Pub Date : 2024-11-07DOI: 10.1016/j.jtcvs.2024.10.056
Paul Stelzer, Javier Mejia
{"title":"Commentary: Second Ross valve; can pigs or cows replace people?","authors":"Paul Stelzer, Javier Mejia","doi":"10.1016/j.jtcvs.2024.10.056","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.056","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631783","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 : 2024-11-06DOI: 10.1016/j.jtcvs.2024.10.047
Christina M Stuart, Adam R Dyas, Elliot J Yee, Otto Thielen, Michael R Bronsert, Benedetto Mungo, Martin D McCarter, Simran K Randhawa, Elizabeth A David, John D Michell, Robert A Meguid
Objective: Delays to definitive surgery in esophageal cancer may be associated with disease progression and worsened survival. The objective of this study was to perform a national assessment for predictors of delay to esophagectomy and to assess for their impact on oncologic and survival outcomes.
Methods: The National Cancer Database, 2010-2020, was queried for patients with locally advanced esophageal adenocarcinoma (Stage I-III). Patients were divided into upfront and post-neoadjuvant chemoradiation (nCRT) cohorts. The primary outcome was time-to-surgery. Time-to-surgery was examined as a continuous and categorical variable, where patients were divided into timely and delayed cohorts (96 days for upfront cohort; 56 days for post-nCRT cohort).
Results: Of 16,486 patients, 4,066 (24.7%) underwent upfront surgery and 12,420 (75.3%) post-nCRT surgery. In the upfront surgery group, median [interquartile range] time-to-surgery was 61 [40-96] days. Risk-adjusted predictors of delay included lack of insurance, lowest quartile of education, biopsy-based staging or surgical staging and robotic-assisted approach. In the post-nCRT cohort time-to-surgery was 55 [44-70] days. Risk-adjusted predictors of delay included Hispanic ethnicity, Medicaid or other government-based insurance, lowest quartile of educational status, and robotic approach. In the upfront surgery group, patients who had delayed surgery had increased odds of pathologic upstaging (1.31, 95% confidence interval 1.06-1.61). In the post-nCRT group, patients with surgical delay had increased odds of 90-day mortality (1.27, 95% confidence interval 1.06-1.51).
Conclusions: Following risk-adjustment for patient, oncologic, facility and surgical characteristics, there were several predictors of increased time to esophagectomy associated with consequences of upstaging and survival.
{"title":"Patient, Facility and Surgical Factors Associated with Significant Delays to Esophagectomy and Subsequent Poor Outcomes: An Analysis of 16,486 Cases.","authors":"Christina M Stuart, Adam R Dyas, Elliot J Yee, Otto Thielen, Michael R Bronsert, Benedetto Mungo, Martin D McCarter, Simran K Randhawa, Elizabeth A David, John D Michell, Robert A Meguid","doi":"10.1016/j.jtcvs.2024.10.047","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.047","url":null,"abstract":"<p><strong>Objective: </strong>Delays to definitive surgery in esophageal cancer may be associated with disease progression and worsened survival. The objective of this study was to perform a national assessment for predictors of delay to esophagectomy and to assess for their impact on oncologic and survival outcomes.</p><p><strong>Methods: </strong>The National Cancer Database, 2010-2020, was queried for patients with locally advanced esophageal adenocarcinoma (Stage I-III). Patients were divided into upfront and post-neoadjuvant chemoradiation (nCRT) cohorts. The primary outcome was time-to-surgery. Time-to-surgery was examined as a continuous and categorical variable, where patients were divided into timely and delayed cohorts (96 days for upfront cohort; 56 days for post-nCRT cohort).</p><p><strong>Results: </strong>Of 16,486 patients, 4,066 (24.7%) underwent upfront surgery and 12,420 (75.3%) post-nCRT surgery. In the upfront surgery group, median [interquartile range] time-to-surgery was 61 [40-96] days. Risk-adjusted predictors of delay included lack of insurance, lowest quartile of education, biopsy-based staging or surgical staging and robotic-assisted approach. In the post-nCRT cohort time-to-surgery was 55 [44-70] days. Risk-adjusted predictors of delay included Hispanic ethnicity, Medicaid or other government-based insurance, lowest quartile of educational status, and robotic approach. In the upfront surgery group, patients who had delayed surgery had increased odds of pathologic upstaging (1.31, 95% confidence interval 1.06-1.61). In the post-nCRT group, patients with surgical delay had increased odds of 90-day mortality (1.27, 95% confidence interval 1.06-1.51).