Journal of Thoracic and Cardiovascular Surgery最新文献_第4页

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。

{"title":"Transcatheter edge-to-edge repair versus mitral valve surgery in octogenarians: Comparative analysis of safety, durability, and survival","authors":"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","doi":"10.1016/j.jtcvs.2025.08.016","DOIUrl":"10.1016/j.jtcvs.2025.08.016","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the short- and long-term outcomes of surgical and transcatheter interventions for treating mitral regurgitation (MR) in patients age ≥80 years.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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%; <em>P</em> = .561). Postoperatively, the MV surgery group had higher rates of atrial fibrillation, prolonged mechanical ventilation, and longer intensive care unit and hospital stays (<em>P</em> < .001 for all). Predischarge echocardiography showed less residual MR (2.4% vs 8%; <em>P</em> < .001), less tricuspid regurgitation (10.5% vs 50%, <em>P</em> < .001), and lower right ventricular systolic pressure (37.5 mm Hg vs 44 mm Hg; <em>P</em> < .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%; <em>P</em> < .001), and 5-year survival was superior (68% vs 56%; <em>P</em> = .019) in the MV surgery group.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 1","pages":"Pages 110-120.e6"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976822","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

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。

{"title":"Challenging the transcatheter-first paradigm: Redo surgical aortic valve replacement after previous transcatheter or surgical aortic valve replacement","authors":"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","doi":"10.1016/j.jtcvs.2025.08.014","DOIUrl":"10.1016/j.jtcvs.2025.08.014","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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%, <em>P</em> < .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%, <em>P</em> = .008) and greater composite complication rates.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 1","pages":"Pages 101-109"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976734","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

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。

{"title":"Active and passive cardiac indexes as complementary predictors of outcomes after left ventricular assist device implantation","authors":"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","doi":"10.1016/j.jtcvs.2025.09.005","DOIUrl":"10.1016/j.jtcvs.2025.09.005","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>A high ActCI >0.903 was associated with better survival (hazard ratio, 0.71; <em>P</em> = .019) whereas PasCI >0.778 predicted worse survival (hazard ratio, 1.39; <em>P</em> = .022). Low ActCI was associated with increased postoperative RV failure (11.3% vs 4.9%; <em>P</em> = .018), dialysis (27.8% vs 11.7%; <em>P</em> < .001), hepatic dysfunction (21.1% vs 8.3%; <em>P</em> < .001), and in-hospital mortality (14.3% vs 5.6%; <em>P</em> = .004). Conversely, higher PasCIs portend increased rates of postoperative dialysis (28.6% vs 11.3%; <em>P</em> < .001), respiratory failure (28.6% vs 19.5%; <em>P</em> = .042), hepatic dysfunction (21.8% vs 7.9%; <em>P</em> < .001), gastrointestinal bleeding (44.4% vs 32.3%; <em>P</em> = .019), and in-hospital mortality (12.0% vs 6.8%; <em>P</em> = .076).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 1","pages":"Pages 218-228.e5"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034420","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

Surgical repair of functional tricuspid regurgitation by drawing the anterior and posterior papillary muscles towards the septum, corrected regurgitation and restored physiologic valve kinematics 环状与亚环状修复修复功能性三尖瓣返流的血流动力学效果。

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.2025.05.002

Dongyang Xu PhD , Daisuke Onohara MD, PhD , Kirthana Sreerangathama Suresh PhD , Kanika Kalra MD , Muralidhar Padala PhD

Background

Surgical repair of functional tricuspid regurgitation (FTR) due to annular dilatation and leaflet tethering from a dilated right ventricle is increasingly performed; however, the optimal approach for such a repair is unclear. In this study, using a diseased model of FTR, we compared annular repair and subannular repair strategies to repair FTR and restore native valve kinematics and mobility.

Methods

A model of FTR was developed using porcine tricuspid valves in a pulse duplicator (n = 11 hearts). The effect of TV annuloplasty (TVA) in reducing FTR was studied first, followed by subannular repair by septal relocation of the posterior and anterior papillary muscles (TVPA), and then a combination of the 2 techniques (TVA+TVPA). FTR was quantified before and after each repair, and real-time ultrasound was used to quantify leaflet coaptation, tenting, and leaflet mobility.

