Pub Date : 2024-10-10DOI: 10.1016/j.jtcvs.2024.09.010
{"title":"Commentator Discussion: Metabolomic studies reveal an organ-protective hibernation state in donor lungs preserved at 10 °C.","authors":"","doi":"10.1016/j.jtcvs.2024.09.010","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.010","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479283","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 : 2024-10-10DOI: 10.1016/j.jtcvs.2024.09.055
Ernest G Chan, Rachel L Deitz, John P Ryan, Yota Suzuki, Chadi A Hage, Masashi Furukawa, Kentaro Noda, Kathirvel Subramaniam, Pablo G Sanchez
Objective: To report differences between 2 anticoagulation protocols during venoarterial extracorporeal membrane oxygenation (VA-ECMO) intraoperative support and their effects on outcomes after lung transplantation.
Methods: We performed a retrospective analysis of patients undergoing double-lung transplantation with intraoperative VA-ECMO from January 1, 2016, to December 30, 2023. Two distinct anticoagulation protocols were in place during this period. One included targeted activated clotting time >180 seconds at all times with protamine reversal after decannulation. The second included 75 units per kilogram of heparin at the time of cannulation with no redosing plus a tranexamic acid infusion after ECMO initiation.
Results: A total of 116 patients (46 low heparin, 70 standard) were included in the analysis. Cannulation strategies and ECMO circuit were equivalent between the groups. The low-dose heparin protocol group had a shorter surgical time (7.28 hours vs 8.53 hours, P < .001) and required significantly less intraoperative packed red blood cells (median 0 vs 4.37 units, P < .001), fresh-frozen plasma (median 0 vs 2 units, P < .001), platelets (median 0 vs 1 units, P < .001), cryoprecipitate (median 0 vs 0 units, P < .001), and total blood products (median 0 vs 9 units, P < .001) compared with the standard group. There were no differences in rates of deep vein thrombosis (P = .13), airway dehiscence (P > .99), pneumonia (P = .38), or acute kidney injury requiring renal-replacement therapy (P = .59). There was no difference in rates of severe grade 3 primary graft dysfunction at 72 hours after transplant (P = .42).
Conclusions: Our low-dose heparin VA-ECMO protocol for intraoperative support during lung transplantation led to a significant reduction of blood product use. Although this did not translate to a reduced rates of grade 3 primary graft dysfunction, the low-dose heparin protocol was associated with similar postoperative outcomes.
{"title":"Bloodless lung transplantation: Comparison between 2 central venoarterial extracorporeal membrane oxygenation anticoagulation strategies and their impact on lung transplant outcomes.","authors":"Ernest G Chan, Rachel L Deitz, John P Ryan, Yota Suzuki, Chadi A Hage, Masashi Furukawa, Kentaro Noda, Kathirvel Subramaniam, Pablo G Sanchez","doi":"10.1016/j.jtcvs.2024.09.055","DOIUrl":"10.1016/j.jtcvs.2024.09.055","url":null,"abstract":"<p><strong>Objective: </strong>To report differences between 2 anticoagulation protocols during venoarterial extracorporeal membrane oxygenation (VA-ECMO) intraoperative support and their effects on outcomes after lung transplantation.</p><p><strong>Methods: </strong>We performed a retrospective analysis of patients undergoing double-lung transplantation with intraoperative VA-ECMO from January 1, 2016, to December 30, 2023. Two distinct anticoagulation protocols were in place during this period. One included targeted activated clotting time >180 seconds at all times with protamine reversal after decannulation. The second included 75 units per kilogram of heparin at the time of cannulation with no redosing plus a tranexamic acid infusion after ECMO initiation.