Pub Date : 2025-02-01DOI: 10.1016/j.jtcvs.2024.01.032
Rana-Armaghan Ahmad BS , Felix Orelaru MD , Akul Arora BS , Carol Ling MS , Karen M. Kim MD , Shinichi Fukuhara MD , Himanshu Patel MD , G. Michael Deeb MD , Bo Yang MD, PhD
Objective
To evaluate the short- and midterm outcomes of surgically managed acute type A intramural hematoma (IMH) versus classic acute type A aortic dissection (ATAAD).
Methods
From 1996 to February 2023, a total of 106 patients with acute type A IMH and 795 patients with classic ATAAD presented for open aortic repair at our institution. Data were obtained from the local Society of Thoracic Surgeons’ Data Warehouse and medical chart review.
Results
Compared with the classic ATAAD group, the IMH group was older (65 vs 59 years, P < .001) and more likely to be female (45% vs 32%, P = .005), with fewer comorbidities such as severe aortic insufficiency (5.0% vs 25%, P < .001), acute stroke (2.8% vs 8.3%, P = .05), acute renal failure (5.7% vs 13%, P = .04), and malperfusion syndrome (8.5% vs 26%, P < .001) but more cardiac tamponade (18% vs 11%, P = .03). The IMH group had less aortic root replacement (15% vs 33%, P < .001), zone 2 arch replacements (9.4% vs 18%, P = .02), and shorter crossclamp times (120 minutes vs 150 minutes, P < .001). The operative mortality was significantly lower in the IMH group (0.9% vs 8.8%, P = .005) and a multivariable regression model showed IMH to be protective, odds ratio of 0.11, P = .03. The 10-year survival was similar between the 2 groups (65% vs 61%, P = .35). The hazard ratio of IMH for midterm mortality after surgery was 0.73, P = .12.
Conclusions
Acute type A IMH could be treated with emergency open aortic repair with excellent short- and midterm outcomes.
{"title":"Acute type A intramural hematoma: The less-deadly acute aortic syndrome?","authors":"Rana-Armaghan Ahmad BS , Felix Orelaru MD , Akul Arora BS , Carol Ling MS , Karen M. Kim MD , Shinichi Fukuhara MD , Himanshu Patel MD , G. Michael Deeb MD , Bo Yang MD, PhD","doi":"10.1016/j.jtcvs.2024.01.032","DOIUrl":"10.1016/j.jtcvs.2024.01.032","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the short- and midterm outcomes of surgically managed acute type A intramural hematoma (IMH) versus classic acute type A aortic dissection (ATAAD).</div></div><div><h3>Methods</h3><div>From 1996 to February 2023, a total of 106 patients with acute type A IMH and 795 patients with classic ATAAD presented for open aortic repair at our institution. Data were obtained from the local Society of Thoracic Surgeons’ Data Warehouse and medical chart review.</div></div><div><h3>Results</h3><div>Compared with the classic ATAAD group, the IMH group was older (65 vs 59 years, <em>P</em> < .001) and more likely to be female (45% vs 32%, <em>P</em><span> = .005), with fewer comorbidities such as severe aortic insufficiency (5.0% vs 25%, </span><em>P</em> < .001), acute stroke (2.8% vs 8.3%, <em>P</em><span> = .05), acute renal failure (5.7% vs 13%, </span><em>P</em><span> = .04), and malperfusion syndrome (8.5% vs 26%, </span><em>P</em><span> < .001) but more cardiac tamponade (18% vs 11%, </span><em>P</em><span> = .03). The IMH group had less aortic root replacement (15% vs 33%, </span><em>P</em> < .001), zone 2 arch replacements (9.4% vs 18%, <em>P</em> = .02), and shorter crossclamp times (120 minutes vs 150 minutes, <em>P</em><span> < .001). The operative mortality was significantly lower in the IMH group (0.9% vs 8.8%, </span><em>P</em> = .005) and a multivariable regression model showed IMH to be protective, odds ratio of 0.11, <em>P</em> = .03. The 10-year survival was similar between the 2 groups (65% vs 61%, <em>P</em> = .35). The hazard ratio of IMH for midterm mortality after surgery was 0.73, <em>P</em> = .12.</div></div><div><h3>Conclusions</h3><div>Acute type A IMH could be treated with emergency open aortic repair with excellent short- and midterm outcomes.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 552-561"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571399","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 : 2025-02-01DOI: 10.1016/j.jtcvs.2024.04.011
Catherine M. Wagner MD , Patricia F. Theurer MSN , Melissa J. Clark MSN , Chang He MS , Carol Ling MS , Edward Murphy MD , James Martin MD , Steven F. Bolling MD , Donald S. Likosky PhD , Michael P. Thompson PhD , Francis D. Pagani MD, PhD , Gorav Ailawadi MD, MBA , Robert B. Hawkins MD, MSc
Objective
Women are less likely to receive guideline-recommended cardiovascular care, but evaluation of sex-based disparities in cardiac surgical procedures is limited. Receipt of concomitant atrial fibrillation (AF) procedures during nonmitral cardiac surgery was compared by sex for patients with preoperative AF.
