Journal of Thoracic and Cardiovascular Surgery最新文献

英文中文

Donor and Recipient Factors Associated with Primary Graft Dysfunction Following Lung Transplantation: A DMG Registry Analysis. 与肺移植后原发性移植物功能障碍相关的供体和受体因素：DMG 登记分析。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2024.10.045

Isaac S Alderete, Cathlyn K Medina, Arya Pontula, Samantha E Halpern, Alexandria L Soto, Kunal J Patel, Jacob A Klapper, Matthew G Hartwig

Objective: Current risk-adjusted models to predict primary graft dysfunction (PGD) following lung transplantation (LTx) do not include bedside donor critical care data. Donor management goals (DMG) represent predefined critical care endpoints aimed at optimizing multi-organ donor management. Here, we sought to identify novel predictors to better understand the relationship between donor management and PGD following LTx.

Methods: We used the national DMG registry to identify a cohort of LTx recipients linked to their respective donors between January 1^st, 2015 and March 1st, 2023. Grade 3 PGD (PGD3) was defined according to modified ISHLT criteria. Multivariable modeling was performed to identify risk factors for the development of PGD3.

Results: A total of 2704 eligible patients were identified of which 643 (23.8%) developed PGD3. After multivariable modeling, the likelihood of PGD3 was greater with increased donor age (OR 1.06 [1.02, 1.10] per 5 year change, p=0.003), increased donor serum pH at the time of authorization (OR 1.14 [1.02, 1.25] per 0.1 increase, p=0.016), donor history of cocaine use (OR 1.34 [1.05, 1.71], p=0.020), and increased recipient central venous pressure (1.03 [1.01, 1.06], p=0.005). Recipients who received donor lungs in which the DMG for PF ratio was met had a lower likelihood of developing PGD3 (OR 0.63 [0.46, 0.86], p=0.006).

Conclusion: This study leverages a novel detailed donor management database to identify factors associated with the development of PGD3. These factors may be used to recognize donors and recipients that may benefit from early interventions to improve short-term outcomes.

目的：目前用于预测肺移植（LTx）后原发性移植物功能障碍（PGD）的风险调整模型不包括床旁供体重症监护数据。供体管理目标（DMG）是预先确定的重症监护终点，旨在优化多器官供体管理。在此，我们试图找出新的预测因素，以更好地了解LTx后供体管理与PGD之间的关系：我们利用全国 DMG 登记册确定了 2015 年 1 月 1 日至 2023 年 3 月 1 日期间与各自供体相关联的 LTx 受体队列。3级PGD（PGD3）是根据修改后的ISHLT标准定义的。结果显示，共有 2704 名符合条件的患者出现了 3 级 PGD（PGD3）：结果：共确定了 2704 名符合条件的患者，其中 643 人（23.8%）出现了 PGD3。经多变量建模后，供体年龄增加（每 5 年变化 OR 1.06 [1.02, 1.10]，P=0.003）、授权时供体血清 pH 值增加（OR 1.14 [1.02, 1.25] per 0.1 increase, p=0.016）、供体有可卡因使用史（OR 1.34 [1.05, 1.71]，p=0.020）和受体中心静脉压升高（1.03 [1.01, 1.06]，p=0.005）。接受符合DMG与PF比值的供肺的受者发生PGD3的可能性较低（OR 0.63 [0.46，0.86]，P=0.006）：本研究利用新颖、详细的捐献者管理数据库来识别与 PGD3 发生相关的因素。这些因素可用于识别可能受益于早期干预以改善短期结果的供体和受体。

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引用次数: 0

Bovine pericardial versus porcine bioprosthetic aortic valves: A nationwide population-based cohort study in Korea 牛心包与猪生物主动脉瓣：韩国一项基于全国人群的队列研究。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jtcvs.2023.10.060

Hong Rae Kim MD , Ho Jin Kim MD , Seonok Kim MD , Yejee Kim MD , Jung-Min Ahn MD , Joon Bum Kim MD , Dae-Hee Kim MD

Objective

To compare the clinical outcomes of aortic valve replacement (AVR) using bovine pericardial and porcine bioprostheses, utilizing a nationwide administrative claims database.

