Journal of Thoracic and Cardiovascular Surgery最新文献

英文中文

Heterogeneous treatment effects of coronary artery bypass grafting in ischemic cardiomyopathy: A machine learning causal forest analysis 缺血性心肌病冠状动脉搭桥术的异质性治疗效果：机器学习因果森林分析。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2023.09.021

Zhuoming Zhou MD , Bohao Jian MD , Xuanyu Chen PhD , Menghui Liu MD, PhD , Shaozhao Zhang MD , Guangguo Fu MD , Gang Li MD , Mengya Liang MD, PhD , Ting Tian PhD , Zhongkai Wu MD, PhD

Objectives

We aim to evaluate the heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy and to identify a group of patients to have greater benefits from coronary artery bypass grafting compared with medical therapy alone.

Methods

Machine learning causal forest modeling was performed to identify the heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy from the Surgical Treatment for Ischemic Heart Failure trial. The risks of death from any cause and death from cardiovascular causes between coronary artery bypass grafting and medical therapy alone were assessed in the identified subgroups.

Results

Among 1212 patients enrolled in the Surgical Treatment for Ischemic Heart Failure trial, left ventricular end-systolic volume index, serum creatinine, and age were identified by the machine learning algorithm to distinguish patients with heterogeneous treatment effects. Among patients with left ventricular end-systolic volume index greater than 84 mL/m² and age 60.27 years or less, coronary artery bypass grafting was associated with a significantly lower risk of death from any cause (adjusted hazard ratio, 0.61; 95% CI, 0.45-0.84) and death from cardiovascular causes (adjusted hazard ratio, 0.63; 95% CI, 0.45-0.89). By contrast, the survival benefits of coronary artery bypass grafting no longer exist in patients with left ventricular end-systolic volume index 84 mL/m² or less and serum creatinine 1.04 mg/dL or less, or patients with left ventricular end-systolic volume index greater than 84 mL/m² and age more than 60.27 years.

Conclusions

The current post hoc analysis of the Surgical Treatment for Ischemic Heart Failure trial identified heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy. Younger patients with severe left ventricular enlargement were more likely to derive greater survival benefits from coronary artery bypass grafting.

目的：我们旨在评估缺血性心肌病患者冠状动脉搭桥术的异质性治疗效果，并确定一组患者与单纯药物治疗相比，冠状动脉搭桥手术具有更大的益处。方法：采用机器学习因果森林模型，从缺血性心力衰竭的外科治疗试验中确定冠状动脉搭桥术对缺血性心肌病患者的异质性治疗效果。在已确定的亚组中评估了冠状动脉搭桥术和单独药物治疗之间任何原因死亡和心血管原因死亡的风险。结果：在1212名参加缺血性心力衰竭外科治疗试验的患者中，通过机器学习算法识别左心室收缩末期容积指数、血清肌酐和年龄，以区分具有不同治疗效果的患者。在左心室收缩末期容积指数大于84 mL/m2且年龄在60.27岁或以下的患者中，冠状动脉搭桥术与任何原因死亡的风险（调整后的危险比，0.61；95%可信区间，0.45-0.84）和心血管原因死亡的危险（调整后危险比，0.62；95%置信区间，0.45-2.89）显著降低相关。相比之下，冠状动脉旁路移植术的生存益处在左心室收缩末期容积指数为84mL/m2或更低且血清肌酐为1.04mg/dL或更低的患者中不再存在，或左心室收缩末期容积指数大于84 mL/m2且年龄大于60.27岁的患者。结论：目前对缺血性心力衰竭手术治疗试验的事后分析发现，冠状动脉搭桥术对缺血性心肌病患者的治疗效果参差不齐。患有严重左心室增大的年轻患者更有可能从冠状动脉搭桥术中获得更大的生存益处。

