Pub Date : 2024-11-01DOI: 10.1016/j.jtcvs.2024.07.055
{"title":"Discussion to: Early real-world experience monitoring circulating tumor DNA in resected early-stage non–small cell lung cancer","authors":"","doi":"10.1016/j.jtcvs.2024.07.055","DOIUrl":"10.1016/j.jtcvs.2024.07.055","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1360-1361"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630972","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.2024.05.020
{"title":"Discussion to: Should sampling of 3 N2 stations be a quality metric for curative resection of stage I lung cancer?","authors":"","doi":"10.1016/j.jtcvs.2024.05.020","DOIUrl":"10.1016/j.jtcvs.2024.05.020","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1346-1348"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630973","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.2024.10.041
Ernest G Chan, Rachel L Deitz, Jack K Donohue, John P Ryan, Yota Suzuki, Masashi Furukawa, Kentaro Noda, Pablo G Sanchez
Purpose: We report outcomes associated with EVLP lungs in high-risk lung transplant recipients utilizing a national database.
Methods: We performed a retrospective analysis of the UNOS Database (1/1/2018-3/31/2024). High-risk status was defined as mean pulmonary arterial pressure > 35 mmHg, lung retransplantation, or bridge to transplant. In addition to univariable analysis, propensity score matched analysis was performed on predictors of donor and recipient characteristics.
Results: Risk of dying on the waitlist was significantly higher for high-risk candidates (HR: 1.69 [1.51 - 1.89], p < 0.001). Following matching, 203 EVLP cases were matched to 609 standard procurement recipients. The EVLP group was associated with higher rates of postoperative acute kidney injury requiring renal replacement therapy (27% vs 16%, p < 0.001), higher mortality on index admission (13% vs. 8%, p = 0.04), and longer length of stay (29 vs 25 days, p = 0.006). EVLP modality was associated with survival time (p < 0.001) with portable EVLP having significantly shorter survival (2.7 years) relative to standard cases (4.7 years, p < 0.02). A subgroup analysis found that this survival effect was limited to bridge and retransplant recipients.
Conclusions: EVLP lungs were associated with higher rates of postoperative AKI and portable EVLP was associated with shorter survival in high-risk lung transplant recipients. However, given the high waitlist mortality in this candidate population, EVLP lungs should still be considered an alternative.
目的：我们利用国家数据库报告了高风险肺移植受者EVLP肺的相关结果：我们对 UNOS 数据库（1/1/2018-3/31/2024）进行了回顾性分析。高风险状态定义为平均肺动脉压> 35 mmHg、肺再移植或移植桥。除了单变量分析外，还对供体和受体特征的预测因素进行了倾向得分匹配分析：结果：高风险候选者在等待名单上死亡的风险明显更高（HR：1.69 [1.51 - 1.89]，P < 0.001）。经过配对，203 个 EVLP 病例与 609 个标准接受者进行了配对。EVLP组需要肾脏替代治疗的术后急性肾损伤发生率较高（27% vs. 16%，p < 0.001），入院时死亡率较高（13% vs. 8%，p = 0.04），住院时间较长（29天 vs. 25天，p = 0.006）。EVLP模式与存活时间相关（p < 0.001），便携式EVLP的存活时间（2.7年）明显短于标准病例（4.7年，p < 0.02）。亚组分析发现，这种存活率影响仅限于桥接和再移植受者：结论：EVLP肺与较高的术后AKI发生率有关，便携式EVLP与高风险肺移植受者较短的生存期有关。然而，考虑到这一候选人群的高等待死亡率，EVLP肺仍应被视为一种替代方案。
