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Comparing 3-Year Survival and Readmissions between HeartMate 3 and Heart Transplant as Primary Treatment for Advanced Heart Failure 比较作为晚期心力衰竭主要治疗方法的 HeartMate 3 和心脏移植手术的 3 年生存率和再住院率
Pub Date : 2023-12-27 DOI: 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.

目标我们的目标是比较接受 HeartMate 3(HM3)左心室辅助装置(LVAD)或正位心脏移植(OHT)作为晚期心衰主要治疗方法的患者的 3 年生存率和再住院率。方法我们回顾性分析了 2014 年 1 月至 2021 年 3 月期间在本中心接受 HM3 LVAD 或列入 OHT 的 381 名成年患者。为了尽量减少交叉偏倚,我们排除了曾接受过 LVAD 的 OHT 患者,并在移植时对 HM3 患者进行了剔除。队列采用倾向评分匹配(PSM),以减少混杂变量。主要结果是 3 年存活率。结果各组包括 185 名(49%)HM3 患者和 196 名(51%)OHT 患者,每组有 104 名 PSM 患者。PSM 后,3 年生存率无统计学差异(HM3 83.7% 对 OHT 87.0%,P = 0.91;RR = 1.00,95% CI = 0.45-2.20)。在非匹配队列中,18-49 岁患者使用 HM3 的存活率与 OHT 相当(96.9% vs 95.9%,N = 91,P = 1.00;RR = 0.92,95% CI = [0.09-9.78]);50 岁以上患者使用 HM3 的存活率相似,尽管有 8.9% 的差异(75.0% vs 83.9%,N = 290,P = 0.60;RR = 1.51,95% CI = [0.85-2.68])。结论这项探索性分析表明,作为心衰的主要治疗方法,对于类似患者,HM3的3年生存率可能与OHT相当,但可能导致更多的再入院率。
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引用次数: 0
Age Is Superior to Aortopathy Phenotype as a Predictor of Aortic Mechanics in Patients with Bicuspid Valve 年龄比大动脉病变表型更能预测双腔瓣患者的主动脉力学状况
Pub Date : 2023-12-26 DOI: 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.

目的根据主动脉最大扩张区域,将主动脉瓣二尖瓣(BAV)主动脉病变定义为三种表型--根型、升型和弥漫型。我们试图确定主动脉机械性能和主动脉病变表型与其他临床变量之间的关联。方法从 2016 年 1 月 8 日至 2022 年 1 月 3 日,我们从 105 名因 BAV 主动脉病变而接受择期升主动脉瘤修复术的患者身上收集了 375 份主动脉标本。平面双轴数据(191 个标本)提供了动脉壁的构成描述,这些描述与活体几何和血流动力学相结合,可预测生理负荷下的刚度、应力和能量密度。单轴测试(184 个样本)评估了失效拉伸和失效考氏应力。结果根表型(样本数=33,31%)和上升/弥漫表型(样本数=72,69%)的机械指标无明显差异。双轴测试表明,年龄越大,周向刚度越大,应力越小,能量密度越小。在单轴测试中,纵向与周向试样在明显较低的考氏应力(第 50 个百分位数[第 15 个百分位数,第 85 个百分位数]:1.0 [0.7, 1.6] MPa vs. 1.9 [1.3, 3.1] MPa; P<0.001)。年龄与失效拉伸和应力的降低有关。结论BAV主动脉病变在生理和衰竭条件下的主动脉机械功能与年龄密切相关,而与主动脉病变表型关系不大。有数据表明,BAV 主动脉病变的根部表型预示着较差的预后,这不太可能与表型特异的异常组织力学有关。
{"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>&lt;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":null,"pages":null},"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}
引用次数: 0
Discussion to: Long-term implantable ventricular assist device support in children 讨论到儿童的长期植入式心室辅助装置支持
Pub Date : 2023-12-22 DOI: 10.1016/j.jtcvs.2023.11.042
Abstract not available
无摘要
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引用次数: 0
Discussion to: Impact of preoperative aortic regurgitation on long-term autograft durability and dilatation in children and adolescents undergoing the Ross procedure 讨论到:接受罗斯手术的儿童和青少年术前主动脉瓣反流对长期自体移植耐久性和扩张的影响
Pub Date : 2023-12-22 DOI: 10.1016/j.jtcvs.2023.11.036
Abstract not available
无摘要
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引用次数: 0
Discussion to: Should mitral valve replacement age guidelines be lowered due to better bioprosthetic mitral valve durability? 讨论到:生物人工二尖瓣耐用性提高,是否应降低二尖瓣置换年龄指南?
Pub Date : 2023-12-21 DOI: 10.1016/j.jtcvs.2023.11.033
Abstract not available
无摘要
{"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":"Abstract not available","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139029601","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}
引用次数: 0
What Determines Outcomes in Multivalve Reoperations? Effect of Patient and Surgical Complexity 是什么决定了多瓣再手术的结果?患者和手术复杂性的影响
Pub Date : 2023-12-09 DOI: 10.1016/j.jtcvs.2023.12.005
Joshua E. Insler, Aaron E. Tipton, Faisal G. Bakaeen, Jules J. Bakhos, Penny L. Houghtaling, Eugene H. Blackstone, Eric E. Roselli, Edward G. Soltesz, Michael Z. Tong, Shinya Unai, Kenneth McCurry, Patrick Vargo, Kevin Hodges, Nicholas G. Smedira, Gösta B. Pettersson, Aaron Weiss, Marijan Koprivanac, Haytham Elgharably, A. Marc Gillinov, Lars G. Svensson

