Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.07.018
Mahmoud Alshneikat MD , Richard Ramsingh MD , Ahmed K. Awad MD , Penny L. Houghtaling MS , Shinya G. Unai MD , Marijan J. Koprivanac MD, MS , Michael Z. Tong MD , Haytham J. Elgharably MD , Kenneth R. McCurry MD , Patrick R. Vargo MD , Edward G. Soltesz MD, MPH , Nicholas G. Smedira MD , Gösta B. Pettersson MD , Eric E. Roselli MD , A. Marc Gillinov MD , Lars G. Svensson MD, PhD , Eugene H. Blackstone MD , Faisal G. Bakaeen MD
Objective
To undertake an in-depth review of patients undergoing redo coronary artery bypass grafting (CABG) despite patent bilateral internal thoracic artery (BITA) grafts.
Methods
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.
Results
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.
Conclusions
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.
{"title":"Redo coronary artery bypass grafting in patients with patent bilateral internal thoracic artery grafts: Exceptions to a lifetime warranty","authors":"Mahmoud Alshneikat MD , Richard Ramsingh MD , Ahmed K. Awad MD , Penny L. Houghtaling MS , Shinya G. Unai MD , Marijan J. Koprivanac MD, MS , Michael Z. Tong MD , Haytham J. Elgharably MD , Kenneth R. McCurry MD , Patrick R. Vargo MD , Edward G. Soltesz MD, MPH , Nicholas G. Smedira MD , Gösta B. Pettersson MD , Eric E. Roselli MD , A. Marc Gillinov MD , Lars G. Svensson MD, PhD , Eugene H. Blackstone MD , 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}
Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.07.020
Evan T. Alicuben MD, Ryan M. Levy MD
{"title":"Commentary: Enhance, don't replace, the tasting menu for Zenker diverticulum","authors":"Evan T. Alicuben MD, 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}
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.
Methods
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.
Results
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%, P = .002), more favorable neurological outcomes at discharge (72.5% vs 66.7%, P = .040), and higher total costs ($30,548 vs $13,374, P < .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.
Conclusions
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.
{"title":"Short-term outcomes of thrombolysis versus surgical pulmonary embolectomy in patients with high-risk pulmonary embolism","authors":"Keiichi Ishida MD, PhD , Yuji Nishimoto MD , Hiroyuki Ohbe MD, PhD , Nobutaka Ikeda MD, PhD , Toshihiko Sugiura MD, PhD , Rika Suda MD, PhD , Nobuhiro Tanabe MD, PhD , Makoto Mo MD, PhD , Yuya Kimura MD, MPH , Hiroki Matsui MPH, PhD , 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> < .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}
Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.08.028
Daniel H. Drake MD
{"title":"Commentary: CATS crash TEE party","authors":"Daniel H. Drake MD","doi":"10.1016/j.jtcvs.2025.08.028","DOIUrl":"10.1016/j.jtcvs.2025.08.028","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 398-399"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976685","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 : 2026-02-01DOI: 10.1016/j.jtcvs.2025.09.024
Alexey Abramov MD, MS , Joseph Costa DHSc, PA-C , Jake Rosen MD , Richa Asija DO, MS , Luke Benvenuto MD , Gabriela Magda MD , Lori Shah MD , Harpreet S. Grewal MD , Angela DiMango MD , Hilary Robbins MD , Selim Arcasoy MD , Bryan P. Stanifer MD, MPH , Philippe Lemaitre MD, PhD , Joshua Sonett MD , Frank D'Ovidio MD, PhD
Objective
Recent work suggests controlled hypothermic preservation (CHP) of lung donor allografts at 10 °C, when compared with standard ice cooler (IC), is associated with improved graft preservation. We hypothesized that clinical outcomes of lung transplant recipients (LTRs) with lungs subjected to increased total preservation time (TPT) at 10 °C would be noninferior.
Methods
This was a retrospective, single-center cohort study of consecutive LTRs from January 2022 to July 2024 in which we compared outcomes of LTRs from donor organs exposed to 10 °C CHP versus standard IC. Lungs meeting criteria were procured, transported in IC, and either implanted or transferred to 10 °C CHP unit until implantation.
