随机试验和移动门柱。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.07.027

Mahmoud Alshneikat MD, Ahmed K. Awad MD, Faisal G. Bakaeen MD

引用次数: 0

Short- and long-term outcomes of chest wall resection and reconstruction for breast cancer 乳腺癌胸壁切除术和重建术的短期和长期疗效。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.07.046

Elizabeth G. Dunne MD , Kay See Tan PhD , Manjit S. Bains MD , Robert J. Downey MD , Farooq Shahzad MD , Evan Matros MD , Prasad S. Adusumilli MD , Valerie W. Rusch MD , Katherine Gray MD , James M. Isbell MD , Daniela Molena MD , Matthew J. Bott MD , James Huang MD , Smita Sihag MD , Bernard J. Park MD , David R. Jones MD , Gaetano Rocco MD

Objective

We sought to determine perioperative characteristics, rates of recurrence, and survival among patients who underwent chest wall resection for breast cancer.

Methods

We identified patients who underwent chest wall resection for breast cancer at our institution from 2000 to 2024. Progression-free survival and overall survival were estimated using the Kaplan–Meier approach. Cumulative incidence of local recurrence was calculated, and its association with disease-free interval was analyzed using Gray's test. Cox models quantified the association between patient characteristics and survival outcomes.

Results

Sixty-three patients were included. Chest wall resection was performed for recurrent breast cancer in 81% of patients (51/63). Most patients underwent rib resection (55/63; 87%) and partial or complete sternal resection (37/63; 59%). Fifty-five patients (87%) had a prosthesis placed for reconstruction; 55 patients (87%) received myocutaneous flaps. R0 resection was performed in 52 patients (83%). Eight patients (13%) had grade 3 or greater complications, nearly all of which (n = 7) were flap infection or necrosis. No patients died within 30 days; 3 patients (5%) died within 90 days. Median follow-up was 10 years (interquartile range, 5-17 years). At 5 years, cumulative incidence of local recurrence was 32%, progression-free survival was 13%, and overall survival was 31%.

Conclusions

Among patients with locally advanced or recurrent breast cancer, chest wall resection can provide local control and has acceptable morbidity and mortality. Given the known effect of chest wall disease on quality of life, chest wall resection should be considered in the multimodal management of patients with locally aggressive breast cancer.

目的：我们试图确定接受胸壁切除术的乳腺癌患者的围手术期特征、复发率和生存率。方法：我们确定了2000年至2024年在我院接受胸壁切除术的乳腺癌患者。使用Kaplan-Meier方法估计无进展生存期和总生存期。计算累积局部复发率，并采用Gray检验分析其与无病期的关系。Cox模型量化了患者特征与生存结果之间的关系。结果：纳入63例患者。81%（51/63）的复发性乳腺癌患者行胸壁切除术。大多数患者行肋骨切除术(55/63；87%)和部分或完全胸骨切除术(37/63；59%)。55例患者（87%）置放假体重建；55例（87%）行肌皮瓣移植。52例（83%）患者行R0切除术。8例（13%）患者出现≥3级并发症，其中7例（n=7）为皮瓣感染或坏死。30天内无患者死亡；3例（5%）在90天内死亡。中位随访时间为10年（四分位数间距为5-17年）。5年的累积局部复发率为32%，无进展生存率为13%，总生存率为31%。结论：在局部晚期或复发乳腺癌患者中，胸壁切除术可提供局部控制，发病率和死亡率可接受。鉴于已知胸壁疾病对生活质量的影响，在局部侵袭性乳腺癌患者的多模式治疗中应考虑胸壁切除术。

{"title":"Short- and long-term outcomes of chest wall resection and reconstruction for breast cancer","authors":"Elizabeth G. Dunne MD , Kay See Tan PhD , Manjit S. Bains MD , Robert J. Downey MD , Farooq Shahzad MD , Evan Matros MD , Prasad S. Adusumilli MD , Valerie W. Rusch MD , Katherine Gray MD , James M. Isbell MD , Daniela Molena MD , Matthew J. Bott MD , James Huang MD , Smita Sihag MD , Bernard J. Park MD , David R. Jones MD , Gaetano Rocco MD","doi":"10.1016/j.jtcvs.2025.07.046","DOIUrl":"10.1016/j.jtcvs.2025.07.046","url":null,"abstract":"<div><h3>Objective</h3><div>We sought to determine perioperative characteristics, rates of recurrence, and survival among patients who underwent chest wall resection for breast cancer.</div></div><div><h3>Methods</h3><div>We identified patients who underwent chest wall resection for breast cancer at our institution from 2000 to 2024. Progression-free survival and overall survival were estimated using the Kaplan–Meier approach. Cumulative incidence of local recurrence was calculated, and its association with disease-free interval was analyzed using Gray's test. Cox models quantified the association between patient characteristics and survival outcomes.</div></div><div><h3>Results</h3><div>Sixty-three patients were included. Chest wall resection was performed for recurrent breast cancer in 81% of patients (51/63). Most patients underwent rib resection (55/63; 87%) and partial or complete sternal resection (37/63; 59%). Fifty-five patients (87%) had a prosthesis placed for reconstruction; 55 patients (87%) received myocutaneous flaps. R0 resection was performed in 52 patients (83%). Eight patients (13%) had grade 3 or greater complications, nearly all of which (n = 7) were flap infection or necrosis. No patients died within 30 days; 3 patients (5%) died within 90 days. Median follow-up was 10 years (interquartile range, 5-17 years). At 5 years, cumulative incidence of local recurrence was 32%, progression-free survival was 13%, and overall survival was 31%.</div></div><div><h3>Conclusions</h3><div>Among patients with locally advanced or recurrent breast cancer, chest wall resection can provide local control and has acceptable morbidity and mortality. Given the known effect of chest wall disease on quality of life, chest wall resection should be considered in the multimodal management of patients with locally aggressive breast cancer.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 1","pages":"Pages 46-52.e1"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800801","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

