Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Prospective evaluation and successful outcomes using vacuum bell therapy for pectus excavatum in selected pediatric patients: Analysis of a prospective cohort study of 240 patients","authors":"Abdullah AlShammari MD ,&nbsp;Gowthanan Santhirakumaran MD ,&nbsp;Akshay Patel MD ,&nbsp;Ian Hunt MD","doi":"10.1016/j.jtcvs.2025.10.036","DOIUrl":"10.1016/j.jtcvs.2025.10.036","url":null,"abstract":"<div><h3>Background</h3><div>Pectus excavatum (PE) is relatively a common congenital chest wall deformity that can cause both functional and psychological impairments. Vacuum bell therapy (VBT) is a nonsurgical treatment modality used to correct sternal depression in growing children and adolescents.</div></div><div><h3>Methods</h3><div>This prospective cohort study assessed the effectiveness of VBT in 240 paediatric patients over an 18- to 24-month period. Baseline data including demographics, clinical and morphological severities were longitudinally assessed over a period of 18 to 24 months. Only patients whose initial assessment showed evidence of sternal elevation on application of VBT were included. Funnel depth, chest pain, and breathing difficulty scores were assessed before and after VBT application. Although not presented as part of this study, the presence of postural related issues also was recorded and subsequently assessed in response to targeted physical therapy.</div></div><div><h3>Results</h3><div>The mean baseline funnel depth was 21.11 mm, which decreased significantly to 7.7 mm following therapy (<em>P</em> &lt; .001). On a 10-point scale, breathing difficulty scores improved from a mean of 3.58 to 2.0 (<em>P</em> &lt; .001), while chest pain scores showed no significant change. On a 10-point scale with higher scores indicating higher satisfaction, patient satisfaction was significantly higher post-VBT compared to pre-VBT (7.94 vs 3.81; <em>P</em> &lt; .001). Multivariable regression analysis indicated that each additional hour of average daily VBT application was associated with a 1.7-mm reduction in funnel depth. Greater baseline severity also was associated with larger residual deformity at follow-up. Overall, 67.5% of the patients showed clinical improvement.</div></div><div><h3>Conclusions</h3><div>The findings support the use of VBT as a safe and effective noninvasive intervention for pediatric patients with PE. Treatment adherence and baseline deformity severity are key factors influencing outcomes.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 732-741.e3"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460411","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":"Cryotherapy use in the context of thoracic surgery","authors":"Aamir Amin MBBS, MRCS, MSc,&nbsp;Hanan Hamead MBBS, MRCS, MS,&nbsp;Sara Tenconi FRCS(Eng),&nbsp;Felice Granato MD, PhD, FRCS","doi":"10.1016/j.jtcvs.2025.10.016","DOIUrl":"10.1016/j.jtcvs.2025.10.016","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages e76-e77"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490819","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":"Comparison of myocardial mechanics after mitral valve repair with leaflet preservation versus leaflet resection: A subanalysis of the randomized Canadian Mitral Research Alliance CardioLink-2 trial","authors":"Rawan K. Rumman MD, PhD ,&nbsp;Subodh Verma MD, PhD ,&nbsp;Vincent Chan MD, MPH ,&nbsp;Alexandra Fottinger BM, BCh ,&nbsp;Adrian Quan MPhil ,&nbsp;Makoto Hibino MD, PhD ,&nbsp;Benoit E. de Varennes MD, MSc ,&nbsp;Daniel J.P. Burns MD, MPhil ,&nbsp;Michael W.A. Chu MD, MEd ,&nbsp;Hwee Teoh PhD ,&nbsp;David A. Latter MD ,&nbsp;Gianluigi Bisleri MD ,&nbsp;Howard Leong-Poi MD ,&nbsp;C. David Mazer MD ,&nbsp;Kim A. Connelly MBBS, PhD","doi":"10.1016/j.jtcvs.2025.07.047","DOIUrl":"10.1016/j.jtcvs.2025.07.047","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies comparing leaflet resection versus leaflet preservation for surgical repair of mitral regurgitation caused by prolapse have focused predominately on measurement of left ventricular ejection fraction without adjusting for loading conditions. This post hoc subanalysis evaluated subclinical differences in myocardial mechanics before mitral valve repair, immediately after, and 1 year after repair, as well as differences between leaflet resection and preservation strategies.