Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Rethinking international collaboration in cardiac surgery in Africa: From dependency to sustainable empowerment","authors":"Valdano Manuel MD, PhD","doi":"10.1016/j.jtcvs.2025.07.022","DOIUrl":"10.1016/j.jtcvs.2025.07.022","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 486-488"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676365","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}

{"title":"Predicting and diagnosing pneumonia in patients undergoing elective cardiac surgery via machine learning analysis of exhaled volatile carbonyl compounds","authors":"Toyokazu Endo MD ,&nbsp;Kevin Tran MS ,&nbsp;Dylan A. Goodin PhD ,&nbsp;Gianna Katsaros MD ,&nbsp;Zhenzhen Xie PhD ,&nbsp;Xiao-An Fu PhD ,&nbsp;George Pantalos PhD ,&nbsp;Hermann B. Frieboes PhD ,&nbsp;Victor van Berkel MD, PhD","doi":"10.1016/j.jtcvs.2025.06.028","DOIUrl":"10.1016/j.jtcvs.2025.06.028","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 465-475.e5"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565381","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}

{"title":"Calcium/calmodulin-dependent protein kinase II inhibition using tatCN19o ameliorates spinal cord ischemia associated with aortic surgery","authors":"Bo Chang Brian Wu MD ,&nbsp;Linling Cheng BS ,&nbsp;Nicolas Chanes MD ,&nbsp;Adam M. Carroll MD, MPH ,&nbsp;Muhammad Aftab MD ,&nbsp;Karl Ulrich Bayer PhD ,&nbsp;T. Brett Reece MD, MBA","doi":"10.1016/j.jtcvs.2025.08.021","DOIUrl":"10.1016/j.jtcvs.2025.08.021","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>P</em> = .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; <em>P</em> = .004) that did not differ significantly from sham (<em>P</em> = .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; <em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 476-485"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976746","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}

{"title":"Reply: Toward personalized, surgeon-level prediction in mitral valve repair","authors":"Mohsyn Imran Malik MD, MSc,&nbsp;Rashmi Nedadur MD, MSc,&nbsp;Michael W.A. Chu MD, MEd","doi":"10.1016/j.jtcvs.2025.08.001","DOIUrl":"10.1016/j.jtcvs.2025.08.001","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages e36-e37"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016539","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}

{"title":"When the gold standard fails: Propensity-matched comparison of peroral endoscopic myotomy after Heller myotomy versus index peroral endoscopic myotomy","authors":"Andrew Conner MD ,&nbsp;Nethra Jain MBBS ,&nbsp;John O. Barron MD ,&nbsp;Andrew J. Toth MS ,&nbsp;Andrew Tang MD ,&nbsp;Feredun Azari MD ,&nbsp;Monisha Sudarshan MD ,&nbsp;Sudish C. Murthy MD, PhD ,&nbsp;Eugene H. Blackstone MD ,&nbsp;Siva Raja MD, PhD","doi":"10.1016/j.jtcvs.2025.10.012","DOIUrl":"10.1016/j.jtcvs.2025.10.012","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = .028). Complete esophageal emptying at 5 years was 20% in the POEM-after-HM group versus 24% in the index-POEM group (<em>P</em> = .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 (<em>P</em> = .24).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 519-529.e9"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314022","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}

{"title":"One thousand cases of ex vivo lung perfusion for lung transplantation: A single-center experience","authors":"Shaf Keshavjee MD ,&nbsp;Andrew T. Sage PhD ,&nbsp;Thomas Borrillo MHSc ,&nbsp;Jonathan C. Yeung MD ,&nbsp;Deween Piyasena BHSc ,&nbsp;Elliot Wakeam MD ,&nbsp;Laura Donahoe MD ,&nbsp;Thomas K. Waddell MD, MSc, PhD ,&nbsp;Marc de Perrot MD ,&nbsp;Andrew Pierre MD ,&nbsp;Sharaniyaa Balachandran ,&nbsp;Rasheed Ghany MSc ,&nbsp;Aadil Ali PhD ,&nbsp;Kazuhiro Yasufuku MD ,&nbsp;Marcelo Cypel MD","doi":"10.1016/j.jtcvs.2025.08.036","DOIUrl":"10.1016/j.jtcvs.2025.08.036","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 540-550.e2"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006791","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}

{"title":"Reply: Discrete subaortic membrane—simple in appearance, complex in reality","authors":"Jie Dong MD ,&nbsp;Keming Yang MD, PhD ,&nbsp;Shuo Dong MD, PhD","doi":"10.1016/j.jtcvs.2025.08.026","DOIUrl":"10.1016/j.jtcvs.2025.08.026","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages e20-e21"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114975","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}

