首页 > 最新文献

Journal of Thoracic and Cardiovascular Surgery最新文献

英文 中文
Commentator Discussion: Metabolomic studies reveal an organ-protective hibernation state in donor lungs preserved at 10 °C. 评论员讨论:代谢组学研究揭示了保存在 10 °C的供体肺的器官保护性冬眠状态。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-10 DOI: 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}
引用次数: 0
Bloodless lung transplantation: Comparison between 2 central venoarterial extracorporeal membrane oxygenation anticoagulation strategies and their impact on lung transplant outcomes. 无血肺移植:两种中央静脉动脉 ECMO 抗凝策略的比较及其对肺移植结果的影响。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-10 DOI: 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.

目的我们报告了 VA-ECMO 术中支持期间两种抗凝方案的差异及其对肺移植术后预后的影响:我们对 2016 年 1 月 1 日至 2023 年 12 月 30 日期间接受术中 VA-ECMO 的双肺移植患者进行了回顾性分析。在此期间实施了两种不同的抗凝方案。其中一个方案包括目标 ACT > 180s,并在拔管后逆转质胺。第二种方案包括在插管时使用 75 Ui 的肝素,在 ECMO 启动后不重新给药并输注 TXA:共有 116 名患者(46 名低肝素患者,70 名标准患者)纳入分析。两组患者的插管策略和 ECMO 循环相同。低肝素方案组的手术时间(7.28 小时对 8.53 小时,P0.99)、肺炎(P=0.38)或急性肾损伤(需要肾脏替代治疗)(P=0.59)更短。移植后72小时出现严重3级PGD的比例没有差异(P=0.42):结论:我们的低肝素VA-ECMO方案用于肺移植术中支持,显著减少了血液制品的使用。结论:我们的低肝素 VA-ECMO 术中支持方案大大减少了血液制品的使用量,虽然这并没有降低 PGD 3 的发生率,但低肝素方案与相似的术后结果相关。
{"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}
引用次数: 0
Commentator Discussion: The cone repair allows right ventricle rehabilitation with excellent tricuspid valve function following the Starnes procedure. 评论员讨论:锥形修复术可使右心室康复,并在 Starnes 手术后保持良好的三尖瓣功能。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-10 DOI: 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}
引用次数: 0
Initial Patient Characteristics of TSOG 102: A Multicenter Prospective Registry of Active Surveillance in Patients with Multiple Ground Glass Opacities. TSOG 102 的初始患者特征:多中心前瞻性登记,对多发性磨玻璃翳患者进行积极监控。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-10 DOI: 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.

目的:多发性磨玻璃不透明(GGOs)越来越常见,但这些病变的最佳治疗方法尚不明确。主动监测已逐渐成为其他低度恶性肿瘤的一种治疗策略。我们假设,对于多发性 GGOs 患者来说,主动监测可能是一种可行且安全的选择:方法:≥2 例 GGOs(磨玻璃为主,结果:≥2 例 GGOs)患者:来自 23 家机构的 337 名患者达到了预期目标。平均年龄为 70 岁(四分位数间距为 65-77 岁),74% 为女性。大多数患者曾经(70%)或现在(9%)吸烟,平均吸烟量为 30 包年(四分位数间距 [IQR],15-44 包年)。半数患者(51%)曾患肺癌,大多数患者(86%)在加入研究时已处于监测中。每名患者的 GGOs 中位数为 3(IQR,2-5),共监测到 1467 个 GGOs。GGO 大小的中位数为 0.9 厘米(IQR,0.7-1.3 厘米)。大多数 GGO 大小为 0.5 至 1 厘米:结论:积极监测而非立即干预是患者可以接受的选择,而且这项登记试验是可行的。根据方案,将在计划的 5 年随访中对安全性终点和长期疗效进行评估。
{"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}
引用次数: 0
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). 协调指南和其他临床实践文件:美国胸外科协会 (AATS)、欧洲心胸外科协会 (EACTS)、欧洲胸外科医师协会 (ESTS) 和胸外科医师协会 (STS) 联合编写的综合方法手册。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-10 DOI: 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}
引用次数: 0
Soluble mesothelin-related peptide as a prognosticator in pleural mesothelioma patients receiving checkpoint immunotherapy. 可溶性间皮素相关肽作为胸膜间皮瘤患者接受检查点免疫疗法的预后指标
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-10 DOI: 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.