{"title":"Lung Transplantation After Ex Vivo Lung Perfusion in High-Risk Recipients: A Propensity Matched Analysis of a National Database.","authors":"Ernest G Chan, Rachel L Deitz, Jack K Donohue, John P Ryan, Yota Suzuki, Masashi Furukawa, Kentaro Noda, Pablo G Sanchez","doi":"10.1016/j.jtcvs.2024.10.041","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.041","url":null,"abstract":"<p><strong>Purpose: </strong>We report outcomes associated with EVLP lungs in high-risk lung transplant recipients utilizing a national database.</p><p><strong>Methods: </strong>We performed a retrospective analysis of the UNOS Database (1/1/2018-3/31/2024). High-risk status was defined as mean pulmonary arterial pressure > 35 mmHg, lung retransplantation, or bridge to transplant. In addition to univariable analysis, propensity score matched analysis was performed on predictors of donor and recipient characteristics.</p><p><strong>Results: </strong>Risk of dying on the waitlist was significantly higher for high-risk candidates (HR: 1.69 [1.51 - 1.89], p < 0.001). Following matching, 203 EVLP cases were matched to 609 standard procurement recipients. The EVLP group was associated with higher rates of postoperative acute kidney injury requiring renal replacement therapy (27% vs 16%, p < 0.001), higher mortality on index admission (13% vs. 8%, p = 0.04), and longer length of stay (29 vs 25 days, p = 0.006). EVLP modality was associated with survival time (p < 0.001) with portable EVLP having significantly shorter survival (2.7 years) relative to standard cases (4.7 years, p < 0.02). A subgroup analysis found that this survival effect was limited to bridge and retransplant recipients.</p><p><strong>Conclusions: </strong>EVLP lungs were associated with higher rates of postoperative AKI and portable EVLP was associated with shorter survival in high-risk lung transplant recipients. However, given the high waitlist mortality in this candidate population, EVLP lungs should still be considered an alternative.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569551","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}
The large number of patients with COVID-19 subjected to prolonged invasive mechanical ventilation has been expected to result in a significant increase in tracheal stenosis in the next years. The aim of this study was to evaluate and compare postoperative outcomes of patients who survived COVID-19 critical illness and underwent tracheal resection for postintubation/posttracheostomy tracheal stenosis with those of non–COVID-19 patients.
Methods
It was single-center, retrospective study. All consecutive patients with post-intubation/posttracheostomy tracheal stenosis who underwent tracheal resection from February 2020 to March 2022 were enrolled. A total of 147 tracheal resections were performed: 24 were in post–COVID-19 patients and 123 were in non–COVID-19 patients. A 1:1 propensity score matching analysis was performed, considering age, gender, body mass index, and length of stenosis. After matching, 2 groups of 24 patients each were identified: a post–COVID-19 group and a non–COVID group.
Results
No mortality after surgery was registered. Posttracheostomy etiology of stenosis resulted more frequently in post–COVID-19 patients (n = 20 in the post–COVID-19 group vs n = 11 in the non–COVID-19 group; P = .03), as well as intensive care unit admissions during the postoperative period (16 vs 9 patients; P = .04). Need for postoperative reintubation for glottic edema and respiratory failure was higher in the post–COVID-19 group (7 vs 2 postoperative reintubation procedures; P = .04). Postoperative dysphonia was observed in 11 (46%) patients in the post–COVID-19 group versus 4 (16%) patients in the non–COVID-19 group (P = .03).
Conclusions
Tracheal resection continues to be safe and effective in COVID-19–related tracheal stenosis scenarios. Intensive care unit admission rates and postoperative complications seem to be higher in post–COVID-19 patients who underwent tracheal resection compared with non–COVID-19 patients.