</p><p><strong>Results: </strong>A total of 116 patients (46 low heparin, 70 standard) were included in the analysis. Cannulation strategies and ECMO circuit were equivalent between the groups. The low-dose heparin protocol group had a shorter surgical time (7.28 hours vs 8.53 hours, P < .001) and required significantly less intraoperative packed red blood cells (median 0 vs 4.37 units, P < .001), fresh-frozen plasma (median 0 vs 2 units, P < .001), platelets (median 0 vs 1 units, P < .001), cryoprecipitate (median 0 vs 0 units, P < .001), and total blood products (median 0 vs 9 units, P < .001) compared with the standard group. There were no differences in rates of deep vein thrombosis (P = .13), airway dehiscence (P > .99), pneumonia (P = .38), or acute kidney injury requiring renal-replacement therapy (P = .59). There was no difference in rates of severe grade 3 primary graft dysfunction at 72 hours after transplant (P = .42).</p><p><strong>Conclusions: </strong>Our low-dose heparin VA-ECMO protocol for intraoperative support during lung transplantation led to a significant reduction of blood product use. Although this did not translate to a reduced rates of grade 3 primary graft dysfunction, the low-dose heparin protocol was associated with similar postoperative outcomes.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407118","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 : 2024-10-10DOI: 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":"https://doi.org/10.1016/j.jtcvs.2024.09.009","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-10","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 : 2024-10-10DOI: 10.1016/j.jtcvs.2024.09.054
James Huang, Kay See Tan, Nasser Altorki, Mara Antonoff, Shanda Blackmon, Raphael Bueno, Bryan Burt, Todd Demmy, Nathaniel Evans, Laura Donahoe, David Harpole, Doraid Jarrar, Benjamin Kozower, Michael Lanuti, Moishe Liberman, Jules Lin, Douglas Liou, Michael Liptay, James Luketich, Arjun Pennathur, Gerard Petersen, Robert Ripley, Matthew Rochefort, Christopher W Seder, Joseph Shrager, Stacey Su, Betty Tong, Yaron Shargall, Ara Vaporciyan, Thomas Waddell, Benny Weksler, Dennis Wigle, Sai Yendamuri, David R Jones
Objective: Presentation with multiple ground glass opacities (GGOs) is an increasingly common occurrence, and the optimal management of these lesions is unclear. Active surveillance has been increasingly adopted as a management strategy for other low-grade malignancies. We hypothesized that active surveillance could be a feasible and safe option for patients with multiple GGOs.
Methods: Patients with ≥2 GGOs (ground glass predominant, <50% solid, ≤3 cm) were enrolled in a multi-institutional registry and prospectively followed up on active surveillance with computed tomography scans every 6 to 12 months. Each GGO was catalogued and measured individually at each follow-up visit.
Results: Target accrual was met, with 337 patients from 23 institutions. The mean age was 70 years (interquartile range, 65-77 years), and 74% were women. Most were former (70%) or current (9%) smokers, with a mean exposure of 30 pack-years (interquartile range [IQR], 15-44 pack-years). Half of the patients (51%) had a previous lung cancer, and the majority (86%) were already under surveillance at the time of study entry. The median number of GGOs per patient was 3 (IQR, 2-5), with a total of 1467 GGOs under surveillance. The median GGO size was 0.9 cm (IQR, 0.7-1.3 cm). Most GGOs were 0.5 to 1 cm in size.
Conclusions: Active surveillance, rather than immediate intervention, was an acceptable option to patients, and accrual to this registry trial was feasible. Safety endpoints and long-term outcomes will be assessed in the planned 5-year follow-up in accordance with the protocol.