Objective

Patient characteristics, risks, and outcomes associated with reoperative multivalve cardiac surgery are poorly characterized. Effect of patient variables and surgical components of each reoperation were evaluated with regard to operative mortality.

Methods

From January 2008 to January 2022, 2324 patients with previous cardiac surgery underwent 2352 reoperations involving repair or replacement of multiple cardiac valves at Cleveland Clinic. Mean age was 66±14 years. Number of surgical components representing surgical complexity (valve procedures, aortic surgery, coronary artery bypass grafting [CABG], and atrial fibrillation procedures) ranged from 2 to 6. Random forest for imbalanced data was used to identify risk factors for operative mortality.

Results

Surgery was elective in 1327 (56%), urgent in 1006 (43%), and emergency in 19 (0.8%). First-time reoperations were performed in 1796 (76%) and 556 (24%) had 2 or more previous operations. Isolated multivalve operations comprised 54% (1265) of cases; 1087 incorporated additional surgical components. Two valves were operated on in 80% (1889) of cases, 3 in 20% (461), and 4 in 0.09% (2). Operative mortality was 4.2% (98/2352), with 1.7% (12/704) for elective, isolated multivalve reoperations. For each added surgical component, operative mortality incrementally increased, from 2.4% for 2 components (24/1009) to 17% for ≥5 (5/30). Predictors of operative mortality included CABG, surgical urgency, cardiac, renal dysfunction, peripheral artery disease, New York Heart Association functional class, and anemia.

Conclusions

Elective, isolated reoperative multivalve surgery can be performed with low mortality. Surgical complexity coupled with key physiologic factors can be used to inform surgical risk and decision-making.

目标与再手术多瓣膜心脏手术相关的患者特征、风险和预后特征尚不明确。方法从2008年1月到2022年1月,克利夫兰诊所的2324名曾接受过心脏手术的患者接受了2352例涉及修复或置换多个心脏瓣膜的再手术。平均年龄为 66±14 岁。代表手术复杂程度的手术组件数量(瓣膜手术、主动脉手术、冠状动脉旁路移植术 [CABG] 和心房颤动手术)从 2 到 6 不等。结果1327例(56%)为择期手术,1006例(43%)为紧急手术,19例(0.8%)为急诊手术。1796人(76%)首次接受再手术,556人(24%)曾接受过2次或2次以上手术。单独的多瓣膜手术占病例总数的54%(1265例),其中1087例使用了额外的手术组件。80%的病例(1889例)对两个瓣膜进行了手术,20%的病例(461例)对3个瓣膜进行了手术,0.09%的病例(2例)对4个瓣膜进行了手术。手术死亡率为 4.2%(98/2352),其中 1.7%(12/704)为选择性、孤立的多瓣膜再手术。每增加一个手术组件,手术死亡率就会增加,从2个组件的2.4%(24/1009)增加到≥5个组件的17%(5/30)。手术死亡率的预测因素包括 CABG、手术紧迫性、心脏、肾功能障碍、外周动脉疾病、纽约心脏协会功能分级和贫血。手术的复杂性和关键生理因素可为手术风险和决策提供参考。
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引用次数: 0
Discussion to: The severity of chronic obstructive pulmonary disease is associated with adverse outcomes after open thoracoabdominal aortic aneurysm repair 讨论到:慢性阻塞性肺病的严重程度与开放性胸腹主动脉瘤修补术后的不良预后有关
Pub Date : 2023-12-07 DOI: 10.1016/j.jtcvs.2023.10.053
Abstract not available
无摘要
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引用次数: 0
Multifocal Disease Progression and Subsequent Intervention in Patients with Actin Alpha-2 Variants; A Single Center Experience 肌动蛋白α-2变异体患者的多灶性疾病进展和后续干预;单中心经验
Pub Date : 2023-12-06 DOI: 10.1016/j.jtcvs.2023.11.052
Jean-Luc A. Maigrot, Patrick R. Vargo, Benjamin Kramer, Christina Rigelsky, Joanna Ghobrial, Kenneth Zahka, Hani Najm, Eric E. Roselli

