Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Lobectomy improves disease-free survival over sublobar resection for high-risk stage IA non−small cell lung cancer","authors":"Raul Caso MD, MSCI ,&nbsp;Nanruoyi Zhou MD ,&nbsp;Matthew Skovgard MD ,&nbsp;Nicolas Toumbacaris MSPH ,&nbsp;Kay See Tan PhD ,&nbsp;Prasad S. Adusumilli MD ,&nbsp;Manjit S. Bains MD ,&nbsp;Matthew J. Bott MD ,&nbsp;Robert J. Downey MD ,&nbsp;James Huang MD ,&nbsp;James M. Isbell MD, MSCI ,&nbsp;Daniela Molena MD ,&nbsp;Bernard J. Park MD ,&nbsp;Gaetano Rocco MD ,&nbsp;Valerie W. Rusch MD ,&nbsp;Smita Sihag MD ,&nbsp;David R. Jones MD ,&nbsp;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> &lt; .001), greater standard uptake value (<em>P</em> &lt; .001), solid tumor texture on computed tomography (<em>P</em> &lt; .001), and micropapillary/solid histology (<em>P</em> &lt; .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}

{"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 ,&nbsp;David Winlaw MD, FRACS ,&nbsp;Stephanie Fuller MD ,&nbsp;Neeta Sethi MD ,&nbsp;Lazaros Kochilas MD ,&nbsp;Iki Adachi MD ,&nbsp;Matthew Stone MD ,&nbsp;Lorna Browne MD ,&nbsp;Nee Khoo MD ,&nbsp;Eduardo da Cruz MD ,&nbsp;Christopher Petit MD ,&nbsp;Damien LaPar MD, MSc ,&nbsp;Lydia Wright MD ,&nbsp;Karen Stout MD ,&nbsp;Mary Donofrio MD, FAAP, FACC, FASE ,&nbsp;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}

{"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}

{"title":"Refining preoperative diabetes assessment: Implications for acute myocardial infarction-coronary artery bypass grafting management and long-term outcomes","authors":"Mengxia Qi MM ,&nbsp;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}

{"title":"Tissue perfusion pressure: A novel hemodynamic measure to assess risk of acute kidney injury after cardiac surgery","authors":"Travis J. Miles MD ,&nbsp;Michael T. Guinn MD ,&nbsp;Xin Tan BS ,&nbsp;Hao Qi BS ,&nbsp;Vicente Orozco-Sevilla MD ,&nbsp;Marc R. Moon MD ,&nbsp;Joseph S. Coselli MD ,&nbsp;Todd K. Rosengart MD ,&nbsp;Meng Li PhD ,&nbsp;Subhasis Chatterjee MD ,&nbsp;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> &lt; .001) and major morbidity (45.1% vs 14.2%; <em>P</em> &lt; .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> &lt; .001). A threshold TPP &lt;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 &lt;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> &lt; .001), higher average vasoactive inotrope score (2.8 [0.3-6.8] vs 0.5 [0.0-2.5], <em>P</em> &lt; .001), and greater incidence of AKI (29.8% vs 10.1%; <em>P</em> &lt; .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}

{"title":"Platelet responsiveness to aspirin in pediatric patients undergoing cardiac surgery: A prospective cohort study","authors":"Supreet P. Marathe FRACS ,&nbsp;Stacey Van Dyk BN ,&nbsp;Sally Campbell FRACP ,&nbsp;Kim S. Betts PhD ,&nbsp;Pasquale Barbaro FRACP ,&nbsp;Siddharth Amboli MCh ,&nbsp;Benjamin Anderson FRACP ,&nbsp;Adrian Mattke FCICM ,&nbsp;Prem Venugopal FRACS ,&nbsp;Nelson Alphonso FRACS","doi":"10.1016/j.jtcvs.2025.09.013","DOIUrl":"10.1016/j.jtcvs.2025.09.013","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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.”&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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 (&lt;em&gt;P&lt;/em&gt; = .167). There were no identifiable risk factors for aspirin unresponsiveness.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;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}

{"title":"Acute type A dissection with iliofemoral or renal malperfusion: Is frozen elephant trunk necessary?","authors":"Alexander P. Nissen MD ,&nbsp;Ross Michael Reul MD ,&nbsp;Muhammad Naeem MD ,&nbsp;Jonathan R. Zurcher MD ,&nbsp;Woodrow J. Farrington MD ,&nbsp;William Brent Keeling MD ,&nbsp;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}

