Pub Date : 2023-12-27DOI: 10.1016/j.jtcvs.2023.12.019
Michael Kirschner, Veli K. Topkara, Jocelyn Sun, Paul Kurlansky, Yuji Kaku, Yoshifumi Naka, Melana Yuzefpolskaya, Paolo C. Colombo, Gabriel Sayer, Nir Uriel, Koji Takeda
Objective
Our objective was to compare 3-year survival and readmissions of patients who received HeartMate 3 (HM3) left ventricular assist device (LVAD) or orthotopic heart transplantation (OHT) as primary treatment for advanced heart failure.
Methods
We retrospectively analyzed 381 adult patients who received HM3 LVAD or were listed for OHT between January 2014 and March 2021 at our center. To minimize crossover bias, OHT patients with prior LVAD were excluded and HM3 patients were censored at time of transplant. Cohorts were propensity score-matched (PSM) to reduce confounding variables. Primary outcome was 3-year survival. Secondary outcome was mean cumulative, all-cause, unplanned readmission.
Results
Cohorts consisted of 185 (49%) HM3 patients and 196 (51%) OHT patients, with 104 PSM patients in each group. After PSM, there was no statistical difference in 3-year survival (HM3 83.7% vs. OHT 87.0%, P = 0.91; RR = 1.00, 95% CI = 0.45-2.20). In unmatched cohorts, patients ages 18-49 had comparable survival with HM3 as with OHT (96.9% vs 95.9%, N = 91, P = 1.00; RR = 0.92, 95% CI = [0.09-9.78]); patients ages 50+ had similar with HM3, despite an 8.9% difference (75.0% vs 83.9%, N = 290, P = 0.60; RR = 1.51, 95% CI = [0.85-2.68]). Mean cumulative readmissions at 3-years was higher in the HM3 cohort (3.89 vs. 2.05, P < 0.001).
Conclusion
This exploratory analysis suggests that for similar patients HM3 may provide comparable 3-year survival to OHT as a primary treatment for heart failure, but may result in more readmissions.
{"title":"Comparing 3-Year Survival and Readmissions between HeartMate 3 and Heart Transplant as Primary Treatment for Advanced Heart Failure","authors":"Michael Kirschner, Veli K. Topkara, Jocelyn Sun, Paul Kurlansky, Yuji Kaku, Yoshifumi Naka, Melana Yuzefpolskaya, Paolo C. Colombo, Gabriel Sayer, Nir Uriel, Koji Takeda","doi":"10.1016/j.jtcvs.2023.12.019","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.12.019","url":null,"abstract":"<h3>Objective</h3><p>Our objective was to compare 3-year survival and readmissions of patients who received HeartMate 3 (HM3) left ventricular assist device (LVAD) or orthotopic heart transplantation (OHT) as primary treatment for advanced heart failure.</p><h3>Methods</h3><p>We retrospectively analyzed 381 adult patients who received HM3 LVAD or were listed for OHT between January 2014 and March 2021 at our center. To minimize crossover bias, OHT patients with prior LVAD were excluded and HM3 patients were censored at time of transplant. Cohorts were propensity score-matched (PSM) to reduce confounding variables. Primary outcome was 3-year survival. Secondary outcome was mean cumulative, all-cause, unplanned readmission.</p><h3>Results</h3><p>Cohorts consisted of 185 (49%) HM3 patients and 196 (51%) OHT patients, with 104 PSM patients in each group. After PSM, there was no statistical difference in 3-year survival (HM3 83.7% vs. OHT 87.0%, P = 0.91; RR = 1.00, 95% CI = 0.45-2.20). In unmatched cohorts, patients ages 18-49 had comparable survival with HM3 as with OHT (96.9% vs 95.9%, N = 91, P = 1.00; RR = 0.92, 95% CI = [0.09-9.78]); patients ages 50+ had similar with HM3, despite an 8.9% difference (75.0% vs 83.9%, N = 290, P = 0.60; RR = 1.51, 95% CI = [0.85-2.68]). Mean cumulative readmissions at 3-years was higher in the HM3 cohort (3.89 vs. 2.05, P < 0.001).</p><h3>Conclusion</h3><p>This exploratory analysis suggests that for similar patients HM3 may provide comparable 3-year survival to OHT as a primary treatment for heart failure, but may result in more readmissions.</p>","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139051559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-26DOI: 10.1016/j.jtcvs.2023.12.018
Matthew A. Thompson, Benjamin Kramer, Samar A. Tarraf, Emily Vianna, Callan Gillespie, Emidio Germano, Brett Gentle, Frank Cikach, Ashley M. Lowry, Amol Pande, Eugene Blackstone, Jennifer Hargrave, Robb Colbrunn, Chiara Bellini, Eric E. Roselli
Objectives
Bicuspid aortic valve (BAV) aortopathy is defined by three phenotypes—root, ascending, and diffuse—based on region of maximal aortic dilation. We sought to determine the association between aortic mechanical behavior and aortopathy phenotype versus other clinical variables.
Methods
From 08/01/2016 to 03/01/2022, 375 aortic specimens were collected from 105 patients undergoing elective ascending aortic aneurysm repair for BAV aortopathy. Planar biaxial data (191 specimens) informed constitutive descriptors of the arterial wall that were combined with in vivo geometry and hemodynamics to predict stiffness, stress, and energy density under physiologic loads. Uniaxial testing (184 specimens) evaluated failure stretch and failure Cauchy stress. Boosting regression was implemented to model the association between clinical variables and mechanical metrics.
