Pub Date : 2025-02-19DOI: 10.1016/j.athoracsur.2025.01.031
Feng Long, Ronghua Zhou
{"title":"Goal-directed Perfusion Strategy During Pediatric Cardiac Operation: Further Detail to Enhance Its Clinical Applicability.","authors":"Feng Long, Ronghua Zhou","doi":"10.1016/j.athoracsur.2025.01.031","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.031","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.athoracsur.2025.01.030
Juan M Farina, Jonathan D'Cunha
{"title":"Sorting Out the Pieces of Fragmented Lung Cancer Care.","authors":"Juan M Farina, Jonathan D'Cunha","doi":"10.1016/j.athoracsur.2025.01.030","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.030","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-13DOI: 10.1016/j.athoracsur.2025.01.028
John Calhoon, Joe Cleveland, William Baumgartner
{"title":"In Memoriam: David Fullerton, STS Past President and Superb Cardiac Surgeon, Educator, Investigator and Leader (1952 - 2024).","authors":"John Calhoon, Joe Cleveland, William Baumgartner","doi":"10.1016/j.athoracsur.2025.01.028","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.028","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-13DOI: 10.1016/j.athoracsur.2025.02.001
Aaron Guo, Nahush Ashok Mokadam
{"title":"The future is the present, but not always the past.","authors":"Aaron Guo, Nahush Ashok Mokadam","doi":"10.1016/j.athoracsur.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.02.001","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-12DOI: 10.1016/j.athoracsur.2025.01.026
John Eisenga, Kyle McCullough, Jasjit Banwait, Timothy George, Kelley Hutcheson, Robert Smith, J Michael DiMaio, Justin Schaffer
Background: Surgical ablation(SA) at the time of isolated mitral valve surgery(MVS) is recommended in patients with preexisting atrial fibrillation(AF). However, SA remains infrequently utilized during MVS with a poorly quantified impact on stroke and survival.
Methods: Medicare claims(2008-2019) were queried to identify beneficiaries with preexisting AF undergoing MVS. All-cause mortality and the post-operative incidence of stroke/transient ischemic attack(TIA) were evaluated as separate endpoints. Overlap propensity score weighting was used to risk-adjust for measured confounding variables. Analyses were repeated using surgeon frequency of SA as an instrumental variable to adjust for unmeasured confounding variables.
Results: From 2008-2019, 41,795 Medicare beneficiaries with a preexisting diagnosis of AF underwent MVS. Surgeons were categorized, with 1,326 infrequently(bottom quartile) performing SA(<30%; 10,364 beneficiaries) and 740 frequently(top quartile) performing SA(≥62%; 10,476 beneficiaries) during MVS. Beneficiaries undergoing MVS with SA("as-treated" analysis) had a risk-adjusted median survival advantage of 0.56[0.33-0.81] years (8.85[8.64-9.04] vs 8.29[8.11-8.47] years, P<0.001 for risk-adjusted survival comparison) compared to those without. Beneficiaries undergoing MVS by frequent SA surgeons("surgeon-preference" analysis) had a risk-adjusted median survival advantage of 0.35[0.05-0.71] years (8.59[8.40-8.85] vs 8.24[7.97-8.40] years, P=0.0015 for risk-adjusted survival comparison) compared to surgeons who infrequently performed SA.
Conclusions: In Medicare beneficiaries with preexisting AF, concomitant SA during MVS is associated with improved survival, as is undergoing surgery by a frequent SA surgeon. When analyzed based on surgeon preference for SA, the magnitude and time-dependent nature of the treatment effect of SA were substantially different compared to the "as-treated" analysis, suggesting that "as-treated" analyses may be subject to bias from unmeasured confounding variables.