</div></div><div><h3>Methods</h3><div>A total of 104 patients were randomized to the resection or preservation group for surgical treatment of posterior leaflet prolapse in the Canadian Mitral Research Alliance CardioLink-2 study. Speckle-tracking echocardiography was performed at baseline (prerepair), immediately postrepair, and 1-year postrepair. Global longitudinal strain (GLS) was compared at the 3 time points, as well as between leaflet preservation and resection groups using descriptive statistics. GLS was adjusted for left ventricular (LV) end-diastolic dimensions to adjust for loading conditions.</div></div><div><h3>Results</h3><div>The mean (standard deviation) age of the participants was 65 ± 10 years, and 83% were male. The mean GLS before mitral valve repair was −19.6% ± 5.4% and did not differ between the leaflet resection and leaflet preservation groups. The mean GLS decreased to −12.8% ± 4.7 immediately postrepair (<em>P</em> = .001 compared with prerepair). At 1-year after repair, the mean GLS improved to −16% ± 4% in both groups but remained below prerepair values; however, the GLS indexed to loading conditions was similar to preoperative values. Preoperative GLS was an independent predictor of postoperative reduced GLS independent of age, sex, body surface area, and repair strategy.</div></div><div><h3>Conclusions</h3><div>Mitral valve repair is associated with an immediate reduction in GLS, but when corrected for loading conditions, indexed GLS demonstrates complete preservation of LV function at 1 year. The leaflet preservation and resection techniques for surgical repair of mitral regurgitation have similar effects on myocardial mechanics 1-year postrepair. Preoperative GLS may be used to predict LV myocardial mechanics 1-year postoperatively (Trial registration number NCT02552771, <span><span>https://clinicaltrials.gov/study/NCT02552771</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 604-612.e1"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812615","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":"Stenotic left atrioventricular valve after atrioventricular septal defect repair: A distinct surgical phenotype","authors":"Can Xu MD, PhD ,&nbsp;Xinyu Nie BS ,&nbsp;Zhifen Chen MD, PhD ,&nbsp;Jason Zhensheng Qu MD ,&nbsp;Dongjin Wang MD, PhD","doi":"10.1016/j.jtcvs.2025.07.032","DOIUrl":"10.1016/j.jtcvs.2025.07.032","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages e66-e67"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862626","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":"Salvage esophageal reconstruction with colonic conduit: A single-center 25-year experience","authors":"John O. Barron MD ,&nbsp;Sadhvika Ramji MBBS ,&nbsp;Nethra Jain MBBS ,&nbsp;Andrew Conner MD ,&nbsp;Andrew J. Toth MS ,&nbsp;Monisha Sudarshan MD ,&nbsp;Daniel P. Raymond MD ,&nbsp;Usman Ahmad MD ,&nbsp;Eugene H. Blackstone MD ,&nbsp;Eric Lamarre MD ,&nbsp;Jeremy M. Lipman MD ,&nbsp;Sudish C. Murthy MD, PhD ,&nbsp;Siva Raja MD, PhD","doi":"10.1016/j.jtcvs.2025.09.032","DOIUrl":"10.1016/j.jtcvs.2025.09.032","url":null,"abstract":"<div><h3>Objective</h3><div>Colonic interposition restores alimentary continuity after esophagectomy when a gastric conduit is unavailable, but its use has been limited by concerns about morbidity and functional outcomes. Hence, we aimed to assess our 25-year institutional experience, including perioperative outcomes, a subset with patient-reported outcomes, and a contemporary cohort treated with middle-colic microvascular “supercharging” to augment perfusion.