Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.07.019
Mario Gaudino MD
{"title":"Key challenges and successful characteristics of cardiothoracic surgical trialists","authors":"Mario Gaudino MD","doi":"10.1016/j.jtcvs.2025.07.019","DOIUrl":"10.1016/j.jtcvs.2025.07.019","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 489-492"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676362","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.2025.08.031
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.
{"title":"Diagnostic yield of routine frozen section pathology examination of lymph nodes in lung resections for clinical stage IA non–small cell lung cancer","authors":"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","doi":"10.1016/j.jtcvs.2025.08.031","DOIUrl":"10.1016/j.jtcvs.2025.08.031","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 493-499.e2"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976730","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.2025.08.024
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.
{"title":"Lobectomy improves disease-free survival over sublobar resection for high-risk stage IA non−small cell lung cancer","authors":"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","doi":"10.1016/j.jtcvs.2025.08.024","DOIUrl":"10.1016/j.jtcvs.2025.08.024","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> < .001), greater standard uptake value (<em>P</em> < .001), solid tumor texture on computed tomography (<em>P</em> < .001), and micropapillary/solid histology (<em>P</em> < .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%, <em>P</em> = .004). Five-year DFS (85% vs 74%, <em>P</em> = .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, <em>P</em> = .012) or 3-4 high-risk features (hazard ratio, 1.97; 95% confidence interval, 1.25-3.10, <em>P</em> = .004) had worse DFS.</div></div><div><h3>Conclusions</h3><div>Lobectomy should be considered over sublobar resection for stage IA NSCLC ≤2 cm in the presence of multiple high-risk features.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 510-518.e2"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976785","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.2025.09.006
James Jaggers MD , David Winlaw MD, FRACS , Stephanie Fuller MD , Neeta Sethi MD , Lazaros Kochilas MD , Iki Adachi MD , Matthew Stone MD , Lorna Browne MD , Nee Khoo MD , Eduardo da Cruz MD , Christopher Petit MD , Damien LaPar MD, MSc , Lydia Wright MD , Karen Stout MD , Mary Donofrio MD, FAAP, FACC, FASE , James St Louis MD, FACC, FACS
{"title":"Corrigendum to “2025 American Association for Thoracic Surgery Congenital Cardiac Surgery Working Group—Expert consensus document on the management of patients with pulmonary atresia with intact ventricular septum” (Journal of Thoracic and Cardiovascular Surgery, 2025;170(2):336–352)","authors":"James Jaggers MD , David Winlaw MD, FRACS , Stephanie Fuller MD , Neeta Sethi MD , Lazaros Kochilas MD , Iki Adachi MD , Matthew Stone MD , Lorna Browne MD , Nee Khoo MD , Eduardo da Cruz MD , Christopher Petit MD , Damien LaPar MD, MSc , Lydia Wright MD , Karen Stout MD , Mary Donofrio MD, FAAP, FACC, FASE , James St Louis MD, FACC, FACS","doi":"10.1016/j.jtcvs.2025.09.006","DOIUrl":"10.1016/j.jtcvs.2025.09.006","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Page 348"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145372710","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)01080-3
{"title":"Information for readers","authors":"","doi":"10.1016/S0022-5223(25)01080-3","DOIUrl":"10.1016/S0022-5223(25)01080-3","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Page 558"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081877","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.2025.02.017
Mengxia Qi MM , Xiangying Yang MM
{"title":"Refining preoperative diabetes assessment: Implications for acute myocardial infarction-coronary artery bypass grafting management and long-term outcomes","authors":"Mengxia Qi MM , Xiangying Yang MM","doi":"10.1016/j.jtcvs.2025.02.017","DOIUrl":"10.1016/j.jtcvs.2025.02.017","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages e41-e42"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674726","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.2025.07.009
Travis J. Miles MD , Michael T. Guinn MD , Xin Tan BS , Hao Qi BS , Vicente Orozco-Sevilla MD , Marc R. Moon MD , Joseph S. Coselli MD , Todd K. Rosengart MD , Meng Li PhD , Subhasis Chatterjee MD , Ravi K. Ghanta MD
Background
Optimal hemodynamic targets for preventing acute kidney injury (AKI) have remained elusive. We hypothesized that lower tissue perfusion pressure (TPP), a novel perfusion index representing the difference between mean arterial pressure and the critical closing pressure, is predictive of AKI after cardiac surgery.
