Journal of Thoracic and Cardiovascular Surgery最新文献

英文中文

Single-surgeon versus 2-surgeon esophagectomy 单外科医生vs双外科医生食管切除术。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.09.033

Aroub Alkaaki MD, Daniela Molena MD

引用次数: 0

The good, the bad, and the ugly: Which part for transapical mitral valve repair with neochord implantation? 好的，坏的，丑的：新脐带植入术的经尖顶二尖瓣修复的哪一部分？

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.06.016

Nicola Pradegan MD, Gino Gerosa MD

引用次数: 0

Commentary: More arteries, better outcomes: A Latin American perspective on multiarterial grafting in coronary artery bypass grafting 评论：更多的动脉，更好的结果：拉丁美洲在冠状动脉搭桥术中多动脉移植的观点。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.07.021

Subodh Verma MD, PhD, FRCSC , Shubh K. Patel , Mario Gaudino MD, MS, PhD , John D. Puskas MD

引用次数: 0

Prediction of graft patency during the year following coronary artery bypass grafting: Preoperative computed tomography–derived fractional flow reserve versus intraoperative transit-time flow measurement 预测冠状动脉旁路移植术后一年的移植物通畅：术前计算机断层扫描衍生的血流储备分数与术中瞬时血流测量。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.08.030

Min-Seok Kim MD, PhD, MSc , Ah-Jin Ryu PhD , Jung Won Kim MD , Cheol Ho Lee MD , Seong Wook Hwang MD , Ki-Bong Kim MD, PhD

Background

Preoperative cardiac computed tomography–derived fractional flow reserve (CT-FFR) and intraoperative transit-time flow measurement (TTFM) values were compared with graft patency after coronary artery bypass grafting (CABG).

Methods

One hundred and eight patients who underwent isolated CABG using an in situ internal thoracic artery (ITA)-based composite graft and whose CT-FFR values were obtained were included. TTFM values (mean graft flow [MGF; mL/min], pulsatility index [PI], and diastolic filling percentage [DF%]) were obtained for each anastomosis in all study patients. Early angiographies examined 342 anatomoses performed in all 108 patients, and 1-year angiographies examined 310 anastomoses performed in 97 patients (89.8%). Angiographic findings of graft flow were categorized as perfectly patent, bidirectionally competitive, unidirectionally competitive, and occluded. Receiver operating characteristic (ROC) curve analysis of CT-FFR and TTFM values for predicting angiographic findings was performed, and cutoff values and area under the ROC curve of CT-FFR and TTFM values were identified.

Results

The early angiograms identified 281 (82.2%) perfectly patent grafts, 33 (9.6%) bidirectionally competitive grafts, 27 (7.9%) unidirectionally competitive grafts, and 1 (0.3%) occluded graft. These numbers were 278 (89.7%), 13 (4.2%), 8 (2.6%), and 11 (3.5%), respectively, on the 1-year angiograms. CT-FFR values in coronary arteries with perfectly patent, bidirectionally competitive, and unidirectionally competitive grafts were significantly different during the year (0.640, 0.807, and 0.816, respectively, in early angiograms [P < .001] vs 0.658, 0.841, and 0.857, respectively, in 1-year angiograms [P < .001]). Cutoff values of CT-FFR, MGF, PI, and DF% predicting competitive graft flow were 0.774, 11 mL/minute, 2.8, and 72%, respectively, in early angiograms and 0.767, 12 mL/minute, 2.8, and 58.0%, respectively, in 1-year angiograms. CT-FFR values better predicted the early and 1-year competitive graft flow compared to TTFM values (MGF, P < .001; PI, P < .001; DF%, P < .001).

Conclusions

The diagnostic accuracy of CT-FFR values for predicting competitive graft flow during the year following CABG using an in situ ITA-based composite graft was high and superior to TTFM values.