Combined inflation and cooling method improves lung function in uncontrolled donation after circulatory death 联合充气降温法可改善循环性死亡后非受控捐献的肺功能。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.08.034

Hiroyuki Ujike MD , Shin Tanaka PhD , Kei Matsubara PhD , Shinichi Kawana MD , Masashi Umeda MD , Tsuyoshi Ryuko MD , Haruki Choshi MD , Yujiro Kubo PhD , Kohei Hashimoto PhD , Lucas Hoyos Mejía PhD , Jose Luis Campo-Cañaveral de la Cruz PhD , Kazuhiko Shien PhD , Ken Suzawa PhD , Kentaroh Miyoshi PhD , Toshiaki Ohara PhD , David Gómez-de-Antonio PhD , Mikio Okazaki PhD , Seiichiro Sugimoto PhD , Akihiro Matsukawa PhD , Shinichi Toyooka PhD

Objective

Currently, the 2 methods used to preserve lungs from uncontrolled donation after circulatory death—topical cooling and inflation—result in the suboptimal use of lungs. This study aimed to introduce an approach that combines cooling and inflation to investigate whether it improves lung conditions in a swine model, even if the lungs had been damaged with long-term warm ischemia, such as in out-of-hospital cardiac arrest.

Methods

Donor lungs subjected to 1.5 hours of warm ischemia were divided into 3 groups: the cooling group, inflation group, and inflation with cooling group (n = 5 per group). Lung preservation was performed for 3 hours, followed by left lung transplantation. Functional assessments were conducted over 4 hours after transplantation.

Results

The inflation with cooling group achieved significantly better oxygenation after 1 hour of reperfusion. Dynamic lung compliance was higher in the inflation with cooling group than in the cooling and inflation groups. Additionally, the wet/dry weight ratio after lung transplantation in the inflation with cooling group was lower than in the other 2 groups. The inflation with cooling group exhibited less severe post-transplantation pathological lung injury. The combination of inflation and cooling maintained superior pulmonary function compared with existing methods.

Conclusions

This method has the potential to prevent the deterioration of lungs from uncontrolled donation after circulatory death, resulting in increased lung use.

目的：目前，用于保存循环死亡后无控制捐赠肺的两种方法-外敷冷却和充气-导致肺的利用率不理想。这项研究旨在引入一种结合冷却和膨胀的方法，以研究它是否能改善猪模型的肺部状况，即使肺部因长期热缺血而受损，比如院外心脏骤停。方法：将热缺血1.5 h的供肺分为冷却组、充气组、充气加冷却组，每组5只。肺保存3 h后行左肺移植。移植后4小时进行功能评估。结果：充气冷却组在再灌注1 h后氧合明显改善。充气加降温组动态肺顺应性高于降温加充气组。充气降温组肺移植后干湿重比低于其他两组。充气降温组移植后病理肺损伤较轻。与现有方法相比，充气和冷却相结合保持了更好的肺功能。结论：该方法有可能防止循环死亡后不受控制的捐赠导致肺恶化，从而增加肺利用率。

