Journal of Thoracic and Cardiovascular Surgery最新文献

英文中文

Short-term outcomes of thrombolysis versus surgical pulmonary embolectomy in patients with high-risk pulmonary embolism 高风险肺栓塞患者溶栓与外科肺栓塞切除术的短期疗效。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.07.039

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

Objective

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.

目的：尽管目前的指南提倡溶栓作为一线治疗方法，但对于高危肺栓塞患者，溶栓与外科肺栓塞切除术相比的生存获益尚未确定。本研究比较了外科肺栓塞切除术和溶栓的短期疗效，以确定高危肺栓塞的最佳治疗方法。方法：使用2010年7月至2023年3月期间日本全国住院患者管理数据库，对入院2天内接受手术肺栓塞切除术或溶栓治疗的高危肺栓塞患者进行识别。主要结局是住院死亡率，次要结局是并发症、住院时间和总住院费用。采用重叠加权对结果进行比较，并采用治疗加权逆概率和多变量logistic回归模型进行敏感性分析。结果：在2,813例符合条件的患者中，526例接受了肺栓塞切除术，2,287例接受了溶栓。重叠加权后，外科肺栓塞切除术的住院死亡率较低（22.2%对30.1%,P = 0.002），出院时神经预后较好（72.5%对66.7%,P = 0.040），总费用较高（30,548美元对13,374美元，P < 0.001）。两组在并发症和住院时间方面无显著差异。敏感性分析的结果与初步分析一致。结论：这些发现提示外科肺栓塞切除术比溶栓治疗高危肺栓塞的潜在益处。对于合适的患者，外科肺栓塞切除术可以被认为是一种合理的再灌注治疗选择。需要进一步的研究来证实这些发现。

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引用次数: 0

Commentary: CATS crash TEE party 评论：猫毁了Tee Party。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.08.028

Daniel H. Drake MD

引用次数: 0

Lung transplant outcomes after implementation of a hospital-based 10 °C controlled hypothermic organ preservation unit 实施医院10C控制低温器官保存单元后肺移植的结果。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 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.

目的：最近的研究表明，与标准冰冷却器（IC）相比，肺供体异体移植物在10°C下的控制低温保存（CHP）与移植物保存的改善有关。我们假设，肺移植受者（LTR）在10℃下接受增加总保存时间（TPT）的临床结果不会较差。方法：对2022年1月至2024年7月连续的ltr进行回顾性单中心队列研究，比较供体器官暴露于10°C CHP与标准IC的ltr的结果。获得符合标准的肺，在IC中运输，然后植入或转移到10°C CHP单元直至植入。结果：纳入263例连续LTR，其中169例在10°C组，94例在IC组。251例患者（95%）存活至90天（161例[95%]10C， 90例[96%]IC， p=0.8）。总体中位TPT为7小时42分钟，在10°C队列中显著增加(10小时12分钟vs. 5小时，p结论：与标准冰冷却器保存相比，在10°C下使用可持续的医院控制低温保存装置延长总保存时间似乎是安全的，而且不差。

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引用次数: 0

Congenital Articles in AATS Journals 先天性文章在AATS期刊

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/S0022-5223(25)01085-2

引用次数: 0

Adult Articles in AATS Journals 成人文章在AATS期刊

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/S0022-5223(25)01087-6

引用次数: 0

Thoracic Articles in AATS Journals AATS期刊中的胸科文章

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/S0022-5223(25)01090-6

引用次数: 0

Assessing the role of induction Therapy and resection in esophageal cancer 评估诱导治疗和食管癌切除术的作用。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.02.006

Xichen Fan MD , Yuxiang Zhao MD , Xin Zhao PhD, MD

引用次数: 0

Key challenges and successful characteristics of cardiothoracic surgical trialists 心胸外科试验医师面临的主要挑战和成功特点。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.07.019

Mario Gaudino MD

引用次数: 0

Diagnostic yield of routine frozen section pathology examination of lymph nodes in lung resections for clinical stage IA non–small cell lung cancer 临床IA期非小细胞肺癌肺切除术淋巴结常规冰冻切片病理检查的诊断率。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.08.031

Belisario A. Ortiz MD , Sam K. Engrav BA , Jennifer M. Boland MD , Anja C. Roden MD , Marie-Christine Aubry MD , Farah A. Abdallah MD , Eunhee S. Yi MD , Stephen D. Cassivi MD, MS , Dennis A. Wigle MD, PhD , K. Robert Shen MD , Sahar A. Saddoughi MD, PhD , Janani S. Reisenauer MD , Luis F. Tapias MD

Objective

Intraoperative identification of lymph node (LN) involvement by carcinoma has an impact on the surgical treatment of patients with clinical stage IA non–small cell lung cancer (NSCLC). This study aimed to identify the diagnostic performance of routine intraoperative frozen section pathology (FSP) evaluation of LNs in these patients.

Methods

Patients with clinical stage IA NSCLC who underwent curative-intent lung resections between 2018 and 2023 were included. Pathology reports were retrospectively reviewed for data on LN evaluation and findings from FSP and final pathology. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the detection of node-positive disease.