</p><p><strong>Conclusions: </strong>Following risk-adjustment for patient, oncologic, facility and surgical characteristics, there were several predictors of increased time to esophagectomy associated with consequences of upstaging and survival.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630899","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 : 2024-11-06DOI: 10.1016/j.jtcvs.2024.10.049
Jules Lin
{"title":"Commentary: Bloodless or less blood: Lung transplantation ECMO anticoagulation strategies.","authors":"Jules Lin","doi":"10.1016/j.jtcvs.2024.10.049","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.049","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631766","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 : 2024-11-05DOI: 10.1016/j.jtcvs.2024.10.044
Viktoria Weixler, Osami Honjo
{"title":"Commentary: Sometimes less is more…but more seems more in treatment of neonates and infants with congenital aortic stenosis.","authors":"Viktoria Weixler, Osami Honjo","doi":"10.1016/j.jtcvs.2024.10.044","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.044","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607284","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 : 2024-11-01DOI: 10.1016/j.jtcvs.2023.10.014
{"title":"Discussion to: Valve-sparing aortic root replacement—for all patients?","authors":"","doi":"10.1016/j.jtcvs.2023.10.014","DOIUrl":"10.1016/j.jtcvs.2023.10.014","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1414-1415"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488183","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 : 2024-11-01DOI: 10.1016/S0022-5223(24)00887-0
{"title":"ABTS Announcement for Continuing Certification","authors":"","doi":"10.1016/S0022-5223(24)00887-0","DOIUrl":"10.1016/S0022-5223(24)00887-0","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Page 1510"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142661455","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 : 2024-11-01DOI: 10.1016/j.jtcvs.2023.07.018
Andrea Guala PhD , Daniel Gil-Sala MD , Marvin E. Garcia Reyes MD , Maria A. Azancot PhD , Lydia Dux-Santoy PhD , Nicolas Allegue Allegue MD , Gisela Teixido-Turà PhD , Gabriela Goncalves Martins MD , Laura Galian-Gay PhD , Juan Garrido-Oliver BSc , Ivan Constenla García MD , Arturo Evangelista PhD , Cristina Tello Díaz MD , Alejandro Carrasco-Poves BSc , Alberto Morales-Galán BSc , Ignacio Ferreira-González PhD , Jose Rodríguez-Palomares PhD , Sergi Bellmunt Montoya PhD
Background
Blunt traumatic thoracic aortic injuries (BTAIs) are associated with a high mortality rate. Thoracic endovascular aortic repair (TEVAR) is the most frequently used surgical strategy in patients with BTAI, as it offers good short- and middle-term results. Previous studies have reported an abnormally high prevalence of hypertension (HT) in these patients. This work aimed to describe the long-term prevalence of HT and provide a comprehensive evaluation of the biomechanical, clinical, and functional factors involved in HT development.
Methods
Twenty-six patients treated with TEVAR following BTAI with no history of HT at the time of trauma were enrolled. They were matched with 37 healthy volunteers based on age, sex, and body surface area and underwent a comprehensive follow-up study, including cardiovascular magnetic resonance, 24-hour ambulatory blood pressure monitoring, and assessment of carotid-femoral pulse wave velocity (cfPWV, a measure of aortic stiffness) and flow-mediated vasodilation.
Results
The mean patient age was 43.5 ± 12.9 years, and the majority were male (23 of 26; 88.5%). At a mean of 120.2 ± 69.7 months after intervention, 17 patients (65%) presented with HT, 14 (54%) had abnormal nighttime blood pressure dipping, and 6 (23%) high cfPWV. New-onset HT was related to a more proximal TEVAR landing zone and greater distal oversizing. Abnormal nighttime blood pressure was related to high cfPWV, which in turn was associated with TEVAR length and premature arterial aging.