Methods
Patients with preoperative AF undergoing coronary artery bypass grafting and/or aortic valve replacement at any of the 33 hospitals in Michigan from 2014 to 2022 were included. Patients with prior cardiac surgery, transcatheter AF procedure, or emergency/salvage status were excluded. Hierarchical logistic regression identified predictors of concomitant AF procedures, account for hospital and surgeon as random effects.
Results
Of 5460 patients with preoperative AF undergoing nonmitral cardiac surgery, 24% (n = 1291) were women with a mean age of 71 years. Women were more likely to have paroxysmal (vs persistent) AF than men (80% vs 72%; P < .001) and had a higher mean predicted risk of mortality (5% vs 3%; P < .001). The unadjusted rate of concomitant AF procedure was 59% for women and 67% for men (P < .001). After risk adjustment, women had 26% lower adjusted odds of concomitant AF procedure than men (adjusted odds ratio, 0.74; 95% CI, 0.64-0.86; P < .001). Female sex was the risk factor associated with the lowest odds of concomitant AF procedure.
Conclusions
Women are less likely to receive guideline recommended concomitant AF procedure during nonmitral surgery. Identification of barriers to concomitant AF procedure in women may improve treatment of AF.
目的：女性接受指南推荐的心血管护理的可能性较低，但对心脏手术过程中基于性别的差异的评估却很有限。我们对术前有房颤的患者在非半身心脏手术中接受房颤并发症治疗的情况进行了性别比较：方法：纳入了 2014-2022 年间在密歇根州 33 家医院中的任何一家接受冠状动脉旁路移植术和/或主动脉瓣置换术的术前房颤患者。排除了既往接受过心脏手术、经导管房颤手术或急诊/抢救状态的患者。分层逻辑回归确定了并发房颤手术的预测因素，并将医院和外科医生作为随机效应：在5460名接受非二尖瓣心脏手术的术前房颤患者中，24%（n=1291）为女性，平均年龄为71岁。与男性相比，女性更有可能患有阵发性房颤（相对于持续性房颤）（80% vs 72%，padj:0.74, (95%CI 0.64-0.86)，pCI 0.64-0.86）：女性在非半月板手术中接受指南推荐的房颤并发症治疗的可能性较低。找出女性接受同期房颤手术的障碍可改善房颤的治疗。
{"title":"Evaluation of sex differences in the receipt of concomitant atrial fibrillation procedures during nonmitral cardiac surgery","authors":"Catherine M. Wagner MD , Patricia F. Theurer MSN , Melissa J. Clark MSN , Chang He MS , Carol Ling MS , Edward Murphy MD , James Martin MD , Steven F. Bolling MD , Donald S. Likosky PhD , Michael P. Thompson PhD , Francis D. Pagani MD, PhD , Gorav Ailawadi MD, MBA , Robert B. Hawkins MD, MSc","doi":"10.1016/j.jtcvs.2024.04.011","DOIUrl":"10.1016/j.jtcvs.2024.04.011","url":null,"abstract":"<div><h3>Objective</h3><div>Women are less likely to receive guideline-recommended cardiovascular care, but evaluation of sex-based disparities in cardiac surgical procedures is limited. Receipt of concomitant atrial fibrillation (AF) procedures during nonmitral cardiac surgery was compared by sex for patients with preoperative AF.</div></div><div><h3>Methods</h3><div>Patients with preoperative AF undergoing coronary artery bypass grafting<span><span> and/or aortic valve replacement at any of the 33 hospitals in Michigan from 2014 to 2022 were included. Patients with prior cardiac surgery, transcatheter AF procedure, or emergency/salvage status were excluded. Hierarchical </span>logistic regression identified predictors of concomitant AF procedures, account for hospital and surgeon as random effects.</span></div></div><div><h3>Results</h3><div>Of 5460 patients with preoperative AF undergoing nonmitral cardiac surgery, 24% (n = 1291) were women with a mean age of 71 years. Women were more likely to have paroxysmal (vs persistent) AF than men (80% vs 72%; <em>P</em> < .001) and had a higher mean predicted risk of mortality (5% vs 3%; <em>P</em> < .001). The unadjusted rate of concomitant AF procedure was 59% for women and 67% for men (<em>P</em> < .001). After risk adjustment, women had 26% lower adjusted odds of concomitant AF procedure than men (adjusted odds ratio, 0.74; 95% CI, 0.64-0.86; <em>P</em> < .001). Female sex was the risk factor associated with the lowest odds of concomitant AF procedure.</div></div><div><h3>Conclusions</h3><div>Women are less likely to receive guideline recommended concomitant AF procedure during nonmitral surgery. Identification of barriers to concomitant AF procedure in women may improve treatment of AF.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 627-634.e4"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866949","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 : 2025-02-01DOI: 10.1016/j.jtcvs.2024.01.046