背景：将术前心脏计算机断层扫描得出的血流储备分数（CT-FFR）和术中瞬时血流测量值（TTFM）与冠状动脉旁路移植术（CABG）后的移植物通畅度进行比较。方法：采用原位胸内动脉（ITA）复合移植术行孤立性冠状动脉搭桥术的患者108例，均获得CT-FFR值。获得所有患者每个吻合口的TTFM值（平均移植物流量[MGF； mL/min]、脉搏指数[PI]和舒张充血率[DF%]）。在所有108例患者中，早期血管造影检查了342例解剖，1年血管造影检查了97例患者（89.8%）的310例吻合口。血管造影结果分为完全通畅、双向竞争、单向竞争和闭塞。对CT-FFR和TTFM值预测血管造影结果的受试者工作特征（ROC）曲线进行分析，确定CT-FFR和TTFM值的截止值和曲线下面积（AUC）。结果：早期完全通畅、双向竞争、单向竞争和闭塞分别为281例（82.2%）、33例（9.6%）、27例（7.9%）和1例（0.3%），1年血管造影分别为278例（89.7%）、13例（4.2%）、8例（2.6%）和11例（3.5%）。完全通畅、双向竞争和单向竞争冠状动脉的CT-FFR值在一年内有显著差异（早期分别为0.640、0.807和0.816）。结论：原位ita基复合冠状动脉冠脉置换术后一年内预测竞争移植物流量的CT-FFR值诊断准确性高且优于TTFM值。

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引用次数: 0

Influence of the Composite allocation Score on racial/ethnic disparities in lung transplantation waitlist outcomes 肺移植等待名单结果的综合分配评分对种族差异的影响。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.08.032

Shi Nan Feng BSPH , Alexandra A. Rizaldi BA , Danica Dong BS , Alice Zhou MS , Andrew Kalra BS , Jessica Ruck MD, PhD , Sean Agbor-Enoh MD, PhD , Errol Bush MD

Objectives

We examined the influence of the March 2023 Composite Allocation Score (CAS) policy change on lung transplantation (LT) versus waitlist death/deterioration by candidate race/ethnicity.

Methods

We identified LT candidates listed from 2020 to 2024 in the United Network for Organ Sharing database. Candidates were categorized by race/ethnicity (White, Black, Hispanic, or Asian). LT versus waitlist death/deterioration was compared across racial/ethnic groups for candidates listed pre-versus post-CAS. Multivariable competing risk regression, including an interaction term for CAS evaluated whether CAS modified the association between race/ethnicity and waitlist outcomes. Separate competing risk models assessed whether disparities persisted post-CAS.

Results

Of 12,478 candidates listed for LT (median age = 63 years; 59.3% men; 71.5% White, 10.3% Black, 14.3% Hispanic, and 3.9% Asian), 9058 candidates were listed pre-CAS and 3420 post-CAS. Post-CAS, the proportion of LT within 6 months increased significantly for Hispanic candidates (80.9% vs 66.8%; P < .001), whereas waitlist death/deterioration decreased for White (3.7% vs 5.8%; P < .001), Black (4.1% vs 7.5%; P = .042), and Hispanic (4.8% vs 8.8%; P < .001) candidates. Competing risk analyses revealed that pre-CAS, Black (subdistribution hazard ratio, 0.88; 95% CI, 0.81-0.95; P = .001), Hispanic (subdistribution hazard ratio, 0.88; 95% CI, 0.82-0.95; P = .001), and Asian (subdistribution hazard ratio, 0.84; 95% CI, 0.75-0.95; P = .006) candidates had significantly lower likelihoods of LT compared with White candidates. Interaction term analysis revealed a greater post-CAS increase in LT likelihood for Hispanic compared with White candidates (interaction subdistribution hazard ratio, 1.23; 95% CI, 1.08-1.39; P = .002). Post-CAS, no significant disparities in waitlist outcomes remained between racial/ethnic groups.

Conclusions

CAS implementation was associated with improved LT access for Hispanic candidates. Race/ethnicity does not predict risk of LT or waitlist death/deterioration in the post-CAS era.