Conclusions
HT frequently occurs otherwise healthy subjects undergoing TEVAR implantation after BTAI. TEVAR stiffness and length, the proximal landing zone, and distal oversizing are potentially modifiable surgical characteristics related to abnormal blood pressure.
{"title":"Impact of thoracic endovascular aortic repair following blunt traumatic thoracic aortic injury on blood pressure","authors":"Andrea Guala PhD , Daniel Gil-Sala MD , Marvin E. Garcia Reyes MD , Maria A. Azancot PhD , Lydia Dux-Santoy PhD , Nicolas Allegue Allegue MD , Gisela Teixido-Turà PhD , Gabriela Goncalves Martins MD , Laura Galian-Gay PhD , Juan Garrido-Oliver BSc , Ivan Constenla García MD , Arturo Evangelista PhD , Cristina Tello Díaz MD , Alejandro Carrasco-Poves BSc , Alberto Morales-Galán BSc , Ignacio Ferreira-González PhD , Jose Rodríguez-Palomares PhD , Sergi Bellmunt Montoya PhD","doi":"10.1016/j.jtcvs.2023.07.018","DOIUrl":"10.1016/j.jtcvs.2023.07.018","url":null,"abstract":"<div><h3>Background</h3><div>Blunt traumatic thoracic aortic injuries<span><span> (BTAIs) are associated with a high mortality rate. </span>Thoracic endovascular aortic repair (TEVAR) is the most frequently used surgical strategy in patients with BTAI, as it offers good short- and middle-term results. Previous studies have reported an abnormally high prevalence of hypertension (HT) in these patients. This work aimed to describe the long-term prevalence of HT and provide a comprehensive evaluation of the biomechanical, clinical, and functional factors involved in HT development.</span></div></div><div><h3>Methods</h3><div><span>Twenty-six patients treated with TEVAR following BTAI with no history of HT at the time of trauma<span><span> were enrolled. They were matched with 37 healthy volunteers based on age, sex, and body </span>surface area and underwent a comprehensive follow-up study, including </span></span>cardiovascular magnetic resonance<span><span><span>, 24-hour ambulatory blood pressure monitoring, and assessment of carotid-femoral </span>pulse wave velocity (cfPWV, a measure of aortic stiffness) and flow-mediated </span>vasodilation.</span></div></div><div><h3>Results</h3><div>The mean patient age was 43.5 ± 12.9 years, and the majority were male (23 of 26; 88.5%). At a mean of 120.2 ± 69.7 months after intervention, 17 patients (65%) presented with HT, 14 (54%) had abnormal nighttime blood pressure dipping, and 6 (23%) high cfPWV. New-onset HT was related to a more proximal TEVAR landing zone and greater distal oversizing. Abnormal nighttime blood pressure was related to high cfPWV, which in turn was associated with TEVAR length and premature arterial aging.</div></div><div><h3>Conclusions</h3><div>HT frequently occurs otherwise healthy subjects undergoing TEVAR implantation after BTAI. TEVAR stiffness and length, the proximal landing zone, and distal oversizing are potentially modifiable surgical characteristics related to abnormal blood pressure.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1428-1437.e3"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10045746","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 : 2024-11-01DOI: 10.1016/j.jtcvs.2023.08.055
Tristan Ehrlich MD, Karen B. Abeln MD, Lennart Froede MD, Christian Burgard MD, Christian Giebels MD, Hans-Joachim Schäfers MD, PhD
Background
Valve-sparing root replacement (VSRR) has been associated with good survival and low rates of valve-related complications (VRCs). Whether these advantages are present irrespective of patient comorbidity or age is unclear. The aim of this study was to analyze survival and frequency of VRCs in relation to patient comorbidity and age.