Methods

Adult patients (age ≥40 years) who underwent bioprosthetic AVR, without other valve replacements, between 2003 and 2018 were identified from the Korean National Health Insurance Service database. The outcomes of interest were all-cause mortality, cardiac mortality, and valve-related events, including the incidence of reoperation, endocarditis, systemic thromboembolism, and major bleeding. Baseline adjustment was performed using propensity score matching. Time-related outcomes were evaluated using a competing risk analysis, with death as a competing risk.

Results

Among the 7714 patients who underwent bioprosthetic AVR, 5621 (72.9%) received bovine pericardial prostheses and 2093 (27.1%) received porcine bioprostheses. After matching, 1937 pairs were included in the final analysis. During follow-up (median, 4.49 years; interquartile range, 2.83-8.20 years), the use of porcine bioprostheses was associated with a higher risk of aortic valve reoperation (adjusted hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.16 to 3.01); however, no significant differences were observed in cumulative incidences of all-cause mortality, cardiac mortality, thromboembolism, or major bleeding. Subgroup analyses revealed that the use of bovine valves was associated with improved survival in patients with diabetes mellitus, whereas in patients undergoing dialysis, porcine valves exhibited better survival than bovine valves.

Conclusions

In this large nationwide cohort study of patients undergoing bioprosthetic aortic valve replacement, the use of porcine prostheses was significantly associated with an increased risk of reoperation compared with the use of bovine prostheses, supporting previous findings.

目的：利用全国管理索赔数据库，比较使用牛心包和猪生物瓣膜进行主动脉瓣置换术的临床结果。方法：从韩国国家健康保险服务数据库中确定2003年至2018年间接受生物主动脉瓣置换术但未进行其他瓣膜置换术的成年患者（≥40岁）。感兴趣的结果是全因死亡率、心脏死亡率和瓣膜相关事件，包括再次手术、心内膜炎、系统性血栓栓塞和大出血的发生率。使用倾向评分匹配进行基线调整。使用竞争风险分析评估与时间相关的结果，将死亡作为竞争风险。结果：在7714例接受生物主动脉瓣置换术的患者中，5621例（72.9%）接受了牛心包膜置换术，2093例（27.1%）接受了猪生物瓣膜置换术。匹配后，1937对被纳入最终分析。在随访期间（中位数4.49年，四分位间距2.83-8.20），使用猪生物瓣膜与主动脉瓣再次手术的风险较高相关（调整后的HR为1.87；95%置信区间为1.16-3.01）；然而，在全因死亡率、心脏死亡率、血栓栓塞或大出血的累积发生率方面没有观察到显著差异。亚组分析显示，使用牛瓣膜可提高糖尿病患者的生存率，而在接受透析的患者中，猪瓣膜的生存率高于牛瓣膜。结论：在这项针对接受生物主动脉瓣置换术患者的大规模全国性队列研究中，与牛人工瓣膜相比，使用猪人工瓣膜与再次手术风险增加显著相关，这支持了先前的研究结果。

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引用次数: 0

Invest in the Future 投资未来

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-11-01 DOI: 10.1016/S0022-5223(24)00886-9

引用次数: 0

Commentary: Epiaortic Ultrasound: Better Habit than Haphazard. 评论：主动脉超声：习惯胜于随意

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-10-30 DOI: 10.1016/j.jtcvs.2024.10.039

Mimi Xiaoming Deng, Abdulaziz M Alhothali, Terrence M Yau

引用次数: 0

Also, long live the joint general surgery/thoracic surgery (4+3) pathway! 此外，普外科/胸外科（4+3）联合路径万岁！

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-10-30 DOI: 10.1016/j.jtcvs.2024.10.002

John J Squiers, Emily Shih, Robert M Goldstein, J Michael DiMaio

引用次数: 0

Commentator Discussion: Cardiac Surgical Unit-Advanced Life Support-certified centers are associated with improved failure to rescue after cardiac arrest: A propensity score-matched analysis. 评论员讨论：心脏外科-高级生命支持认证中心与改善心脏骤停后抢救失败率有关：倾向得分匹配分析。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-10-30 DOI: 10.1016/j.jtcvs.2024.10.001