Results

At baseline, all valves were competent without FTR. In the FTR model, the regurgitation fraction increased to 28 ± 16.2%. With TVA, the regurgitation fraction was reduced to 11.3 ± 5.9% with a 30-mm ring and to 4.6 ± 3.8% with a 28-mm ring. With TVPA alone, the regurgitation fraction was reduced to 6.5 ± 8.5%, and when TVA+TVPA were combined, it reduced to 2.9 ± 4.3% with a 30-mm ring and to 1.3 ± 1.6% with a 28-mm ring. The largest systolic coaptation height and leaflet mobility were achieved with TVA+TVPA, with physiologic levels of leaflet mobility restored.

Conclusions

In this diseased model, correction of FTR, restoration of highest systolic coaptation height and physiologic leaflet mobility were achieved with isolated sub-annular repair and further enhanced with concomitant annular repair.

目的：由于右心室扩张引起的功能性三尖瓣反流的手术修复越来越多，但这种修复的最佳方法尚不清楚。在本研究中，使用FTR病变模型，比较了环形和亚环形修复策略在修复FTR和恢复瓣膜运动学和活动性方面的效果。方法：将11颗猪心脏置于脉冲复制器中，建立患病的FTR模型。首先研究了环形成形术环（TVA）在减少FTR中的作用，然后研究了后乳头肌和前乳头肌（TVPA）间隔移位的亚环形修复，然后是两种技术的组合（TVA+TVPA）。在每次修复前后定量FTR，并使用实时超声定量小叶适应、支帐篷和小叶活动性。结果：基线时，所有瓣膜均正常，无FTR。在FTR模型中，反流率增加到28±16.2%。采用TVA后，FTR分别降至11.3±5.9% （30mm环）和4.6±3.8% （28mm环）。单独使用TVPA时，FTR降低到6.5±8.5%。采用TVA+TVPA时，FTR分别为2.9±4.3% （30mm TVA+TVPA）和1.3±1.6% （28mm TVA+TVPA）。TVA+TVPA组的收缩期适应高度最大，小叶活动性恢复到生理水平，小叶活动性恢复到生理水平。结论：在该病变模型中，与孤立的环或亚环修复相比，环和亚环联合修复可实现FTR的完全矫正，最大的收缩适应高度和恢复生理小叶的活动性。

{"title":"Surgical repair of functional tricuspid regurgitation by drawing the anterior and posterior papillary muscles towards the septum, corrected regurgitation and restored physiologic valve kinematics","authors":"Dongyang Xu PhD , Daisuke Onohara MD, PhD , Kirthana Sreerangathama Suresh PhD , Kanika Kalra MD , Muralidhar Padala PhD","doi":"10.1016/j.jtcvs.2025.05.002","DOIUrl":"10.1016/j.jtcvs.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>Surgical repair of functional tricuspid regurgitation (FTR) due to annular dilatation and leaflet tethering from a dilated right ventricle is increasingly performed; however, the optimal approach for such a repair is unclear. In this study, using a diseased model of FTR, we compared annular repair and subannular repair strategies to repair FTR and restore native valve kinematics and mobility.</div></div><div><h3>Methods</h3><div>A model of FTR was developed using porcine tricuspid valves in a pulse duplicator (n = 11 hearts). The effect of TV annuloplasty (TVA) in reducing FTR was studied first, followed by subannular repair by septal relocation of the posterior and anterior papillary muscles (TVPA), and then a combination of the 2 techniques (TVA+TVPA). FTR was quantified before and after each repair, and real-time ultrasound was used to quantify leaflet coaptation, tenting, and leaflet mobility.</div></div><div><h3>Results</h3><div>At baseline, all valves were competent without FTR. In the FTR model, the regurgitation fraction increased to 28 ± 16.2%. With TVA, the regurgitation fraction was reduced to 11.3 ± 5.9% with a 30-mm ring and to 4.6 ± 3.8% with a 28-mm ring. With TVPA alone, the regurgitation fraction was reduced to 6.5 ± 8.5%, and when TVA+TVPA were combined, it reduced to 2.9 ± 4.3% with a 30-mm ring and to 1.3 ± 1.6% with a 28-mm ring. The largest systolic coaptation height and leaflet mobility were achieved with TVA+TVPA, with physiologic levels of leaflet mobility restored.</div></div><div><h3>Conclusions</h3><div>In this diseased model, correction of FTR, restoration of highest systolic coaptation height and physiologic leaflet mobility were achieved with isolated sub-annular repair and further enhanced with concomitant annular repair.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 1","pages":"Pages 142-152.e1"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095681","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

An artificial intelligence and machine learning model for personalized prediction of long-term mitral valve repair durability 用于二尖瓣长期修复耐久性个性化预测的人工智能和机器学习模型。

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.2025.07.017

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

Objective

The study objective was to compare Random Survival Forest, a machine learning method, with Cox proportional hazards models in predicting long-term mitral valve repair durability, focusing on clinical utility and personalized decision-making.