Methods
Between October 1995 and December 2021, 1156 patients with a bicuspid or tricuspid aortic valve were treated by root remodeling. The mean patient age was 53.3 ± 14 years, and 973 (84%) were male. The mean duration of follow-up was 6.7 ± 5.5 years (median, 5.9 years), and follow-up was 95% complete (7746 patient-years). We analyzed the population according to comorbidity and age at surgery. A discriminating cutoff for the effect of age was determined using receiver operating characteristic curve (ROC) analysis.
Results
Mean survival at 15 years was 74.7 ± 2.5%. Deceased patients were older (mean, 65.3 ± 12 years vs 51.6 ± 14.1 years; P < .001) at the time of surgery and had more comorbidities (coronary artery disease [CAD], 28.4% vs 9.8%; P < .001). The sole significant adjusted predictor was age (P < .001). By ROC analysis (area under the curve, 0.780), the optimal cutoff for age was 61 years. Survival was 87.1 ± 2.8% at 15 years in patients age <61 years, compared to 55.3 ± 4.3% in patients age >61 years (P < .0001). Using competing risk analysis, VRC-free survival at 15 years was 66.8% at 15 years, including 76.7% in patients age <61 years and 52.4% in those age >61 years (P < .0001).
Conclusions
VSRR is associated with a low incidence of VRC and excellent durability. Survival is decreased in the presence of comorbidities, mainly CAD, and patient age >61 years. Despite lower survival, freedom from VRC is good.
{"title":"Valve-sparing aortic root replacement—for all patients?","authors":"Tristan Ehrlich MD, Karen B. Abeln MD, Lennart Froede MD, Christian Burgard MD, Christian Giebels MD, Hans-Joachim Schäfers MD, PhD","doi":"10.1016/j.jtcvs.2023.08.055","DOIUrl":"10.1016/j.jtcvs.2023.08.055","url":null,"abstract":"<div><h3>Background</h3><div>Valve-sparing root replacement (VSRR) has been associated with good survival and low rates of valve-related complications (VRCs). Whether these advantages are present irrespective of patient comorbidity or age is unclear. The aim of this study was to analyze survival and frequency of VRCs in relation to patient comorbidity and age.</div></div><div><h3>Methods</h3><div>Between October 1995 and December 2021, 1156 patients with a bicuspid or tricuspid aortic valve were treated by root remodeling. The mean patient age was 53.3 ± 14 years, and 973 (84%) were male. The mean duration of follow-up was 6.7 ± 5.5 years (median, 5.9 years), and follow-up was 95% complete (7746 patient-years). We analyzed the population according to comorbidity and age at surgery. A discriminating cutoff for the effect of age was determined using receiver operating characteristic curve (ROC) analysis.</div></div><div><h3>Results</h3><div>Mean survival at 15 years was 74.7 ± 2.5%. Deceased patients were older (mean, 65.3 ± 12 years vs 51.6 ± 14.1 years; <em>P</em> < .001) at the time of surgery and had more comorbidities (coronary artery disease [CAD], 28.4% vs 9.8%; <em>P</em> < .001). The sole significant adjusted predictor was age (<em>P</em> < .001). By ROC analysis (area under the curve, 0.780), the optimal cutoff for age was 61 years. Survival was 87.1 ± 2.8% at 15 years in patients age <61 years, compared to 55.3 ± 4.3% in patients age >61 years (<em>P</em> < .0001). Using competing risk analysis, VRC-free survival at 15 years was 66.8% at 15 years, including 76.7% in patients age <61 years and 52.4% in those age >61 years (<em>P</em> < .0001).</div></div><div><h3>Conclusions</h3><div>VSRR is associated with a low incidence of VRC and excellent durability. Survival is decreased in the presence of comorbidities, mainly CAD, and patient age >61 years. Despite lower survival, freedom from VRC is good.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1403-1413.e2"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10203618","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 : 2024-11-01DOI: 10.1016/j.jtcvs.2023.11.033
{"title":"Discussion to: Should mitral valve replacement age guidelines be lowered due to better bioprosthetic mitral valve durability?","authors":"","doi":"10.1016/j.jtcvs.2023.11.033","DOIUrl":"10.1016/j.jtcvs.2023.11.033","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1459-1461"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139029601","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}
To improve preoperative risk stratification in lung cancer lobectomy by identifying and comparing optimal thresholds for peak oxygen uptake (VO2peak) presented as weight-indexed and percent of predicted values, respectively.