引用次数: 0

Commentary: Blood Biomarkers: Barriers and Benefits. 评论：血液生物标志物：障碍与益处。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-10-30 DOI: 10.1016/j.jtcvs.2024.10.040

Rebecca Bellis, Victoria Cranwell, Prasad S Adusumilli

引用次数: 0

Commentator Discussion: Personalizing patient risk of a life-altering event: An application of machine learning to hemiarch surgery. 评论员讨论：个性化病人面临改变生命事件的风险：机器学习在半弓手术中的应用。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-10-30 DOI: 10.1016/j.jtcvs.2024.07.003

引用次数: 0

The long-term impact of lesion set in the surgical ablation of atrial fibrillation during mitral valve surgery: multi-center propensity-score weighted study. 二尖瓣手术中心房颤动手术消融病灶设置的长期影响：多中心倾向分数加权研究。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-10-29 DOI: 10.1016/j.jtcvs.2024.10.036

Won Kyung Pyo, Joon Bum Kim, Yang Hyun Cho, Hyung Gon Je, Hee-Jung Kim, Seung Hyun Lee

Objective: This study aimed to assess the effect of the lesion sets for surgical ablation (SA) of atrial fibrillation (AF) on long-term outcomes and identify the optimal lesion set.

Methods: Between 2005 and 2017, 1825 patients underwent SA concomitant to mitral valve (MV) surgery in the participating institutions. Of these, 529 underwent left atrial (LA) ablation, whereas the remainder had biatrial (BA) ablation. The clinical and rhythm outcomes were compared, considering death as a competing event. Inverse probability treatment weighting (IPTW) was used to mitigate the selection bias.

Results: The patients undergoing LA ablation were younger and less frequently had long-standing AF with a shorter duration or required concomitant tricuspid valve surgery. Adjusted analysis showed that LA ablation was associated with a lower risk of early pacemaker implantation (odds ratio, 0.16; 95% confidence interval [CI], 0.07-0.38; p<0.001) than BA ablation. Over a median follow-up of 70.4 months (interquartile 44.1-111.2 months), the LA ablation group presented a higher risk of AF recurrence (subdistribution hazard ratio [SHR]1.26; 95% CI 1.12-1.41; p<0.001), with a 5-year cumulative incidence of 34.2% compared to 28.6% in the BA group. The risk of late mortality (SHR, 1.17; 95% CI, 0.74-1.86; p=0.507) and stroke (SHR, 1.21; 95% CI, 0.82-1.79; p=0.345) did not differ between the groups CONCLUSION: In patients undergoing SA concomitant to MV surgery, both lesion sets provided comparable incidence of mortality and stroke. However, BA ablation was associated with a superior rhythm outcome at the expense of a higher risk of early pacemaker implantation.

目的本研究旨在评估心房颤动（房颤）手术消融（SA）的病灶组对长期预后的影响，并确定最佳病灶组：2005 年至 2017 年间，参与研究的机构共有 1825 名患者在接受二尖瓣手术的同时接受了房颤消融术。其中，529 名患者接受了左心房（LA）消融术，其余患者接受了双心房（BA）消融术。将死亡作为竞争事件，对临床和心律结果进行了比较。采用反概率治疗加权法（IPTW）减轻选择偏差：结果：接受LA消融术的患者年龄较轻，房颤持续时间较短或需要同时接受三尖瓣手术的患者较少。调整后的分析表明，LA消融术与较低的早期起搏器植入风险相关（几率比为0.16；95%置信区间[CI]为0.07-0.38；P＜0.05）。

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引用次数: 0

Operation for acute type A aortic dissection with internal carotid artery occlusion: Is it justified? 急性 A 型主动脉夹层伴颈内动脉闭塞的手术：手术合理吗？

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2024-10-28 DOI: 10.1016/j.jtcvs.2024.10.003

Hiroshi Nagamine, Hiroshi Nagano, Mitsuru Asano

引用次数: 0

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