{"title":"Heterogeneous treatment effects of coronary artery bypass grafting in ischemic cardiomyopathy: A machine learning causal forest analysis","authors":"Zhuoming Zhou MD , Bohao Jian MD , Xuanyu Chen PhD , Menghui Liu MD, PhD , Shaozhao Zhang MD , Guangguo Fu MD , Gang Li MD , Mengya Liang MD, PhD , Ting Tian PhD , Zhongkai Wu MD, PhD","doi":"10.1016/j.jtcvs.2023.09.021","DOIUrl":"10.1016/j.jtcvs.2023.09.021","url":null,"abstract":"<div><h3>Objectives</h3><div>We aim to evaluate the heterogeneous treatment effects of coronary artery bypass grafting<span><span> in patients with ischemic cardiomyopathy and to identify a group of patients to have greater benefits from </span>coronary artery bypass grafting compared with medical therapy alone.</span></div></div><div><h3>Methods</h3><div><span><span>Machine learning causal forest modeling was performed to identify the heterogeneous treatment effects of coronary artery bypass grafting in patients with </span>ischemic cardiomyopathy from the Surgical Treatment for </span>Ischemic Heart Failure trial. The risks of death from any cause and death from cardiovascular causes between coronary artery bypass grafting and medical therapy alone were assessed in the identified subgroups.</div></div><div><h3>Results</h3><div><span><span>Among 1212 patients enrolled in the Surgical Treatment for Ischemic Heart Failure trial, left ventricular end-systolic volume index, </span>serum creatinine, and age were identified by the machine learning algorithm to distinguish patients with heterogeneous treatment effects. Among patients with left ventricular end-systolic volume index greater than 84 mL/m</span><sup>2</sup> and age 60.27 years or less, coronary artery bypass grafting was associated with a significantly lower risk of death from any cause (adjusted hazard ratio, 0.61; 95% CI, 0.45-0.84) and death from cardiovascular causes (adjusted hazard ratio, 0.63; 95% CI, 0.45-0.89). By contrast, the survival benefits of coronary artery bypass grafting no longer exist in patients with left ventricular end-systolic volume index 84 mL/m<sup>2</sup><span> or less and serum creatinine 1.04 mg/dL or less, or patients with left ventricular end-systolic volume index greater than 84 mL/m</span><sup>2</sup> and age more than 60.27 years.</div></div><div><h3>Conclusions</h3><div>The current post hoc analysis<span> of the Surgical Treatment for Ischemic Heart Failure trial identified heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy. Younger patients with severe left ventricular enlargement were more likely to derive greater survival benefits from coronary artery bypass grafting.</span></div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1462-1471.e7"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10635732","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}

引用次数: 0

Commentary: Truncal valve repair: Reduce the root, preserve the cusps 评论：截流瓣修复术：缩小根部，保留瓣尖。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.03.021

Igor E. Konstantinov MD, PhD, FRACS , Tyson A. Fricke MBBS, PhD, FRACS

引用次数: 0

Reply: Experience is the true dictum of complications in pectus excavatum surgery, not Haller index 回复：经验才是乳房下垂手术并发症的真正决定因素，而不是哈勒指数。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.05.027

Rawan M. Zeineddine MD, Juan M. Farina MD, Dawn E. Jaroszewski MD

引用次数: 0

Enhanced Recovery After Surgery Cardiac Society turnkey order set for surgical-site infection prevention: Proceedings from the American Association for Thoracic Surgery ERAS Conclave 2023 ERAS®心脏学会手术部位感染预防交钥匙订单集：AATS ERAS 2023 年会议论文集。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.03.027

Cheryl Crisafi MSN, RN , Michael C. Grant MD, MSE , Amanda Rea DNP, CRNP , Vicki Morton-Bailey DNP , Alexander J. Gregory MD , Rakesh C. Arora MD, PhD , Subhasis Chatterjee MD , Sylvain A. Lother MD, FRCPC, DTMH , Busra Cangut MD , Daniel T. Engelman MD

Objectives

Surgical-site infections (SSIs) after cardiac surgery increase morbidity and mortality, consume health care resources, impair recovery, and diminish patients’ quality of life. Numerous guidelines and expert consensus documents have been published to address the prevention and management of SSIs. Our objective is to integrate these documents into an order set that will facilitate the adoption and implementation of evidence-based best practices for preventing and managing SSIs after cardiac surgery.

Methods

Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set for SSI reduction. Orders derived from consistent class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the turnkey order set in bold type. Selected orders that were inconsistent class I or IIA, class IIB or otherwise supported by published evidence, were also included in italicized type.

