Pub Date : 2026-03-01Epub Date: 2025-06-23DOI: 10.1016/j.athoracsur.2025.06.009
Shinsuke Kitazawa MD, PhD , Nicholas Bernards PhD , Yuki Sata MD, PhD , Fumi Yokote MD, PhD , Hiroyuki Ogawa MD, PhD , Takamasa Koga MD, PhD , Yoshihisa Hiraishi MD, PhD , Takahiro Yanagihara MD, PhD , Alexander Gregor MD, PhD , Laura Donahoe MD, MSc , Jonathan Yeung MD, PhD , Marcelo Cypel MD, MSc , Marc De Perrot MD, MSc , Andrew Pierre MD, MSc , Thomas Waddell MD, PhD , Shaf Keshavjee MD, MSc , Robert Weersink PhD , Michael Cabanero MD , Yukio Sato MD, PhD , Kazuhiro Yasufuku MD, PhD
Background
While early lung cancers are increasingly managed with sublobar resection, inadequate surgical margin (SM) is still a major concern, increasing the risk of locoregional recurrence. In this study, we evaluated the feasibility of using computed tomography (CT) as an intraoperative SM guidance tool by comparing with histopathologic SM measurement.
Methods
Patients scheduled for segmentectomy or wedge resection were enrolled. Immediately after resection, lung samples were reinflated and CT images were acquired. SM length, defined as the distance between the tumor and staple line, was measured by both CT and pathology. CT-derived SM length was compared with pathology-derived SM length using Bland-Altman analysis. Factors affecting differences between the 2 measurements were assessed using multiple linear regression analysis.
Results
A total of 52 resected specimens were analyzed. There were 34 solid (65.4%) and 18 subsolid tumors (34.6%). The mean SM length by CT and pathology was 11.3 mm and 10.1 mm, respectively. There was overall a 10.6% reduction from CT to pathology (P = .033). In Brand-Altman analysis, the mean difference between SM on CT and pathology was 1.2 mm, with the 95% limits of agreement from –7.2 to 9.6 mm. The multiple linear regression analysis revealed that subsolid tumors (P = .047) and depth from pleura (P < .01) were independent factors affecting SM discrepancy.
Conclusions
SM measurement by CT is feasible and has the potential to aid in the evaluation of SM intraoperatively. However, surgeons must anticipate the potentially greater discordance when using this technique for subsolid tumors.
{"title":"Intraoperative Surgical Margin Assessment of Sublobar Lung Resection Specimens Using Computed Tomography","authors":"Shinsuke Kitazawa MD, PhD , Nicholas Bernards PhD , Yuki Sata MD, PhD , Fumi Yokote MD, PhD , Hiroyuki Ogawa MD, PhD , Takamasa Koga MD, PhD , Yoshihisa Hiraishi MD, PhD , Takahiro Yanagihara MD, PhD , Alexander Gregor MD, PhD , Laura Donahoe MD, MSc , Jonathan Yeung MD, PhD , Marcelo Cypel MD, MSc , Marc De Perrot MD, MSc , Andrew Pierre MD, MSc , Thomas Waddell MD, PhD , Shaf Keshavjee MD, MSc , Robert Weersink PhD , Michael Cabanero MD , Yukio Sato MD, PhD , Kazuhiro Yasufuku MD, PhD","doi":"10.1016/j.athoracsur.2025.06.009","DOIUrl":"10.1016/j.athoracsur.2025.06.009","url":null,"abstract":"<div><h3>Background</h3><div>While early lung cancers are increasingly managed with sublobar resection, inadequate surgical margin (SM) is still a major concern, increasing the risk of locoregional recurrence. In this study, we evaluated the feasibility of using computed tomography (CT) as an intraoperative SM guidance tool by comparing with histopathologic SM measurement.</div></div><div><h3>Methods</h3><div>Patients scheduled for segmentectomy or wedge resection were enrolled. Immediately after resection, lung samples were reinflated and CT images were acquired. SM length, defined as the distance between the tumor and staple line, was measured by both CT and pathology. CT-derived SM length was compared with pathology-derived SM length using Bland-Altman analysis. Factors affecting differences between the 2 measurements were assessed using multiple linear regression analysis.</div></div><div><h3>Results</h3><div>A total of 52 resected specimens were analyzed. There were 34 solid (65.4%) and 18 subsolid tumors (34.6%). The mean SM length by CT and pathology was 11.3 mm and 10.1 mm, respectively. There was overall a 10.6% reduction from CT to pathology (<em>P</em> = .033). In Brand-Altman analysis, the mean difference between SM on CT and pathology was 1.2 mm, with the 95% limits of agreement from –7.2 to 9.6 mm. The multiple linear regression analysis revealed that subsolid tumors (<em>P</em> = .047) and depth from pleura (<em>P</em> < .01) were independent factors affecting SM discrepancy.</div></div><div><h3>Conclusions</h3><div>SM measurement by CT is feasible and has the potential to aid in the evaluation of SM intraoperatively. However, surgeons must anticipate the potentially greater discordance when using this technique for subsolid tumors.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 654-661"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499087","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 : 2026-03-01Epub Date: 2025-06-28DOI: 10.1016/j.athoracsur.2025.06.015