{"title":"New perspectives on tracheal resection for COVID-19–related stenosis: A propensity score matching analysis","authors":"Cecilia Menna MD , Silvia Fiorelli MD , Beatrice Trabalza Marinucci MD , Domenico Massullo MD , Antonio D'Andrilli MD , Anna Maria Ciccone MD, PhD , Claudio Andreetti MD, PhD , Giulio Maurizi MD, PhD , Camilla Vanni MD, PhD , Alessandra Siciliani MD, PhD , Matteo Tiracorrendo MD , Massimiliano Mancini MD, PhD , Federico Venuta MD , Erino Angelo Rendina MD , Mohsen Ibrahim MD, PhD","doi":"10.1016/j.jtcvs.2024.03.028","DOIUrl":"10.1016/j.jtcvs.2024.03.028","url":null,"abstract":"<div><h3>Objective</h3><div>The large number of patients with COVID-19 subjected to prolonged invasive mechanical ventilation has been expected to result in a significant increase in tracheal stenosis in the next years. The aim of this study was to evaluate and compare postoperative outcomes of patients who survived COVID-19 critical illness and underwent tracheal resection for postintubation/posttracheostomy tracheal stenosis with those of non–COVID-19 patients.</div></div><div><h3>Methods</h3><div>It was single-center, retrospective study. All consecutive patients with post-intubation/posttracheostomy tracheal stenosis who underwent tracheal resection from February 2020 to March 2022 were enrolled. A total of 147 tracheal resections were performed: 24 were in post–COVID-19 patients and 123 were in non–COVID-19 patients. A 1:1 propensity score matching analysis was performed, considering age, gender, body mass index, and length of stenosis. After matching, 2 groups of 24 patients each were identified: a post–COVID-19 group and a non–COVID group.</div></div><div><h3>Results</h3><div>No mortality after surgery was registered. Posttracheostomy etiology of stenosis resulted more frequently in post–COVID-19 patients (n = 20 in the post–COVID-19 group vs n = 11 in the non–COVID-19 group; <em>P</em> = .03), as well as intensive care unit admissions during the postoperative period (16 vs 9 patients; <em>P</em> = .04). Need for postoperative reintubation for glottic edema and respiratory failure was higher in the post–COVID-19 group (7 vs 2 postoperative reintubation procedures; <em>P</em> = .04). Postoperative dysphonia was observed in 11 (46%) patients in the post–COVID-19 group versus 4 (16%) patients in the non–COVID-19 group (<em>P =</em> .03).</div></div><div><h3>Conclusions</h3><div>Tracheal resection continues to be safe and effective in COVID-19–related tracheal stenosis scenarios. Intensive care unit admission rates and postoperative complications seem to be higher in post–COVID-19 patients who underwent tracheal resection compared with non–COVID-19 patients.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1385-1393"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332268","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jtcvs.2024.03.030
{"title":"Discussion to: Implantation of the HeartMate 3 left ventricular assist device using a thoracotomy-based implant technique: Multicenter HeartMate 3 SWIFT study","authors":"","doi":"10.1016/j.jtcvs.2024.03.030","DOIUrl":"10.1016/j.jtcvs.2024.03.030","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1485-1487"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140762696","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)00849-3
{"title":"Thoracic Articles in AATS Journals","authors":"","doi":"10.1016/S0022-5223(24)00849-3","DOIUrl":"10.1016/S0022-5223(24)00849-3","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Page e137"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142662000","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.2024.04.032
Igor Vendramin MD, Uberto Bortolotti MD, Ugolino Livi MD
{"title":"Follow-up of bioprosthesis recipients: How long should a long-term be?","authors":"Igor Vendramin MD, Uberto Bortolotti MD, Ugolino Livi MD","doi":"10.1016/j.jtcvs.2024.04.032","DOIUrl":"10.1016/j.jtcvs.2024.04.032","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Page e181"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141181137","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.2024.04.005
Rawan M. Zeineddine MD, Michael Botros MD, Kenan A. Shawwaf MD, Ryan Moosavi MD, Mohamed R. Aly MD, Juan M. Farina MD, Jesse J. Lackey CSFA, Beth A. Sandstrom RN, Dawn E. Jaroszewski MD
Objective
Severity for pectus excavatum includes Haller index (HI) > 3.25. An extremely high HI (≥8) may influence surgical approach and complications. This study reviews outcomes of patients with high HI after repair.
Methods
A single institution retrospective analysis was performed on adult patients with HI ≥ 8 undergoing pectus excavatum repairs. For outcomes, a propensity score-matched control group with a HI ≤ 4 was utilized.
Results
In total, 64 cases (mean age, 33.5 ± 10.9 years; HI, 13.1 ± 5.0; 56% women) were included. A minimally invasive repair was successful in 84%. A hybrid procedure was performed in the remaining either to repair fractures of the ribs (8 patients) and sternum (5 patients) or when osteotomy and/or cartilage resection was required (10 patients). In comparison with the matched cohort (HI ≤ 4), patients with high HI had longer operative times (171 vs 133 minutes; P < .001), more frequently required hybrid procedures (16% vs 2%; P = .005), experienced higher incidences of rib (22% vs 3%; P = .001) and sternal fractures (12% vs 0%; P = .003), and had increased repair with 3 bars (50% vs 19%; P < .001). There were no significant differences between the groups for length of hospital stay or postoperative 30-day complications.
Conclusions
Patients with an extremely high HI can be challenging cases with greater risks of fracture and need for osteotomy/cartilage resection. Despite this, minimally invasive repair techniques can be utilized in most cases without increased complications when performed by an experienced surgeon.