Tirone E. David MD, Joy Park MSc, Chun-Po Steve Fan PhD
Objective
To review the pathology of the mitral valve (MV) and long-term outcomes of surgery in patients with Marfan syndrome (MFS).
Patients and Methods
From 1988 through 2020, 60 patients with MFS had surgery to correct mitral regurgitation (MR): 19 had isolated MV surgery, 32 had combined MV and aortic root surgery, and 9 had MV surgery after aortic root surgery. Follow-up was complete for a median of 16.1 years.
Results
MV pathology was myxomatous degeneration in all patients and of advanced degree in 78.6% with bileaflet prolapse in 65.5%, mitral annulus disjunction in 57.5%, and mitral annulus calcification in 8.2% of patients. The MV was repaired in 47 patients and replaced in 13. Kaplan–Meier estimates of cumulative mortality at 20 years 21.3% for all patients, 6.7% after MV repair, and 57.8% after replacement (P < .001). MV reoperations were performed in 5 patients: 2 after repair and 3 after replacement. The cumulative incidence rate of reoperations on the MV was 3.8% at 10 years and 11.0% at 20 years in the entire cohort. Among 47 patients who had MV repair, moderate MR developed in 11 patients and severe in 2. Both patients with severe MR underwent MV reoperation. The cumulative incidence rate of recurrent moderate or severe MR after MV repair was 20.4% at 10 years, and 36.5% at 20 years.
Conclusions
MV repair was associated with better survival than MV replacement, but recurrent MR after repair occurred in approximately one-third of the patients at 20 years after surgery.
{"title":"Mitral valve surgery in patients with Marfan syndrome","authors":"Tirone E. David MD, Joy Park MSc, Chun-Po Steve Fan PhD","doi":"10.1016/j.jtcvs.2024.01.046","DOIUrl":"10.1016/j.jtcvs.2024.01.046","url":null,"abstract":"<div><h3>Objective</h3><div><span>To review the pathology of the mitral valve (MV) and long-term outcomes of surgery in patients with </span>Marfan syndrome (MFS).</div></div><div><h3>Patients and Methods</h3><div><span>From 1988 through 2020, 60 patients with MFS had surgery to correct mitral regurgitation (MR): 19 had isolated </span>MV surgery<span>, 32 had combined MV and aortic root surgery, and 9 had MV surgery after aortic root surgery. Follow-up was complete for a median of 16.1 years.</span></div></div><div><h3>Results</h3><div><span><span><span>MV pathology was myxomatous degeneration in all patients and of advanced degree in 78.6% with bileaflet prolapse in 65.5%, </span>mitral annulus disjunction in 57.5%, and mitral annulus calcification in 8.2% of patients. The MV was repaired in 47 patients and replaced in 13. Kaplan–Meier estimates of cumulative mortality at 20 years 21.3% for all patients, 6.7% after </span>MV repair, and 57.8% after replacement (</span><em>P</em><span> < .001). MV reoperations were performed in 5 patients: 2 after repair and 3 after replacement. The cumulative incidence rate of reoperations on the MV was 3.8% at 10 years and 11.0% at 20 years in the entire cohort. Among 47 patients who had MV repair, moderate MR developed in 11 patients and severe in 2. Both patients with severe MR underwent MV reoperation. The cumulative incidence rate of recurrent moderate or severe MR after MV repair was 20.4% at 10 years, and 36.5% at 20 years.