Peter L. Zhan MD , Maureen E. Canavan PhD, MPH , Justin M. Bader MD , Daniel J. Boffa MD, MBA , Benjamin J. Resio MD , Gavitt A. Woodard MD
Background
The Mesothelioma and Radical Surgery 2 (MARS 2) trial demonstrated no survival benefit from cytoreductive surgical resection over chemotherapy alone in resectable pleural mesothelioma. Using the National Cancer Database (NCDB), this study investigated the necessity of surgery for long-term survival in patients with mesothelioma.
Methods
The NCDB was queried for all adult patients with a diagnosis of malignant pleural mesothelioma between 2010 and 2018. Kaplan-Meier analysis compared survival across patient cohorts by treatment, including patients receiving chemotherapy who declined or forewent recommended surgical resection. Survival outcomes were compared with those in patients who underwent chemotherapy and surgical resection, with and without propensity score matching.
Results
Of 21,768 included patients, 9.4% (2045) survived ≥5 years. Among them, 1227 underwent surgical resection, and 708 did not receive any surgical intervention. Multivariable logistic regression modeling identified young age, treatment at an academic center, chemotherapy, epithelioid histologic type, and clinical stage I disease as characteristics associated with improved survival among nonsurgically treated patients. In propensity-matched cohorts, patients receiving chemotherapy and refusing surgical resection (n = 116) had nearly identical 5-year overall survival (OS) rates (16.4%; median OS, 22.9 months [interquartile range, 10.8-38.2 months]) as patients receiving chemotherapy and undergoing surgical resection (n = 232; 16.4% 5-year OS; median OS, 21.9 months [interquartile range, 11.6-50.9 months]; P = .77).
Conclusions
NCDB data align with the randomized MARS 2 findings, showing that long-term survival without curative-intent surgical resection is possible for some patients with mesothelioma. Notably, more than 16% of chemotherapy-treated patients who declined surgical resection survived ≥5 years after diagnosis. Methods to identify patients who are most likely to achieve long-term survival on the basis of clinical or biologic features are needed to refine prognostication and guide treatment.
{"title":"Prolonged Survival in Mesothelioma Patients Without Surgical Resection: A National Cancer Database Analysis","authors":"Peter L. Zhan MD , Maureen E. Canavan PhD, MPH , Justin M. Bader MD , Daniel J. Boffa MD, MBA , Benjamin J. Resio MD , Gavitt A. Woodard MD","doi":"10.1016/j.athoracsur.2025.06.015","DOIUrl":"10.1016/j.athoracsur.2025.06.015","url":null,"abstract":"<div><h3>Background</h3><div>The Mesothelioma and Radical Surgery 2 (MARS 2) trial demonstrated no survival benefit from cytoreductive surgical resection over chemotherapy alone in resectable pleural mesothelioma. Using the National Cancer Database (NCDB), this study investigated the necessity of surgery for long-term survival in patients with mesothelioma.</div></div><div><h3>Methods</h3><div>The NCDB was queried for all adult patients with a diagnosis of malignant pleural mesothelioma between 2010 and 2018. Kaplan-Meier analysis compared survival across patient cohorts by treatment, including patients receiving chemotherapy who declined or forewent recommended surgical resection. Survival outcomes were compared with those in patients who underwent chemotherapy and surgical resection, with and without propensity score matching.</div></div><div><h3>Results</h3><div>Of 21,768 included patients, 9.4% (2045) survived ≥5 years. Among them, 1227 underwent surgical resection, and 708 <em>did not</em> receive any surgical intervention. Multivariable logistic regression modeling identified young age, treatment at an academic center, chemotherapy, epithelioid histologic type, and clinical stage I disease as characteristics associated with improved survival among nonsurgically treated patients. In propensity-matched cohorts, patients receiving chemotherapy and refusing surgical resection (n = 116) had nearly identical 5-year overall survival (OS) rates (16.4%; median OS, 22.9 months [interquartile range, 10.8-38.2 months]) as patients receiving chemotherapy and undergoing surgical resection (n = 232; 16.4% 5-year OS; median OS, 21.9 months [interquartile range, 11.6-50.9 months]; <em>P</em> = .77).</div></div><div><h3>Conclusions</h3><div>NCDB data align with the randomized MARS 2 findings, showing that long-term survival without curative-intent surgical resection is possible for some patients with mesothelioma. Notably, more than 16% of chemotherapy-treated patients who declined surgical resection survived ≥5 years after diagnosis. Methods to identify patients who are most likely to achieve long-term survival on the basis of clinical or biologic features are needed to refine prognostication and guide treatment.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 633-642"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530957","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}