</div></div><div><h3>Methods</h3><div>From January 2000 to June 2024, 99 patients underwent substernal colonic interposition. End points included perioperative outcomes, postoperative symptoms, assessed by Cleveland Clinic Esophageal Questionnaire (CEQ), and overall survival estimated by Kaplan-Meier method.</div></div><div><h3>Results</h3><div>Median age was 61 [47, 73] years. Forty-eight (48%) patients had esophageal cancer. An inferior mesenteric artery-based transverse colon segment was used in 83 (84%). Sixteen (16%) underwent supercharge. Thirty-day mortality was 5%. One patient with supercharge (6.3%; 68% confidence interval, 2.3%-16%), and 36 without (43%; confidence interval, 38%-49%), developed a cervical anastomotic leak (<em>P</em> = .004). Among 18 patients with CEQ scores, most symptoms were experienced never or rarely; weekly postprandial diarrhea and bloating were the most common symptoms, reported by 10 (56%) and 9 (50%) patients, respectively. Median CEQ T scores for each symptom domain ranged from 42 to 56 after colon interposition versus 40 to 47 after gastric conduit. Overall survival with and without esophageal cancer was 25% to 66% at 10 years (<em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>Colonic interposition historically carried substantial short-term morbidity attributable to sequelae of frequent anastomotic leaks. Presently, this can be mitigated with microvascular supercharge and a standardized multidisciplinary approach, warranting routine use. Contradicting conventional wisdom, long-term functional outcomes are similar to patients with a gastric conduit.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 762-770.e10"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182109","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":"Propofol-supplemented cardioplegia: A multicenter blinded 3-group randomized trial (Propofol for Myocardial Protection Trial 2: ProMPT2)","authors":"Gianni D. Angelini MD, MCh, FRCS, FETCS ,&nbsp;Helena J.M. Smartt PhD ,&nbsp;Katherine Joyce MSc ,&nbsp;Rachael Heys MSc ,&nbsp;Rachel Maishman PhD ,&nbsp;Lucy Culliford PhD ,&nbsp;Samantha E. de Jesus MPharm ,&nbsp;Beth M. Fitzgerald MRes ,&nbsp;M. Saadeh Suleiman PhD, DSc ,&nbsp;Prakash Punjabi MS, MCh, FRCS, FCCP ,&nbsp;Nnamdi Nwaejike MD, FRCS(CTh) ,&nbsp;Richard Downes ACP ,&nbsp;Ben Gibbison MD, FRCA, FFICM ,&nbsp;Chris A. Rogers PhD","doi":"10.1016/j.jtcvs.2025.09.040","DOIUrl":"10.1016/j.jtcvs.2025.09.040","url":null,"abstract":"<div><h3>Objective</h3><div>Coronary artery bypass grafting using cardiopulmonary bypass and cardioplegic arrest is an effective treatment for coronary artery disease. Research suggests supplementing the cardioplegia solution with propofol may be cardioprotective. Our aim was to compare the safety and efficacy of supplementing the cardioplegia solution with different doses of propofol in adults undergoing first-time surgery.</div></div><div><h3>Methods</h3><div>A blinded, parallel group randomized controlled trial conducted in 3 hospitals in the United Kingdom compared a cardioplegia solution supplemented with high-dose propofol (concentration 12 μg/mL), low-dose propofol (concentration 6 μg/mL), and placebo (saline). Primary outcome was cardiac troponin T measurements over the first 48 hours after surgery. Participants were followed for 12 months.</div></div><div><h3>Results</h3><div>In total, 240 participants, median age 66 years, 90% male, were randomly allocated: 78 to high-dose propofol, 80 to low-dose propofol, and 82 to placebo. In total, 239 participants were included in the primary analysis. Geometric mean cardiac troponin release at 48 hours (95% confidence interval) was 145 ng/L (125-168), 162 ng/L (138-191), and 150 ng/L (125-180) in the high-dose propofol, low-dose propofol, and placebo groups, respectively (adjusted geometric mean ratio 1.06; 95% confidence interval, 0.97-1.15; <em>P</em> = .20, for pairwise comparisons between high- and low-dose propofol and between low-dose propofol and placebo). A total of 96 adverse events that prolonged the hospital stay or were life-threatening were reported (33, 26, and 37 in the high-dose propofol, low-dose propofol, and placebo groups, respectively), as well as 4 deaths (1 low-dose propofol group, 3 placebo group).