Pub Date : 2026-03-01Epub Date: 2025-12-13DOI: 10.1016/j.jtcvs.2025.12.007
Harold M. Burkhart MD , Mathew D. Campbell MD , Neil M. Venardos MD , Holly I. Burkhart , Arshid Mir MD
{"title":"Surgical management of a newborn with interrupted aortic arch and subaortic obstruction","authors":"Harold M. Burkhart MD , Mathew D. Campbell MD , Neil M. Venardos MD , Holly I. Burkhart , Arshid Mir MD","doi":"10.1016/j.jtcvs.2025.12.007","DOIUrl":"10.1016/j.jtcvs.2025.12.007","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages e60-e64"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145758164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-08-21DOI: 10.1016/j.jtcvs.2025.08.017
Betemariam Sharew BA , Joanna Chikwe MD , Aminah Sallam MD , Allen A. Razavi MD , Derrick Tam MD, PhD , Amy S. Nowacki PhD , Natalia Egorova PhD , Dominic Emerson MD , Michael E. Bowdish MD , Eugene Blackstone MD
Background
Ventricular arrhythmias occur in a subset of patients with mitral valve prolapse; however, their impact on postoperative survival after degenerative mitral repair is unclear.
Methods
We compared long-term survival after degenerative mitral repair in patients presenting with and without arrhythmic mitral valve prolapse (defined by degenerative mitral regurgitation and ventricular arrhythmias) in a national insurance database. Our primary outcome was survival up to 5 years; secondary outcomes were implantable cardiac defibrillator (ICD) and ventricular arrhythmia–related readmissions. Multivariable adjustment accounted for baseline differences. Median follow-up was 3.8 years (interquartile range, 1.5-6.6 years).
Results
Among 20,980 patients, 1745 (8.3%) had arrhythmic mitral valve prolapse, of whom 1121 (64%) underwent surgical repair and 624 (36%) underwent transcatheter edge-to-edge repair (TEER). The 5-year survival after surgical repair was 86% in patients with arrhythmic mitral valve prolapse compared to 81% in patients without (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.64-0.97; P = .02). The 5-year survival after TEER was 34% in patients with arrhythmic mitral valve prolapse compared to 43% in patients without (HR, 1.26; 95% CI, 1.07-1.49; P < .001). Rates of ICD were higher following surgery in patients with arrhythmia (1.3% vs 0.4%; P < .01) and similar following TEER in the 2 groups (0.6% vs 0.4%; P = .5).
Conclusions
Arrhythmic mitral valve prolapse is not associated with worse survival after surgical mitral repair; however, arrhythmic mitral valve prolapse is associated with significantly worse survival after TEER. Prospective mechanistic studies are needed to elucidate the pathophysiology of and inform treatment choices in patients with arrhythmic mitral valve prolapse.
目的：二尖瓣脱垂患者可发生室性心律失常。然而，它们对退行性二尖瓣修复术后存活的影响尚不清楚。方法：我们在国家保险数据库中比较了伴有和不伴有心律失常的二尖瓣脱垂（由退行性二尖瓣反流和室性心律失常定义）的患者行退行性二尖瓣修复后的长期生存率。我们的主要终点是5年生存率：次要终点是植入式心脏除颤器（ICD）和室性心律失常相关的再入院。多变量调整解释了基线差异。中位随访时间为3.8年（IQR: 1.5-6.6）。结果：20980例患者中，1745例（8.3%）有心律失常二尖瓣脱垂，其中1121例（64%）行手术修复，624例（36%）行经导管边缘到边缘修复（TEER）。二尖瓣脱垂患者手术修复后的5年生存率为86%，无二尖瓣脱垂患者为81% （HR: 0.79, 95% CI: 0.64-0.97, p = 0.02）。心律失常二尖瓣脱垂患者的5年生存率为34%，无二尖瓣脱垂患者为43% （HR: 1.26, 95% CI: 1.07-1.49, p < 0.001）。心律失常患者手术后ICD发生率较高（1.3% vs. 0.4%）。结论：心律失常二尖瓣脱垂与二尖瓣手术修复后较差的生存率无关。然而，心律不齐的二尖瓣脱垂与TEER后的生存率显著降低相关。需要前瞻性的机制研究来阐明心律失常二尖瓣脱垂患者的病理生理学和治疗选择。