目的：我们研究了2023年3月综合分配评分（CAS）政策变化对肺移植（LT）与候选种族/民族等待名单死亡/恶化的影响。方法：我们从联合器官共享网络数据库中确定2020-2024年列出的LT候选人。候选人按种族/民族（白人、黑人、西班牙裔或亚洲人）分类。在不同种族/族裔的候选者中，对cas前和cas后的候选者进行了LT与等候名单死亡/恶化的比较。多变量竞争风险回归包括CAS的相互作用项，评估CAS是否修改了种族/民族与候补名单结果之间的关联。独立的竞争风险模型评估了cas后差异是否持续存在。结果：在12478名LT患者中（中位年龄为63岁，男性59.3%，白人71.5%，黑人10.3%，西班牙裔14.3%，亚裔3.9%），9058名患者为cas前患者，3420名患者为cas后患者。在CAS后，西班牙裔候选人6个月内的LT比例显著增加（80.9% vs. 66.8%）。结论：CAS的实施与西班牙裔候选人LT获取的改善有关。种族/民族不能预测后cas时代LT或候补死亡/恶化的风险。

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引用次数: 0

Refining surgical decision-making for high-risk stage IA Non–Small cell lung cancer 改进高风险IA期非小细胞肺癌的手术决策。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.09.009

Qiang Wu MD, Zhe Fan MD, Hao Su MD, Ting Lei MD

引用次数: 0

Adult Articles in AATS Journals 成人文章在AATS期刊

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/S0022-5223(25)00997-3

引用次数: 0

Is propensity score matching still a valid design choice for surgical comparative effectiveness research? 倾向评分匹配仍然是外科比较疗效研究的有效设计选择吗？

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.03.035

Fei Wan PhD

引用次数: 0

Commentator Discussion: From zone −1 to zone 3: Feasibility and safety of complex endovascular aortic repairs in type A aortic dissection 讲解员讨论：从1区到3区：A型主动脉夹层复杂血管内主动脉修复的可行性和安全性。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.03.017

引用次数: 0

Outcomes of ischemic mitral regurgitation after coronary revascularization alone in patients with acute coronary syndrome 急性冠脉综合征患者单独冠脉血运重建术后缺血性二尖瓣反流的结局。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.jtcvs.2025.04.037

Mincheol Chae MD , Sungsil Yoon MD , Hee Jeong Lee MD , Woo Sung Jang MD, PhD , Yun Seok Kim MD, PhD , Jaehyeong Cho PhD , Kitae Kim MD , Kyungsub Song MD

Objective

Ischemic mitral regurgitation impacts patient survival and quality of life due to left ventricular remodeling post–myocardial infarction. However, effective treatment strategies for this condition, particularly in the setting of acute coronary syndrome, remain insufficiently evidenced. In this article, we provide treatment references for the management of ischemic mitral regurgitation in patients with acute coronary syndrome.

Methods

In this single-center retrospective study, we evaluated patients with ischemic mitral regurgitation who underwent coronary revascularization for acute coronary syndrome without concurrent mitral valve surgery. Patients were categorized into 2 groups based on mitral regurgitation severity: grade II (grade II ischemic mitral regurgitation, n = 117) and grade III-IV (grade III or IV ischemic mitral regurgitation, n = 40). The primary end point was the improvement in mitral regurgitation severity at 2 years.

Results

Baseline characteristics did not differ significantly between the groups. Ischemic mitral regurgitation significantly improved in the grade II group compared with the grade III-IV group (70.9% vs 30%, P < .001). Multivariate analyses revealed that left ventricular reverse remodeling (odds ratio, 5.712; 95% CI, 1.716-19.046; P = .005) and effective management of congestive heart failure (odds ratio, 3.900; 95% CI, 1.322-11.501; P = .01) were significant predictors of ischemic mitral regurgitation improvement in the grade II group. However, there were no significant predictors of ischemic mitral regurgitation improvement in the grade III-IV group, including left ventricular reverse remodeling (odds ratio, 6.302; 95% CI, 0.476-71.800; P = .17).

Conclusions

In patients with acute coronary syndrome and ischemic mitral regurgitation, coronary revascularization alone was insufficient for treating advanced ischemic mitral regurgitation, grade III or IV, necessitating additional treatment options for ischemic mitral regurgitation.