The predominant method for preventing cerebral infarction secondary to air embolism in cardiac surgery is the use of root vents to remove air. However, in the case of minimally invasive aortic valve replacement (MIAVR) surgery, the risk of air embolism is lower compared with other types of minimally invasive cardiac surgery, and some surgeons routinely forgo root venting. This study sought to quantify how much difference root venting makes in stroke and asymptomatic brain injury (ABI) incidence in MIAVR.
Methods
The study enrolled patients undergoing elective MIAVR from January 2016 to March 2023 at 1 hospital. The patients were categorized into groups, with (R group) and without root venting (N group). All patients underwent brain magnetic resonance imaging, including diffusion-weighted imaging, 1 day preoperatively and 5 days post operatively.
Results
The R and N groups consisted of 126 cases each. ABI incidence was significantly greater in the N group (46% vs 31%; P < .05). Only 1 patient in the entire cohort sustained a stroke (R group). The incidence of ABI was not significantly different among different sites of cannulation over all patients. However, the incidence of ABI was significantly lower in the R group than in the N group for patients whose cannulation site was the femoral artery.
Conclusions
Deairing with a root vent resulted in fewer ABIs even in MIAVR. However, given that ABI is asymptomatic, the tradeoff between prevention of ABI and surgical simplicity should be considered.
背景：预防心脏手术中空气栓塞引起的脑梗死的主要方法是利用根通风口排出空气。然而，在微创主动脉瓣置换术（MIAVR）中，与其他类型的微创心脏手术相比，空气栓塞的风险较低，一些外科医生通常会放弃根部通气。我们想量化脑根通气对MIAVR患者卒中和无症状脑损伤（ABI）发生率的影响。方法：我们招募了2016年1月至2023年3月在一家医院接受选择性MIAVR的患者。我们将其分为有（R组）和无根通气（N组）两组。所有患者术前1天和术后5天均行脑磁共振成像，包括弥散加权成像。结果：R组和N组各126例。N组的ABI发生率明显更高（46% vs 31%）。结论：即使在MIAVR中，使用根管通气也能减少ABI。然而，鉴于ABI是无症状的，应该考虑预防ABI和手术简单性之间的权衡。
{"title":"Impact of Root Venting on Brain Injury in Minithoracotomy Aortic Valve Replacement: Prospective Evaluation With Preoperative and Postoperative Brain MRI in 252 Patients","authors":"Shuhei Nishijima MD, PhD , Yoshitsugu Nakamura MD, PhD , Yuka Higuma MD , Kusumi Niitsuma MD , Yuto Yasumoto MD , Miho Kuroda MD , Satoshi Okugi MD, PhD , Yujiro Hayashi MD , Taisuke Nakayama MD, PhD , Yujiro Ito MD","doi":"10.1016/j.athoracsur.2025.07.042","DOIUrl":"10.1016/j.athoracsur.2025.07.042","url":null,"abstract":"<div><h3>Background</h3><div>The predominant method for preventing cerebral infarction secondary to air embolism in cardiac surgery is the use of root vents to remove air. However, in the case of minimally invasive aortic valve replacement (MIAVR) surgery, the risk of air embolism is lower compared with other types of minimally invasive cardiac surgery, and some surgeons routinely forgo root venting. This study sought to quantify how much difference root venting makes in stroke and asymptomatic brain injury (ABI) incidence in MIAVR.</div></div><div><h3>Methods</h3><div>The study enrolled patients undergoing elective MIAVR from January 2016 to March 2023 at 1 hospital. The patients were categorized into groups, with (R group) and without root venting (N group). All patients underwent brain magnetic resonance imaging, including diffusion-weighted imaging, 1 day preoperatively and 5 days post operatively.</div></div><div><h3>Results</h3><div>The R and N groups consisted of 126 cases each. ABI incidence was significantly greater in the N group (46% vs 31%; <em>P</em> < .05). Only 1 patient in the entire cohort sustained a stroke (R group). The incidence of ABI was not significantly different among different sites of cannulation over all patients. However, the incidence of ABI was significantly lower in the R group than in the N group for patients whose cannulation site was the femoral artery.</div></div><div><h3>Conclusions</h3><div>Deairing with a root vent resulted in fewer ABIs even in MIAVR. However, given that ABI is asymptomatic, the tradeoff between prevention of ABI and surgical simplicity should be considered.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 597-604"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977509","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 : 2026-03-01Epub Date: 2025-08-20DOI: 10.1016/j.athoracsur.2025.07.039
Victor B. Yang MD , Luke X. Zhao MD , Shi Nan Feng BS , Mayen Gonzalez MD , Hanghang Wang MD, PhD , Jinny Ha MD
Background