Methods
This was a longitudinal cohort study including national registry data on patients scheduled for cancer lobectomy that used available data from preoperative cardiopulmonary exercise testing. The measured VO2peak was indexed by body mass (mL/kg/min) and also compared with 2 established reference equations (Wasserman-Hansen and Study of Health in Pomerania, respectively). By receiver operating characteristic analysis, a lower 90% specificity and an upper 90% sensitivity threshold were determined for each measure, in relation to the outcome of any major complication or death. For each measure and based on these thresholds, patients were categorized as low risk, intermediate risk, or high risk. The frequency of complications was compared between groups using χ2.
Results
The frequency of complications differed significantly between the proposed low-, intermediate-, and high-risk groups when using % predicted Study of Health in Pomerania (5%, 21%, 35%, P = .007) or % predicted Wasserman-Hansen (5%, 25%, 35%, P = .002) but not when using the weight-indexed VO2peak groups (7%, 23%, 15%, P = .08). Nonsignificant differences were found using the threshold <15 mL/kg/min (P = .34).
Conclusions
This study showed that weight-indexed VO2peak was of less use as a marker of risk at the lower range of exercise capacity, whereas % predicted VO2peak was associated with a continuously increasing risk of major complications, also at the lower end of exercise capacity. As identifying subjects at high risk of complications is important, % predicted VO2peak is therefore preferable.
{"title":"Percent predicted peak oxygen uptake is superior to weight-indexed peak oxygen uptake in risk stratification before lung cancer lobectomy","authors":"Karolina Kristenson MD, PhD , Kristofer Hedman MD, PhD","doi":"10.1016/j.jtcvs.2024.02.021","DOIUrl":"10.1016/j.jtcvs.2024.02.021","url":null,"abstract":"<div><h3>Objective</h3><div>To improve preoperative risk stratification in lung cancer lobectomy by identifying and comparing optimal thresholds for peak oxygen uptake (VO<sub>2peak</sub>) presented as weight-indexed and percent of predicted values, respectively.</div></div><div><h3>Methods</h3><div>This was a longitudinal cohort study including national registry data on patients scheduled for cancer lobectomy that used available data from preoperative cardiopulmonary exercise testing. The measured VO<sub>2peak</sub> was indexed by body mass (mL/kg/min) and also compared with 2 established reference equations (Wasserman-Hansen and Study of Health in Pomerania, respectively). By receiver operating characteristic analysis, a lower 90% specificity and an upper 90% sensitivity threshold were determined for each measure, in relation to the outcome of any major complication or death. For each measure and based on these thresholds, patients were categorized as low risk, intermediate risk, or high risk. The frequency of complications was compared between groups using χ<sup>2</sup>.</div></div><div><h3>Results</h3><div>The frequency of complications differed significantly between the proposed low-, intermediate-, and high-risk groups when using % predicted Study of Health in Pomerania (5%, 21%, 35%, <em>P</em> = .007) or % predicted Wasserman-Hansen (5%, 25%, 35%, <em>P</em> = .002) but not when using the weight-indexed VO<sub>2peak</sub> groups (7%, 23%, 15%, <em>P</em> = .08). Nonsignificant differences were found using the threshold <15 mL/kg/min (<em>P</em> = .34).</div></div><div><h3>Conclusions</h3><div>This study showed that weight-indexed VO<sub>2peak</sub> was of less use as a marker of risk at the lower range of exercise capacity, whereas % predicted VO<sub>2peak</sub> was associated with a continuously increasing risk of major complications, also at the lower end of exercise capacity. As identifying subjects at high risk of complications is important, % predicted VO<sub>2peak</sub> is therefore preferable.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1375-1384.e4"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号