Journal of Thoracic and Cardiovascular Surgery最新文献

英文中文

Sex-specific outcomes after thoracic aortic surgery 胸主动脉手术后的性别差异结果。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-09-08 DOI: 10.1016/j.jtcvs.2025.08.044

Maria Servito MD , Moniruzzaman Moni MSc , Weiang Yan MD, PhD , Carly Lodewyks MD, MSc , Michael Yamashita MDCM, MPH , Hellmuth Ricky Muller Moran MD, MSc , Jonathan Hong MD, MHS

Introduction

The impact of sex on quality of life (QoL) and long-term mortality after thoracic aortic surgery is incompletely understood. We investigated whether sex-related differences in these outcomes exist after surgery.

Methods

Patients undergoing thoracic aortic surgery between 2004 and 2023 were identified using the Manitoba Thoracic Aortic Database, which was linked to population-level registries in the Manitoba Centre for Health Policy. Inverse probability treatment weighting was performed to account for the differences in baseline characteristics between sexes. The outcomes were survival and surrogate measures of QoL, which were disability (composite of stroke, long-term care admission, or hospital admission ≥3 episodes) and days alive and out of hospital. Post-aortic surgery survival was compared with the age- and sex-matched general population.

Results

There were 1065 patients identified, 25% of whom were female (n = 261). Female patients were older and had greater weighted Charlson Comorbidity Index scores. At 15 years, survival (31% vs 39%) and freedom from disability (53% vs 65%) were lower in female patients. The risk of disability and mortality was greater in female patients (hazard ratio, 1.34; 95% confidence interval, 1.10-1.63). Post-aortic surgery survival was lower than the age- and sex-matched general population. Female patients had lower days alive and out of hospital at 30 (17 [0-22] days vs 20 [11-24] days, P < .001), 90 (76 [54-82] days vs 80 [70-83] days, P < .001), and 180 days (167 [142-172] days vs 170 [158-173] days, P = .001).

Conclusions

Female patients have worse survival and QoL after thoracic aortic surgery. Further research exploring reasons for this disparity is needed to develop sex-specific strategies for the management of thoracic aortic disease.

性别对胸主动脉手术后生活质量（QoL）和长期死亡率的影响尚不完全清楚。我们调查了手术后这些结果是否存在与性别相关的差异。方法：使用马尼托巴胸主动脉数据库确定2004-2023年间接受胸主动脉手术的患者，该数据库与马尼托巴卫生政策中心的人口水平登记处相关联。采用逆概率处理加权（IPTW）来解释性别之间基线特征的差异。结果是生存和生活质量的替代指标，即残疾（卒中、长期护理住院和住院≥3次）和存活和出院天数（DAOH）。将主动脉手术后的生存率与年龄和性别匹配的普通人群进行比较。结果：共发现1065例患者，其中25%为女性（n=261）。女性年龄较大，加权Charlson合并症指数较高。在15年时，女性的生存率（31%对39%）和免于残疾（53%对65%）较低。女性致残和死亡的风险更高（危险比：1.34；95%可信区间：1.10-1.63）。主动脉手术后的生存率低于年龄和性别匹配的普通人群。女性在30（17[0-22]天和20[11-24]天）时DAOH较低。结论：女性胸主动脉手术后生存率和生活质量较差。需要进一步研究这种差异的原因，以制定针对不同性别的胸主动脉疾病治疗策略。

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引用次数: 0

Do patients with severe aortic stenosis and progressive left ventricular ejection fraction decline 50 to 59% remain asymptomatic? 严重主动脉瓣狭窄并进行性LVEF下降至<50-59%的患者是否仍然无症状？

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-09-19 DOI: 10.1016/j.jtcvs.2025.09.019

Muhammad Etiwy MD , Adam N. Berman MD, MPH , Michael H. Picard MD , Chiara Fraccaro MD, PhD , Nicole Karam MD, PhD , Meagan M. Wasfy MD, MPH , Cynthia Taub MD, MBA , John Hsu MD, MSCE , James L. Januzzi Jr. MD , Jason H. Wasfy MD, MPhil

引用次数: 0

Impact of normothermic regional perfusion on ex vivo lung perfusion outcomes in donation after circulatory death lung donors 常温局部灌注对DCD肺供体EVLP结果的影响。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-16 DOI: 10.1016/j.jtcvs.2025.10.014

Caitlin T. Demarest MD, PhD , Brandi Z. Zofkie BA, MPH , Sam Popa , John W. Stokes MD , Riley Messer , Kirby von Kessler MD , Anil J. Trindade MD , Stefan Schwarz MD, PhD , Andrew Sage PhD , Elly Zhou , Sumin Kim , Micheal C. McInnis MD , Shaf Keshavjee MD , Jorge Mallea MD , Matthew Bacchetta MD, MBA , Konrad Hoetzenecker MD, PhD

Objectives

Ex vivo lung perfusion (EVLP) is commonly used to assess extended-criteria donor lungs, particularly from donation after circulatory death (DCD) donors. Normothermic regional perfusion (NRP) is increasingly used in DCD procurement, but its impact on EVLP outcomes remains unclear.