{"title":"Ventricular arrhythmias in patients undergoing degenerative mitral repair: Prevalence and impact on survival","authors":"Betemariam Sharew BA , Joanna Chikwe MD , Aminah Sallam MD , Allen A. Razavi MD , Derrick Tam MD, PhD , Amy S. Nowacki PhD , Natalia Egorova PhD , Dominic Emerson MD , Michael E. Bowdish MD , Eugene Blackstone MD","doi":"10.1016/j.jtcvs.2025.08.017","DOIUrl":"10.1016/j.jtcvs.2025.08.017","url":null,"abstract":"<div><h3>Background</h3><div>Ventricular arrhythmias occur in a subset of patients with mitral valve prolapse; however, their impact on postoperative survival after degenerative mitral repair is unclear.</div></div><div><h3>Methods</h3><div>We compared long-term survival after degenerative mitral repair in patients presenting with and without arrhythmic mitral valve prolapse (defined by degenerative mitral regurgitation and ventricular arrhythmias) in a national insurance database. Our primary outcome was survival up to 5 years; secondary outcomes were implantable cardiac defibrillator (ICD) and ventricular arrhythmia–related readmissions. Multivariable adjustment accounted for baseline differences. Median follow-up was 3.8 years (interquartile range, 1.5-6.6 years).</div></div><div><h3>Results</h3><div>Among 20,980 patients, 1745 (8.3%) had arrhythmic mitral valve prolapse, of whom 1121 (64%) underwent surgical repair and 624 (36%) underwent transcatheter edge-to-edge repair (TEER). The 5-year survival after surgical repair was 86% in patients with arrhythmic mitral valve prolapse compared to 81% in patients without (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.64-0.97; <em>P</em> = .02). The 5-year survival after TEER was 34% in patients with arrhythmic mitral valve prolapse compared to 43% in patients without (HR, 1.26; 95% CI, 1.07-1.49; <em>P</em> < .001). Rates of ICD were higher following surgery in patients with arrhythmia (1.3% vs 0.4%; <em>P</em> < .01) and similar following TEER in the 2 groups (0.6% vs 0.4%; <em>P</em> = .5).</div></div><div><h3>Conclusions</h3><div>Arrhythmic mitral valve prolapse is not associated with worse survival after surgical mitral repair; however, arrhythmic mitral valve prolapse is associated with significantly worse survival after TEER. Prospective mechanistic studies are needed to elucidate the pathophysiology of and inform treatment choices in patients with arrhythmic mitral valve prolapse.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 623-631.e16"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976748","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}
To assess the production of nitric oxide and endothelin in off-pump coronary artery bypass grafting by comparing 2 techniques of internal thoracic artery preparation: skeletonized and pedicled without endothoracic fascia.
Methods
In this prospective, randomized clinical study, 40 patients undergoing off-pump coronary artery bypass grafting were randomized according to internal thoracic artery preparation technique into the skeletonized or pedicled (without endothoracic fascia) groups (n = 20 each). Endothelial expression of CD31 was evaluated by means of immunohistochemistry and en face immunofluorescence. Nitric oxide and cyclic guanosine monophosphate levels in internal thoracic artery plasma, as well as cyclic guanosine monophosphate and endothelin-1 levels in unused internal thoracic artery segments, were measured using enzyme-linked immunosorbent assays. Endothelin-1 mRNA expression was assessed by in situ hybridization.