</span></div></div><div><h3>Conclusions</h3><div>MV repair was associated with better survival than MV replacement, but recurrent MR after repair occurred in approximately one-third of the patients at 20 years after surgery.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 599-605"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868682","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 : 2025-02-01DOI: 10.1016/j.jtcvs.2024.06.006
Matthew J. Bott MD
{"title":"Commentary: Cracking the code: Deciphering predictors of treatment response in non–small cell lung cancer","authors":"Matthew J. Bott MD","doi":"10.1016/j.jtcvs.2024.06.006","DOIUrl":"10.1016/j.jtcvs.2024.06.006","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 464-465"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141328027","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 : 2025-02-01DOI: 10.1016/j.jtcvs.2024.03.009
Cathrine M. Moeller MD, MSc , Gal Rubinstein MD , Daniel Oren MD, MSc , Andrea Fernandez Valledor MD , Dor Lotan MD , Jayant K. Raikhelkar MD , Kevin J. Clerkin MD, MSc , Paolo C. Colombo MD , Nicole E. Leahy MPH, RN, NEA-BC , Justin A. Fried MD , Yuji Kaku MD , Yoshifumi Naka MD, PhD , Koji Takeda MD, PhD , Melana Yuzefpolskaya MD , Veli K. Topkara MD , Gabriel T. Sayer MD , Nir Uriel MD, MSc
Objective
The HeartMate 3 survival risk score was recently validated in the Multicenter study Of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 to predict patient-specific survival in HeartMate 3 left ventricular assist device candidates. The HeartMate 3 survival risk score stratifies individuals into tertiles according to survival probability.
Methods
We performed a single-center retrospective review of all HeartMate 3 left ventricular assist device recipients between September 2017 and August 2022. Baseline characteristics were collected from the electronic medical records. HeartMate 3 survival risk scores were calculated for all eligible patients. One- and 2-year Kaplan–Meier survival analyses were conducted. A univariate and multivariable Cox regression model was used to identify predictors.
Results
A total of 181 patients were included in this final analysis. The median age was 62 years, 83% were male, and 26% were Interagency Registry for Mechanically Assisted Circulatory Support Profile 1. The mean HeartMate 3 survival risk score for the entire cohort was 2.66 ± 0.66. Two-year survivals in the high, average, and low survival groups were 93.5% ± 3.2%, 81.6% ± 7.4%, and 82.0% ± 6.6%, respectively. As a continuous variable, the unadjusted HeartMate 3 survival risk score was a significant predictor of mortality (hazard ratio, 2.20; 95% CI, 1.08-4.45; P = .029). The areas under the curve were 0.70 and 0.66 at 1 and 2 years, respectively. We were unable to demonstrate the discriminatory ability of the HeartMate 3 survival risk score using the original stratification, but we found significantly increased survival in the high survival group using a binary cutoff (hazard ratio, 4.8; 95% CI, 1.01-20.9; P = .038).
Conclusions
The unadjusted HeartMate 3 survival risk score was associated with postimplant survival in patients outside of the Multicenter study Of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 but did not remain an independent predictor after adjusting for ischemic etiology and severe diabetes. The HeartMate 3 survival risk score was able to identify patients at high survival using a binary cutoff, but we were unable to demonstrate its discriminatory ability among the previously published risk tertiles.