{"title":"Initial Patient Characteristics of TSOG 102: A Multicenter Prospective Registry of Active Surveillance in Patients with Multiple Ground Glass Opacities.","authors":"James Huang, Kay See Tan, Nasser Altorki, Mara Antonoff, Shanda Blackmon, Raphael Bueno, Bryan Burt, Todd Demmy, Nathaniel Evans, Laura Donahoe, David Harpole, Doraid Jarrar, Benjamin Kozower, Michael Lanuti, Moishe Liberman, Jules Lin, Douglas Liou, Michael Liptay, James Luketich, Arjun Pennathur, Gerard Petersen, Robert Ripley, Matthew Rochefort, Christopher W Seder, Joseph Shrager, Stacey Su, Betty Tong, Yaron Shargall, Ara Vaporciyan, Thomas Waddell, Benny Weksler, Dennis Wigle, Sai Yendamuri, David R Jones","doi":"10.1016/j.jtcvs.2024.09.054","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.054","url":null,"abstract":"<p><strong>Objective: </strong>Presentation with multiple ground glass opacities (GGOs) is an increasingly common occurrence, and the optimal management of these lesions is unclear. Active surveillance has been increasingly adopted as a management strategy for other low-grade malignancies. We hypothesized that active surveillance could be a feasible and safe option for patients with multiple GGOs.</p><p><strong>Methods: </strong>Patients with ≥2 GGOs (ground glass predominant, <50% solid, ≤3 cm) were enrolled in a multi-institutional registry and prospectively followed up on active surveillance with computed tomography scans every 6 to 12 months. Each GGO was catalogued and measured individually at each follow-up visit.</p><p><strong>Results: </strong>Target accrual was met, with 337 patients from 23 institutions. The mean age was 70 years (interquartile range, 65-77 years), and 74% were women. Most were former (70%) or current (9%) smokers, with a mean exposure of 30 pack-years (interquartile range [IQR], 15-44 pack-years). Half of the patients (51%) had a previous lung cancer, and the majority (86%) were already under surveillance at the time of study entry. The median number of GGOs per patient was 3 (IQR, 2-5), with a total of 1467 GGOs under surveillance. The median GGO size was 0.9 cm (IQR, 0.7-1.3 cm). Most GGOs were 0.5 to 1 cm in size.</p><p><strong>Conclusions: </strong>Active surveillance, rather than immediate intervention, was an acceptable option to patients, and accrual to this registry trial was feasible. Safety endpoints and long-term outcomes will be assessed in the planned 5-year follow-up in accordance with the protocol.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479290","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 : 2024-10-10DOI: 10.1016/j.jtcvs.2024.07.048
Milan Milojevic, Nick Freemantle, J W Awori Hayanga, Rosemary F Kelly, Patrick O Myers, René Horsleben Petersen, Isabelle Opitz, Joseph F Sabik, Faisal G Bakaeen
{"title":"Harmonizing guidelines and other clinical practice documents: A joint comprehensive methodology manual by the American Association for Thoracic Surgery (AATS), European Association for Cardio-Thoracic Surgery (EACTS), European Society of Thoracic Surgeons (ESTS), and Society of Thoracic Surgeons (STS).","authors":"Milan Milojevic, Nick Freemantle, J W Awori Hayanga, Rosemary F Kelly, Patrick O Myers, René Horsleben Petersen, Isabelle Opitz, Joseph F Sabik, Faisal G Bakaeen","doi":"10.1016/j.jtcvs.2024.07.048","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.07.048","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479288","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 : 2024-10-10DOI: 10.1016/j.jtcvs.2024.10.005
Sonali Mitra, Hee-Jin Jang, Allen Kuncheria, Sung Wook Kang, Jong Min Choi, Ji Seon Shim, Claire Lee, Priyanka Ranchod, Peter Jindra, Maheshwari Ramineni, Meera Patel, R Taylor Ripley, Shawn S Groth, Shanda H Blackmon, Bryan M Burt, Hyun-Sung Lee
Background: Immune checkpoint therapy (ICT) has significantly impacted the treatment of malignant pleural mesothelioma (MPM). Despite some promising results from combination therapies, nearly half of MPM patients do not benefit, underscoring the urgent need for reliable predictive biomarkers. This study assesses the prognostic value of serum soluble mesothelin-related peptide (SMRP) and PD-L1 levels in MPM patients receiving ICT.
Methods: We conducted a retrospective analysis of 125 MPM patients treated with ICT by measuring pre-ICT serum levels of SMRP and PD-L1. We also examined the correlation of these serum levels with tumor mRNA expressions of mesothelin and PD-L1. Both univariable and multivariable Cox regression analyses were used to determine independent prognosticators for overall survival (OS). A prospective ICT clinical trial and our historical cohort were included for validation.
Results: Seventy-seven patients (62%) were treated with either anti-PD-(L)1 monotherapy, and the remaining 38% received combination ICT. Higher pre-ICT SMRP levels were observed in epithelioid MPM compared to nonepithelioid MPM. Serum PD-L1 levels did not differ significantly between the different histologic groups. Univariable analysis identified durable clinical benefit, development of immune-related adverse events, and SMRP levels as significantly associated with OS. Multivariable analysis confirmed SMRP as an independent prognostic factor, with lower levels (≤1.35 nmol/L) correlating with improved OS. The association of high SMRP with worse prognosis was validated in the prospective ICT clinical trial cohort and not in our historical cohort treated without ICT.