Objectives

Describe patient characteristics and indications for surgical intervention, reoperation, and outcomes in patients with actin alpha-2 (ACTA2) variants.

Methods

Single center retrospective cohort study with prospective follow-up was performed for 38 patients with an ACTA2 variant.

Results

From 1999–2020, twenty-six (70%) patients underwent surgery, 11 remain under surveillance (mean follow-up 7.5 ± 5 years). Median age at index operation was 42 (range 10-69) years, with 4 pediatric cases. Thoracic aortic aneurysm was present in 19 (73%) patients (mean adult max diameter 5.2 ± 0.8 cm, pediatric z-score 10.7 ± 5.4). Aortic dissection was present in 13 (50%) patients, with 4 (15%) having Type A dissection. Operations included replacement of the aortic root in 16 (17%), ascending aorta in 20 (77%), and aortic arch in 14 (54%) patients. Four (15%) patients had coronary artery disease (CAD), and 2 (7.7%) underwent concomitant coronary artery bypass grafting. There was no operative mortality, stroke, re-operation for bleeding, or dialysis-dependent renal failure; One (3.8%) patient developed acute on chronic kidney injury. Three patients (12%) required prolonged ventilation. Eleven (42%) patients underwent 26 reoperations, median time 45 (range 4-147) months, including 5 open thoracoabdominal aneurysm repairs.

Conclusions

Patients with ACTA2 variants frequently develop aortic aneurysm and are at risk of aortic dissection and CAD. However, age at diagnosis and symptoms at presentation are highly variable. Multiple operations are often required for disease management, particularly after dissection. Close monitoring and timely intervention are important in mitigating disease progression and improving outcomes.

目的描述肌动蛋白α-2(ACTA2)变异体患者的特征、手术干预指征、再次手术和预后。方法对38例ACTA2变异体患者进行前瞻性随访的单中心回顾性队列研究。手术年龄中位数为 42 岁(10-69 岁),其中 4 例为儿童。19例(73%)患者存在胸主动脉瘤(成人最大直径平均为5.2 ± 0.8厘米,儿童z-score为10.7 ± 5.4)。13例(50%)患者存在主动脉夹层,其中4例(15%)为A型夹层。手术包括更换主动脉根部 16 例(17%)、升主动脉 20 例(77%)和主动脉弓 14 例(54%)。4名患者(15%)患有冠状动脉疾病(CAD),2名患者(7.7%)同时接受了冠状动脉旁路移植手术。手术中没有出现死亡、中风、因出血再次手术或透析依赖性肾衰竭;1 名患者(3.8%)出现急性慢性肾损伤。三名患者(12%)需要延长通气时间。11名患者(42%)接受了26次再手术,中位时间为45个月(4-147个月),其中包括5次开胸腹部动脉瘤修补术。然而,确诊时的年龄和发病时的症状差异很大。通常需要多次手术才能控制病情,尤其是在夹层发生后。密切监测和及时干预对于缓解疾病进展和改善预后非常重要。
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引用次数: 0
National utilization, trends, and lung transplant outcomes of static vs. portable ex vivo lung perfusion platforms. 静态与便携式体外肺灌注平台的全国使用情况、趋势和肺移植结果。
Pub Date : 2023-12-01 DOI: 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":null,"pages":null},"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}
引用次数: 0
Discussion to: Digital spatial profiling to predict recurrence in grade 3 stage I lung adenocarcinoma. 讨论到:预测肺腺癌 3 级 I 期复发的数字空间剖面图。
Pub Date : 2023-12-01 DOI: 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":null,"pages":null},"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}
引用次数: 0
期刊
The Journal of Thoracic and Cardiovascular Surgery
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