Methods
Individual patient TPP waveforms were constructed from continuous hemodynamic data in 1224 patients after cardiac surgery. The relationship of TPP and AKI was determined and stratified by vasoactive inotrope score. Logistic regression was performed to identify the optimal TPP threshold for predicting AKI. Unsupervised machine learning was used to explore different hemodynamic phenotypes and their association with AKI.
Results
AKI occurred in 17.6% of patients and was associated with higher rates of mortality (15.8% vs 2.0%; P < .001) and major morbidity (45.1% vs 14.2%; P < .001) and significantly lower average TPP (37.6 mm Hg [33.7-41.0 mm Hg] vs 39.0 mm Hg [34.6-42.6 mm Hg], P < .001). A threshold TPP <38 mm Hg effectively stratified patients by AKI risk (odds ratio, 1.75; 95% CI, 1.30-2.35). For patients requiring vasoactive medications, average TPP <38 mm Hg indicated higher risk of AKI independent of average mean arterial pressure (adjusted odds ratio, 1.69; 95% CI, 1.17-2.45). K-means clustering identified a high-risk phenotype with lower average TPP (35.6 mm Hg [30.9-39.8 mm Hg] vs 40.4 mm Hg [35.9-44.5 mm Hg]; P < .001), higher average vasoactive inotrope score (2.8 [0.3-6.8] vs 0.5 [0.0-2.5], P < .001), and greater incidence of AKI (29.8% vs 10.1%; P < .001).
Conclusions
Lower TPP is associated with greater risk of AKI after cardiac surgery. TPP could serve as an adjunct to traditional hemodynamic measures to guide hemodynamic management, especially in patients with higher vasopressor requirements.
背景：预防急性肾损伤（AKI）的最佳血流动力学目标仍然难以捉摸。我们假设较低的组织灌注压（TPP）是一种代表平均动脉压（MAP）与临界闭合压之差的新灌注指标，可以预测心脏手术后AKI的发生。方法：利用1224例心脏手术后患者的连续血流动力学数据构建个体TPP波形。通过血管活性肌力评分（vasoactive inotrope score， VIS）确定TPP与AKI的关系并进行分层。采用Logistic回归来确定预测AKI的最佳TPP阈值。使用无监督机器学习来探索不同的血液动力学表型及其与AKI的关系。结果：17.6%的患者发生AKI，并与较高的死亡率相关（15.8% vs 2.0%）。结论：较低的TPP与心脏手术后AKI的高风险相关。TPP可以作为传统血液动力学措施的辅助手段，指导血液动力学管理，特别是在血管加压药物需求较高的患者中。
{"title":"Tissue perfusion pressure: A novel hemodynamic measure to assess risk of acute kidney injury after cardiac surgery","authors":"Travis J. Miles MD , Michael T. Guinn MD , Xin Tan BS , Hao Qi BS , Vicente Orozco-Sevilla MD , Marc R. Moon MD , Joseph S. Coselli MD , Todd K. Rosengart MD , Meng Li PhD , Subhasis Chatterjee MD , Ravi K. Ghanta MD","doi":"10.1016/j.jtcvs.2025.07.009","DOIUrl":"10.1016/j.jtcvs.2025.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Optimal hemodynamic targets for preventing acute kidney injury (AKI) have remained elusive. We hypothesized that lower tissue perfusion pressure (TPP), a novel perfusion index representing the difference between mean arterial pressure and the critical closing pressure, is predictive of AKI after cardiac surgery.</div></div><div><h3>Methods</h3><div>Individual patient TPP waveforms were constructed from continuous hemodynamic data in 1224 patients after cardiac surgery. The relationship of TPP and AKI was determined and stratified by vasoactive inotrope score. Logistic regression was performed to identify the optimal TPP threshold for predicting AKI. Unsupervised machine learning was used to explore different hemodynamic phenotypes and their association with AKI.