目的乳房下垂的严重程度包括哈勒指数（HI）> 3.25。极高的 HI（≥8）可能会影响手术方法和并发症。本研究回顾了高HI患者修复后的结果。方法对HI≥8的成年患者进行了单机构回顾性分析。结果共纳入 64 例患者（平均年龄为 33.5 ± 10.9 岁；HI 为 13.1 ± 5.0；56% 为女性）。84%的患者成功进行了微创修复。其余的患者要么是为了修复肋骨（8 例）和胸骨（5 例）骨折，要么是需要截骨和/或软骨切除（10 例），因此采用了混合手术。与匹配队列（HI ≤ 4）相比，HI 高的患者手术时间更长（171 分钟 vs 133 分钟；P < .001），更频繁地需要混合手术（16% vs 2%；P = .005），肋骨骨折（22% vs 3%；P = .001）和胸骨骨折（12% vs 0%；P = .003）的发生率更高，使用 3 根钢筋进行修复的比例更高（50% vs 19%；P < .001）。结论HI极高的患者可能是具有挑战性的病例，骨折和需要截骨/软骨切除的风险更大。尽管如此，如果由经验丰富的外科医生操作，微创修复技术仍可用于大多数病例，且不会增加并发症。
{"title":"Does a high Haller index influence outcomes in pectus excavatum repair?","authors":"Rawan M. Zeineddine MD, Michael Botros MD, Kenan A. Shawwaf MD, Ryan Moosavi MD, Mohamed R. Aly MD, Juan M. Farina MD, Jesse J. Lackey CSFA, Beth A. Sandstrom RN, Dawn E. Jaroszewski MD","doi":"10.1016/j.jtcvs.2024.04.005","DOIUrl":"10.1016/j.jtcvs.2024.04.005","url":null,"abstract":"<div><h3>Objective</h3><div>Severity for pectus excavatum includes Haller index (HI) > 3.25. An extremely high HI (≥8) may influence surgical approach and complications. This study reviews outcomes of patients with high HI after repair.</div></div><div><h3>Methods</h3><div>A single institution retrospective analysis was performed on adult patients with HI ≥ 8 undergoing pectus excavatum repairs. For outcomes, a propensity score-matched control group with a HI ≤ 4 was utilized.</div></div><div><h3>Results</h3><div><span><span>In total, 64 cases (mean age, 33.5 ± 10.9 years; HI, 13.1 ± 5.0; 56% women) were included. A minimally invasive repair was successful in 84%. A hybrid procedure was performed in the remaining either to repair fractures of the ribs (8 patients) and sternum (5 patients) or when </span>osteotomy and/or cartilage resection was required (10 patients). In comparison with the matched cohort (HI ≤ 4), patients with high HI had longer operative times (171 vs 133 minutes; </span><em>P</em> < .001), more frequently required hybrid procedures (16% vs 2%; <em>P</em> = .005), experienced higher incidences of rib (22% vs 3%; <em>P</em> = .001) and sternal fractures (12% vs 0%; <em>P</em> = .003), and had increased repair with 3 bars (50% vs 19%; <em>P</em> < .001). There were no significant differences between the groups for length of hospital stay or postoperative 30-day complications.</div></div><div><h3>Conclusions</h3><div>Patients with an extremely high HI can be challenging cases with greater risks of fracture and need for osteotomy/cartilage resection. Despite this, minimally invasive repair techniques can be utilized in most cases without increased complications when performed by an experienced surgeon.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1395-1402"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140759005","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.2023.10.012
Matthew Romano MD , Patrick M. McCarthy MD , Abigail S. Baldridge MS , Jane Kruse BSN , Anna Huskin BSN , China Green MS , Jessica Woodford MPH , Heather Byrd MS , Steven F. Bolling MD
Objective
Guideline recommendations for mechanical or bioprosthetic valve for mitral valve replacement by age remains controversial. We sought to determine bovine pericardial valve durability by age and risk of reintervention.
Methods
This retrospective study between 2 large university-based cardiac surgery programs examined patients who underwent bioprosthetic mitral valve replacement from 2004 to 2020. Follow-up was obtained through June 2022. Durability outcomes involving structural valve deterioration were compared by age decile.