</div></div><div><h3>Conclusions</h3><div>Propofol supplementation of warm blood cardioplegia at both the lower and higher concentrations is safe, but there is no evidence to suggest either dose is cardioprotective.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 649-658"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228658","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":"Clinic-radiologic predictors of pathological characteristics in pure ground-glass nodules: Development and validation of a predictive nomogram","authors":"Songxin Zhu MS,&nbsp;Chunming He MD,&nbsp;Xindi Zhang MS,&nbsp;Yougan Zhao MS,&nbsp;Xiaojing Zhao MD","doi":"10.1016/j.jtcvs.2025.10.013","DOIUrl":"10.1016/j.jtcvs.2025.10.013","url":null,"abstract":"<div><h3>Objectives</h3><div>The objective of this study was to explore the relationship between the clinic-radiologic characteristics of pure ground-glass nodules (pGGNs) and key pathologic features of lung adenocarcinoma, including tumor invasiveness, proliferative activity, driver oncogenic mutations, and the tumor immune microenvironment.</div></div><div><h3>Methods</h3><div>A total of 1070 surgically resected pGGNs were retrospectively analyzed and categorized pathologically into 224 precursor glandular lesions (PGLs), 600 minimally invasive adenocarcinomas (MIAs), and 246 invasive adenocarcinomas (IAs). Receiver operating characteristic curves and area under the curve were used to assess the diagnostic performance of various size and density parameters. After adjusting for clinical covariates, computed tomography (CT) features were compared across the different pathologic subgroups. The relationships between clinic-radiologic characteristics and the Ki-67 proliferation index, EGFR mutation status, and tertiary lymphoid structures (TLS) were examined. Finally, a clinic-radiologic nomogram was developed and externally validated to enable accurate preoperative prediction of IA presenting as pGGNs.</div></div><div><h3>Results</h3><div>Receiver operating characteristic analysis revealed that density-related parameters of pGGNs had strong discriminatory power for both MIA and IA, with the lung/max CT value showing the greatest diagnostic performance, followed by the max CT value. The optimal cut-off values for differentiating MIA from PGL were 1.62 (lung/max CT value), −548 HU (max CT value), and 8.6 mm (max diameter), whereas for distinguishing IA from MIA, the respective thresholds were 1.89, −458 HU, and 11.5 mm. After adjusting for clinical covariates, CT features such as size, density, shape, border, and voxel heterogeneity remained significantly different across the PGL, MIA, and IA groups. Furthermore, a positive correlation was found between max CT value and pathologic indicators, including Ki-67 proliferation index, EGFR mutation, and TLS. A clinic-radiologic nomogram that incorporated age, max diameter, lung/max CT value, and shape demonstrated excellent discriminatory ability for IA (area under the curve, 0.883-0.920), along with good calibration and clinical utility.</div></div><div><h3>Conclusions</h3><div>Size and density, as key radiologic features in the assessment of pGGNs, proved to be reliable predictors of pathologic invasiveness, proliferative activity, EGFR mutation status, and TLS levels. A clinic-radiologic nomogram for noninvasive prediction of IA offered a valuable tool to guide surveillance strategies and therapeutic decisions for patients with pGGNs.