</div></div><div><h3>Results</h3><div>AKI occurred in 17.6% of patients and was associated with higher rates of mortality (15.8% vs 2.0%; <em>P</em> < .001) and major morbidity (45.1% vs 14.2%; <em>P</em> < .001) and significantly lower average TPP (37.6 mm Hg [33.7-41.0 mm Hg] vs 39.0 mm Hg [34.6-42.6 mm Hg], <em>P</em> < .001). A threshold TPP <38 mm Hg effectively stratified patients by AKI risk (odds ratio, 1.75; 95% CI, 1.30-2.35). For patients requiring vasoactive medications, average TPP <38 mm Hg indicated higher risk of AKI independent of average mean arterial pressure (adjusted odds ratio, 1.69; 95% CI, 1.17-2.45). <em>K</em>-means clustering identified a high-risk phenotype with lower average TPP (35.6 mm Hg [30.9-39.8 mm Hg] vs 40.4 mm Hg [35.9-44.5 mm Hg]; <em>P</em> < .001), higher average vasoactive inotrope score (2.8 [0.3-6.8] vs 0.5 [0.0-2.5], <em>P</em> < .001), and greater incidence of AKI (29.8% vs 10.1%; <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>Lower TPP is associated with greater risk of AKI after cardiac surgery. TPP could serve as an adjunct to traditional hemodynamic measures to guide hemodynamic management, especially in patients with higher vasopressor requirements.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 455-462.e3"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668835","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.2025.09.013
Supreet P. Marathe FRACS , Stacey Van Dyk BN , Sally Campbell FRACP , Kim S. Betts PhD , Pasquale Barbaro FRACP , Siddharth Amboli MCh , Benjamin Anderson FRACP , Adrian Mattke FCICM , Prem Venugopal FRACS , Nelson Alphonso FRACS
<div><h3>Background</h3><div>Aspirin at 3 to 5 mg/kg is the cornerstone of thromboprophylaxis in pediatric cardiac surgery. The reported prevalence of aspirin unresponsiveness is 1% to 35% in adults and 10% to 15% in children. The present study aimed to (1) describe the prevalence of aspirin responsiveness in the pediatric cardiac surgical population using light transmission aggregometry (LTA), the gold standard; (2) evaluate the dose-dependent response to aspirin; (3) compare LTA with point-of-care thromboelastography with platelet mapping (TEG-PM); and (4) describe adverse events and report a risk factor analysis.</div></div><div><h3>Methods</h3><div>This prospective cohort study (Clinical Trials Registry ACTRN12618001879257) was conducted from 2022 to 2024 in a quaternary children's hospital and included patients age 0 to 18 years who required aspirin prophylaxis after cardiac surgery. Patients who were allergic to aspirin or received other anticoagulants, such as warfarin, were excluded. Aspirin responsiveness was tested after at least 3 days of a standard aspirin dose of 5 mg/kg or 150 mg (whichever was less). LTA showing ≥20% platelet aggregation stimulated by arachidonic acid or ≥70% platelet aggregation to adenosine diphosphate denoted aspirin unresponsiveness. To evaluate TEG-PM compared to the gold standard (LTA), TEG-PM showing ≥50% platelet aggregation denoted aspirin unresponsiveness. The dose was increased to 10 mg/kg in these patients, and aspirin responsiveness was reevaluated. Those patients still not responding were labeled “aspirin-resistant.”