Results
Of 1544 available patients, mean age was 66 ± 13 years and 652 (42%) were aged less than 65 years. Indications for mitral valve replacement were as follows: mitral regurgitation greater than 2+ in 53% (n = 813), mitral stenosis in 44% (n = 650), endocarditis in 18% (n = 277), and reoperation in 39% (n = 602). Concomitant procedures were aortic valve replacement in 28% (n = 426), tricuspid valve in 36% (n = 550), and coronary artery bypass in 19% (n = 290). Thirty-day mortality was 5.4%. In follow-up (clinical: median [interquartile range] 75 [25-129] months), reoperation for endocarditis and new stroke were low (0.30 and 1.06 per 100 patient/years, respectively). The cumulative incidence of mitral valve reintervention for structural valve deterioration among all patients was 6.2% at 10 years and 9.0% at 12 years with no statistical difference in structural valve deterioration in patients aged 40 to 70 years (P = .1). In 90 patients with mitral valve reintervention, 30-day mortality after reintervention was 4.7% (n = 2) for 43 with mitral valve-in-valve and 6.4% (n = 3) for 47 with reoperation.
Conclusions
Bovine pericardial mitral valve replacement is a durable option for younger patients. The opportunity to avoid anticoagulation and the associated risks with mechanical mitral valve replacement may be of benefit to patients. These insights may provide data needed to revise the current guidelines.
{"title":"Should mitral valve replacement age guidelines be lowered due to better bioprosthetic mitral valve durability?","authors":"Matthew Romano MD , Patrick M. McCarthy MD , Abigail S. Baldridge MS , Jane Kruse BSN , Anna Huskin BSN , China Green MS , Jessica Woodford MPH , Heather Byrd MS , Steven F. Bolling MD","doi":"10.1016/j.jtcvs.2023.10.012","DOIUrl":"10.1016/j.jtcvs.2023.10.012","url":null,"abstract":"<div><h3>Objective</h3><div><span>Guideline recommendations for mechanical or bioprosthetic valve for </span>mitral valve replacement by age remains controversial. We sought to determine bovine pericardial valve durability by age and risk of reintervention.</div></div><div><h3>Methods</h3><div>This retrospective study between 2 large university-based cardiac surgery programs examined patients who underwent bioprosthetic mitral valve<span> replacement from 2004 to 2020. Follow-up was obtained through June 2022. Durability outcomes involving structural valve deterioration were compared by age decile.</span></div></div><div><h3>Results</h3><div><span><span>Of 1544 available patients, mean age was 66 ± 13 years and 652 (42%) were aged less than 65 years. Indications for mitral valve replacement were as follows: mitral regurgitation<span> greater than 2+ in 53% (n = 813), mitral stenosis<span> in 44% (n = 650), endocarditis in 18% (n = 277), and </span></span></span>reoperation<span><span> in 39% (n = 602). Concomitant procedures were aortic valve replacement<span> in 28% (n = 426), tricuspid valve in 36% (n = 550), and </span></span>coronary artery bypass<span><span> in 19% (n = 290). Thirty-day mortality was 5.4%. In follow-up (clinical: median [interquartile range] 75 [25-129] months), reoperation for endocarditis and new stroke were low (0.30 and 1.06 per 100 patient/years, respectively). The cumulative incidence of mitral valve reintervention for </span>structural valve deterioration among all patients was 6.2% at 10 years and 9.0% at 12 years with no statistical difference in structural valve deterioration in patients aged 40 to 70 years (</span></span></span><em>P</em> = .1). In 90 patients with mitral valve reintervention, 30-day mortality after reintervention was 4.7% (n = 2) for 43 with mitral valve-in-valve and 6.4% (n = 3) for 47 with reoperation.</div></div><div><h3>Conclusions</h3><div>Bovine pericardial mitral valve replacement is a durable option for younger patients. The opportunity to avoid anticoagulation and the associated risks with mechanical mitral valve replacement may be of benefit to patients. These insights may provide data needed to revise the current guidelines.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1448-1458.e4"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240373","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.2023.08.037
Carlos E. Diaz-Castrillon MD , Derek Serna-Gallegos MD , George Arnaoutakis MD , Joshua Grimm MD , Wilson Y. Szeto MD , Danny Chu MD , Ahmet Sezer PhD , Ibrahim Sultan MD
Objective
To determine the relationship between volume of cases and failure-to-rescue (FTR) rate after surgery for acute type A aortic dissection (ATAAD) across the United States.