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 742-753.e17"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314089","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":"Aortic remodeling and pulmonary autograft performance over 2 decades after the Ross procedure in the pediatric and young adult population","authors":"Mohamed Salem MD ,&nbsp;Uygar Yörüker MD ,&nbsp;Klaus Valeske MD ,&nbsp;Joseph Thul MD ,&nbsp;Matthias Müller MD ,&nbsp;Christian Jux MD ,&nbsp;Hakan Akintürk MD","doi":"10.1016/j.jtcvs.2025.10.042","DOIUrl":"10.1016/j.jtcvs.2025.10.042","url":null,"abstract":"<div><h3>Objectives</h3><div>The Ross procedure is a well-established treatment for nonrepairable aortic valve disease in children and young adults. This study evaluates the mid- and long-term clinical outcomes of more than 20 years of autograft hemodynamics/performance with the Ross procedure in infants, children, and young adults.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 149 consecutive patients who underwent the Ross procedure at our center between March 1996 and August 2023. All surgeries were performed as root replacements by a single experienced surgeon. Sinus of Valsalva and annulus diameters were measured to calculate z scores from the most recent magnetic resonance imaging follow-up. Aortic and pulmonary valve insufficiency was assessed by magnetic resonance imaging or echocardiography.</div></div><div><h3>Results</h3><div>Median age at surgery was 12.3 years (range, 0-33 years) and median weight 50.1 kg (7.25-126 kg). Most patients had congenital pathology (90%) or aortic valve endocarditis (6.9%). Previous aortic valve interventions had been performed in 66.5%. Hospital mortality was 0%. Postoperative echocardiography showed no or trivial autograft regurgitation in 98.7%. Reoperation for autograft dilatation or insufficiency occurred in 13 patients (8.7%). Homograft degeneration requiring surgical or catheter-based intervention occurred in 24 patients (16%). Freedom from autograft reoperation was 99%, 96%, and 95% at 5, 10, and 15 years; for the pulmonary valve, these rates were 94%, 81%, and 74%, respectively.</div></div><div><h3>Conclusions</h3><div>The Ross procedure provides excellent long-term durability and hemodynamics with freedom from autograft reoperation in young patients. Homograft degeneration remains common but is rarely life-threatening, and catheter-based interventions offer effective management when needed.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 703-710.e5"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490793","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":"Optimizing patient blood management through intraoperative goal-directed fluid therapy protocol within an enhanced recovery after cardiac surgery program","authors":"Clément Schneider MD ,&nbsp;Marc Darras MD ,&nbsp;Walid Oulehri MD, PhD ,&nbsp;Sandrine Marguerite MD ,&nbsp;Saadé Saadé MD ,&nbsp;Coralie Pauzet MD ,&nbsp;Mircea Cristinar MD ,&nbsp;Salomé Sender MD ,&nbsp;Charles Tacquard MD, PhD ,&nbsp;Olivier Collange MD, PhD ,&nbsp;Paul-Michel Mertes MD, PhD ,&nbsp;Michel Kindo MD, PhD","doi":"10.1016/j.jtcvs.2025.07.028","DOIUrl":"10.1016/j.jtcvs.2025.07.028","url":null,"abstract":"<div><h3>Objective</h3><div>This study assessed the impact of intraoperative goal-directed fluid therapy integrated within an Enhanced Recovery After Surgery program on early coagulation parameters, transfusion requirements, hemoglobin levels, chest tube output, and hemodynamic profiles in patients undergoing elective cardiac surgery.</div></div><div><h3>Methods</h3><div>In this single-center, retrospective ancillary analysis, patients who underwent elective cardiac procedures between 2015 and 2021 were stratified based on the implementation of an Enhanced Recovery After Surgery protocol incorporating goal-directed fluid therapy. Propensity score matching generated 1026 well-balanced pairs. Primary end points included platelet count, fibrinogen concentration, prothrombin time, activated partial thromboplastin time, and hemoglobin levels measured at intensive care unit admission and on postoperative day 1. Secondary outcomes included transfusions (red blood cells, allogeneic blood components, coagulation factor concentrates), chest tube output, glomerular filtration rate, mean arterial pressure, central venous pressure, and vasoactive-inotropic score at intensive care unit admission and postoperative day 1.