Results
In total, 263 consecutive LTRs with 169 in the 10 °C cohort and 94 in the IC cohort were included; 251 patients (95%) survived to 90 days (161 patients [95%] 10 °C, 90 patients [96%] IC, P = .8). Overall median TPT was 7 hours, 42 minutes, significantly increased in 10 °C cohort (10 hours, 12 minutes vs 5 hours, P < .001). TPT range varied from 3 hours, 2 minutes to 22 hours, 49 minutes. When comparing LTRs with TPT over 12 hours (10 °C extended) versus others in the 10 °C cohort (10 °C regular) versus IC, there were no observed differences in primary graft dysfunction at 72 hours (P = .2), median number of days of extracorporeal membrane oxygenation support (P = .4), or duration of mechanical ventilation (P = .8). Overall survival at 1 year (n = 236, [90%], P = .9) revealed no differences.
Conclusions
Extension of total preservation time with a sustainable hospital-based controlled hypothermic preservation unit at 10 °C appears to be safe and noninferior when compared with standard ice cooler preservation.
{"title":"Lung transplant outcomes after implementation of a hospital-based 10 °C controlled hypothermic organ preservation unit","authors":"Alexey Abramov MD, MS , Joseph Costa DHSc, PA-C , Jake Rosen MD , Richa Asija DO, MS , Luke Benvenuto MD , Gabriela Magda MD , Lori Shah MD , Harpreet S. Grewal MD , Angela DiMango MD , Hilary Robbins MD , Selim Arcasoy MD , Bryan P. Stanifer MD, MPH , Philippe Lemaitre MD, PhD , Joshua Sonett MD , Frank D'Ovidio MD, PhD","doi":"10.1016/j.jtcvs.2025.09.024","DOIUrl":"10.1016/j.jtcvs.2025.09.024","url":null,"abstract":"<div><h3>Objective</h3><div>Recent work suggests controlled hypothermic preservation (CHP) of lung donor allografts at 10 °C, when compared with standard ice cooler (IC), is associated with improved graft preservation. We hypothesized that clinical outcomes of lung transplant recipients (LTRs) with lungs subjected to increased total preservation time (TPT) at 10 °C would be noninferior.</div></div><div><h3>Methods</h3><div>This was a retrospective, single-center cohort study of consecutive LTRs from January 2022 to July 2024 in which we compared outcomes of LTRs from donor organs exposed to 10 °C CHP versus standard IC. Lungs meeting criteria were procured, transported in IC, and either implanted or transferred to 10 °C CHP unit until implantation.</div></div><div><h3>Results</h3><div>In total, 263 consecutive LTRs with 169 in the 10 °C cohort and 94 in the IC cohort were included; 251 patients (95%) survived to 90 days (161 patients [95%] 10 °C, 90 patients [96%] IC, <em>P</em> = .8). Overall median TPT was 7 hours, 42 minutes, significantly increased in 10 °C cohort (10 hours, 12 minutes vs 5 hours, <em>P</em> < .001). TPT range varied from 3 hours, 2 minutes to 22 hours, 49 minutes. When comparing LTRs with TPT over 12 hours (10 °C extended) versus others in the 10 °C cohort (10 °C regular) versus IC, there were no observed differences in primary graft dysfunction at 72 hours (<em>P</em> = .2), median number of days of extracorporeal membrane oxygenation support (<em>P</em> = .4), or duration of mechanical ventilation (<em>P</em> = .8). Overall survival at 1 year (n = 236, [90%], <em>P</em> = .9) revealed no differences.</div></div><div><h3>Conclusions</h3><div>Extension of total preservation time with a sustainable hospital-based controlled hypothermic preservation unit at 10 °C appears to be safe and noninferior when compared with standard ice cooler preservation.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 532-539.e2"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180252","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 : 2026-02-01DOI: 10.1016/S0022-5223(25)01085-2
{"title":"Congenital Articles in AATS Journals","authors":"","doi":"10.1016/S0022-5223(25)01085-2","DOIUrl":"10.1016/S0022-5223(25)01085-2","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Page e19"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081619","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 : 2026-02-01DOI: 10.1016/S0022-5223(25)01087-6
{"title":"Adult Articles in AATS Journals","authors":"","doi":"10.1016/S0022-5223(25)01087-6","DOIUrl":"10.1016/S0022-5223(25)01087-6","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Page e30"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081874","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 : 2026-02-01DOI: 10.1016/S0022-5223(25)01090-6
{"title":"Thoracic Articles in AATS Journals","authors":"","doi":"10.1016/S0022-5223(25)01090-6","DOIUrl":"10.1016/S0022-5223(25)01090-6","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Page e46"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081953","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":"Assessing the role of induction Therapy and resection in esophageal cancer","authors":"Xichen Fan MD , Yuxiang Zhao MD , Xin Zhao PhD, MD","doi":"10.1016/j.jtcvs.2025.02.006","DOIUrl":"10.1016/j.jtcvs.2025.02.006","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Page e47"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568616","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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