Methods

We analyzed 444 patients undergoing primary mitral valve repair for degenerative mitral regurgitation (2008-2024). The primary outcome was mitral repair failure, defined as recurrent regurgitation/stenosis or reintervention. Random Survival Forest and penalized Cox proportional hazards models were compared for predictive accuracy and interpretability. A web-based application was created to demonstrate the Random Survival Forest model.

Results

The failure end point, mitral repair failure, occurred in 13 individuals (3%) during the study period. Random Survival Forest showed superior discrimination (Concordance index: 0.874 vs 0.796) and identified both coaptation length and early mean mitral gradient as key predictors. Cox proportional hazards identified coaptation length alone, with each 1-mm increase reducing failure by approximately 40%. Random Survival Forest–predicted freedom from mitral repair failure at 5, 10, and 15 years was 94%, 74%, and 51% for coaptation length of 6 mm; 98%, 94%, and 91% for 9 mm; and 99%, 98%, and 96% for 12 mm, respectively. Mean gradients of 2 to 5 mm Hg were linked to 90% or greater durability at 5 to 10 years, whereas 8 mm Hg predicted worse outcomes (68% at 10 years, 64% at 15 years). Random Survival Forest further provided nuanced interpretation of temporal risk patterns and generated patient-specific survival estimates to improve repair durability forecasting.

Conclusions

Machine learning outperforms traditional methods by modeling complex, nonlinear associations and identifying clinically actionable predictors. Integrating machine learning into surgical practice may support more personalized, data-driven mitral repair strategies and improve long-term outcomes.

目的：比较随机生存森林（RSF），一种机器学习（ML）方法，与Cox比例风险（CPH）模型预测长期二尖瓣（MV）修复耐久性，重点是临床实用性和个性化决策。方法：我们分析了444例因退行性二尖瓣反流接受初级中压修复的患者（2008-2024）。主要结局是二尖瓣修复失败（MRF），定义为复发性反流/狭窄或再干预。比较RSF和惩罚CPH模型的预测准确性和可解释性。创建了一个基于web的应用程序来演示RSF模型。结果：在研究期间，13人（3%）出现了MRF失败终点。RSF表现出较强的辨别能力（c指数：0.874比0.796），并将适应长度和早期平均二尖瓣梯度确定为关键预测因子。CPH单独确定了覆盖长度，每增加1毫米，失效率降低约40%。覆盖长度为6mm时，rsf预测的5、10和15年MRF自由度分别为94%、74%和51%；9mm为98%，94%,91%；12毫米的是99% 98% 96%2-5 mmHg的平均梯度与5-10年≥90%的耐久性相关，而8 mmHg预测更差的结果（10年68%，15年64%）。RSF进一步提供了对时间风险模式的细致解释，并生成了患者特异性生存估计，以改进修复耐久性预测。结论：ML通过建模复杂的非线性关联和识别临床可操作的预测因子优于传统方法。将机器学习整合到外科实践中可以支持更个性化的、数据驱动的二尖瓣修复策略，并改善长期结果。

