Annals of Thoracic Surgery最新文献

Background: The Thoracic Surgery Directors Association In-Training Exam (TSITE) provides an annual, formative standardized assessment for cardiothoracic surgery trainees. This report outlines its historical development, governance, administration, and performance data from exams delivered from 2020 to 2025.

Methods: The TSITE is administered annually by the Thoracic Surgery Directors Association to assess trainee knowledge using a structured taxonomy aligned with American Board of Thoracic Surgery (ABTS) qualification content. The multiple-choice question exam comprises 160 questions (80 cardiac, 80 thoracic) derived through a rigorous question-writing and vetting process. Annual metrics included exam completion time, average scores, performance distribution, and Cronbach alpha.

Results: Examinee numbers increased from 437 in 2020 to 567 in 2025. Cronbach alpha ranged from 0.80 to 0.86, reflecting high reliability. A shift from four options, with three distractors to three options and two distractors in 2025 decreased average exam time. Score distributions demonstrated stable performance trends, with most trainees scoring between 50% and 69%.

Conclusions: The TSITE is a valid, reliable, and evolving personalized learning tool that supports both trainee self-assessment and programmatic benchmarking. Its iterative refinement reflects ongoing efforts to align with evolving clinical practice, ABTS expectations, and user feedback.

Background: Hypertrophic obstructive cardiomyopathy (HOCM) is a structurally heterogeneous disease with variable clinical outcomes. While septal myectomy provides symptomatic benefits, interindividual differences in postoperative risk and long-term prognosis remain unknown.

Methods: A retrospective cohort of 699 patients with HOCM was analyzed. A Latent class analysis model was derived to identify distinct subgroups. Group-specific postoperative and long-term outcomes were compared. A decision tree model was developed to simplify clinical classification.

Results: Three subgroups were identified: Group 1 (younger patients), Group 2 (older patients with smaller left atrial diameter [LAD]), and Group 3 (older patients with enlarged LAD). Compared with Group 1, Group 3 had a significantly higher risk of postoperative new-onset atrial fibrillation, prolonged ventilation, renal failure, and composite complications During a median follow-up of 7.7 years, Group 3 showed an increased risk of composite outcome of all-cause mortality and cardiac readmission (adjusted hazard ratio, 1.67; 95% CI, 1.13-2.45, P = 0.009) and major adverse cardiac and cerebrovascular events (adjusted hazard ratio, 2.18; 95% CI, 1.17-4.05; P = 0.014). Group 1 had the highest risk of ventricular arrhythmias compared with Group 2 (adjusted hazard ratio, 2.58; 95% CI, 1.20-5.57; P = 0.016). A simplified decision tree using age ≥ 50 years and LAD ≥ 42 mm achieved a classification accuracy of 95.7%.

Conclusions: Latent class analysis revealed distinct subgroups of HOCM. Older patients with enlarged LAD portended the highest cardiovascular risk, while younger patients had elevated arrhythmia risk. Subgroup-based stratification may inform personalized perioperative and long-term surveillance strategies in HOCM patients.

Background: Tracheobronchomalacia is characterized by excessive dynamic airway collapse, often associated with a wide posterior membrane. We report outcomes of an innovative tapering membrane reduction tracheobronchoplasty (TMRT) designed to narrow the posterior membrane and improve functional airway stability.

Methods: Retrospective study of patients who underwent TMRT for severe tracheobronchomalacia with wide posterior membrane from 2022-2024 at two institutions. Under bronchoscopic guidance, a longitudinal strip of posterior membrane was resected with concurrent two-layered longitudinal closure. Patient characteristics and outcomes were analyzed.

Results: Eighty-five patients (male 65%; esophageal atresia 66%) underwent TMRT at median age of 30 months (range newborn-21 years). Common indications included recurrent respiratory infections (41%), inability to wean from positive pressure ventilation (21%) and blue spells (18%) . Tapered segment was tracheal (68%), bronchial (5%), and both (27%). Concomitant procedures included posterior tracheobronchopexy (96%), posterior descending aortopexy (7%), and esophageal repair (35%). Median follow was 22 (interquartile range 18-26) months. Significant improvements were seen in blue spells, respiratory infections and ability to wean from ventilation or supplemental oxygen (p<0.05). Complications included esophageal leak (4%), transient vocal fold dysfunction (7%), chylothorax (4%), dysphagia requiring esophageal dilation (8%), and tracheal stenosis requiring dilation (1%). Four patients (5%) required subsequent airway procedures. There were no mortalities.

Conclusions: TMRT is feasible and safe for severe tracheobronchomalacia with a wide posterior membrane and is associated with substantial early improvement in functional airway stability and respiratory outcomes. Further study is needed to assess long-term durability and broader applicability.

Background: Native aortic valve endocarditis (NAVE) could present with invasive pathology, which may require complex aortic root reconstruction. Therefore, we aim to examine the incidence of invasive pathology of NAVE, yield of preoperative diagnosis, and surgical approaches in single center experience.

Methods: From 2002 to 2020, 1,488 patients underwent surgery for aortic valve endocarditis at a tertiary institution, including 644 with NAVE. Data was obtained from an institutional Endocarditis Registry database and matching was performed to ensure balanced baseline characteristics.

Results: Among 644 patients with NAVE, 260 (40%) had intra-operative findings of invasive pathology. Staphylococcus aureus was the most common pathogen (26%). Pre-operative echocardiogram detected invasion in only 43% with sensitivity of 52.1% and 35.3% for TEE and TTE, respectively. Computed tomography angiography (CTA) confirmed invasion in 50% (19/38) of echocardiography-positive cases and 22% (9/41) of echocardiography-negative cases with sensitivity of 35.4%. Compared to non-invasive NAVE, invasive NAVE has prolonged CBP times, ventilation, and ICU stay were significantly higher in invasive NAVE (p<0.001, p=0.004, and 0.005, respectively). AVR with an allograft was the most performed surgery for extensive invasive pathology while with patch repair for focal invasion. Survival at 15 years was similar in propensity-matched invasive vs. non-invasive NAVE (40% vs. 39%, p=0.76).

Conclusions: NAVE is not uncommon to present with invasive pathology which could be missed on preoperative imaging. Thus, a high index of suspicion for invasive pathology is advised and preparation for a possible complex operation.