</div></div><div><h3>Results</h3><div>At intensive care unit admission, the Enhanced Recovery After Surgery group demonstrated significantly higher platelet count, fibrinogen, prothrombin time, and hemoglobin (all <em>P &lt;</em> .001). Red blood cell transfusion rates were significantly lower intraoperatively and at postoperative day 1 (<em>P &lt;</em> .001), whereas transfusion of other blood products and coagulation factor concentrates did not differ between groups. At postoperative day 1, the Enhanced Recovery After Surgery group exhibited significantly lower chest tube output (<em>P &lt;</em> .001) and higher glomerular filtration rate (<em>P =</em> .042). Although mean arterial pressure remained comparable, central venous pressure was significantly lower and vasoactive-inotropic score was higher at intensive care unit admission in the Enhanced Recovery After Surgery group, with both parameters normalizing by postoperative day 1.</div></div><div><h3>Conclusions</h3><div>Goal-directed fluid therapy within an Enhanced Recovery After Surgery program reduces intraoperative hemodilution, improves coagulation integrity, reduces postoperative bleeding, decreases transfusion needs, and maintains end-organ perfusion after elective cardiac surgery.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 671-680.e4"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144734979","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":"Oral anticoagulation in patients with atrial fibrillation and heart valve prosthesis: A substudy from the Left Atrial Appendage Occlusion Study (LAAOS) III trial","authors":"Domenico Paparella MD ,&nbsp;Emilie P. Belley-Cote MD, PhD ,&nbsp;Michele Di Mauro MD, PhD ,&nbsp;Enrico Squiccimarro PhD ,&nbsp;Martina Macella MD ,&nbsp;Katheryn Brady BSc ,&nbsp;Michael W.A. Chu MD ,&nbsp;Richard P. Whitlock MD, PhD","doi":"10.1016/j.jtcvs.2025.08.046","DOIUrl":"10.1016/j.jtcvs.2025.08.046","url":null,"abstract":"<div><h3>Objective</h3><div>Societal guidelines recommend vitamin K antagonists (VKAs) for patients with atrial fibrillation with recent biological valve implantation, but the safety and efficacy of direct oral anticoagulants (DOACs) in this setting remain uncertain, especially in the early postoperative period. This substudy of the Left Atrial Appendage Occlusion Study (LAAOS) III trial aimed to compare thromboembolic and bleeding outcomes in patients discharged on VKAs versus DOACs after bioprosthesis implantation or mitral valve repair.</div></div><div><h3>Methods</h3><div>A total of 2645 patients were included, with 461 discharged on DOACs and 2184 on VKAs. Patients with mechanical valves or isolated coronary surgery were excluded. The primary end point was stroke or systemic thromboembolism. Major bleeding was a secondary end point. Cox proportional hazard models adjusted for time-dependent covariates and clinical factors (eg, age, previous stroke, left atrial appendage occlusion) were applied to assess outcomes.</div></div><div><h3>Results</h3><div>Patients discharged on DOACs were older, mostly male, and had lower rates of rheumatic heart disease than those on VKAs. During follow-up, no significant differences were observed in thromboembolic (hazard ratio, 0.754; 95% confidence interval, 0.496-1.145; <em>P</em> = .185) or major bleeding events (hazard ratio, 0.760; 95% confidence interval, 0.601-1.153; <em>P</em> = .197) between groups. A nonsignificant trend toward worse outcomes was noted for patients who discontinued or switched anticoagulation.</div></div><div><h3>Conclusions</h3><div>In this large cohort of patients after mitral and/or aortic bioprosthesis implantation or mitral valve repair within the LAAOS III, DOACs showed similar thromboembolic and bleeding risks as VKAs, suggesting they may be a safe alternative.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 683-692.e2"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034369","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}