Results

Preventative care begins with the preoperative identification of both modifiable and nonmodifiable SSI risks by health care providers. Assessment tools can be used to assist in identifying patients at a high risk of SSI. Preoperative recommendations include screening for and treating Staphylococcus aureus nasal carriage. Intraoperatively, tailored prophylactic intravenous antibiotics and maintaining blood glucose levels below 180 mg/dL are essential elements. Postoperative care includes maintaining normothermia, glucose control and patient engagement.

Conclusions

Despite the well-documented advantages of a multidisciplinary care pathway for SSI in cardiac surgery, there are inconsistencies in its adoption and implementation. This article provides an order set that incorporates recommendations from existing guidelines to prevent SSI in the cardiac surgical population.

目的心脏手术后的手术部位感染（SSI）会增加发病率和死亡率、消耗医疗资源、影响康复并降低患者的生活质量。针对 SSI 的预防和管理，已经发布了大量指南和专家共识文件。我们的目标是将这些文件整合到一套医嘱中，以促进采用和实施循证最佳实践来预防和管理心脏手术后的 SSI。根据参考指南和共识手稿中一致的 I 级、IIA 级或同等建议制定的医嘱以粗体字显示在整套医嘱中。选定的不符合 I 级或 IIA 级、IIB 级或有其他已发表证据支持的医嘱也以斜体字显示。结果预防性护理始于医护人员术前识别可改变和不可改变的 SSI 风险。评估工具可用于帮助识别 SSI 高风险患者。术前建议包括筛查和治疗金黄色葡萄球菌鼻腔携带。术中，量身定制的预防性静脉注射抗生素和将血糖水平维持在 180 mg/dL 以下是必不可少的要素。术后护理包括维持体温正常、血糖控制和患者参与。结论尽管多学科护理路径在心脏手术中治疗 SSI 的优势已得到充分证明，但在采用和实施过程中仍存在不一致之处。本文提供了一套整合了现有指南建议的医嘱，用于预防心脏手术人群中的 SSI。

{"title":"Enhanced Recovery After Surgery Cardiac Society turnkey order set for surgical-site infection prevention: Proceedings from the American Association for Thoracic Surgery ERAS Conclave 2023","authors":"Cheryl Crisafi MSN, RN , Michael C. Grant MD, MSE , Amanda Rea DNP, CRNP , Vicki Morton-Bailey DNP , Alexander J. Gregory MD , Rakesh C. Arora MD, PhD , Subhasis Chatterjee MD , Sylvain A. Lother MD, FRCPC, DTMH , Busra Cangut MD , Daniel T. Engelman MD","doi":"10.1016/j.jtcvs.2024.03.027","DOIUrl":"10.1016/j.jtcvs.2024.03.027","url":null,"abstract":"<div><h3>Objectives</h3><div>Surgical-site infections (SSIs) after cardiac surgery increase morbidity and mortality, consume health care resources, impair recovery, and diminish patients’ quality of life. Numerous guidelines and expert consensus documents have been published to address the prevention and management of SSIs. Our objective is to integrate these documents into an order set that will facilitate the adoption and implementation of evidence-based best practices for preventing and managing SSIs after cardiac surgery.</div></div><div><h3>Methods</h3><div>Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set for SSI reduction. Orders derived from consistent class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the turnkey order set in bold type. Selected orders that were inconsistent class I or IIA, class IIB or otherwise supported by published evidence, were also included in italicized type.</div></div><div><h3>Results</h3><div>Preventative care begins with the preoperative identification of both modifiable and nonmodifiable SSI risks by health care providers. Assessment tools can be used to assist in identifying patients at a high risk of SSI. Preoperative recommendations include screening for and treating <em>Staphylococcus aureus</em> nasal carriage. Intraoperatively, tailored prophylactic intravenous antibiotics and maintaining blood glucose levels below 180 mg/dL are essential elements. Postoperative care includes maintaining normothermia, glucose control and patient engagement.</div></div><div><h3>Conclusions</h3><div>Despite the well-documented advantages of a multidisciplinary care pathway for SSI in cardiac surgery, there are inconsistencies in its adoption and implementation. This article provides an order set that incorporates recommendations from existing guidelines to prevent SSI in the cardiac surgical population.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1500-1509"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140787964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ventricular assist device using a thoracotomy-based implant technique: Multi-Center Implantation of the HeartMate 3 in Subjects With Heart Failure Using Surgical Techniques Other Than Full Median Sternotomy (HM3 SWIFT) 使用胸廓切开术植入技术的心室辅助装置：多中心 HeartMate 3 SWIFT 研究