Results
Skeletonized internal thoracic artery showed areas of poor endothelial continuity, whereas the pedicled internal thoracic artery without endothoracic fascia retained a uniform endothelium on immunostaining. This injury was accompanied by the absence of endothelial nitric oxide synthase immunostaining at regions of endothelial denudation. Plasma nitric oxide concentration was significantly lower, and endothelin-1 release from tissue extracts significantly greater, in skeletonized internal thoracic artery compared with pedicled internal thoracic artery without endothoracic fascia. In situ hybridization assay showed that endothelin-1 (EDN1) mRNA expression is upregulated in endothelial cells remaining in skeletonized internal thoracic artery.
Conclusions
Reduced nitric oxide release and increased endothelin-1 release was observed in skeletonized internal thoracic artery compared with atraumatically prepared pedicled internal thoracic artery without endothoracic fascia. These observations may influence graft performance.
{"title":"The harvesting technique affects the production of nitric oxide and endothelin in the internal thoracic artery graft","authors":"Kenji Iino MD, PhD , Kazuaki Yoshioka PhD , Tomohiro Iba PhD , Yukinobu Ito MD, PhD , Ai Sakai MD , Beta C. Harlyjoy MD , Yoshitaka Yamamoto MD, PhD , Hitoshi Ando MD, PhD , Hisamichi Naito MD, PhD , Hirofumi Takemura MD, PhD","doi":"10.1016/j.jtcvs.2025.08.045","DOIUrl":"10.1016/j.jtcvs.2025.08.045","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the production of nitric oxide and endothelin in off-pump coronary artery bypass grafting by comparing 2 techniques of internal thoracic artery preparation: skeletonized and pedicled without endothoracic fascia.</div></div><div><h3>Methods</h3><div>In this prospective, randomized clinical study, 40 patients undergoing off-pump coronary artery bypass grafting were randomized according to internal thoracic artery preparation technique into the skeletonized or pedicled (without endothoracic fascia) groups (n = 20 each). Endothelial expression of CD31 was evaluated by means of immunohistochemistry and en face immunofluorescence. Nitric oxide and cyclic guanosine monophosphate levels in internal thoracic artery plasma, as well as cyclic guanosine monophosphate and endothelin-1 levels in unused internal thoracic artery segments, were measured using enzyme-linked immunosorbent assays. Endothelin-1 mRNA expression was assessed by in situ hybridization.</div></div><div><h3>Results</h3><div>Skeletonized internal thoracic artery showed areas of poor endothelial continuity, whereas the pedicled internal thoracic artery without endothoracic fascia retained a uniform endothelium on immunostaining. This injury was accompanied by the absence of endothelial nitric oxide synthase immunostaining at regions of endothelial denudation. Plasma nitric oxide concentration was significantly lower, and endothelin-1 release from tissue extracts significantly greater, in skeletonized internal thoracic artery compared with pedicled internal thoracic artery without endothoracic fascia. In situ hybridization assay showed that endothelin-1 (<em>EDN1</em>) mRNA expression is upregulated in endothelial cells remaining in skeletonized internal thoracic artery.</div></div><div><h3>Conclusions</h3><div>Reduced nitric oxide release and increased endothelin-1 release was observed in skeletonized internal thoracic artery compared with atraumatically prepared pedicled internal thoracic artery without endothoracic fascia. These observations may influence graft performance.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 640-648"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034331","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":"On atrioventricular canal defects in patients with and without -down syndrome: A further look","authors":"Flaminia Pugnaloni MD, PhD, Carolina Putotto MD, PhD, Bruno Marino MD, PhD","doi":"10.1016/j.jtcvs.2025.09.031","DOIUrl":"10.1016/j.jtcvs.2025.09.031","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages e65-e66"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338084","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}
Fluctuations in cerebral perfusion contribute to brain injury in neonates with congenital heart disease. This study aimed to describe longitudinal postnatal and perioperative cerebral blood flow using bedside cerebral Doppler ultrasound.
Methods
Neonates with critical congenital heart disease requiring cardiac surgery or a catheter-based valve intervention within the first 6 weeks of life were prospectively included. Cerebral Doppler ultrasound was used to repeatedly measure anterior cerebral artery flow velocity, pulsatility index, and resistive index before and up to 3 days after intervention. Brain injury was assessed on pre- and postinterventional magnetic resonance imaging. Flow parameters and their association with cardiac anatomy, prostaglandin administration, and brain injury were analyzed using mixed effects models.