目的：缺血性二尖瓣反流（IMR）影响心肌梗死后左室重构患者的生存和生活质量。然而，有效的治疗策略，特别是在急性冠脉综合征（ACS）的情况下，仍然没有充分的证据。本文为ACS患者IMR的处理提供治疗参考。方法：在这项单中心回顾性研究中，我们评估了因ACS接受冠状动脉血运重建术而未同时进行二尖瓣手术的IMR患者。患者根据MR严重程度分为两组：II级（II级IMR， n = 117）和III-IV级（III或IV级IMR， n = 40）。主要终点是两年时MR严重程度的改善。结果：两组间基线特征无显著差异。与III-IV级相比，II级组的IMR显著改善（70.9% vs. 30%, p < 0.001）。多因素分析显示左室（LV）反向重构(OR, 5.712；95% ci, 1.716-19.046；p = 0.005)和充血性心力衰竭的有效管理(OR, 3.900；95% ci, 1.322-11.501；p = 0.01)是II级组IMR改善的显著预测因子。然而，III-IV级组没有显著的IMR改善预测因子，包括左室反向重构(OR, 6.302；95% ci, 0.476-71.800；P = 0.17)。结论：在ACS和IMR患者中，单独冠脉血运重建术不足以治疗晚期IMR， III级或IV级，需要额外的IMR治疗方案。

{"title":"Outcomes of ischemic mitral regurgitation after coronary revascularization alone in patients with acute coronary syndrome","authors":"Mincheol Chae MD , Sungsil Yoon MD , Hee Jeong Lee MD , Woo Sung Jang MD, PhD , Yun Seok Kim MD, PhD , Jaehyeong Cho PhD , Kitae Kim MD , Kyungsub Song MD","doi":"10.1016/j.jtcvs.2025.04.037","DOIUrl":"10.1016/j.jtcvs.2025.04.037","url":null,"abstract":"<div><h3>Objective</h3><div>Ischemic mitral regurgitation<span><span><span><span> impacts patient survival and quality of life due to left </span>ventricular remodeling post–myocardial infarction. However, effective treatment strategies for this condition, particularly in the setting of </span>acute coronary syndrome, remain insufficiently evidenced. In this article, we provide treatment references for the management of ischemic </span>mitral regurgitation<span> in patients with acute coronary syndrome.</span></span></div></div><div><h3>Methods</h3><div><span>In this single-center retrospective study, we evaluated patients with ischemic mitral regurgitation<span> who underwent coronary revascularization for acute coronary syndrome without concurrent </span></span>mitral valve surgery. Patients were categorized into 2 groups based on mitral regurgitation severity: grade II (grade II ischemic mitral regurgitation, n = 117) and grade III-IV (grade III or IV ischemic mitral regurgitation, n = 40). The primary end point was the improvement in mitral regurgitation severity at 2 years.</div></div><div><h3>Results</h3><div><span>Baseline characteristics did not differ significantly between the groups. Ischemic mitral regurgitation significantly improved in the grade II group compared with the grade III-IV group (70.9% vs 30%, </span><em>P <</em><span> .001). Multivariate analyses revealed that left ventricular reverse remodeling (odds ratio, 5.712; 95% CI, 1.716-19.046; </span><em>P =</em><span> .005) and effective management of congestive heart failure (odds ratio, 3.900; 95% CI, 1.322-11.501; </span><em>P =</em> .01) were significant predictors of ischemic mitral regurgitation improvement in the grade II group. However, there were no significant predictors of ischemic mitral regurgitation improvement in the grade III-IV group, including left ventricular reverse remodeling (odds ratio, 6.302; 95% CI, 0.476-71.800; <em>P =</em> .17).</div></div><div><h3>Conclusions</h3><div>In patients with acute coronary syndrome and ischemic mitral regurgitation, coronary revascularization alone was insufficient for treating advanced ischemic mitral regurgitation, grade III or IV, necessitating additional treatment options for ischemic mitral regurgitation.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 1","pages":"Pages 122-132.e1"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Journal of Thoracic and Cardiovascular Surgery

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