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.02.013

Igor Gosev MD , Duc Thinh Pham MD , John Y. Um MD , Anelechi C. Anyanwu MD , Akinobu Itoh MD, PhD , Kunal Kotkar MD , Koji Takeda MD , Yoshifumi Naka MD, PhD , Matthias Peltz MD , Scott C. Silvestry MD , Gregory Couper MD , Marzia Leacche MD , Vivek Rao MD, PhD , Benjamin Sun MD , Ryan J. Tedford MD , Nahush Mokadam MD , Robert McNutt PhD , Daniel Crandall PhD , Mandeep R. Mehra MD, MSc , Christopher T. Salerno MD

Objectives

The HeartMate 3 (Abbott) left ventricular assist device provides substantial improvement in long-term morbidity and mortality in patients with advanced heart failure. The Implantation of the HeartMate 3 in Subjects With Heart Failure Using Surgical Techniques Other Than Full Median Sternotomy study compares thoracotomy-based implantation clinical outcomes with standard median sternotomy.

Methods

We conducted a prospective, multicenter, single-arm study in patients eligible for HeartMate 3 implantation with thoracotomy-based surgical technique (bilateral thoracotomy or partial upper sternotomy with left thoracotomy). The composite primary end point was survival free of disabling stroke (modified Rankin score >3), or reoperation to remove or replace a malfunctioning device, or conversion to median sternotomy at 6-months postimplant (elective transplants were treated as a success). The primary end point (noninferiority, −15% margin) was assessed with >90% power compared with a propensity score-matched cohort (ratio 1:2) derived from the Multi-Center Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 continued access protocol.

Results

The study enrolled 102 patients between December 2020 and July 2022 in the thoracotomy-based arm at 23 North American centers. Follow-up concluded in December 2022. In the Implantation of the HeartMate 3 in Subjects With Heart Failure Using Surgical Techniques Other Than Full Median Sternotomy study group, noninferiority criteria was met (absolute between-group difference, −1.2%; Farrington Manning lower 1-sided 95% CI, −9.3%; P < .0025) and event-free survival was not different (85.0% vs 86.2%; hazard ratio, 1.01; 95% CI, 0.58-2.10). Length of stay with thoracotomy-based implant was longer (median, 20 vs 17 days; P = .03). No differences were observed for blood product utilization, adverse events (including right heart failure), functional status, and quality of life between cohorts.

Conclusions

Thoracotomy-based implantation of the HeartMate 3 left ventricular assist device is noninferior to implantation via standard full sternotomy. This study supports thoracotomy-based implantation as an additional standard for surgical implantation of the HeartMate 3 left ventricular assist device.

目的HeartMate 3（雅培）左心室辅助装置大大改善了晚期心力衰竭患者的长期发病率和死亡率。方法我们对符合条件的患者进行了一项前瞻性、多中心、单臂研究，研究对象是采用开胸手术技术（双侧开胸或部分上胸骨切口加左胸骨切口）植入 HeartMate 3 的心衰患者。复合主要终点是植入后 6 个月内无致残性中风（改良 Rankin 评分 3 分）、或因移除或更换故障装置而再次手术、或转为胸骨正中切开术（选择性移植视为成功）的存活率。主要终点（非劣效性，-15%差值）的评估以>90%的功率进行，与来自 "MagLev技术在接受HeartMate 3机械循环支持治疗患者中的多中心研究 "的倾向评分匹配队列（比例为1:2）进行比较。随访于 2022 年 12 月结束。在使用除全中线切开术以外的外科技术的心衰受试者中植入 HeartMate 3 研究组中，达到了非劣效性标准（组间绝对差异，-1.2%；Farrington Manning 较低的单侧 95% CI，-9.3%；P <.0025），无事件生存率无差异（85.0% vs 86.2%；危险比，1.01；95% CI，0.58-2.10）。采用开胸手术植入的患者住院时间更长（中位数为 20 天 vs 17 天；P = .03）。在血液制品使用量、不良事件（包括右心衰竭）、功能状态和生活质量方面，各组间未观察到差异。这项研究支持将基于胸廓切开术的植入作为手术植入 HeartMate 3 左心室辅助装置的额外标准。