Conclusions: SMRP is a promising serum biomarker for predicting survival in MPM patients treated with ICT and warrants prospective investigation.
{"title":"Soluble mesothelin-related peptide as a prognosticator in pleural mesothelioma patients receiving checkpoint immunotherapy.","authors":"Sonali Mitra, Hee-Jin Jang, Allen Kuncheria, Sung Wook Kang, Jong Min Choi, Ji Seon Shim, Claire Lee, Priyanka Ranchod, Peter Jindra, Maheshwari Ramineni, Meera Patel, R Taylor Ripley, Shawn S Groth, Shanda H Blackmon, Bryan M Burt, Hyun-Sung Lee","doi":"10.1016/j.jtcvs.2024.10.005","DOIUrl":"10.1016/j.jtcvs.2024.10.005","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint therapy (ICT) has significantly impacted the treatment of malignant pleural mesothelioma (MPM). Despite some promising results from combination therapies, nearly half of MPM patients do not benefit, underscoring the urgent need for reliable predictive biomarkers. This study assesses the prognostic value of serum soluble mesothelin-related peptide (SMRP) and PD-L1 levels in MPM patients receiving ICT.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 125 MPM patients treated with ICT by measuring pre-ICT serum levels of SMRP and PD-L1. We also examined the correlation of these serum levels with tumor mRNA expressions of mesothelin and PD-L1. Both univariable and multivariable Cox regression analyses were used to determine independent prognosticators for overall survival (OS). A prospective ICT clinical trial and our historical cohort were included for validation.</p><p><strong>Results: </strong>Seventy-seven patients (62%) were treated with either anti-PD-(L)1 monotherapy, and the remaining 38% received combination ICT. Higher pre-ICT SMRP levels were observed in epithelioid MPM compared to nonepithelioid MPM. Serum PD-L1 levels did not differ significantly between the different histologic groups. Univariable analysis identified durable clinical benefit, development of immune-related adverse events, and SMRP levels as significantly associated with OS. Multivariable analysis confirmed SMRP as an independent prognostic factor, with lower levels (≤1.35 nmol/L) correlating with improved OS. The association of high SMRP with worse prognosis was validated in the prospective ICT clinical trial cohort and not in our historical cohort treated without ICT.</p><p><strong>Conclusions: </strong>SMRP is a promising serum biomarker for predicting survival in MPM patients treated with ICT and warrants prospective investigation.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479294","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 : 2024-10-09DOI: 10.1016/j.jtcvs.2024.09.050
Tedy Sawma, Hartzell V Schaff, Fernando Juarez-Casso, Serena Rahme, Austin Todd, Joseph A Dearani, Gabor Bagameri, Steve R Ommen, Jeffrey B Geske
Objectives: Surgical septal reduction is sometimes avoided in older adults due to anticipated high operative risk. The study objectives were to compare the clinical and echocardiographic characteristics of young and older patients undergoing septal myectomy for obstructive hypertrophic cardiomyopathy and assess differences in early and late postoperative outcomes.
Methods: A total of 2663 patients with obstructive hypertrophic cardiomyopathy underwent transaortic septal myectomy between 2000 and 2021 and were categorized by age: 18 to 64 years, 65 to 74 years, and 75 years or more.
Results: Median age at the time of surgery increased over the study interval. Female sex (P < .001), hypertension P < .001), and diabetes (P = .004) were more prevalent in older patients, but extent of functional limitation (New York Heart Association) was similar (P = .092). Elderly patients had thinner septal and posterior walls (P < .001, P = .006) and less prominent asymmetry (P < .001). They are less likely to have positive genetic testing. Hospital mortality was 0.2%, 0.5%, and 1.3% in patients aged less than 65 years, 65 to 74 years, and 75 years or more, respectively (P = .06), and 5-year survivals were 97%, 93%, and 91%, respectively. Septal-to-posterior wall thickness ratio significantly correlated with increased mortality in patients aged more than 65 years, but not in patients aged less than 65 years (P = .92). Most of the patients reported improved quality of life after myectomy.
Conclusions: Clinical characteristics of obstructive hypertrophic cardiomyopathy in older patients differ from those in younger patients. More symmetric but less extensive ventricular hypertrophy and less positive genetic testing suggests that hypertrophic cardiomyopathy has distinct clinical and morphological variants in the elderly. Septal myectomy is safe in older patients, but the presence of left ventricular wall asymmetry portends a poorer prognosis.