</div></div><div><h3>Results</h3><div>The 133 eligible patients included 77 males (58%), 49 with a single ventricle (37%), and 119 who underwent surgery using cardiopulmonary bypass (89%). The most common indications for aspirin were shunts/Fontan in single ventricle patients (n = 44; 33%) and valve repair/replacement (n = 25; 19%). The median patient age was 1.9 years (interquartile range [IQR], 0.13-12 years), and the median weight was 15.1 kg (IQR, 4.2-44.1 kg). Twenty-four patients (18%) did not respond to the standard aspirin dose, and the dose was increased in 23 patients (17%). Twenty patients (15%) were tested a second time; 13 (10%) responded to the increased aspirin dose (10 mg/kg). Seven patients (5%) were aspirin-resistant. There was no correlation between the results of aspirin responsiveness tested using LTA and TEG-PM (<em>P</em> = .167). There were no identifiable risk factors for aspirin unresponsiveness.</div></div><div><h3>Conclusions</h3><div>Almost 20% of pediatric cardiac surgical patients do not respond to a standard 5 mg/kg aspirin dose. Most non-responders have a dose-dependent response to aspirin. Only 5% of patients are genuinely aspirin-resistant (as defined by LTA). TEG-PM does not correlate with the gold standard LTA test to determine aspirin responsiveness. Testing for aspirin responsiveness should be considered in patients undergoing pediatric cardiac surger
{"title":"Platelet responsiveness to aspirin in pediatric patients undergoing cardiac surgery: A prospective cohort study","authors":"Supreet P. Marathe FRACS , Stacey Van Dyk BN , Sally Campbell FRACP , Kim S. Betts PhD , Pasquale Barbaro FRACP , Siddharth Amboli MCh , Benjamin Anderson FRACP , Adrian Mattke FCICM , Prem Venugopal FRACS , Nelson Alphonso FRACS","doi":"10.1016/j.jtcvs.2025.09.013","DOIUrl":"10.1016/j.jtcvs.2025.09.013","url":null,"abstract":"<div><h3>Background</h3><div>Aspirin at 3 to 5 mg/kg is the cornerstone of thromboprophylaxis in pediatric cardiac surgery. The reported prevalence of aspirin unresponsiveness is 1% to 35% in adults and 10% to 15% in children. The present study aimed to (1) describe the prevalence of aspirin responsiveness in the pediatric cardiac surgical population using light transmission aggregometry (LTA), the gold standard; (2) evaluate the dose-dependent response to aspirin; (3) compare LTA with point-of-care thromboelastography with platelet mapping (TEG-PM); and (4) describe adverse events and report a risk factor analysis.</div></div><div><h3>Methods</h3><div>This prospective cohort study (Clinical Trials Registry ACTRN12618001879257) was conducted from 2022 to 2024 in a quaternary children's hospital and included patients age 0 to 18 years who required aspirin prophylaxis after cardiac surgery. Patients who were allergic to aspirin or received other anticoagulants, such as warfarin, were excluded. Aspirin responsiveness was tested after at least 3 days of a standard aspirin dose of 5 mg/kg or 150 mg (whichever was less). LTA showing ≥20% platelet aggregation stimulated by arachidonic acid or ≥70% platelet aggregation to adenosine diphosphate denoted aspirin unresponsiveness. To evaluate TEG-PM compared to the gold standard (LTA), TEG-PM showing ≥50% platelet aggregation denoted aspirin unresponsiveness. The dose was increased to 10 mg/kg in these patients, and aspirin responsiveness was reevaluated. Those patients still not responding were labeled “aspirin-resistant.”