{"title":"Ventricular assist device using a thoracotomy-based implant technique: Multi-Center Implantation of the HeartMate 3 in Subjects With Heart Failure Using Surgical Techniques Other Than Full Median Sternotomy (HM3 SWIFT)","authors":"Igor Gosev MD , Duc Thinh Pham MD , John Y. Um MD , Anelechi C. Anyanwu MD , Akinobu Itoh MD, PhD , Kunal Kotkar MD , Koji Takeda MD , Yoshifumi Naka MD, PhD , Matthias Peltz MD , Scott C. Silvestry MD , Gregory Couper MD , Marzia Leacche MD , Vivek Rao MD, PhD , Benjamin Sun MD , Ryan J. Tedford MD , Nahush Mokadam MD , Robert McNutt PhD , Daniel Crandall PhD , Mandeep R. Mehra MD, MSc , Christopher T. Salerno MD","doi":"10.1016/j.jtcvs.2024.02.013","DOIUrl":"10.1016/j.jtcvs.2024.02.013","url":null,"abstract":"<div><h3>Objectives</h3><div>The HeartMate 3 (Abbott) left ventricular assist device provides substantial improvement in long-term morbidity and mortality in patients with advanced heart failure. The Implantation of the HeartMate 3 in Subjects With Heart Failure Using Surgical Techniques Other Than Full Median Sternotomy study compares thoracotomy-based implantation clinical outcomes with standard median sternotomy.</div></div><div><h3>Methods</h3><div>We conducted a prospective, multicenter, single-arm study in patients eligible for HeartMate 3 implantation with thoracotomy-based surgical technique (bilateral thoracotomy or partial upper sternotomy with left thoracotomy). The composite primary end point was survival free of disabling stroke (modified Rankin score >3), or reoperation to remove or replace a malfunctioning device, or conversion to median sternotomy at 6-months postimplant (elective transplants were treated as a success). The primary end point (noninferiority, −15% margin) was assessed with >90% power compared with a propensity score-matched cohort (ratio 1:2) derived from the Multi-Center Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 continued access protocol.</div></div><div><h3>Results</h3><div>The study enrolled 102 patients between December 2020 and July 2022 in the thoracotomy-based arm at 23 North American centers. Follow-up concluded in December 2022. In the Implantation of the HeartMate 3 in Subjects With Heart Failure Using Surgical Techniques Other Than Full Median Sternotomy study group, noninferiority criteria was met (absolute between-group difference, −1.2%; Farrington Manning lower 1-sided 95% CI, −9.3%; <em>P</em> < .0025) and event-free survival was not different (85.0% vs 86.2%; hazard ratio, 1.01; 95% CI, 0.58-2.10). Length of stay with thoracotomy-based implant was longer (median, 20 vs 17 days; <em>P</em> = .03). No differences were observed for blood product utilization, adverse events (including right heart failure), functional status, and quality of life between cohorts.</div></div><div><h3>Conclusions</h3><div>Thoracotomy-based implantation of the HeartMate 3 left ventricular assist device is noninferior to implantation via standard full sternotomy. This study supports thoracotomy-based implantation as an additional standard for surgical implantation of the HeartMate 3 left ventricular assist device.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1474-1484.e12"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139890926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early real-world experience monitoring circulating tumor DNA in resected early-stage non–small cell lung cancer 监测切除早期非小细胞肺癌患者循环肿瘤 DNA 的早期实际经验。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.01.017

Travis K. Martin DO , Aaron Dinerman MD , Sumedha Sudhaman PhD , Griffin Budde PharmD , Charuta C. Palsuledesai PhD , Michael Krainock MD, PhD , Minetta C. Liu MD , Emy Smith ACNP , Leonidas Tapias MD , Eitan Podgaetz MD , Gary Schwartz MD

Objective

The study objective was to evaluate the impact of monitoring circulating tumor DNA on the detection and management of recurrence in patients with resected early-stage non–small cell lung cancer.