{"title":"Clinical features and postoperative outcomes in elderly patients undergoing septal myectomy for hypertrophic cardiomyopathy.","authors":"Tedy Sawma, Hartzell V Schaff, Fernando Juarez-Casso, Serena Rahme, Austin Todd, Joseph A Dearani, Gabor Bagameri, Steve R Ommen, Jeffrey B Geske","doi":"10.1016/j.jtcvs.2024.09.050","DOIUrl":"10.1016/j.jtcvs.2024.09.050","url":null,"abstract":"<p><strong>Objectives: </strong>Surgical septal reduction is sometimes avoided in older adults due to anticipated high operative risk. The study objectives were to compare the clinical and echocardiographic characteristics of young and older patients undergoing septal myectomy for obstructive hypertrophic cardiomyopathy and assess differences in early and late postoperative outcomes.</p><p><strong>Methods: </strong>A total of 2663 patients with obstructive hypertrophic cardiomyopathy underwent transaortic septal myectomy between 2000 and 2021 and were categorized by age: 18 to 64 years, 65 to 74 years, and 75 years or more.</p><p><strong>Results: </strong>Median age at the time of surgery increased over the study interval. Female sex (P < .001), hypertension P < .001), and diabetes (P = .004) were more prevalent in older patients, but extent of functional limitation (New York Heart Association) was similar (P = .092). Elderly patients had thinner septal and posterior walls (P < .001, P = .006) and less prominent asymmetry (P < .001). They are less likely to have positive genetic testing. Hospital mortality was 0.2%, 0.5%, and 1.3% in patients aged less than 65 years, 65 to 74 years, and 75 years or more, respectively (P = .06), and 5-year survivals were 97%, 93%, and 91%, respectively. Septal-to-posterior wall thickness ratio significantly correlated with increased mortality in patients aged more than 65 years, but not in patients aged less than 65 years (P = .92). Most of the patients reported improved quality of life after myectomy.</p><p><strong>Conclusions: </strong>Clinical characteristics of obstructive hypertrophic cardiomyopathy in older patients differ from those in younger patients. More symmetric but less extensive ventricular hypertrophy and less positive genetic testing suggests that hypertrophic cardiomyopathy has distinct clinical and morphological variants in the elderly. Septal myectomy is safe in older patients, but the presence of left ventricular wall asymmetry portends a poorer prognosis.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401771","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":"Reply: Achieving environmental justice will reduce lung cancer health disparities.","authors":"Hollis Hutchings, Haroutioun Boyajian, Ikenna Okereke","doi":"10.1016/j.jtcvs.2024.08.032","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.08.032","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479293","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 : 2024-10-09DOI: 10.1016/j.jtcvs.2024.09.038
Rachel L Deitz, Ernest G Chan, John P Ryan, Jenalee N Coster, Masashi Furukawa, Chadi A Hage, Pablo G Sanchez
Objective: Lung transplantation is a complex surgical procedure performed by specialized teams. Practice changes to eliminate overnight lung transplants were implemented at our center and patient outcomes were evaluated.
Methods: Patient and donor organ selection were performed in the standard fashion. All donors with a cross clamp after 6 PM matched to any of our listed recipients-independent of their surgical complexity or risk-were kept in a temperature-controlled iceless cooler from procurement to recipient implant. All recipients had a 7 AM in-room start. Data were prospectively collected and compared to a cohort of recipients from the previous fifteen months.
Results: 82 transplants were performed at a single academic institution between 7/1/22 and 1/7/24, 21% of which included allografts with extended ischemic times utilizing the iceless cooler (n=18) with a median average temperature of 6.81 degrees Celsius. Median ischemic times were 13.9 (12.5 - 15.6) hours, more than twice the length of ischemic times in the standard group (n=64, 6.8 (6.1 - 7.4) hours). Post-operative outcomes were similar between groups, including post-operative ICU duration (12 vs 9 days in the standard group), length of stay (24 vs 20 days), PGD3 (17% vs 20%), post-operative ECMO (22% vs 20%), and six-month survival (94% vs 91%).