Methods
The Society of Thoracic Surgeons adult cardiac surgery database was used to review outcomes of surgery after ATAAD between June 2017 and December 2021. Mixed-effect models and restricted cubic splines were used to determine the risk-adjusted relationships between ATAAD average volume and FTR rate. FTR calculation was based on deaths associated with the following complications: venous thromboembolism/deep venous thrombosis, stroke, renal failure, mechanical ventilation >48 hours, sepsis, gastrointestinal complications, cardiopulmonary resuscitation, and unplanned reoperation.
Results
In total, 18,192 patients underwent surgery for ATAAD in 832 centers. The included hospitals' median volume was 2.2 cases/year (interquartile range [IQR], 0.9-5.8). Quartiles’ distribution was 615 centers in the first (1.3 cases/year, IQR, 0.4-2.9); 123 centers in the second (8 cases/year, IQR, 6.7-10.2); 66 centers in the third (15.6 cases/year, IQR, 14.2-18); and 28 centers in the fourth quartile (29.3 cases/year, IQR, 28.8-46.0). Fourth-quartile hospitals performed more extensive procedures. Overall complication, mortality, and FTR rates were 52.6%, 14.2%, and 21.7%, respectively. Risk-adjusted analysis demonstrated increased odds of FTR when the average volume was fewer than 10 cases per year.
Conclusions
Although high-volume centers performed more complex procedures than low-volume centers, their operative mortality was lower, perhaps reflecting their ability to rescue patients and mitigate complications. An average of fewer than 10 cases per year at an institution is associated with increased odds of failure to rescue patients after ATAAD repair.
{"title":"Volume-failure-to-rescue relationship in acute type A aortic dissections: An analysis of The Society of Thoracic Surgeons Database","authors":"Carlos E. Diaz-Castrillon MD , Derek Serna-Gallegos MD , George Arnaoutakis MD , Joshua Grimm MD , Wilson Y. Szeto MD , Danny Chu MD , Ahmet Sezer PhD , Ibrahim Sultan MD","doi":"10.1016/j.jtcvs.2023.08.037","DOIUrl":"10.1016/j.jtcvs.2023.08.037","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the relationship between volume of cases and failure-to-rescue (FTR) rate after surgery for acute type A aortic dissection (ATAAD) across the United States.</div></div><div><h3>Methods</h3><div><span>The Society of Thoracic Surgeons adult cardiac surgery database was used to review outcomes of surgery after ATAAD between June 2017 and December 2021. Mixed-effect models and restricted cubic splines were used to determine the risk-adjusted relationships between ATAAD average volume and FTR rate. FTR calculation was based on deaths associated with the following complications: venous thromboembolism/deep venous thrombosis, stroke, renal failure, mechanical ventilation<span><span> >48 hours, sepsis, </span>gastrointestinal complications, cardiopulmonary resuscitation, and unplanned </span></span>reoperation.</div></div><div><h3>Results</h3><div>In total, 18,192 patients underwent surgery for ATAAD in 832 centers. The included hospitals' median volume was 2.2 cases/year (interquartile range [IQR], 0.9-5.8). Quartiles’ distribution was 615 centers in the first (1.3 cases/year, IQR, 0.4-2.9); 123 centers in the second (8 cases/year, IQR, 6.7-10.2); 66 centers in the third (15.6 cases/year, IQR, 14.2-18); and 28 centers in the fourth quartile (29.3 cases/year, IQR, 28.8-46.0). Fourth-quartile hospitals performed more extensive procedures. Overall complication, mortality, and FTR rates were 52.6%, 14.2%, and 21.7%, respectively. Risk-adjusted analysis demonstrated increased odds of FTR when the average volume was fewer than 10 cases per year.</div></div><div><h3>Conclusions</h3><div><span>Although high-volume centers performed more complex procedures than low-volume centers, their operative mortality was lower, perhaps reflecting their ability to </span>rescue patients and mitigate complications. An average of fewer than 10 cases per year at an institution is associated with increased odds of failure to rescue patients after ATAAD repair.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1416-1425.e7"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10140762","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}
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