Methods

Between October 2021 and March 2023, postoperative circulating tumor DNA was monitored in patients with non–small cell lung cancer (N = 108). Longitudinal blood samples (n = 378 samples) were collected for prospective circulating tumor DNA analysis at 3-month intervals after curative-intent resection. A tumor-informed assay was used for the detection and quantification of circulating tumor DNA. The primary outcome measure was a circulating tumor DNA–positive result. The secondary outcome measure was changes in practice after a circulating tumor DNA–positive result.

Results

The mean age of the patients in this cohort was 68.1 years. Of the 108 patients, 12 (11.1%) were circulating tumor DNA positive at least at 1 timepoint postsurgery, of whom 8 (66.7%) had a clinically evident recurrence and the remaining 4 had limited clinical follow-up. Of the 10 patients with recurrent disease, 8 demonstrated circulating tumor DNA positivity and the remaining 2 patients had brain-only metastases. Postoperative clinical care was altered in 100% (12/12) of circulating tumor DNA–positive patients, with 58.3% (7/12) receiving an early computed tomography scan and 100% (12/12) receiving an early positron emission tomography computed tomography scan as part of their surveillance strategy. Among the patients who received an early positron emission tomography scan, 66.6% (8/12) were positive for malignant features.

Conclusions

Routine monitoring of tumor-informed circulating tumor DNA after curative intent therapy improved patient risk stratification and prognostication.

目的评估监测循环肿瘤DNA（ctDNA）对早期非小细胞肺癌（NSCLC）切除患者复发检测和管理的影响：方法：2021年10月至2023年3月期间，对NSCLC患者（108人）的术后ctDNA进行监测。采集纵向血液样本（样本数=378），在治愈性切除术后每隔3个月进行前瞻性ctDNA分析。ctDNA的检测和定量采用肿瘤信息分析法。主要结果指标是ctDNA阳性结果。次要结果指标是出现ctDNA阳性结果后的实践变化：本组患者的平均年龄为 68.1 岁。在108名患者中，有12名患者（11.1%）在术后至少一个时间点上ctDNA呈阳性，其中8名患者（66.7%）有明显的临床复发，其余4名患者的临床随访有限。在 10 名复发患者中，8 名患者的ctDNA呈阳性，2 名患者仅有脑转移。在ctDNA阳性患者中，100%（12/12）的患者术后临床护理发生了改变，其中58.3%（7/12）的患者接受了早期CT扫描，100%（12/12）的患者接受了早期PET-CT扫描，作为其监测策略的一部分。在接受早期 PET 扫描的患者中，66.6%（8/12）的患者恶性特征呈阳性：结论：治愈性治疗后对肿瘤信息ctDNA的常规监测可改善患者的风险分层和预后。

{"title":"Early real-world experience monitoring circulating tumor DNA in resected early-stage non–small cell lung cancer","authors":"Travis K. Martin DO , Aaron Dinerman MD , Sumedha Sudhaman PhD , Griffin Budde PharmD , Charuta C. Palsuledesai PhD , Michael Krainock MD, PhD , Minetta C. Liu MD , Emy Smith ACNP , Leonidas Tapias MD , Eitan Podgaetz MD , Gary Schwartz MD","doi":"10.1016/j.jtcvs.2024.01.017","DOIUrl":"10.1016/j.jtcvs.2024.01.017","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to evaluate the impact of monitoring circulating tumor DNA on the detection and management of recurrence in patients with resected early-stage non–small cell lung cancer.</div></div><div><h3>Methods</h3><div><span>Between October 2021 and March 2023, postoperative circulating tumor DNA was monitored in patients with non–small cell lung cancer (N = 108). Longitudinal blood samples (n = 378 samples) were collected for prospective circulating tumor </span>DNA analysis at 3-month intervals after curative-intent resection. A tumor-informed assay was used for the detection and quantification of circulating tumor DNA. The primary outcome measure was a circulating tumor DNA–positive result. The secondary outcome measure was changes in practice after a circulating tumor DNA–positive result.</div></div><div><h3>Results</h3><div>The mean age of the patients in this cohort was 68.1 years. Of the 108 patients, 12 (11.1%) were circulating tumor DNA positive at least at 1 timepoint postsurgery, of whom 8 (66.7%) had a clinically evident recurrence and the remaining 4 had limited clinical follow-up. Of the 10 patients with recurrent disease, 8 demonstrated circulating tumor DNA positivity and the remaining 2 patients had brain-only metastases<span><span>. Postoperative clinical care was altered in 100% (12/12) of circulating tumor DNA–positive patients, with 58.3% (7/12) receiving an early computed tomography scan<span> and 100% (12/12) receiving an early positron emission tomography computed tomography scan as part of their surveillance strategy. Among the patients who received an early </span></span>positron emission tomography scan, 66.6% (8/12) were positive for malignant features.</span></div></div><div><h3>Conclusions</h3><div>Routine monitoring of tumor-informed circulating tumor DNA after curative intent therapy improved patient risk stratification and prognostication.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1349-1359.e2"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139512890","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}