Conclusions: Donor lungs preserved in an iceless cooler were successfully transplanted after extended cold ischemic times. Adoption of a semi-elective transplant strategy can be successfully implemented without compromising patient outcomes. Additional advantages may be gleaned through daytime transplantation with standard transplant surgical teams rather than overnight, on call-teams.
目的:肺移植是一项复杂的外科手术,由专业团队完成。我们中心改变了做法,取消了隔夜肺移植,并对患者的治疗效果进行了评估:患者和供体器官的选择按标准方式进行。所有在下午 6 点后进行交叉钳夹并与我们列出的任何受体相匹配的供体--无论其手术复杂程度或风险如何--从采集到受体植入都被保存在一个温度可控的无冰冷藏箱中。所有受者均从早上 7 点开始在室内接受手术。我们对数据进行了前瞻性收集,并与之前 15 个月的受体群进行了比较:22年1月7日至24年7月1日期间,在一家学术机构进行了82例移植手术,其中21%的异体移植物缺血时间延长,使用无冰冷却器(18例)的中位平均温度为6.81摄氏度。缺血时间中位数为 13.9(12.5 - 15.6)小时,是标准组(64 人,6.8(6.1 - 7.4)小时)缺血时间的两倍多。各组的术后结果相似,包括术后重症监护室持续时间(标准组为 12 天 vs 9 天)、住院时间(24 天 vs 20 天)、PGD3(17% vs 20%)、术后 ECMO(22% vs 20%)和 6 个月存活率(94% vs 91%):结论:在无冰冷却器中保存的捐献肺经过延长的低温缺血时间后成功移植。采用半选择性移植策略可以在不影响患者预后的情况下成功实施移植。通过标准移植手术团队在白天进行移植手术,而不是通宵待命团队进行移植手术,可能会获得更多优势。
{"title":"Adoption of a Semi-elective Lung Transplantation Practice by Safely Extending Cold Ischemic Times.","authors":"Rachel L Deitz, Ernest G Chan, John P Ryan, Jenalee N Coster, Masashi Furukawa, Chadi A Hage, Pablo G Sanchez","doi":"10.1016/j.jtcvs.2024.09.038","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.038","url":null,"abstract":"<p><strong>Objective: </strong>Lung transplantation is a complex surgical procedure performed by specialized teams. Practice changes to eliminate overnight lung transplants were implemented at our center and patient outcomes were evaluated.</p><p><strong>Methods: </strong>Patient and donor organ selection were performed in the standard fashion. All donors with a cross clamp after 6 PM matched to any of our listed recipients-independent of their surgical complexity or risk-were kept in a temperature-controlled iceless cooler from procurement to recipient implant. All recipients had a 7 AM in-room start. Data were prospectively collected and compared to a cohort of recipients from the previous fifteen months.</p><p><strong>Results: </strong>82 transplants were performed at a single academic institution between 7/1/22 and 1/7/24, 21% of which included allografts with extended ischemic times utilizing the iceless cooler (n=18) with a median average temperature of 6.81 degrees Celsius. Median ischemic times were 13.9 (12.5 - 15.6) hours, more than twice the length of ischemic times in the standard group (n=64, 6.8 (6.1 - 7.4) hours). Post-operative outcomes were similar between groups, including post-operative ICU duration (12 vs 9 days in the standard group), length of stay (24 vs 20 days), PGD3 (17% vs 20%), post-operative ECMO (22% vs 20%), and six-month survival (94% vs 91%).</p><p><strong>Conclusions: </strong>Donor lungs preserved in an iceless cooler were successfully transplanted after extended cold ischemic times. Adoption of a semi-elective transplant strategy can be successfully implemented without compromising patient outcomes. Additional advantages may be gleaned through daytime transplantation with standard transplant surgical teams rather than overnight, on call-teams.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407117","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 : 2024-10-09DOI: 10.1016/j.jtcvs.2024.10.006
Kyle W Blackburn, Subhasis Chatterjee
{"title":"Commentary: Cutting through the noise: Can natural language processing improve literature review in cardiac surgery?","authors":"Kyle W Blackburn, Subhasis Chatterjee","doi":"10.1016/j.jtcvs.2024.10.006","DOIUrl":"10.1016/j.jtcvs.2024.10.006","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407119","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}