Methods

This study included 187 DCD lungs perfused between October 2021 and August 2024 at 2 centralized EVLP facilities. Donor demographics, EVLP characteristics, and radiographs obtained during EVLP were analyzed.

Results

In total, 160 lungs were assessed by EVLP after rapid procurement; 13 of these were procured in the setting of an abdominal NRP protocol. In total, 23 DCD donor lungs underwent EVLP after thoracoabdominal (TA) NRP procurement. The primary indication for EVLP across the whole study cohort was DCD status (41%), followed by concerns about organ quality raised by the procurement team (34%), and low oxygen tension (12%). One lung from the TA-NRP group and 3 lungs from the rapid procurement group were not placed on EVLP upon arrival at the EVLP facility because of grossly abnormal appearance. Decline rates were 52% in the TA-NRP group and 50% in the rapid procurement group (P = .777). EVLP characteristics as well as radiographs were comparable across the 2 groups. In multivariate analysis, none of the available donor demographic factors or the indications for EVLP influenced EVLP outcomes. Notably, also TA-NRP was not a significant factor for EVLP conversion rates in multivariate analysis (odds ratio, 0.889; 0.338-2.339; P = .812).

Conclusions

This early experience suggests that EVLP can be safely performed after TA-NRP without increasing the risk of donor lung loss.

目的：体外肺灌注（EVLP）通常用于评估扩展标准供体肺，特别是循环性死亡（DCD）供体后的捐赠。常温区域灌注（NRP）越来越多地用于DCD采购，但其对EVLP结果的影响尚不清楚。方法：本研究纳入了2021年10月至2024年8月在两个集中式EVLP设施进行灌注的187个DCD肺。分析供体人口统计学、EVLP特征和EVLP期间获得的x线片。结果：160个肺在快速获取后被EVLP评估，其中13个是在腹部常温区域灌注（NRP）方案下获得的。23例DCD供体肺在胸腹（TA-）NRP采取后行EVLP。在整个研究队列中，EVLP的主要指征是DCD状态（41%），其次是采购团队提出的对器官质量的担忧（34%）和低pO2（12%）。TA-NRP组的一个肺和快速获取组的三个肺在到达EVLP设施时由于外观严重异常而未进行EVLP。TA-NRP组的下降率为52%，快速采购组为50% （p=0.777）。两组的EVLP特征和x线片具有可比性。在多变量分析中，供者的人口统计学因素或EVLP的适应症都不影响EVLP的结果。值得注意的是，在多变量分析中，TA-NRP也不是EVLP转换率的显著因素（OR 0.889 (0.338-2.339), p=0.812）。结论：这一早期经验表明，TA-NRP术后EVLP可以安全进行，而不会增加供体肺损失的风险。

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引用次数: 0

We’re not advancing—We’re escalating: The dangerous drift of esophageal cancer care 我们不是在进步，而是在升级：食管癌护理的危险漂移。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-13 DOI: 10.1016/j.jtcvs.2025.10.017

Ben Rembetski MD , Stephanie G. Worrell MD, FACS

引用次数: 0

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

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-03-01 Epub Date: 2026-02-28 DOI: 10.1016/S0022-5223(26)00077-2

引用次数: 0

Commentary: In search of intrinsic indices, the Holy Grail for assessment of dysfunction and interventional results 评论：寻找内在指标，评估功能障碍和介入结果的圣杯。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-08-26 DOI: 10.1016/j.jtcvs.2025.08.019

Daniel H. Drake MD

引用次数: 0

Commentary: Goal-directed fluid therapy integrated in Enhanced Recovery After Surgery, one step to improve outcomes in cardiac surgery 评论：目标导向的液体治疗整合在ERAS，一步改善心脏手术的结果。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-09-05 DOI: 10.1016/j.jtcvs.2025.08.042

Gry Dahle MD, PhD

引用次数: 0

Reply: Underscoring the importance of surgical judgment 回答：强调手术判断的重要性。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-13 DOI: 10.1016/j.jtcvs.2025.09.016