{"title":"Validation of the HeartMate 3 survival risk score in a large left ventricular assist device center","authors":"Cathrine M. Moeller MD, MSc , Gal Rubinstein MD , Daniel Oren MD, MSc , Andrea Fernandez Valledor MD , Dor Lotan MD , Jayant K. Raikhelkar MD , Kevin J. Clerkin MD, MSc , Paolo C. Colombo MD , Nicole E. Leahy MPH, RN, NEA-BC , Justin A. Fried MD , Yuji Kaku MD , Yoshifumi Naka MD, PhD , Koji Takeda MD, PhD , Melana Yuzefpolskaya MD , Veli K. Topkara MD , Gabriel T. Sayer MD , Nir Uriel MD, MSc","doi":"10.1016/j.jtcvs.2024.03.009","DOIUrl":"10.1016/j.jtcvs.2024.03.009","url":null,"abstract":"<div><h3>Objective</h3><div><span>The HeartMate 3 survival risk score was recently validated in the Multicenter study Of MagLev Technology in Patients Undergoing Mechanical Circulatory Support<span> Therapy with HeartMate 3 to predict patient-specific survival in HeartMate 3 left ventricular assist device candidates. The HeartMate 3 survival risk score stratifies individuals into tertiles according to </span></span>survival probability.</div></div><div><h3>Methods</h3><div><span>We performed a single-center retrospective review of all HeartMate 3 left ventricular assist device recipients between September 2017 and August 2022. Baseline characteristics were collected from the electronic medical records. HeartMate 3 survival risk scores were calculated for all eligible patients. One- and 2-year Kaplan–Meier survival analyses were conducted. A univariate and multivariable </span>Cox regression model was used to identify predictors.</div></div><div><h3>Results</h3><div>A total of 181 patients were included in this final analysis. The median age was 62 years, 83% were male, and 26% were Interagency Registry for Mechanically Assisted Circulatory Support Profile 1. The mean HeartMate 3 survival risk score for the entire cohort was 2.66 ± 0.66. Two-year survivals in the high, average, and low survival groups were 93.5% ± 3.2%, 81.6% ± 7.4%, and 82.0% ± 6.6%, respectively. As a continuous variable, the unadjusted HeartMate 3 survival risk score was a significant predictor of mortality (hazard ratio, 2.20; 95% CI, 1.08-4.45; <em>P</em> = .029). The areas under the curve were 0.70 and 0.66 at 1 and 2 years, respectively. We were unable to demonstrate the discriminatory ability of the HeartMate 3 survival risk score using the original stratification, but we found significantly increased survival in the high survival group using a binary cutoff (hazard ratio, 4.8; 95% CI, 1.01-20.9; <em>P</em> = .038).</div></div><div><h3>Conclusions</h3><div>The unadjusted HeartMate 3 survival risk score was associated with postimplant survival in patients outside of the Multicenter study Of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 but did not remain an independent predictor after adjusting for ischemic etiology and severe diabetes. The HeartMate 3 survival risk score was able to identify patients at high survival using a binary cutoff, but we were unable to demonstrate its discriminatory ability among the previously published risk tertiles.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 650-657.e4"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635556","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 : 2025-02-01DOI: 10.1016/j.jtcvs.2024.08.052
Jasleen Kukreja MD , Jose Luis Campo-Canaveral de la Cruz MD, PhD , Dirk Van Raemdonck MD , Edward Cantu MD, MSCE , Hiroshi Date MD, PhD , Frank D'Ovidio MD, PhD , Matthew Hartwig MD , Jacob A. Klapper MD , Rosemary F. Kelly MD , Sandra Lindstedt MD, PhD , Lorenzo Rosso MD, PhD , Lara Schaheen MD , Michael Smith MD , Bryan Whitson MD , Sahar A. Saddoughi MD, PhD , Marcelo Cypel MD
Background
Donor lung procurement and preservation is critical for lung transplantation success. Unfortunately, the large variability in techniques impacts organ utilization rates and transplantation outcomes. Compounding this variation, recent developments in cold static preservation and new technological advances with machine perfusion have increased the complexity of the procedure. The objective of the American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) expert panel was to make evidence-based recommendations for best practices in donor lung procurement and preservation based on review of the existing literature.
Methods
The AATS CPSC assembled an expert panel of 16 lung transplantation surgeons from 14 centers who developed a consensus document of recommendations. The panel was divided into 7 subgroups covering (1) intraoperative donor assessment, (2) surgical techniques, (3) ex situ static lung preservation methods, (4) hypothermic preservation, (5) normothermic ex vivo lung perfusion (EVLP), (6) donation after circulatory death (DCD) and normothermic regional perfusion, and (7) donor management centers, organ assessment centers, and third-party procurement teams. Following a focused literature review, each subgroup formulated recommendation statements for each subtopic, which were reviewed and further refined using a Delphi process until a 75% consensus was achieved on each final statement by the voting group.
Results
The expert panel achieved consensus on 34 recommendations for current best practices in donor lung procurement and preservation both in brain-dead as well as DCD donation. The use of new methods of cold preservation, the role of EVLP, and DCD with and without concomitant heart donation are described in detail.
Conclusions
Consistent and best practices in donor lung procurement and preservation are critical to improve both lung transplantation numbers as well as recipient outcomes. The recommendations described here provide guidance for professionals involved in the care of patients with end-stage lung disease considered for transplantation.