Despite recent progress, significant gender disparities persist in cardiothoracic surgery. Whereas inequalities in compensation, training, research funding, and leadership roles are well-documented, less is known about gender disparities in industry partnerships, which are important for career advancement.
Methods
We retrospectively analyzed transactions from the Open Payments Database (OPD) from 2016 to 2022, examining federally reported industry payments to cardiothoracic surgeons. Data were stratified by year, surgeon gender, payment type, and geographic region based on both surgeon practice location and company headquarters.
Results
There were 417,530 transactions, totaling $230,304,205, conducted between 829 companies and 5971 cardiothoracic surgeons over 7 years. Female surgeons, comprising 8.3% of the workforce, accounted for only 2.2% of total transaction dollars. The top 100 earners received 22.7% of transaction dollars, with only 1 female surgeon represented. Female surgeons earned significantly less (median, $1582 vs $3124 for men; P < .001) and participated in fewer transactions (median, 13 vs 29 for men; P < .001). They were underrepresented in consulting and education-related transactions (4.0% vs 5.2% for other categories; P < .001). Regional disparities were notable, with the Midwest showing the largest gender gaps. Although the gender gap narrowed modestly over time, these gains were inconsistent across regions and payment categories.
Conclusions
Female cardiothoracic surgeons engage less with industry in both transaction volume and value, with disparities varying by region and payment type. Sustained efforts are needed to promote equitable access to industry partnerships, which are critical for career advancement and innovation in cardiothoracic surgery.
{"title":"Evaluating Gender Disparities in Cardiothoracic Surgery Through the Lens of Industry-Surgeon Partnerships","authors":"Victor B. Yang MD , Luke X. Zhao MD , Shi Nan Feng BS , Mayen Gonzalez MD , Hanghang Wang MD, PhD , Jinny Ha MD","doi":"10.1016/j.athoracsur.2025.07.039","DOIUrl":"10.1016/j.athoracsur.2025.07.039","url":null,"abstract":"<div><h3>Background</h3><div>Despite recent progress, significant gender disparities persist in cardiothoracic surgery. Whereas inequalities in compensation, training, research funding, and leadership roles are well-documented, less is known about gender disparities in industry partnerships, which are important for career advancement.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed transactions from the Open Payments Database (OPD) from 2016 to 2022, examining federally reported industry payments to cardiothoracic surgeons. Data were stratified by year, surgeon gender, payment type, and geographic region based on both surgeon practice location and company headquarters.</div></div><div><h3>Results</h3><div>There were 417,530 transactions, totaling $230,304,205, conducted between 829 companies and 5971 cardiothoracic surgeons over 7 years. Female surgeons, comprising 8.3% of the workforce, accounted for only 2.2% of total transaction dollars. The top 100 earners received 22.7% of transaction dollars, with only 1 female surgeon represented. Female surgeons earned significantly less (median, $1582 vs $3124 for men; <em>P</em> < .001) and participated in fewer transactions (median, 13 vs 29 for men; <em>P</em> < .001). They were underrepresented in consulting and education-related transactions (4.0% vs 5.2% for other categories; <em>P</em> < .001). Regional disparities were notable, with the Midwest showing the largest gender gaps. Although the gender gap narrowed modestly over time, these gains were inconsistent across regions and payment categories.</div></div><div><h3>Conclusions</h3><div>Female cardiothoracic surgeons engage less with industry in both transaction volume and value, with disparities varying by region and payment type. Sustained efforts are needed to promote equitable access to industry partnerships, which are critical for career advancement and innovation in cardiothoracic surgery.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 732-739"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977452","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 : 2026-03-01Epub Date: 2025-11-05DOI: 10.1016/j.athoracsur.2025.10.015
Nicole Lin MD, MPH, Ntemena Kapula MAS, Bailey Wallen MD, Jake Kim BS, Pooja Manapat, Devanish Kamtam MD, Brandon Guenthart MD, Irmina Elliott MD, Natalie Lui MD, Leah Backhus MD, MPH, Joseph Shrager MD, Mark Berry MD, Douglas Z. Liou MD
Background
Management of postoperative chylothorax typically involves a stepwise strategy of initial conservative management followed by lymphangiography and reoperation when conservative management fails. This study tested the hypothesis that high-volume chylothorax drainage over the first 48 hours is associated with failure of conservative management.