Adrienne Kline MD, PhD , Parisa Rashidi PhD , Arman Kilic MD , Robert M. Sade MD

引用次数: 0

Association of short-term outcomes and long-term survival after lung cancer resection 肺癌切除术后短期预后与长期生存的关系。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-18 DOI: 10.1016/j.jtcvs.2025.11.007

David Richard P. Woodson MS, Ntemena Kapula MS, Douglas Z. Liou MD, Irmina A. Elliott MD, Joseph B. Shrager MD, Mark F. Berry MD

Background

Quality metrics that compare care across institutions typically are based on short-term outcomes. This study evaluated whether short-term quality metrics for non–small cell lung cancer (NSCLC) resection predict long-term survival.

Methods

Centers in the National Cancer Database that performed ≥30 NSCLC resections between 2010 and 2019 were ranked based on major postoperative morbidity, defined as a weighted composite of 30-day mortality, unplanned readmissions, and hospital length of stay longer than 14 days. Centers were stratified by morbidity rates into quintiles, with the top quintile designated high quality. The impact of care at high-quality institutions on survival was assessed with Kaplan-Meier analysis and Cox proportional hazards modeling.

Results

The study included 198,115 patients from 928 centers. Compared to non–high-quality centers, high-quality centers had lower rates of 30-day mortality (0.8% [n = 362/47,321] vs 2.4% [n = 3614/150,794]: P < .001) and morbidity (median, 5% [interquartile range (IQR), 4.0%-5.9%] vs 10.8% [IQR, 8.7%-14.0%]; P < .001). Patients treated at high-quality centers had improved long-term survival compared to other patients in both univariable analysis (5-year survival, 71.5% [95% confidence interval (CI), 71.0%-71.9%] vs 62.6% [95% CI, 62.3%-62.8%]; P < .0001) and multivariable analysis (hazard ratio [HR], 0.75; 95% CI, 0.73-0.77; P < .001). Sensitivity analysis of stage IA patients treated with lobectomy and no induction therapy showed similar survival benefits as care at high-quality centers in both univariable analysis (5-year survival, 79% [95% CI, 78.3%-79.7%] vs 73.2% [95% CI, 72.8%-73.6%]; P < .001) and multivariable analysis (HR, 0.76; 95% CI, 0.73-0.78; P < .001).

Conclusions

Patients who underwent lung cancer resection at institutions deemed high-quality based on short-term outcomes also had better long-term survival.

目的：比较各机构护理的质量指标通常基于短期结果。本研究评估了非小细胞肺癌（NSCLC）切除术的短期质量指标是否能预测长期生存。方法：2010-2019年期间，国家癌症数据库中进行≥30例非小细胞肺癌切除术的中心根据主要术后发病率进行排名，该发病率定义为30天死亡率、计划外再入院和住院时间超过14天的加权组合。中心按发病率分成五分之一，最高的五分之一指定为高质量。采用Kaplan-Meier分析和Cox比例风险模型评估高质量机构护理对生存率的影响。结果：该研究包括来自928个中心的198,115名患者。高质量中心的30天死亡率较低（0.8% [362/47,321]vs 2.4%[3,614/150,794]）。结论：在基于短期结果的高质量机构接受肺癌切除术的患者也有更好的长期生存率。

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引用次数: 0

Complications following airway resections: Insights from a large contemporary multi-institutional cohort 气道切除术后的并发症：来自当代大型多机构队列的见解。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-25 DOI: 10.1016/j.jtcvs.2025.10.026

Olaf Mercier MD, PhD , Mohsen Ibrahim MD, PhD , Matthias Evermann MD , Beatrice Trabalza Marinucci MD , Amir Hanna MD , Caitlin T. Demarest MD, PhD , Anil J. Trindade MD , Stefan Schwarz MD, PhD , Thomas Schweiger MD, PhD , Elie Fadel MD, PhD , Erino A. Rendina MD , Konrad Hoetzenecker MD, PhD

Background

Airway surgery remains a rarely performed procedure and reports on complication rates are scarce in the literature. Given several recent technical advances in airway surgery, we aimed to assess the rates of procedure-associated complications in a contemporary, multi-institutional cohort of patients.

Methods

Airway resections performed between January 2013 and December 2023 in 3 European institutions with a dedicated airway program were included in this retrospective analysis.