</div></div><div><h3>Results</h3><div>The 133 eligible patients included 77 males (58%), 49 with a single ventricle (37%), and 119 who underwent surgery using cardiopulmonary bypass (89%). The most common indications for aspirin were shunts/Fontan in single ventricle patients (n = 44; 33%) and valve repair/replacement (n = 25; 19%). The median patient age was 1.9 years (interquartile range [IQR], 0.13-12 years), and the median weight was 15.1 kg (IQR, 4.2-44.1 kg). Twenty-four patients (18%) did not respond to the standard aspirin dose, and the dose was increased in 23 patients (17%). Twenty patients (15%) were tested a second time; 13 (10%) responded to the increased aspirin dose (10 mg/kg). Seven patients (5%) were aspirin-resistant. There was no correlation between the results of aspirin responsiveness tested using LTA and TEG-PM (<em>P</em> = .167). There were no identifiable risk factors for aspirin unresponsiveness.</div></div><div><h3>Conclusions</h3><div>Almost 20% of pediatric cardiac surgical patients do not respond to a standard 5 mg/kg aspirin dose. Most non-responders have a dose-dependent response to aspirin. Only 5% of patients are genuinely aspirin-resistant (as defined by LTA). TEG-PM does not correlate with the gold standard LTA test to determine aspirin responsiveness. Testing for aspirin responsiveness should be considered in patients undergoing pediatric cardiac surger","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 338-347.e1"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103020","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.2025.09.014
Alexander P. Nissen MD , Ross Michael Reul MD , Muhammad Naeem MD , Jonathan R. Zurcher MD , Woodrow J. Farrington MD , William Brent Keeling MD , Bradley G. Leshnower MD
Background
Frozen elephant trunk (FET) is being increasingly used for acute type A aortic dissection (ATAAD) with distal malperfusion. The efficacy of adding a stent graft remains unclear, however. This study investigated the efficacy of adding FET to conventional arch repair when treating ATAAD with iliofemoral or renal malperfusion.
Methods
A review of the Emory Aortic Database identified 969 patients with acute DeBakey 1 dissection from 2004 to February 2025. One hundred fifty-three patients with iliofemoral and/or renal malperfusion underwent emergent central aortic repair alone (conventional group; n = 102) or central repair plus FET (FET group; n = 51). Univariate statistics were used to compare the 2 groups. Multivariable logistic regression was used to examine factors associated with postoperative limb revascularization and new renal failure. Selection bias was addressed through inverse-probability treatment weighting adjustment.
Results
Age and preoperative comorbidities were equivalent in the 2 groups. Limb ischemia requiring revascularization (17.6% for conventional vs 15.7% for FET; P = .856), or new dialysis (21.6% for conventional vs 17.6% for FET; P = .547) also was similar between the groups. Multivariable regression did not identify FET as independently associated with a reduced need for limb revascularization in iliofemoral malperfusion patients (odds ratio [OR], 1.334; 95% confidence interval [CI], 0.434-4.098; P = .614) or with avoiding dialysis in renal malperfusion patients (OR, 1.166; 95% CI, 0.252-5.382; P = .844). Mid-term survival (71.1% for conventional 71.1% vs 75.5% for FET; log-rank P = .753) and distal reintervention-free survival (64.9% for conventional vs 69.4% for FET; log-rank P = .902) were equivalent.
Conclusions
The addition of FET to conventional repair did not impact limb revascularization, new dialysis, or mid-term reintervention or improve mid-term survival in ATAAD with iliofemoral or renal malperfusion.