Methods
Our institutional database was queried for patients treated between 2009 and 2024 who developed chylothorax following lung, foregut, or mediastinal surgery and underwent initial conservative management. Patients were stratified according to whether the chylothorax resolved with conservative management vs intervention with lymphangiography and/or reoperation. Daily thoracostomy tube drainage was evaluated, and a 48-hour chylothorax volume cutoff point associated with failure of conservative management was calculated by using Youden’s index from the receiver operating characteristic curve. Predictors of failed conservative management were estimated using multivariable logistic regression.
Results
Seventy-seven patients experienced postoperative chylothorax, including 43 (56%) after lung resection, 22 (29%) after esophageal surgery, and 12 (16%) after mediastinal surgery. Forty-eight (62%) patients were successfully managed conservatively and 29 (38%) patients required intervention. Daily chylothorax drainage was notably lower in patients who required conservative management. The area under the receiver operating characteristic curve was 0.75, and the 48-hour chylothorax volume cutoff point was 1110 mL based on Youden’s index. This cutoff was associated with a nearly 4-fold increased risk of failed conservative management (adjusted odds ratio, 3.84, P = .023).
Conclusions
Patients who develop postoperative chylothorax with drainage >1100 mL over the first 48 hours should be considered for early intervention with lymphangiography or reoperation, given the likelihood of failing conservative management.
{"title":"Assessment of Postoperative Chylothorax Volume Threshold Associated with Failed Conservative Management","authors":"Nicole Lin MD, MPH, Ntemena Kapula MAS, Bailey Wallen MD, Jake Kim BS, Pooja Manapat, Devanish Kamtam MD, Brandon Guenthart MD, Irmina Elliott MD, Natalie Lui MD, Leah Backhus MD, MPH, Joseph Shrager MD, Mark Berry MD, Douglas Z. Liou MD","doi":"10.1016/j.athoracsur.2025.10.015","DOIUrl":"10.1016/j.athoracsur.2025.10.015","url":null,"abstract":"<div><h3>Background</h3><div>Management of postoperative chylothorax typically involves a stepwise strategy of initial conservative management followed by lymphangiography and reoperation when conservative management fails. This study tested the hypothesis that high-volume chylothorax drainage over the first 48 hours is associated with failure of conservative management.</div></div><div><h3>Methods</h3><div>Our institutional database was queried for patients treated between 2009 and 2024 who developed chylothorax following lung, foregut, or mediastinal surgery and underwent initial conservative management. Patients were stratified according to whether the chylothorax resolved with conservative management vs intervention with lymphangiography and/or reoperation. Daily thoracostomy tube drainage was evaluated, and a 48-hour chylothorax volume cutoff point associated with failure of conservative management was calculated by using Youden’s index from the receiver operating characteristic curve. Predictors of failed conservative management were estimated using multivariable logistic regression.</div></div><div><h3>Results</h3><div>Seventy-seven patients experienced postoperative chylothorax, including 43 (56%) after lung resection, 22 (29%) after esophageal surgery, and 12 (16%) after mediastinal surgery. Forty-eight (62%) patients were successfully managed conservatively and 29 (38%) patients required intervention. Daily chylothorax drainage was notably lower in patients who required conservative management. The area under the receiver operating characteristic curve was 0.75, and the 48-hour chylothorax volume cutoff point was 1110 mL based on Youden’s index. This cutoff was associated with a nearly 4-fold increased risk of failed conservative management (adjusted odds ratio, 3.84, <em>P</em> = .023).</div></div><div><h3>Conclusions</h3><div>Patients who develop postoperative chylothorax with drainage >1100 mL over the first 48 hours should be considered for early intervention with lymphangiography or reoperation, given the likelihood of failing conservative management.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 688-695"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472436","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 : 2026-03-01Epub Date: 2025-11-11DOI: 10.1016/j.athoracsur.2025.10.029
Milo Engoren MD , David Sturmer MS , Donald S. Likosky PhD
Background
Although delivering less oxygen is associated with acute kidney injury, little is known about its association with long-term mortality and how the association may be modified by transfusion.