Results

A total of 640 patients were included in the analysis. This included 313 tracheal, 309 cricotracheal, and 18 laryngotracheal reconstructions with rib cartilage interpositions. The median length of resection was 25 mm (range, 8-70 mm). The median hospital length of stay was 6 days (interquartile range, [IQR], 5-9 days). In-hospital mortality was recorded in 2 patients (0.3%). The most prevalent early complication was glottic swelling (5%), followed by surgical site infection (4%). Anastomosis dehiscence was a rare event, with 12 partial dehiscences (2%). Most patients (93%) experienced normal healing of their anastomosis. Granuloma formation was noted in 3.3% of patients, restenosis in 3.1%, and malacia in 0.2%. With a median follow-up of 2 years and 5 months (IQR, 4-47 months), only 5 patients (0.7%) required a stent, 2 (0.3%) required a T-tube, and 9 (1.4%) underwent a permanent tracheostomy.

Conclusions

This large, contemporary, international cohort of airway cases demonstrates that complications following airway resection are significantly lower than previously reported. This finding is crucial for informed and shared decision making with patients suffering from operable airway conditions.

背景：气道手术仍然是一种很少进行的手术，文献中关于并发症发生率的报道很少。鉴于最近气道手术的一些技术进步，我们旨在评估当代多机构患者队列中手术相关并发症的发生率。方法：回顾性分析了2013年1月至2023年12月在3家欧洲机构进行的气道切除术，这些机构有专门的气道项目。结果：共纳入640例患者。其中气管重建313条，环气管重建309条，喉气管重建18条。中位切除长度为25 mm（范围8-70 mm）。住院时间中位数为6天（四分位数间距，[IQR]， 5-9天）。2例患者住院死亡（0.3%）。最常见的早期并发症是声门肿胀（5%），其次是手术部位感染（4%）。吻合口开裂罕见，部分开裂12例（2%）。大多数患者（93%）吻合口愈合正常。3.3%的患者出现肉芽肿，3.1%的患者出现再狭窄，0.2%的患者出现软化。中位随访2年零5个月（IQR， 4-47个月），只有5例（0.7%）患者需要支架，2例（0.3%）患者需要t管，9例（1.4%）患者需要永久性气管切开术。结论：这一庞大的、当代的、国际性的气道病例队列研究表明，气道切除术后的并发症明显低于先前报道。这一发现对于患有可手术气道疾病的患者的知情和共同决策至关重要。

{"title":"Complications following airway resections: Insights from a large contemporary multi-institutional cohort","authors":"Olaf Mercier MD, PhD , Mohsen Ibrahim MD, PhD , Matthias Evermann MD , Beatrice Trabalza Marinucci MD , Amir Hanna MD , Caitlin T. Demarest MD, PhD , Anil J. Trindade MD , Stefan Schwarz MD, PhD , Thomas Schweiger MD, PhD , Elie Fadel MD, PhD , Erino A. Rendina MD , Konrad Hoetzenecker MD, PhD","doi":"10.1016/j.jtcvs.2025.10.026","DOIUrl":"10.1016/j.jtcvs.2025.10.026","url":null,"abstract":"<div><h3>Background</h3><div>Airway surgery remains a rarely performed procedure and reports on complication rates are scarce in the literature. Given several recent technical advances in airway surgery, we aimed to assess the rates of procedure-associated complications in a contemporary, multi-institutional cohort of patients.</div></div><div><h3>Methods</h3><div>Airway resections performed between January 2013 and December 2023 in 3 European institutions with a dedicated airway program were included in this retrospective analysis.</div></div><div><h3>Results</h3><div>A total of 640 patients were included in the analysis. This included 313 tracheal, 309 cricotracheal, and 18 laryngotracheal reconstructions with rib cartilage interpositions. The median length of resection was 25 mm (range, 8-70 mm). The median hospital length of stay was 6 days (interquartile range, [IQR], 5-9 days). In-hospital mortality was recorded in 2 patients (0.3%). The most prevalent early complication was glottic swelling (5%), followed by surgical site infection (4%). Anastomosis dehiscence was a rare event, with 12 partial dehiscences (2%). Most patients (93%) experienced normal healing of their anastomosis. Granuloma formation was noted in 3.3% of patients, restenosis in 3.1%, and malacia in 0.2%. With a median follow-up of 2 years and 5 months (IQR, 4-47 months), only 5 patients (0.7%) required a stent, 2 (0.3%) required a T-tube, and 9 (1.4%) underwent a permanent tracheostomy.</div></div><div><h3>Conclusions</h3><div>This large, contemporary, international cohort of airway cases demonstrates that complications following airway resection are significantly lower than previously reported. This finding is crucial for informed and shared decision making with patients suffering from operable airway conditions.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 773-784.e3"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656208","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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