{"title":"An artificial intelligence and machine learning model for personalized prediction of long-term mitral valve repair durability","authors":"Mohsyn Imran Malik MD, MSc, Rashmi Nedadur MD, MSc, Michael W.A. Chu MD, MEd","doi":"10.1016/j.jtcvs.2025.07.017","DOIUrl":"10.1016/j.jtcvs.2025.07.017","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to compare Random Survival Forest, a machine learning method, with Cox proportional hazards models in predicting long-term mitral valve repair durability, focusing on clinical utility and personalized decision-making.</div></div><div><h3>Methods</h3><div>We analyzed 444 patients undergoing primary mitral valve repair for degenerative mitral regurgitation (2008-2024). The primary outcome was mitral repair failure, defined as recurrent regurgitation/stenosis or reintervention. Random Survival Forest and penalized Cox proportional hazards models were compared for predictive accuracy and interpretability. A web-based application was created to demonstrate the Random Survival Forest model.</div></div><div><h3>Results</h3><div>The failure end point, mitral repair failure, occurred in 13 individuals (3%) during the study period. Random Survival Forest showed superior discrimination (Concordance index: 0.874 vs 0.796) and identified both coaptation length and early mean mitral gradient as key predictors. Cox proportional hazards identified coaptation length alone, with each 1-mm increase reducing failure by approximately 40%. Random Survival Forest–predicted freedom from mitral repair failure at 5, 10, and 15 years was 94%, 74%, and 51% for coaptation length of 6 mm; 98%, 94%, and 91% for 9 mm; and 99%, 98%, and 96% for 12 mm, respectively. Mean gradients of 2 to 5 mm Hg were linked to 90% or greater durability at 5 to 10 years, whereas 8 mm Hg predicted worse outcomes (68% at 10 years, 64% at 15 years). Random Survival Forest further provided nuanced interpretation of temporal risk patterns and generated patient-specific survival estimates to improve repair durability forecasting.</div></div><div><h3>Conclusions</h3><div>Machine learning outperforms traditional methods by modeling complex, nonlinear associations and identifying clinically actionable predictors. Integrating machine learning into surgical practice may support more personalized, data-driven mitral repair strategies and improve long-term outcomes.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 1","pages":"Pages 133-141.e4"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676357","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

VALUE Trial: Phase 1 safety and feasibility study of same-day discharge after video-assisted thoracoscopic surgery lung resection 价值试验：VATS肺切除术后当日出院的一期安全性和可行性研究。

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.2025.07.040

Lyndon C. Walsh BA , Merav Rokah MD , Joseph Seitlinger MD, PhD , Filippo Tommaso Gallina MD , Caroline Huynh MD , Morgan S. Gold MD , Avik Sengupta MD , Tia Nicholls-Wallace RN , Erin Cronin RN , Mehrnoush Dehghani PhD , Roni Rayes PhD , David Mulder MD , Christian Sirois MD , Mathieu Rousseau MD , Lorenzo Ferri MD, PhD , Jonathan Cools-Lartigue MD, PhD , Florin Costescu MD , Sara Najmeh MD, MSc , Jonathan D. Spicer MD, PhD

Objectives

Although Enhanced Recovery After Surgery programs are becoming more prevalent in thoracic surgery, minimal prospective research exists for same-day discharge after lung resection. Thus, this trial aimed to evaluate the safety and feasibility of same-day discharge after video-assisted thoracoscopic surgery.

Methods

This phase 1 registered trial (NCT05583916) enrolled patients from a single institution who were candidates for a video-assisted thoracoscopic surgery anatomic or wedge resection to treat confirmed or suspected lung malignancy. After preoperative education, patients were discharged home with a chest tube connected to a mini-atrium. Patients returned 1 to 3 days later for evaluation of chest tube removal. Quality of life was assessed using the Functional Assessment of Cancer Therapy – Lung and Edmonton Symptom Assessment Scale questionnaires. Descriptive statistics were conducted for clinical outcomes, and univariant t test analyzed quality of life data.

Results

Twenty-one patients (n = 16; 76% female) were enrolled. The mean age was 65 years with 12 (57%) past or current smokers. Staging was 88% (n = 15) with stage I, 12% (n = 2) with stage II, and 19% (n = 4) with metastasis to the lung. Two patients withdrew their consent; the remaining 19 patients underwent video-assisted thoracoscopic surgery lobectomy (n = 9), segmentectomy (n = 4), or wedge (n = 6). Same-day discharge was achieved in 95% of cases (n = 18). Median chest tube duration was 2 days (range of values, 1-10). One emergency department visit occurred. Two grade 2 prolonged air leaks occurred with no grade 3 to 5 adverse events. Quality of life data did not significantly differ from a standard-of-care cohort (n = 151).

Conclusions

Same-day discharge after video-assisted thoracoscopic surgery lung resections appears safe and feasible for carefully selected patients with planned anatomic or nonanatomic resections.