目的：冷冻象鼻（FET）越来越多地用于急性A型主动脉夹层（ATAAD）远端灌注不良。然而，增加支架移植的效果尚不清楚。本研究探讨了在常规弓修复中加入场效应晶体管治疗伴髂股或肾灌注不良的ATAAD的疗效。方法：回顾Emory主动脉数据库，从2004年至2025年2月，确定了969例急性DeBakey 1型夹层患者。153例髂股和/或肾脏灌注不良患者接受了紧急中央主动脉修复术（常规，n=102）或中央修复+ FET （FET, n= 51）。采用单变量统计进行组间比较。采用多变量logistic回归分析术后肢体血运重建和新发肾功能衰竭的相关因素。利用逆概率处理加权（IPTW）调整来解决选择偏差。结果：两组患者的年龄和术前合并症相当。肢体缺血需要血供重建术（常规17.6% vs FET 15.7% p=0.856），或新透析（常规21.6% vs FET 17.6%, p=0.547）组间相等。多变量回归未发现FET与髂股灌注不良患者肢体血运重建需求减少独立相关（OR为1.334 [0.434-4.098],p=0.614），也未发现肾灌注不良患者避免透析（OR为1.166 [0.52 -5.382],p=0.844）。中期生存率（常规71.1% vs. FET 75.5%, log-rank p=0.753）和远端无再干预生存率（常规64.9% vs. FET 69.4%, log-rank p=0.902）相当。结论：在常规修复的基础上加入FET对合并髂股或肾灌注不良的A型夹层患者的肢体血运重建、新透析、中期再干预或改善中期生存无影响。
{"title":"Acute type A dissection with iliofemoral or renal malperfusion: Is frozen elephant trunk necessary?","authors":"Alexander P. Nissen MD , Ross Michael Reul MD , Muhammad Naeem MD , Jonathan R. Zurcher MD , Woodrow J. Farrington MD , William Brent Keeling MD , Bradley G. Leshnower MD","doi":"10.1016/j.jtcvs.2025.09.014","DOIUrl":"10.1016/j.jtcvs.2025.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Frozen elephant trunk (FET) is being increasingly used for acute type A aortic dissection (ATAAD) with distal malperfusion. The efficacy of adding a stent graft remains unclear, however. This study investigated the efficacy of adding FET to conventional arch repair when treating ATAAD with iliofemoral or renal malperfusion.</div></div><div><h3>Methods</h3><div>A review of the Emory Aortic Database identified 969 patients with acute DeBakey 1 dissection from 2004 to February 2025. One hundred fifty-three patients with iliofemoral and/or renal malperfusion underwent emergent central aortic repair alone (conventional group; n = 102) or central repair plus FET (FET group; n = 51). Univariate statistics were used to compare the 2 groups. Multivariable logistic regression was used to examine factors associated with postoperative limb revascularization and new renal failure. Selection bias was addressed through inverse-probability treatment weighting adjustment.</div></div><div><h3>Results</h3><div>Age and preoperative comorbidities were equivalent in the 2 groups. Limb ischemia requiring revascularization (17.6% for conventional vs 15.7% for FET; <em>P</em> = .856), or new dialysis (21.6% for conventional vs 17.6% for FET; <em>P</em> = .547) also was similar between the groups. Multivariable regression did not identify FET as independently associated with a reduced need for limb revascularization in iliofemoral malperfusion patients (odds ratio [OR], 1.334; 95% confidence interval [CI], 0.434-4.098; <em>P</em> = .614) or with avoiding dialysis in renal malperfusion patients (OR, 1.166; 95% CI, 0.252-5.382; <em>P</em> = .844). Mid-term survival (71.1% for conventional 71.1% vs 75.5% for FET; log-rank <em>P</em> = .753) and distal reintervention-free survival (64.9% for conventional vs 69.4% for FET; log-rank <em>P</em> = .902) were equivalent.</div></div><div><h3>Conclusions</h3><div>The addition of FET to conventional repair did not impact limb revascularization, new dialysis, or mid-term reintervention or improve mid-term survival in ATAAD with iliofemoral or renal malperfusion.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 366-373.e1"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102867","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.2025.08.035
Michaela E. Corvi BA , Nikhil Panda MD, MPH , Beverly J. Fu BA, MA , Jacob C. Hurd BS , Margaret E. Yang BS , Jacob N. Anderson BS , Sangkavi Kuhan BS , Chi-Fu Jeffery Yang MD , Dean M. Donahue MD
Objective
The study objective was to evaluate the association between subclavian vein patency and health-related quality of life after supraclavicular thoracic outlet decompression among patients with venous thoracic outlet syndrome.