Results
Forty-two patients were included, with 114 preinterventional and 124 postinterventional Doppler measurements. Before intervention, peak systolic and time-averaged maximum velocity increased significantly with each day (slope 2.5 cm/s, 95% CI, 1.4-3.3, P < .001 and 1.2 cm/s, 95% CI, 0.4-2.0, P = .003), and absent diastolic flow was detected in 69% of patients. The type of congenital heart disease and prostaglandin administration were associated with higher pulsatility index (0.72, 95% CI, 0.25-1.20, P = .003; 0.55, 95% CI, 0.06-1.04, P = .028 and .68, 95% CI, 0.06-1.30, P = .031). After intervention, all flow velocities increased significantly with each day. Preinterventional (46%) and new postinterventional brain injury (53%) were not associated with flow velocities.
Conclusions
Preinterventional compromised cerebral diastolic flow is common and associated with cardiac anatomy and prostaglandin therapy. Flow velocities were not associated with brain injury.
目的：脑灌注波动与先天性心脏病新生儿脑损伤有关。本研究旨在利用床边脑多普勒超声描述产后和围手术期的纵向脑血流。方法：前瞻性纳入出生后6周内需要心脏手术或导管瓣膜干预的危重先天性心脏病新生儿。采用脑多普勒超声反复测量干预前及干预后3 d内的大脑前动脉血流速度、脉搏、指数和阻力指数。通过介入前和介入后MRI评估脑损伤。采用混合效应模型分析血流参数及其与心脏解剖、前列腺素给药和脑损伤的关系。结果：纳入42例患者，114例介入前和124例介入后多普勒测量。在干预前，收缩峰值和时间平均最大流速每天显著增加（斜率2.5 cm/s, 95% CI 1.4-3.3, p）。结论：介入前脑舒张血流损害是常见的，与心脏解剖和前列腺素治疗有关。血流速度与脑损伤无关。
{"title":"Postnatal and postinterventional cerebral Doppler ultrasound in neonates with critical congenital heart disease","authors":"Rian Bosch MD , Johannes M.P.J. Breur MD, PhD , Manon J.N.L. Benders MD, PhD , Nathalie H.P. Claessens MD, PhD , Erik Koomen MD, PhD , Maaike Nijman MD , Hanna Talacua MD, PhD , Thomas Alderliesten MD, PhD , Joppe Nijman MD, PhD","doi":"10.1016/j.jtcvs.2025.11.016","DOIUrl":"10.1016/j.jtcvs.2025.11.016","url":null,"abstract":"<div><h3>Objectives</h3><div>Fluctuations in cerebral perfusion contribute to brain injury in neonates with congenital heart disease. This study aimed to describe longitudinal postnatal and perioperative cerebral blood flow using bedside cerebral Doppler ultrasound.</div></div><div><h3>Methods</h3><div>Neonates with critical congenital heart disease requiring cardiac surgery or a catheter-based valve intervention within the first 6 weeks of life were prospectively included. Cerebral Doppler ultrasound was used to repeatedly measure anterior cerebral artery flow velocity, pulsatility index, and resistive index before and up to 3 days after intervention. Brain injury was assessed on pre- and postinterventional magnetic resonance imaging. Flow parameters and their association with cardiac anatomy, prostaglandin administration, and brain injury were analyzed using mixed effects models.</div></div><div><h3>Results</h3><div>Forty-two patients were included, with 114 preinterventional and 124 postinterventional Doppler measurements. Before intervention, peak systolic and time-averaged maximum velocity increased significantly with each day (slope 2.5 cm/s, 95% CI, 1.4-3.3, <em>P</em> < .001 and 1.2 cm/s, 95% CI, 0.4-2.0, <em>P = .</em>003), and absent diastolic flow was detected in 69% of patients. The type of congenital heart disease and prostaglandin administration were associated with higher pulsatility index (0.72, 95% CI, 0.25-1.20, <em>P = .</em>003; 0.55, 95% CI, 0.06-1.04, <em>P = .</em>028 and .68, 95% CI, 0.06-1.30, <em>P = .</em>031). After intervention, all flow velocities increased significantly with each day. Preinterventional (46%) and new postinterventional brain injury (53%) were not associated with flow velocities.</div></div><div><h3>Conclusions</h3><div>Preinterventional compromised cerebral diastolic flow is common and associated with cardiac anatomy and prostaglandin therapy. Flow velocities were not associated with brain injury.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 711-721.e6"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-24DOI: 10.1016/j.jtcvs.2025.11.015