目的:免疫检查点疗法(ICT)对恶性胸膜间皮瘤(MPM)的治疗产生了重大影响。尽管联合疗法取得了一些令人鼓舞的结果,但仍有近一半的间皮瘤患者未能从中获益,这就凸显了对可靠预测性生物标志物的迫切需求。本研究评估了接受ICT治疗的MPM患者血清可溶性间皮素相关肽(SMRP)和PD-L1水平的预后价值:我们对125名接受ICT治疗的MPM患者进行了回顾性分析,测量了ICT前血清中SMRP和PD-L1的水平。我们还研究了这些血清水平与 MSLN 和 PD-L1 肿瘤 mRNA 表达的相关性。我们使用单变量和多变量考克斯回归分析来确定总生存期(OS)的独立预后指标。一项前瞻性ICT临床试验和我们的历史队列被纳入验证范围:77名患者(62%)接受了抗PD-(L)1单药治疗,其余38%接受了联合ICT治疗。在上皮样与非上皮样骨髓瘤中观察到较高的ICT前SMRP水平。血清PD-L1水平在各组间无显著差异。单变量分析发现,持久临床获益、免疫相关不良事件的发生和SMRP水平与OS显著相关。多变量分析证实,SMRP是一个独立的预后因素,较低水平(≤1.35 nmol/L)与OS改善相关。高SMRP与较差预后的关联在前瞻性ICT临床试验队列中得到了验证,而在我们未接受ICT治疗的历史队列中未得到验证:结论:SMRP是预测接受ICT治疗的MPM患者生存期的一种有希望的血清生物标志物,值得进行前瞻性研究。
{"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}
引用次数: 0
Clinical features and postoperative outcomes in elderly patients undergoing septal myectomy for hypertrophic cardiomyopathy. 因肥厚型心肌病而接受房间隔肌肉切除术的老年患者的临床特征和术后效果。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-09 DOI: 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.

背景:由于预期手术风险较高,老年人有时会避免进行房间隔减容手术:方法:2663 名 oHCM 患者在 2000 年至 2021 年间接受了经主动脉房间隔切除术,并按年龄分为:18-64 岁、65-74 岁和≥75 岁:结果:在研究期间,手术时的中位年龄有所增加。结果:手术时的中位年龄随研究间隔而增加:老年 oHCM 患者的临床特征与年轻患者不同。心室肥大更对称但范围更小,基因检测阳性率更低,这表明老年 HCM 具有不同的临床和形态变异。对老年患者进行室间隔切除术是安全的,但左心室壁不对称预示着预后较差。
{"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}
引用次数: 0
Reply: Achieving environmental justice will reduce lung cancer health disparities. 答复:实现环境正义将减少肺癌健康差异。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-09 DOI: 10.1016/j.jtcvs.2024.08.032
Hollis Hutchings, Haroutioun Boyajian, Ikenna Okereke
{"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}
引用次数: 0
Adoption of a Semi-elective Lung Transplantation Practice by Safely Extending Cold Ischemic Times. 通过安全延长冷缺血时间,采用半选择性肺移植实践。
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-09 DOI: 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}
引用次数: 0
Commentary: Cutting through the noise: Can natural language processing improve literature review in cardiac surgery? 评论:拨开杂音--自然语言处理能否改善心脏外科的文献综述?
IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-09 DOI: 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}
引用次数: 0
期刊
Journal of Thoracic and Cardiovascular Surgery
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1