{"title":"Redo coronary artery bypass grafting in patients with patent bilateral internal thoracic artery grafts: Exceptions to a lifetime warranty","authors":"Mahmoud Alshneikat MD ,&nbsp;Richard Ramsingh MD ,&nbsp;Ahmed K. Awad MD ,&nbsp;Penny L. Houghtaling MS ,&nbsp;Shinya G. Unai MD ,&nbsp;Marijan J. Koprivanac MD, MS ,&nbsp;Michael Z. Tong MD ,&nbsp;Haytham J. Elgharably MD ,&nbsp;Kenneth R. McCurry MD ,&nbsp;Patrick R. Vargo MD ,&nbsp;Edward G. Soltesz MD, MPH ,&nbsp;Nicholas G. Smedira MD ,&nbsp;Gösta B. Pettersson MD ,&nbsp;Eric E. Roselli MD ,&nbsp;A. Marc Gillinov MD ,&nbsp;Lars G. Svensson MD, PhD ,&nbsp;Eugene H. Blackstone MD ,&nbsp;Faisal G. Bakaeen MD","doi":"10.1016/j.jtcvs.2025.07.018","DOIUrl":"10.1016/j.jtcvs.2025.07.018","url":null,"abstract":"<div><h3>Objective</h3><div>To undertake an in-depth review of patients undergoing redo coronary artery bypass grafting (CABG) despite patent bilateral internal thoracic artery (BITA) grafts.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 429-437.e6"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676364","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}

{"title":"Commentary: Enhance, don't replace, the tasting menu for Zenker diverticulum","authors":"Evan T. Alicuben MD,&nbsp;Ryan M. Levy MD","doi":"10.1016/j.jtcvs.2025.07.020","DOIUrl":"10.1016/j.jtcvs.2025.07.020","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 530-531"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676358","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}

{"title":"Short-term outcomes of thrombolysis versus surgical pulmonary embolectomy in patients with high-risk pulmonary embolism","authors":"Keiichi Ishida MD, PhD ,&nbsp;Yuji Nishimoto MD ,&nbsp;Hiroyuki Ohbe MD, PhD ,&nbsp;Nobutaka Ikeda MD, PhD ,&nbsp;Toshihiko Sugiura MD, PhD ,&nbsp;Rika Suda MD, PhD ,&nbsp;Nobuhiro Tanabe MD, PhD ,&nbsp;Makoto Mo MD, PhD ,&nbsp;Yuya Kimura MD, MPH ,&nbsp;Hiroki Matsui MPH, PhD ,&nbsp;Hideo Yasunaga MD, PhD","doi":"10.1016/j.jtcvs.2025.07.039","DOIUrl":"10.1016/j.jtcvs.2025.07.039","url":null,"abstract":"<div><h3>Objective</h3><div>The survival benefit of thrombolysis compared with surgical pulmonary embolectomy for high-risk pulmonary embolism has not been established, although current guidelines advocate thrombolysis as first-line therapy. This study compared the short-term outcomes of surgical pulmonary embolectomy and thrombolysis to determine the optimal treatment for high-risk pulmonary embolism.</div></div><div><h3>Methods</h3><div>Patients with high-risk pulmonary embolism who underwent surgical pulmonary embolectomy or thrombolysis within 2 days of admission were identified using a nationwide inpatient administrative database in Japan between July 2010 and March 2023. The primary outcome was in-hospital mortality, and secondary outcomes were complications, length of hospital stay, and total hospitalization costs. Outcomes were compared using overlap weighting, with sensitivity analyses conducted using inverse probability of treatment weighting and multivariate logistic regression model.</div></div><div><h3>Results</h3><div>Of the 2813 eligible patients, 526 underwent surgical pulmonary embolectomy, and 2287 underwent thrombolysis. After overlap weighting, surgical pulmonary embolectomy was associated with lower in-hospital mortality (22.2% vs 30.1%, <em>P = .</em>002), more favorable neurological outcomes at discharge (72.5% vs 66.7%, <em>P = .</em>040), and higher total costs ($30,548 vs $13,374, <em>P</em> &lt; .001) than thrombolysis. No significant differences were observed in complications or length of hospital stay between the 2 groups. Sensitivity analyses yielded results consistent with the primary analyses.</div></div><div><h3>Conclusions</h3><div>These findings suggest potential benefits of surgical pulmonary embolectomy over thrombolysis for high-risk pulmonary embolism. Surgical pulmonary embolectomy may be considered a reasonable reperfusion therapy option for suitable patients. Further research is needed to confirm these findings.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 410-418.e4"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776689","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}