Gita N. Mody MD, MPH, Danielle O'Hara MD
{"title":"Commentary: The heart of the matter: Prioritizing wellness in cardiothoracic training","authors":"Gita N. Mody MD, MPH, Danielle O'Hara MD","doi":"10.1016/j.jtcvs.2025.11.015","DOIUrl":"10.1016/j.jtcvs.2025.11.015","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 812-813"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-28DOI: 10.1016/S0022-5223(26)00075-9
{"title":"Adult Articles in AATS Journals","authors":"","doi":"10.1016/S0022-5223(26)00075-9","DOIUrl":"10.1016/S0022-5223(26)00075-9","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Page e49"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147415160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-09-29DOI: 10.1016/j.jtcvs.2025.09.036
Sina Danesh MD , Vincy Tam MBBS , Aurora Lee MD , Tedy Sawma MD , Arman Arghami MD , John M. Stulak MD , Philip Rowse MD , Kimberly Holst MD , Austin Todd MS , Kevin L. Greason MD , Malakh Shrestha MD , Gabor Bagameri MD , Alberto Pochettino MD , Vuyisile T. Nkomo MD , Sorin V. Pislaru MD , Mackram F. Eleid MD , Rajiv Gulati MD , Mayra Guerrero MD , Trevor Simard MD , Joseph A. Dearani MD , Paul C. Tang MD
Background
We examined the potential influence of effective orifice area (EOA) and EOA index (EOAi) on survival between bioprosthetic and mechanical valves.
Methods
We analyzed 3265 patients aged 75 years or younger undergoing aortic valve replacement with or without coronary artery bypass grafting. EOA and EOAi were obtained from predischarge echocardiograms. Bootstrapped logistic regression and restricted cubic splines identified optimal survival cut points for EOA and EOAi. Multivariable Cox proportional hazards models were fitted, and adjusted Kaplan-Meier survival curves were generated using the identified EOA cut points.
Results
The mechanical aortic valve replacement group was younger (age 60 vs 69 years; P < .001). For mechanical and bioprosthetic aortic valve replacement groups, respectively, the median EOA was (2.0 cm2; range, 1.6-2.4 vs 2.1 cm2; range, 1.7-2.6 cm2; P < .001) and EOA index was (1.0 cm2/m2; range, 0.8-1.2 cm2/m2 vs 1.1 cm2/m2, range, 0.9-1.3 cm2/m2; P < .001) In patients with EOA ≥2 cm2, long-term adjusted risk of mortality was higher in the bioprosthesis group compared with the mechanical group (hazard ratio, 1.33; P = .010). However, no significant difference was observed for those with EOA <2 cm2 (hazard ratio, 1.01; 95% CI, 0.83-1.23; P = .932). Similarly, for EOA index ≥1.08 cm2/m2, the bioprosthesis group was associated with higher risk of long-term mortality (hazard ratio, 1.29; 95% CI, 1.01-1.64, P = .040), whereas no significant association was found for those with an EOA index <1.08 cm2/m2 (hazard ratio, 1.05; P = .621).
Conclusions
In this cohort, there was a survival advantage of mechanical valves over bioprostheses in larger valve sizes but not in patients with smaller EOA metrics.