目的：尽管提高术后恢复的方案在胸外科手术中越来越普遍，但对肺切除术后当日出院（SDD）的前瞻性研究很少。因此，本试验旨在评价视频胸腔镜手术（VATS）后SDD的安全性和可行性。方法：该1期注册试验（NCT05583916）纳入了来自单一机构的患者，这些患者是VATS解剖或楔形切除治疗确诊或疑似肺恶性肿瘤的候选人。在接受术前教育后，患者出院回家，胸管连接到小心房。患者于1-3天后返回评估胸管拔除情况。使用FACT-L和ESAS问卷评估生活质量（QoL）。对临床结果进行描述性统计，对生活质量数据进行单变量t检验。结果：21例患者(n=16；76%为女性)。平均年龄为65岁，有12人（57%）过去或现在吸烟。分期为88% （n=15）为I期，12% （n=2）为II期，19% （n=4）为肺转移。2例患者撤回同意，其余19例患者行VATS肺叶切除术（n=9）、节段切除术（n=4）或楔形切除术（n=6）。95%的病例（n=18）实现了SDD。中位胸管持续时间为2天（取值范围：1-10）。发生了一次急诊室就诊。发生2例2级长时间空气泄漏，无3-5级不良事件。生活质量数据与标准护理队列（n=151）无显著差异。结论：对于精心挑选的计划解剖或非解剖切除的患者，VATS肺切除术后同日出院是安全可行的。

{"title":"VALUE Trial: Phase 1 safety and feasibility study of same-day discharge after video-assisted thoracoscopic surgery lung resection","authors":"Lyndon C. Walsh BA , Merav Rokah MD , Joseph Seitlinger MD, PhD , Filippo Tommaso Gallina MD , Caroline Huynh MD , Morgan S. Gold MD , Avik Sengupta MD , Tia Nicholls-Wallace RN , Erin Cronin RN , Mehrnoush Dehghani PhD , Roni Rayes PhD , David Mulder MD , Christian Sirois MD , Mathieu Rousseau MD , Lorenzo Ferri MD, PhD , Jonathan Cools-Lartigue MD, PhD , Florin Costescu MD , Sara Najmeh MD, MSc , Jonathan D. Spicer MD, PhD","doi":"10.1016/j.jtcvs.2025.07.040","DOIUrl":"10.1016/j.jtcvs.2025.07.040","url":null,"abstract":"<div><h3>Objectives</h3><div>Although Enhanced Recovery After Surgery programs are becoming more prevalent in thoracic surgery, minimal prospective research exists for same-day discharge after lung resection. Thus, this trial aimed to evaluate the safety and feasibility of same-day discharge after video-assisted thoracoscopic surgery.</div></div><div><h3>Methods</h3><div>This phase 1 registered trial (NCT05583916) enrolled patients from a single institution who were candidates for a video-assisted thoracoscopic surgery anatomic or wedge resection to treat confirmed or suspected lung malignancy. After preoperative education, patients were discharged home with a chest tube connected to a mini-atrium. Patients returned 1 to 3 days later for evaluation of chest tube removal. Quality of life was assessed using the Functional Assessment of Cancer Therapy – Lung and Edmonton Symptom Assessment Scale questionnaires. Descriptive statistics were conducted for clinical outcomes, and univariant <em>t</em> test analyzed quality of life data.</div></div><div><h3>Results</h3><div>Twenty-one patients (n = 16; 76% female) were enrolled. The mean age was 65 years with 12 (57%) past or current smokers. Staging was 88% (n = 15) with stage I, 12% (n = 2) with stage II, and 19% (n = 4) with metastasis to the lung. Two patients withdrew their consent; the remaining 19 patients underwent video-assisted thoracoscopic surgery lobectomy (n = 9), segmentectomy (n = 4), or wedge (n = 6). Same-day discharge was achieved in 95% of cases (n = 18). Median chest tube duration was 2 days (range of values, 1-10). One emergency department visit occurred. Two grade 2 prolonged air leaks occurred with no grade 3 to 5 adverse events. Quality of life data did not significantly differ from a standard-of-care cohort (n = 151).</div></div><div><h3>Conclusions</h3><div>Same-day discharge after video-assisted thoracoscopic surgery lung resections appears safe and feasible for carefully selected patients with planned anatomic or nonanatomic resections.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 1","pages":"Pages 33-39"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805155","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