引用次数: 0

Surgical resection of benign primary cardiac tumors: A 6-decade evaluation of survival and recurrence 良性原发性心脏肿瘤的手术切除：六十年来对存活率和复发率的评估。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.02.020

Annalisa Bernabei MD , Andrew J. Toth MS , A. Marc Gillinov MD , Eugene H. Blackstone MD , Michael B. Komarovsky BA , Jacky H.K. Chen BS , Peter Chin BA , James C. Witten MD , Daniel J.P. Burns MD, MPhil , Patrick Collier MD, PhD , Rohit Moudgil MD, PhD , Eric E. Roselli MD

引用次数: 0

Discussion to: New perspectives on tracheal resection for COVID-19–related stenosis: A propensity score matching analysis 讨论至COVID-19相关气管狭窄气管切除术的新视角：倾向评分匹配分析

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.07.051

引用次数: 0

Risk factors and early outcomes of repeat sternotomy in 1960 adults with congenital heart disease: A 30-year, single-center study 1960例成人先天性心脏病重复胸骨切开术的危险因素和早期结果:一项30年单中心研究

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2023.11.014

Ahmed A. Abdelrehim MBBCh , Joseph A. Dearani MD , Kimberly A. Holst MD , William R. Miranda MD , Heidi M. Connolly MD , Austin L. Todd MS , Luke J. Burchill MBBS, PhD , Hartzell V. Schaff MD , Alberto Pochettino MD , Elizabeth H. Stephens MD, PhD

Objective

Patients with congenital heart disease (CHD) increasingly live into adulthood, often requiring cardiac reoperation. We aimed to assess the outcomes of adults with CHD (ACHD) undergoing repeat sternotomy at our institution.

Methods

Review of our institution's cardiac surgery database identified 1960 ACHD patients undergoing repeat median sternotomy from 1993 to 2023. The primary outcome was early mortality, and the secondary outcome was a composite end point of mortality and significant morbidity. Univariable and multivariable logistic regression models were used to determine factors independently associated with outcomes.

Results

Of the 1960 ACHDs patient undergoing repeat sternotomy, 1183 (60.3%) underwent a second, third (n = 506, 25.8%), fourth (n = 168, 8.5%), fifth (n = 70, 3.5%), and sixth sternotomy or greater (n = 33, 1.6%). CHD diagnoses were minor complexity (n = 145, 7.4%), moderate complexity (n = 1380, 70.4%), and major complexity (n = 435, 22.1%). Distribution of procedures included valve (n = 549, 28%), congenital (n = 625, 32%), aortic (n = 104, 5.3%), and major procedural combinations (n = 682, 34.7%). Overall early mortality was 3.1%. Factors independently associated with early mortality were older age at surgery, CHD of major complexity, preoperative renal failure, preoperative ejection fraction, urgent operation, and postoperative blood transfusion. In addition, sternotomy number and bypass time were independently associated with the composite outcome.

Conclusions

Despite the increase in early mortality with sternotomy number, sternotomy number was not independently associated with early mortality but with increased morbidity. Improvement strategies should target factors leading to urgent operations, early referral, along with operative efficiency including bypass time and blood conservation.