{"title":"Influence of effective orifice area on long-term survival in bioprosthetic versus mechanical aortic valves","authors":"Sina Danesh MD , Vincy Tam MBBS , Aurora Lee MD , Tedy Sawma MD , Arman Arghami MD , John M. Stulak MD , Philip Rowse MD , Kimberly Holst MD , Austin Todd MS , Kevin L. Greason MD , Malakh Shrestha MD , Gabor Bagameri MD , Alberto Pochettino MD , Vuyisile T. Nkomo MD , Sorin V. Pislaru MD , Mackram F. Eleid MD , Rajiv Gulati MD , Mayra Guerrero MD , Trevor Simard MD , Joseph A. Dearani MD , Paul C. Tang MD","doi":"10.1016/j.jtcvs.2025.09.036","DOIUrl":"10.1016/j.jtcvs.2025.09.036","url":null,"abstract":"<div><h3>Background</h3><div>We examined the potential influence of effective orifice area (EOA) and EOA index (EOAi) on survival between bioprosthetic and mechanical valves.</div></div><div><h3>Methods</h3><div>We analyzed 3265 patients aged 75 years or younger undergoing aortic valve replacement with or without coronary artery bypass grafting. EOA and EOAi were obtained from predischarge echocardiograms. Bootstrapped logistic regression and restricted cubic splines identified optimal survival cut points for EOA and EOAi. Multivariable Cox proportional hazards models were fitted, and adjusted Kaplan-Meier survival curves were generated using the identified EOA cut points.</div></div><div><h3>Results</h3><div>The mechanical aortic valve replacement group was younger (age 60 vs 69 years; <em>P</em> < .001). For mechanical and bioprosthetic aortic valve replacement groups, respectively, the median EOA was (2.0 cm<sup>2</sup>; range, 1.6-2.4 vs 2.1 cm<sup>2</sup>; range, 1.7-2.6 cm<sup>2</sup>; <em>P</em> < .001) and EOA index was (1.0 cm<sup>2</sup>/m<sup>2</sup>; range, 0.8-1.2 cm<sup>2</sup>/m<sup>2</sup> vs 1.1 cm<sup>2</sup>/m<sup>2</sup>, range, 0.9-1.3 cm<sup>2</sup>/m<sup>2</sup>; <em>P</em> < .001) In patients with EOA ≥2 cm<sup>2</sup>, long-term adjusted risk of mortality was higher in the bioprosthesis group compared with the mechanical group (hazard ratio, 1.33; <em>P</em> = .010). However, no significant difference was observed for those with EOA <2 cm<sup>2</sup> (hazard ratio, 1.01; 95% CI, 0.83-1.23; <em>P</em> = .932). Similarly, for EOA index ≥1.08 cm<sup>2</sup>/m<sup>2</sup>, the bioprosthesis group was associated with higher risk of long-term mortality (hazard ratio, 1.29; 95% CI, 1.01-1.64, <em>P</em> = .040), whereas no significant association was found for those with an EOA index <1.08 cm<sup>2</sup>/m<sup>2</sup> (hazard ratio, 1.05; <em>P</em> = .621).</div></div><div><h3>Conclusions</h3><div>In this cohort, there was a survival advantage of mechanical valves over bioprostheses in larger valve sizes but not in patients with smaller EOA metrics.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 592-603.e7"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-09-24DOI: 10.1016/j.jtcvs.2025.09.027
Jack Yi MD, MBA , Jakraphan Yu MD , Samantha Procasky MS , Ruth Obiarinze MD , Mehran Rahimi MD , Batool Arif MS , Leslie D. Wilson DVM, PhD , Jonathan K. Zoller MD , Matthew R. Schill MD , Ralph J. Damiano Jr. MD , Christian Zemlin PhD
Objective
This study examined the feasibility of creating Cox-maze IV lesions, including the ablation of the left posterior wall (box) and the isthmus lines, using nanosecond pulsed-field ablation (nsPFA) in a beating heart porcine model.