{"title":"Combined inflation and cooling method improves lung function in uncontrolled donation after circulatory death","authors":"Hiroyuki Ujike MD , Shin Tanaka PhD , Kei Matsubara PhD , Shinichi Kawana MD , Masashi Umeda MD , Tsuyoshi Ryuko MD , Haruki Choshi MD , Yujiro Kubo PhD , Kohei Hashimoto PhD , Lucas Hoyos Mejía PhD , Jose Luis Campo-Cañaveral de la Cruz PhD , Kazuhiko Shien PhD , Ken Suzawa PhD , Kentaroh Miyoshi PhD , Toshiaki Ohara PhD , David Gómez-de-Antonio PhD , Mikio Okazaki PhD , Seiichiro Sugimoto PhD , Akihiro Matsukawa PhD , Shinichi Toyooka PhD","doi":"10.1016/j.jtcvs.2025.08.034","DOIUrl":"10.1016/j.jtcvs.2025.08.034","url":null,"abstract":"<div><h3>Objective</h3><div>Currently, the 2 methods used to preserve lungs from uncontrolled donation after circulatory death—topical cooling and inflation—result in the suboptimal use of lungs. This study aimed to introduce an approach that combines cooling and inflation to investigate whether it improves lung conditions in a swine model, even if the lungs had been damaged with long-term warm ischemia, such as in out-of-hospital cardiac arrest.</div></div><div><h3>Methods</h3><div>Donor lungs subjected to 1.5 hours of warm ischemia were divided into 3 groups: the cooling group, inflation group, and inflation with cooling group (n = 5 per group). Lung preservation was performed for 3 hours, followed by left lung transplantation. Functional assessments were conducted over 4 hours after transplantation.</div></div><div><h3>Results</h3><div>The inflation with cooling group achieved significantly better oxygenation after 1 hour of reperfusion. Dynamic lung compliance was higher in the inflation with cooling group than in the cooling and inflation groups. Additionally, the wet/dry weight ratio after lung transplantation in the inflation with cooling group was lower than in the other 2 groups. The inflation with cooling group exhibited less severe post-transplantation pathological lung injury. The combination of inflation and cooling maintained superior pulmonary function compared with existing methods.</div></div><div><h3>Conclusions</h3><div>This method has the potential to prevent the deterioration of lungs from uncontrolled donation after circulatory death, resulting in increased lung use.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 1","pages":"Pages 61-72.e3"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006715","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

Active and passive cardiac indexes as complementary predictors of outcomes after left ventricular assist device implantation 主动和被动心脏指数作为LVAD植入后预后的互补预测因子。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.09.005

Wing Sum Vincy Tam MBBS , Rolando Calderon MD , Shuyang Lu MD , Austin Todd MS , Andrew Rosenbaum MD , John M. Stulak MD , Paul C. Tang MD, PhD

Background

Goals of left ventricular assist device (LVAD) therapy include low rates of right ventricle (RV) failure and favorable survival outcomes. However, conventional metrics often fail to capture its physiologic complexity. We evaluated the prognostic utility of the active cardiac index (ActCI) and passive cardiac index (PasCI), which reflect cardiac output driven by active RV contractility and passive venous return, respectively.

Methods

We retrospectively analyzed 399 patients who underwent primary continuous-flow LVAD implantation at Mayo Clinic (2007 to 2023). Pre-LVAD ActCI and PasCI were calculated from preoperative right heart catheterization data. Optimal thresholds predicting survival were identified using spline analysis. Outcomes were evaluated using Kaplan-Meier curves, multivariable Cox models, and concordance statistics. Comparisons were made against the pulmonary artery pulsatility index and RV stroke work index.

Results

A high ActCI >0.903 was associated with better survival (hazard ratio, 0.71; P = .019) whereas PasCI >0.778 predicted worse survival (hazard ratio, 1.39; P = .022). Low ActCI was associated with increased postoperative RV failure (11.3% vs 4.9%; P = .018), dialysis (27.8% vs 11.7%; P < .001), hepatic dysfunction (21.1% vs 8.3%; P < .001), and in-hospital mortality (14.3% vs 5.6%; P = .004). Conversely, higher PasCIs portend increased rates of postoperative dialysis (28.6% vs 11.3%; P < .001), respiratory failure (28.6% vs 19.5%; P = .042), hepatic dysfunction (21.8% vs 7.9%; P < .001), gastrointestinal bleeding (44.4% vs 32.3%; P = .019), and in-hospital mortality (12.0% vs 6.8%; P = .076).

Conclusions

ActCI and PasCI independently predict survival and RV failure after LVAD. These indices outperform pulmonary artery pulsatility index and RV stroke work index and may enhance pre-LVAD risk stratification and help balance decisions for heart transplantation.

导读：左心室辅助装置（LVAD）治疗的目标包括低右心室衰竭（RVF）率和良好的生存结果。然而，传统的度量标准往往无法捕捉其生理复杂性。我们评估了主动心脏指数（ActCI）和被动心脏指数（PasCI）的预后效用，它们分别反映了由主动右心室收缩力和被动静脉回流驱动的心输出量。方法：我们回顾性分析了2007年至2023年在梅奥诊所接受初级连续血流LVAD植入的399例患者。根据术前右心导管数据计算lvad前的ActCI和PasCI。使用样条分析确定预测生存的最佳阈值。结果采用Kaplan-Meier曲线、多变量Cox模型和c统计进行评估。比较肺动脉搏动指数（PAPi）和左室卒中工作指数（RVSWi）。结果：高actici >0.903与较好的生存率相关（HR 0.71, p = 0.019），而PasCI >0.778预测较差的生存率（HR 1.39, p = 0.022）。低ActCI与术后RV衰竭（11.3% vs. 4.9%; p = 0.018）和透析(27.8% vs. 11.7%； p结论：ActCI和PasCI独立预测LVAD后的生存和RVF。这些指标优于PAPi和RVSWi，并可能增强左室病变前的风险分层，有助于心脏移植的平衡决策。

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