{"title":"The 2024 American Association for Thoracic Surgery expert consensus document: Current standards in donor lung procurement and preservation","authors":"Jasleen Kukreja MD , Jose Luis Campo-Canaveral de la Cruz MD, PhD , Dirk Van Raemdonck MD , Edward Cantu MD, MSCE , Hiroshi Date MD, PhD , Frank D'Ovidio MD, PhD , Matthew Hartwig MD , Jacob A. Klapper MD , Rosemary F. Kelly MD , Sandra Lindstedt MD, PhD , Lorenzo Rosso MD, PhD , Lara Schaheen MD , Michael Smith MD , Bryan Whitson MD , Sahar A. Saddoughi MD, PhD , Marcelo Cypel MD","doi":"10.1016/j.jtcvs.2024.08.052","DOIUrl":"10.1016/j.jtcvs.2024.08.052","url":null,"abstract":"<div><h3>Background</h3><div>Donor lung procurement and preservation is critical for lung transplantation success. Unfortunately, the large variability in techniques impacts organ utilization rates and transplantation outcomes. Compounding this variation, recent developments in cold static preservation and new technological advances with machine perfusion have increased the complexity of the procedure. The objective of the American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) expert panel was to make evidence-based recommendations for best practices in donor lung procurement and preservation based on review of the existing literature.</div></div><div><h3>Methods</h3><div>The AATS CPSC assembled an expert panel of 16 lung transplantation surgeons from 14 centers who developed a consensus document of recommendations. The panel was divided into 7 subgroups covering (1) intraoperative donor assessment, (2) surgical techniques, (3) ex situ static lung preservation methods, (4) hypothermic preservation, (5) normothermic ex vivo lung perfusion (EVLP), (6) donation after circulatory death (DCD) and normothermic regional perfusion, and (7) donor management centers, organ assessment centers, and third-party procurement teams. Following a focused literature review, each subgroup formulated recommendation statements for each subtopic, which were reviewed and further refined using a Delphi process until a 75% consensus was achieved on each final statement by the voting group.</div></div><div><h3>Results</h3><div>The expert panel achieved consensus on 34 recommendations for current best practices in donor lung procurement and preservation both in brain-dead as well as DCD donation. The use of new methods of cold preservation, the role of EVLP, and DCD with and without concomitant heart donation are described in detail.</div></div><div><h3>Conclusions</h3><div>Consistent and best practices in donor lung procurement and preservation are critical to improve both lung transplantation numbers as well as recipient outcomes. The recommendations described here provide guidance for professionals involved in the care of patients with end-stage lung disease considered for transplantation.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 484-504"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014931","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jtcvs.2024.04.030
Diana S. Hsu MD, Peter J. Kneuertz MD
{"title":"Commentary: HIITing the jackpot with prehabilitation before minimally invasive lung cancer surgery","authors":"Diana S. Hsu MD, Peter J. Kneuertz MD","doi":"10.1016/j.jtcvs.2024.04.030","DOIUrl":"10.1016/j.jtcvs.2024.04.030","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 529-530"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873292","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 : 2025-02-01DOI: 10.1016/j.jtcvs.2024.07.036
{"title":"Commentator Discussion: Influence of air quality on lung cancer in people who have never smoked","authors":"","doi":"10.1016/j.jtcvs.2024.07.036","DOIUrl":"10.1016/j.jtcvs.2024.07.036","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 462-463"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977128","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 : 2025-02-01DOI: 10.1016/j.jtcvs.2024.09.009
{"title":"Commentator Discussion: The cone repair allows right ventricle rehabilitation with excellent tricuspid valve function following the Starnes procedure","authors":"","doi":"10.1016/j.jtcvs.2024.09.009","DOIUrl":"10.1016/j.jtcvs.2024.09.009","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 362-363"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479285","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 : 2025-02-01DOI: 10.1016/j.jtcvs.2024.02.019
Gardner Yost MD, MS , David Williams MD , Bo Yang MD, PhD
{"title":"Commentary: Acute type A dissection with malperfusion syndrome: Start your stopwatch?","authors":"Gardner Yost MD, MS , David Williams MD , Bo Yang MD, PhD","doi":"10.1016/j.jtcvs.2024.02.019","DOIUrl":"10.1016/j.jtcvs.2024.02.019","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 574-575"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050786","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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