Methods
Patients who underwent supraclavicular thoracic outlet decompression (ie, first thoracic rib resection, scalenectomy, and subclavian venolysis) were identified from a prospectively maintained database. Demography, perioperative venography, and catheter-directed interventions were recorded. The primary end points were subclavian vein patency and health-related quality of life after decompression. The association between subclavian vein patency and health-related quality of life was evaluated in unadjusted and logistic regression analyses.
Results
Among 1032 patients with thoracic outlet syndrome who underwent surgery (2007-2021), 275 patients presented with venous thoracic outlet syndrome. A total of 225 patients (81.8%) underwent preoperative venography; 221 patients (98.2%) had completely or partially stenosed subclavian veins. Preoperative catheter-based interventions were performed in 166 patients (60.4%); stenosis remained in 130 patients (78.3%). Postoperatively, 216 patients (78.5%) underwent routine venography; improvement in stenosis was observed in 54 patients (25.0%). Additional catheter-based interventions were performed in 155 patients (56.4%) with improvement in stenosis observed in 131 patients (84.5%). At a median follow-up of 279 days (interquartile range, 95-674), 94.0% of patients reported improvement in health-related quality of life. Improvement in subclavian vein patency was associated with improved health-related quality of life (adjusted odds ratio, 2.19 [95% CI, 1.12-4.28], P = .021).
Conclusions
Subclavian vein patency is associated with improved health-related quality of life among patients with venous thoracic outlet syndrome. Effective venolysis during thoracic outlet decompression with perioperative catheter-directed intervention contributes most significantly to vein patency.
{"title":"Association between subclavian vein patency and health-related quality of life outcomes among patients with venous thoracic outlet syndrome","authors":"Michaela E. Corvi BA , Nikhil Panda MD, MPH , Beverly J. Fu BA, MA , Jacob C. Hurd BS , Margaret E. Yang BS , Jacob N. Anderson BS , Sangkavi Kuhan BS , Chi-Fu Jeffery Yang MD , Dean M. Donahue MD","doi":"10.1016/j.jtcvs.2025.08.035","DOIUrl":"10.1016/j.jtcvs.2025.08.035","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to evaluate the association between subclavian vein patency and health-related quality of life after supraclavicular thoracic outlet decompression among patients with venous thoracic outlet syndrome.</div></div><div><h3>Methods</h3><div>Patients who underwent supraclavicular thoracic outlet decompression (ie, first thoracic rib resection, scalenectomy, and subclavian venolysis) were identified from a prospectively maintained database. Demography, perioperative venography, and catheter-directed interventions were recorded. The primary end points were subclavian vein patency and health-related quality of life after decompression. The association between subclavian vein patency and health-related quality of life was evaluated in unadjusted and logistic regression analyses.</div></div><div><h3>Results</h3><div>Among 1032 patients with thoracic outlet syndrome who underwent surgery (2007-2021), 275 patients presented with venous thoracic outlet syndrome. A total of 225 patients (81.8%) underwent preoperative venography; 221 patients (98.2%) had completely or partially stenosed subclavian veins. Preoperative catheter-based interventions were performed in 166 patients (60.4%); stenosis remained in 130 patients (78.3%). Postoperatively, 216 patients (78.5%) underwent routine venography; improvement in stenosis was observed in 54 patients (25.0%). Additional catheter-based interventions were performed in 155 patients (56.4%) with improvement in stenosis observed in 131 patients (84.5%). At a median follow-up of 279 days (interquartile range, 95-674), 94.0% of patients reported improvement in health-related quality of life. Improvement in subclavian vein patency was associated with improved health-related quality of life (adjusted odds ratio, 2.19 [95% CI, 1.12-4.28], <em>P</em> = .021).</div></div><div><h3>Conclusions</h3><div>Subclavian vein patency is associated with improved health-related quality of life among patients with venous thoracic outlet syndrome. Effective venolysis during thoracic outlet decompression with perioperative catheter-directed intervention contributes most significantly to vein patency.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 551-557.e1"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006762","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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