目的:先天性心脏病(CHD)患者越来越多地活到成年，经常需要心脏再手术。我们的目的是评估成人冠心病(ACHD)患者在我们机构接受重复胸骨切开术的结果。方法:回顾我院心脏外科数据库，确定1993-2023年间1,960例接受重复胸骨正中切开术的ACHD患者。主要终点是早期死亡率，次要终点是死亡率和显著发病率的复合终点。采用单变量和多变量logistic回归模型确定与结果独立相关的因素。结果:1960例行重复胸骨切开术的ACHD患者中，第2次、第3次(n=506, 25.8%)、第4次(n=168, 8.5%)、第5次(n=70, 3.5%)和≥第6次(n=33, 1.6%)患者共1183例(60.3%)。冠心病诊断为:轻度并发症145例(7.4%)、中度并发症1380例(70.4%)、重度并发症435例(22.1%)。手术分布包括瓣膜手术(n=549, 28%)、先天性手术(n=625, 32%)、主动脉手术(n=104, 5.3%)和主要手术组合(n=682, 34.7%)。总体早期死亡率为3.1%。与早期死亡独立相关的因素是手术时年龄较大、主要复杂性冠心病、术前肾功能衰竭、术前射血分数、紧急手术和术后输血。此外，胸骨切开次数和搭桥时间与综合结果独立相关。结论:尽管胸骨切开次数增加了早期死亡率，但胸骨切开次数与早期死亡率没有独立相关，而是与发病率增加有关。改善策略应针对导致紧急手术，早期转诊的因素，以及手术效率，包括旁路时间和血液保存。

{"title":"Risk factors and early outcomes of repeat sternotomy in 1960 adults with congenital heart disease: A 30-year, single-center study","authors":"Ahmed A. Abdelrehim MBBCh , Joseph A. Dearani MD , Kimberly A. Holst MD , William R. Miranda MD , Heidi M. Connolly MD , Austin L. Todd MS , Luke J. Burchill MBBS, PhD , Hartzell V. Schaff MD , Alberto Pochettino MD , Elizabeth H. Stephens MD, PhD","doi":"10.1016/j.jtcvs.2023.11.014","DOIUrl":"10.1016/j.jtcvs.2023.11.014","url":null,"abstract":"<div><h3>Objective</h3><div><span>Patients with congenital heart disease (CHD) increasingly live into adulthood, often requiring cardiac </span>reoperation<span>. We aimed to assess the outcomes of adults with CHD (ACHD) undergoing repeat sternotomy at our institution.</span></div></div><div><h3>Methods</h3><div>Review of our institution's cardiac surgery database identified 1960 ACHD patients undergoing repeat median sternotomy from 1993 to 2023. The primary outcome was early mortality, and the secondary outcome was a composite end point of mortality and significant morbidity. Univariable and multivariable logistic regression models were used to determine factors independently associated with outcomes.</div></div><div><h3>Results</h3><div>Of the 1960 ACHDs patient undergoing repeat sternotomy, 1183 (60.3%) underwent a second, third (n = 506, 25.8%), fourth (n = 168, 8.5%), fifth (n = 70, 3.5%), and sixth sternotomy or greater (n = 33, 1.6%). CHD diagnoses were minor complexity (n = 145, 7.4%), moderate complexity (n = 1380, 70.4%), and major complexity (n = 435, 22.1%). Distribution of procedures included valve (n = 549, 28%), congenital (n = 625, 32%), aortic (n = 104, 5.3%), and major procedural combinations (n = 682, 34.7%). Overall early mortality was 3.1%. Factors independently associated with early mortality were older age at surgery, CHD of major complexity, preoperative renal failure, preoperative ejection fraction<span>, urgent operation, and postoperative blood transfusion. In addition, sternotomy number and bypass time were independently associated with the composite outcome.</span></div></div><div><h3>Conclusions</h3><div>Despite the increase in early mortality with sternotomy number, sternotomy number was not independently associated with early mortality but with increased morbidity. Improvement strategies should target factors leading to urgent operations, early referral, along with operative efficiency including bypass time and blood conservation.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 5","pages":"Pages 1326-1336.e1"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138048351","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}

引用次数: 0

Thrombus within a stent graft 支架移植物内的血栓。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.05.015

Bobiet Aurélien MD, Géraldine Allain MD, PhD, Pierre Corbi MD, PhD, Jamil Hajj-Chahine MD, Christophe Jayle MD, PhD

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Journal of Thoracic and Cardiovascular Surgery

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