背景:对于已有心房颤动(房颤)的患者,建议在进行孤立二尖瓣手术(MVS)时进行手术消融(SA)。然而,在二尖瓣置换术中使用手术消融的情况仍不常见,对中风和存活率的影响也很少量化:方法:查询了医疗保险报销单(2008-2019 年),以确定接受 MVS 的原有房颤受益人。将全因死亡率和术后中风/短暂性脑缺血发作(TIA)发生率作为单独的终点进行评估。采用重叠倾向评分加权法对测量的混杂变量进行风险调整。使用外科医生的SA频率作为工具变量重复分析,以调整未测量的混杂变量:2008-2019 年间,41,795 名已有房颤诊断的医疗保险受益人接受了 MVS。对外科医生进行了分类,其中1326名外科医生很少(最低四分位数)进行SA手术:对于已有心房颤动的医保受益人而言,在 MVS 期间同时进行 SA 与生存率的提高有关,由经常进行 SA 的外科医生进行手术也与生存率的提高有关。根据外科医生对 SA 的偏好进行分析时,SA 治疗效果的程度和时间依赖性与 "按治疗 "分析相比有很大不同,这表明 "按治疗 "分析可能会受到未测量混杂变量的影响。
{"title":"Enhanced Survival With Surgical Ablation of Atrial Fibrillation During Mitral Valve Surgery.","authors":"John Eisenga, Kyle McCullough, Jasjit Banwait, Timothy George, Kelley Hutcheson, Robert Smith, J Michael DiMaio, Justin Schaffer","doi":"10.1016/j.athoracsur.2025.01.026","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.026","url":null,"abstract":"<p><strong>Background: </strong>Surgical ablation(SA) at the time of isolated mitral valve surgery(MVS) is recommended in patients with preexisting atrial fibrillation(AF). However, SA remains infrequently utilized during MVS with a poorly quantified impact on stroke and survival.</p><p><strong>Methods: </strong>Medicare claims(2008-2019) were queried to identify beneficiaries with preexisting AF undergoing MVS. All-cause mortality and the post-operative incidence of stroke/transient ischemic attack(TIA) were evaluated as separate endpoints. Overlap propensity score weighting was used to risk-adjust for measured confounding variables. Analyses were repeated using surgeon frequency of SA as an instrumental variable to adjust for unmeasured confounding variables.</p><p><strong>Results: </strong>From 2008-2019, 41,795 Medicare beneficiaries with a preexisting diagnosis of AF underwent MVS. Surgeons were categorized, with 1,326 infrequently(bottom quartile) performing SA(<30%; 10,364 beneficiaries) and 740 frequently(top quartile) performing SA(≥62%; 10,476 beneficiaries) during MVS. Beneficiaries undergoing MVS with SA(\"as-treated\" analysis) had a risk-adjusted median survival advantage of 0.56[0.33-0.81] years (8.85[8.64-9.04] vs 8.29[8.11-8.47] years, P<0.001 for risk-adjusted survival comparison) compared to those without. Beneficiaries undergoing MVS by frequent SA surgeons(\"surgeon-preference\" analysis) had a risk-adjusted median survival advantage of 0.35[0.05-0.71] years (8.59[8.40-8.85] vs 8.24[7.97-8.40] years, P=0.0015 for risk-adjusted survival comparison) compared to surgeons who infrequently performed SA.</p><p><strong>Conclusions: </strong>In Medicare beneficiaries with preexisting AF, concomitant SA during MVS is associated with improved survival, as is undergoing surgery by a frequent SA surgeon. When analyzed based on surgeon preference for SA, the magnitude and time-dependent nature of the treatment effect of SA were substantially different compared to the \"as-treated\" analysis, suggesting that \"as-treated\" analyses may be subject to bias from unmeasured confounding variables.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-11DOI: 10.1016/j.athoracsur.2025.01.024
Anthony V Norman, Matthew P Weber, Mohamad El Moheb, Alexander M Wisniewski, Raymond J Strobel, Alan Speir, Michael Mazzeffi, Aarathi Manchikalapud, Mark Joseph, Daniel Tang, Ramesh Singh, Mohammed Quader, Jared P Beller, Kenan Yount, Nicholas R Teman
Background: Non-ST elevation myocardial infarction (NSTEMI) patients benefit from revascularization, but guidelines are vague regarding optimal timing. We aimed to identify the ideal timing of coronary artery bypass grafting (CABG) after NSTEMI.