Methods
Nine pigs underwent surgical nsPFA. Lesions included the right atrial appendage, left atrial appendage, left atrial posterior wall (the box), and isthmus lines, as replicated by ablating across the mitral and tricuspid annuli. Each ablation lasted 2.5 to 5 seconds. At 30 days, the cardiac tissue was examined histologically. Ablation lines were sectioned at 5-mm intervals and stained with 10% triphenyl tetrazolium chloride and Gomori trichrome. Exit block testing and echocardiography were performed before, after, and 30 days postablation. Valvular and coronary tissues were assessed by a blinded pathologist.
Results
Seven pigs survived for an average of 26 ± 8 days. Two pigs died acutely from refractory ventricular fibrillation immediately after transvalvular ablations. Transmurality was confirmed for 99.6% (251/252) of histologic cross-sections and 97% (32/33) of lesions. The mean ablated tissue thickness was 6.7 ± 3.3 mm. At 30 days, exit block was confirmed at 94% of available testing sites (16/17). There was no evidence of progression of baseline valvular regurgitation. Histologic assessment did not find significant differences between ablated and nonablated valves or coronary arteries.
Conclusions
An nsPFA clamp device effectively created transmural lesions, including the box and isthmus lesions. This nonthermal energy source may shorten procedural time and enable surgical ablation in the beating heart. However, the relationship between nsPFA and ventricular arrhythmias warrants additional study.
{"title":"Nanosecond pulsed field ablation: Feasibility of creating the Cox-maze lesion set on the beating heart","authors":"Jack Yi MD, MBA , Jakraphan Yu MD , Samantha Procasky MS , Ruth Obiarinze MD , Mehran Rahimi MD , Batool Arif MS , Leslie D. Wilson DVM, PhD , Jonathan K. Zoller MD , Matthew R. Schill MD , Ralph J. Damiano Jr. MD , Christian Zemlin PhD","doi":"10.1016/j.jtcvs.2025.09.027","DOIUrl":"10.1016/j.jtcvs.2025.09.027","url":null,"abstract":"<div><h3>Objective</h3><div>This study examined the feasibility of creating Cox-maze IV lesions, including the ablation of the left posterior wall (box) and the isthmus lines, using nanosecond pulsed-field ablation (nsPFA) in a beating heart porcine model.</div></div><div><h3>Methods</h3><div>Nine pigs underwent surgical nsPFA. Lesions included the right atrial appendage, left atrial appendage, left atrial posterior wall (the box), and isthmus lines, as replicated by ablating across the mitral and tricuspid annuli. Each ablation lasted 2.5 to 5 seconds. At 30 days, the cardiac tissue was examined histologically. Ablation lines were sectioned at 5-mm intervals and stained with 10% triphenyl tetrazolium chloride and Gomori trichrome. Exit block testing and echocardiography were performed before, after, and 30 days postablation. Valvular and coronary tissues were assessed by a blinded pathologist.</div></div><div><h3>Results</h3><div>Seven pigs survived for an average of 26 ± 8 days. Two pigs died acutely from refractory ventricular fibrillation immediately after transvalvular ablations. Transmurality was confirmed for 99.6% (251/252) of histologic cross-sections and 97% (32/33) of lesions. The mean ablated tissue thickness was 6.7 ± 3.3 mm. At 30 days, exit block was confirmed at 94% of available testing sites (16/17). There was no evidence of progression of baseline valvular regurgitation. Histologic assessment did not find significant differences between ablated and nonablated valves or coronary arteries.</div></div><div><h3>Conclusions</h3><div>An nsPFA clamp device effectively created transmural lesions, including the box and isthmus lesions. This nonthermal energy source may shorten procedural time and enable surgical ablation in the beating heart. However, the relationship between nsPFA and ventricular arrhythmias warrants additional study.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 632-639.e2"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180314","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":"Clarifying the prognostic implications of high Deauville scores in stage I Non − Small cell lung cancer","authors":"Yuanpu Wei MD , Hancheng Yin MD , Zhang Yang MD, PhD","doi":"10.1016/j.jtcvs.2025.09.021","DOIUrl":"10.1016/j.jtcvs.2025.09.021","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Page e73"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287567","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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