{"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 ,&nbsp;Nikhil Panda MD, MPH ,&nbsp;Beverly J. Fu BA, MA ,&nbsp;Jacob C. Hurd BS ,&nbsp;Margaret E. Yang BS ,&nbsp;Jacob N. Anderson BS ,&nbsp;Sangkavi Kuhan BS ,&nbsp;Chi-Fu Jeffery Yang MD ,&nbsp;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}

{"title":"Long-term survival and operative outcomes of the Bentall procedure for aortic root aneurysm, aortic dissection, and endocarditis","authors":"Christopher Lau MD,&nbsp;Alexander Gregg MD,&nbsp;Eilon Ram MD,&nbsp;Charles Mack MD,&nbsp;Katherine Krieger BS,&nbsp;Mohamed Rahouma MD,&nbsp;Ivancarmine Gambardella MD,&nbsp;Giovanni Soletti Jr. MD,&nbsp;Mario Gaudino MD,&nbsp;Leonard N. Girardi MD","doi":"10.1016/j.jtcvs.2025.09.018","DOIUrl":"10.1016/j.jtcvs.2025.09.018","url":null,"abstract":"<div><h3>Objective</h3><div>To assess outcomes after aortic root replacement with Bentall procedure for aortic aneurysm, dissection, and endocarditis.</div></div><div><h3>Methods</h3><div>We identified consecutive patients undergoing Bentall procedures from 1997 to 2023, with stratification based on the primary diagnosis. Operative outcomes and long-term survival were compared.</div></div><div><h3>Results</h3><div>Of 1493 patients, 1378 (92.3%) underwent surgery for aneurysms, 75 (5%) for dissections, and 40 (2.7%) for endocarditis. The aneurysm group was older (61 years [range, 50-70 years] vs 57 years [range, 47-66.5 years] vs 56 years [range, 49-64 years]; <em>P</em> = .024). Patients with dissection or endocarditis had more preoperative myocardial infarctions (7.4% vs 12% vs 17.5%; <em>P</em> = .026), cerebrovascular accidents (9.6% vs 18.7% vs 45%; <em>P</em> &lt; .001), renal dysfunction (8.3% vs 22.7% vs 45%; <em>P</em> &lt; .001), shock (0.1% vs 10.7% vs 15%; <em>P</em> &lt; .001), and ruptures (0.4% vs 10.7% vs 10%; <em>P</em> &lt; .001). Regarding outcomes, acute renal failure (0.6% vs 1.3% vs 7.5%; <em>P</em> &lt; .001) and operative mortality (0.4% vs 1.3% vs 7.5%; <em>P</em> = .001) were higher for endocarditis. Reexploration for bleeding was highest for dissections (4.1% vs 12% vs 2.5%; <em>P</em> = .004). Ten-year survival was similar between groups (71.8% vs 67% vs 83.7%; <em>P</em> = .94), with mean follow-up 68.2 ± 2.08 months. Multivariable analysis found age (hazard ratio [HR], 1.04; 95% CI, 1.03-1.05; <em>P</em> &lt; .001), chronic obstructive pulmonary disease (HR, 2.12; 95% CI, 1.44-3.11; <em>P</em> &lt; .001), renal dysfunction (HR, 1.97; 95% CI, 1.4-2.78; <em>P</em> &lt; .001), and ejection fraction (HR, 0.97; 95% CI, 0.95-0.98; <em>P</em> &lt; .001) were associated with late mortality but primary diagnosis was not.</div></div><div><h3>Conclusions</h3><div>The Bentall procedure can be performed with low operative risk for aneurysms and selected dissections. Endocarditis is associated with higher but acceptable operative mortality. Excellent long-term survival can be expected after surviving initial operative risk.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 357-365.e2"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115000","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":"Commentary: Symptomatic myocardial bridges—Bridging the unknown","authors":"Anusha Jegatheeswaran MD, PhD, FRCSC ,&nbsp;Ruchika Kamojjala BA","doi":"10.1016/j.jtcvs.2025.10.005","DOIUrl":"10.1016/j.jtcvs.2025.10.005","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 427-428"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281567","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}