Methods: We examined NSTEMI patients who underwent isolated CABG within 30 days of cardiac catheterization between July 2011-July 2023 using a multicenter regional collaborative. Patients were stratified into three groups: <2 days, 3-7 days, and 8-30 days. Multivariable logistic regression analysis was performed to identify risk factors associated with mortality.
Results: We identified 10,271 CABG patients, of which 3,464 (34%) underwent CABG within <2 days, 5,751 (56%) 3-7 days, and 1056 (10%) 8-30 days. The 3-7 day group had the lowest median Society of Thoracic Surgeons predicted risk of mortality (1.36% vs. 1.35% vs. 2.09%, p<0.001). The <2 day group more frequently presented with left main disease (19% vs. 16% vs. 16%, p<0.001) and cardiogenic shock (5.1% vs. 1.8% vs. 2%, p<0.001). Mean cardiopulmonary bypass time was similar between groups (97 mins vs 97 vs 97, p=0.63). The 3-7 day group had the lowest operative mortality (3.2% vs. 1.8% vs. 4%, p<0.001) and major morbidity (14% vs 11% vs. 16%, p<0.001). After risk-adjustment, the 3-7 day window was associated with decreased mortality compared to <2 days (OR 0.56, 95%CI 0.4-0.78, p<0.001) and 8-30 days (OR 0.51, 95%CI 0.32-0.81, p<0.001).
Conclusions: CABG between 3-7 days after cardiac catheterization for NSTEMI was associated with the lowest risk of mortality. When possible, CABG within this window may afford better outcomes.
{"title":"Ideal Timing of Coronary Artery Bypass Grafting after Non-ST Elevation Myocardial Infarction.","authors":"Anthony V Norman, Matthew P Weber, Mohamad El Moheb, Alexander M Wisniewski, Raymond J Strobel, Alan Speir, Michael Mazzeffi, Aarathi Manchikalapud, Mark Joseph, Daniel Tang, Ramesh Singh, Mohammed Quader, Jared P Beller, Kenan Yount, Nicholas R Teman","doi":"10.1016/j.athoracsur.2025.01.024","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.024","url":null,"abstract":"<p><strong>Background: </strong>Non-ST elevation myocardial infarction (NSTEMI) patients benefit from revascularization, but guidelines are vague regarding optimal timing. We aimed to identify the ideal timing of coronary artery bypass grafting (CABG) after NSTEMI.</p><p><strong>Methods: </strong>We examined NSTEMI patients who underwent isolated CABG within 30 days of cardiac catheterization between July 2011-July 2023 using a multicenter regional collaborative. Patients were stratified into three groups: <2 days, 3-7 days, and 8-30 days. Multivariable logistic regression analysis was performed to identify risk factors associated with mortality.</p><p><strong>Results: </strong>We identified 10,271 CABG patients, of which 3,464 (34%) underwent CABG within <2 days, 5,751 (56%) 3-7 days, and 1056 (10%) 8-30 days. The 3-7 day group had the lowest median Society of Thoracic Surgeons predicted risk of mortality (1.36% vs. 1.35% vs. 2.09%, p<0.001). The <2 day group more frequently presented with left main disease (19% vs. 16% vs. 16%, p<0.001) and cardiogenic shock (5.1% vs. 1.8% vs. 2%, p<0.001). Mean cardiopulmonary bypass time was similar between groups (97 mins vs 97 vs 97, p=0.63). The 3-7 day group had the lowest operative mortality (3.2% vs. 1.8% vs. 4%, p<0.001) and major morbidity (14% vs 11% vs. 16%, p<0.001). After risk-adjustment, the 3-7 day window was associated with decreased mortality compared to <2 days (OR 0.56, 95%CI 0.4-0.78, p<0.001) and 8-30 days (OR 0.51, 95%CI 0.32-0.81, p<0.001).</p><p><strong>Conclusions: </strong>CABG between 3-7 days after cardiac catheterization for NSTEMI was associated with the lowest risk of mortality. When possible, CABG within this window may afford better outcomes.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-11DOI: 10.1016/j.athoracsur.2025.01.023
Connor Raikar, Stanley Wolfe, Luigi F Lagazzi, Ali Darehzereshki, Nathan Kister, Lawrence Wei, Vinay Badhwar, J Hunter Mehaffey
Background: Patients with endocarditis frequently require valve surgery, and despite recent growth of minimally invasive cardiac surgery (MICS) for complex valve operations, consensus recommendations still suggest conventional sternotomy.