Results
There were no significant differences in mechanical metrics between the root phenotype (N=33, 31%) and ascending/diffuse phenotypes (N=72, 69%). Biaxial testing demonstrated older age was associated with increased circumferential stiffness, decreased stress, and decreased energy density. On uniaxial testing, longitudinally versus circumferentially oriented specimens failed at significantly lower Cauchy stress (50th [15th, 85th percentiles]: 1.0 [0.7, 1.6] MPa vs. 1.9 [1.3, 3.1] MPa; P<0.001). Age was associated with decreased failure stretch and stress. Elongated ascending aortas were also associated with decreased failure stress.
Conclusions
Aortic mechanical function under physiologic and failure conditions in BAV aortopathy is robustly associated with age and poorly associated with aortopathy phenotype. Data suggesting that the root phenotype of BAV aortopathy portends worse outcomes are unlikely to be related to aberrant, phenotype-specific tissue mechanics.
{"title":"Age Is Superior to Aortopathy Phenotype as a Predictor of Aortic Mechanics in Patients with Bicuspid Valve","authors":"Matthew A. Thompson, Benjamin Kramer, Samar A. Tarraf, Emily Vianna, Callan Gillespie, Emidio Germano, Brett Gentle, Frank Cikach, Ashley M. Lowry, Amol Pande, Eugene Blackstone, Jennifer Hargrave, Robb Colbrunn, Chiara Bellini, Eric E. Roselli","doi":"10.1016/j.jtcvs.2023.12.018","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.12.018","url":null,"abstract":"<h3>Objectives</h3><p>Bicuspid aortic valve (BAV) aortopathy is defined by three phenotypes—root, ascending, and diffuse—based on region of maximal aortic dilation. We sought to determine the association between aortic mechanical behavior and aortopathy phenotype versus other clinical variables.</p><h3>Methods</h3><p>From 08/01/2016 to 03/01/2022, 375 aortic specimens were collected from 105 patients undergoing elective ascending aortic aneurysm repair for BAV aortopathy. Planar biaxial data (191 specimens) informed constitutive descriptors of the arterial wall that were combined with <em>in vivo</em> geometry and hemodynamics to predict stiffness, stress, and energy density under physiologic loads. Uniaxial testing (184 specimens) evaluated failure stretch and failure Cauchy stress. Boosting regression was implemented to model the association between clinical variables and mechanical metrics.</p><h3>Results</h3><p>There were no significant differences in mechanical metrics between the root phenotype (N=33, 31%) and ascending/diffuse phenotypes (N=72, 69%). Biaxial testing demonstrated older age was associated with increased circumferential stiffness, decreased stress, and decreased energy density. On uniaxial testing, longitudinally versus circumferentially oriented specimens failed at significantly lower Cauchy stress (50th [15th, 85th percentiles]: 1.0 [0.7, 1.6] MPa vs. 1.9 [1.3, 3.1] MPa; <em>P</em><0.001). Age was associated with decreased failure stretch and stress. Elongated ascending aortas were also associated with decreased failure stress.</p><h3>Conclusions</h3><p>Aortic mechanical function under physiologic and failure conditions in BAV aortopathy is robustly associated with age and poorly associated with aortopathy phenotype. Data suggesting that the root phenotype of BAV aortopathy portends worse outcomes are unlikely to be related to aberrant, phenotype-specific tissue mechanics.</p>","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139054360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.1016/j.jtcvs.2023.11.042
Abstract not available
无摘要
{"title":"Discussion to: Long-term implantable ventricular assist device support in children","authors":"","doi":"10.1016/j.jtcvs.2023.11.042","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.11.042","url":null,"abstract":"Abstract not available","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139029602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.1016/j.jtcvs.2023.11.036
Abstract not available
无摘要
{"title":"Discussion to: Impact of preoperative aortic regurgitation on long-term autograft durability and dilatation in children and adolescents undergoing the Ross procedure","authors":"","doi":"10.1016/j.jtcvs.2023.11.036","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.11.036","url":null,"abstract":"Abstract not available","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139029599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.jtcvs.2023.12.015
A. Zhou, J. Ruck, A. Casillan, Emily L. Larson, Benjamin L. Shou, J. Ha, Pali D. Shah, Christian A. Merlo, Errol L. Bush
{"title":"National utilization, trends, and lung transplant outcomes of static vs. portable ex vivo lung perfusion platforms.","authors":"A. Zhou, J. Ruck, A. Casillan, Emily L. Larson, Benjamin L. Shou, J. Ha, Pali D. Shah, Christian A. Merlo, Errol L. Bush","doi":"10.1016/j.jtcvs.2023.12.015","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.12.015","url":null,"abstract":"","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":"69 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139016416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.jtcvs.2023.11.039
{"title":"Discussion to: Digital spatial profiling to predict recurrence in grade 3 stage I lung adenocarcinoma.","authors":"","doi":"10.1016/j.jtcvs.2023.11.039","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.11.039","url":null,"abstract":"","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":"48 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139014748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.jtcvs.2023.11.033
{"title":"Discussion to: Should mitral valve replacement age guidelines be lowered due to better bioprosthetic mitral valve durability?","authors":"","doi":"10.1016/j.jtcvs.2023.11.033","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.11.033","url":null,"abstract":"","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":"291 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139026440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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