Results

Of 1008 patients who underwent surgery during the study period, 909 (90.2%) were included in this analysis. Nodal upstaging occurred in 46 patients (5.1%), corresponding to pN1 in 31 (3.4%) and to pN2 in 15 (1.7%). FSP detected patients with node-positive disease with a sensitivity of 80.4%, specificity of 99.9%, PPV of 97.4%, and NPV of 99.0%. Of the 7016 LNs analyzed, 95 (1.4%) were involved by carcinoma on final pathology. At the LN level, FSP detected nodal disease with a sensitivity of 83.2%, specificity of 100%, PPV of 98.8%, and NPV of 99.8%. Of 565 patients with a plan to undergo sublobar resection, 556 (98.4%) had all negative LNs on FSP; only 5 (0.9%) were found to have node-positive disease on final pathology.

Conclusions

FSP performs well in detecting LN metastasis intraoperatively in patients with clinical stage IA NSCLC. FSP use should be considered as sublobar resections gain widespread application.

目的：术中淋巴结浸润癌的鉴别对临床分期IA期NSCLC患者的手术治疗有重要影响。本研究旨在确定常规术中淋巴结冷冻切片（FSP）评估在这些患者中的诊断价值。方法：纳入2018-2023年期间接受治疗目的肺切除术的临床IA期非小细胞肺癌患者。病理报告回顾性回顾淋巴结评估数据和FSP和最终病理结果。计算检测淋巴结阳性疾病的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。结果：研究期间1008例手术患者中，909例（90.2%）纳入本分析。46例（5.1%）患者出现淋巴结抢先期，对应于31例pN1（3.4%）和15例pN2（1.7%）。FSP检测淋巴结阳性患者的敏感性为80.4%，特异性为99.9%，PPV为97.4%，NPV为99.0%。7016个淋巴结中95个（1.4%）在最终病理上被癌累及。在淋巴结水平，FSP检测淋巴结病变的敏感性为83.2%，特异性为100%，PPV为98.8%，NPV为99.8%。565例计划行叶下切除术的患者中，556例（98.4%）的FSP全部阴性；最终病理仅5例（0.9%）为淋巴结阳性。结论：FSP在IA期非小细胞肺癌患者术中有较好的淋巴结转移检测效果。随着叶下切除术的广泛应用，FSP的应用应该被考虑。

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引用次数: 0

Lobectomy improves disease-free survival over sublobar resection for high-risk stage IA non−small cell lung cancer 与叶下切除术相比，肺叶切除术可提高高风险IA期非小细胞肺癌的无病生存率。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.08.024

Raul Caso MD, MSCI , Nanruoyi Zhou MD , Matthew Skovgard MD , Nicolas Toumbacaris MSPH , Kay See Tan PhD , Prasad S. Adusumilli MD , Manjit S. Bains MD , Matthew J. Bott MD , Robert J. Downey MD , James Huang MD , James M. Isbell MD, MSCI , Daniela Molena MD , Bernard J. Park MD , Gaetano Rocco MD , Valerie W. Rusch MD , Smita Sihag MD , David R. Jones MD , Katherine D. Gray MD

Objective

To investigate disease-free survival (DFS) of sublobar resection versus lobectomy for stage IA non−small cell lung cancer (NSCLC) with preoperative high-risk features.

Methods

Data were abstracted from a prospective database to identify patients with clinical T1a-T1bN0M0 NSCLC (≤2 cm) who underwent lobectomy or sublobar resection (wedge resection or segmentectomy). 1:1 propensity matching was used to balance the dataset for forced expiratory volume in 1 second ≥60% and high-risk features: cT1b versus cT1a, standard uptake value of the primary tumor on positron emission tomography, solid versus subsolid tumor texture on computed tomography, and micropapillary/solid histology. The primary outcome was DFS.

Results

In total, 825 patients met inclusion criteria: 52% (n = 426) patients underwent lobectomy and 48% (n = 399) of patients underwent sublobar resection (45% segmentectomy, 55% wedge resection). Lobectomy was associated with more preoperative high-risk features: cT1b (P < .001), greater standard uptake value (P < .001), solid tumor texture on computed tomography (P < .001), and micropapillary/solid histology (P < .001). In total, 660 patients were included in the matched analysis with all high-risk features balanced. Nodal upstaging (N1) was greater in patients who underwent lobectomy (9.1% vs 3.4%, P = .004). Five-year DFS (85% vs 74%, P = .12) was equivalent in the matched cohort. Lobectomy was protective for recurrence in the presence of 2 or greater high-risk features: sublobar resection patients with 2 high-risk features (hazard ratio, 1.77; 95% confidence interval, 1.13-2.76, P = .012) or 3-4 high-risk features (hazard ratio, 1.97; 95% confidence interval, 1.25-3.10, P = .004) had worse DFS.

Conclusions

Lobectomy should be considered over sublobar resection for stage IA NSCLC ≤2 cm in the presence of multiple high-risk features.

目的：探讨具有术前高危特征的IA期非小细胞肺癌（NSCLC）的叶下切除术与叶下切除术的无病生存率（DFS）。方法：从前瞻性数据库中提取数据，识别临床T1a-T1bN0M0 NSCLC（≤2 cm）行肺叶切除术或叶下切除术（楔形切除术或节段切除术）的患者。使用1:1倾向匹配来平衡FEV1≥60%的数据集和高风险特征：cT1b与cT1a， PET上原发肿瘤的SUV， CT上实性与次实性肿瘤质地，微乳头状(MIP)/实性组织学。主要终点为DFS。结果：825例患者符合纳入标准：52% （N=426）的患者行肺叶切除术，48% （N=399）的患者行肺叶下切除术（45%节段切除术，55%楔形切除术）。结论：对于≤2cm的IA期NSCLC，在存在多种高危特征的情况下，应考虑行肺叶切除术，而非叶下切除术。

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