Methods: Institutional Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database evaluated all patients undergoing valve surgery for endocarditis (1/2016-3/2024). Patients were stratified by conventional sternotomy vs MICS approach, including hemi-sternotomy, right -thoracotomy, and robotic-assisted mitral/tricuspid/aortic valve surgery. Logistic regression assessed risk-adjusted association with the primary outcomes of STS major morbidity or mortality and MICS approach accounting for all covariates in current STS risk models.
Results: Of 741 patients undergoing valve surgery for endocarditis, median age 37 years, 582 (78.5%) had substance use disorder, 210 (28.3%) redo sternotomies and 166 (22.4%) redo valve operations. MICS was associated with a higher repair rate for mitral valves (76.3% vs 48%, p<0.0001) but lower for tricuspid valve (22.5% vs 44.1%, p<0.0001), with no difference for aortic valves (8.3% vs 7.4%, p=0.372). Prior to risk adjustment, MICS was associated with longer cross clamp times (99 min vs 86 min, p=0.019) but lower incidence of STS major morbidity or mortality (15.4% vs 27.8%, p=0.019). After robust risk adjustment, age (OR 1.1, p=0.008), lung disease (OR 2.2, p=0.010), preoperative creatinine (OR 1.3, p=0.016), valve repair vs replacement (OR 0.17, p=0.002), but not MICS (OR 1.2, p=0.807) were independently associated with STS major morbidity and mortality.
Conclusions: MICS valve surgery for endocarditis appears both safe and effective, with similar repair rates and risk adjusted outcomes to open surgery.
{"title":"Minimally Invasive Valve Surgery for Patients with Infective Endocarditis: A Comparative Study.","authors":"Connor Raikar, Stanley Wolfe, Luigi F Lagazzi, Ali Darehzereshki, Nathan Kister, Lawrence Wei, Vinay Badhwar, J Hunter Mehaffey","doi":"10.1016/j.athoracsur.2025.01.023","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.023","url":null,"abstract":"<p><strong>Background: </strong>Patients with endocarditis frequently require valve surgery, and despite recent growth of minimally invasive cardiac surgery (MICS) for complex valve operations, consensus recommendations still suggest conventional sternotomy.</p><p><strong>Methods: </strong>Institutional Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database evaluated all patients undergoing valve surgery for endocarditis (1/2016-3/2024). Patients were stratified by conventional sternotomy vs MICS approach, including hemi-sternotomy, right -thoracotomy, and robotic-assisted mitral/tricuspid/aortic valve surgery. Logistic regression assessed risk-adjusted association with the primary outcomes of STS major morbidity or mortality and MICS approach accounting for all covariates in current STS risk models.</p><p><strong>Results: </strong>Of 741 patients undergoing valve surgery for endocarditis, median age 37 years, 582 (78.5%) had substance use disorder, 210 (28.3%) redo sternotomies and 166 (22.4%) redo valve operations. MICS was associated with a higher repair rate for mitral valves (76.3% vs 48%, p<0.0001) but lower for tricuspid valve (22.5% vs 44.1%, p<0.0001), with no difference for aortic valves (8.3% vs 7.4%, p=0.372). Prior to risk adjustment, MICS was associated with longer cross clamp times (99 min vs 86 min, p=0.019) but lower incidence of STS major morbidity or mortality (15.4% vs 27.8%, p=0.019). After robust risk adjustment, age (OR 1.1, p=0.008), lung disease (OR 2.2, p=0.010), preoperative creatinine (OR 1.3, p=0.016), valve repair vs replacement (OR 0.17, p=0.002), but not MICS (OR 1.2, p=0.807) were independently associated with STS major morbidity and mortality.</p><p><strong>Conclusions: </strong>MICS valve surgery for endocarditis appears both safe and effective, with similar repair rates and risk adjusted outcomes to open surgery.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}