Methods
Minute-by-minute pump flow and hemoglobin were used to estimate oxygen delivery indexed to body surface area (DO2I) during cardiopulmonary bypass. In this retrospective study, the associations between mean DO2I and cumulative DO2I deficit <300 mL/min/m2 threshold and long-term mortality were estimated using Cox proportional and nonproportional hazard models.
Results
At a mean follow-up of 5.00 (SD, 1.86) years (range, 3.10-8.12 year), 698 of 4203 patients (17%) had died. Patients who died had lower mean DO2I (230 [SD, 40] mL/min/m2 vs 251 [SD, 47] mL/min/m2) and greater cumulative DO2I deficit (9.94 [SD, 8.64] mL/min/m2 vs 7.01 [SD, 7.07] L/min/m2). After adjusting for demographics, comorbidities, laboratory values, type and status of the operations, blood pressure, and red blood cell transfusion during bypass, we found that mean DO2I was associated with mortality (hazard ratio [HR], 0.997; 95% CI, 0.995-0.999; P = .001). When cumulative DO2I deficit was added to the model, it replaced mean DO2I (HR, 1.031; 95% CI, 1.018-1.045; P < .001) of dying for each liter of O2/m2 deficit, with a small time-varying component (HR, 0.994; 95% CI, 0.990-0.999) per year of follow-up (P = .010). After adjustment, red blood cell transfusion did not remain in the models.
Conclusions
There is an inverse relationship between decreased DO2I (measured as mean or cumulative deficit) and long-term mortality. Red blood cell transfusion did not significantly modify the relationship between DO2I and mortality.
{"title":"Association of Low Oxygen Delivery on Cardiopulmonary Bypass and Increased Long-Term Mortality","authors":"Milo Engoren MD , David Sturmer MS , Donald S. Likosky PhD","doi":"10.1016/j.athoracsur.2025.10.029","DOIUrl":"10.1016/j.athoracsur.2025.10.029","url":null,"abstract":"<div><h3>Background</h3><div>Although delivering less oxygen is associated with acute kidney injury, little is known about its association with long-term mortality and how the association may be modified by transfusion.</div></div><div><h3>Methods</h3><div>Minute-by-minute pump flow and hemoglobin were used to estimate oxygen delivery indexed to body surface area (DO<sub>2</sub>I) during cardiopulmonary bypass. In this retrospective study, the associations between mean DO<sub>2</sub>I and cumulative DO<sub>2</sub>I deficit <300 mL/min/m<sup>2</sup> threshold and long-term mortality were estimated using Cox proportional and nonproportional hazard models.</div></div><div><h3>Results</h3><div>At a mean follow-up of 5.00 (SD, 1.86) years (range, 3.10-8.12 year), 698 of 4203 patients (17%) had died. Patients who died had lower mean DO<sub>2</sub>I (230 [SD, 40] mL/min/m<sup>2</sup> vs 251 [SD, 47] mL/min/m<sup>2</sup>) and greater cumulative DO<sub>2</sub>I deficit (9.94 [SD, 8.64] mL/min/m<sup>2</sup> vs 7.01 [SD, 7.07] L/min/m<sup>2</sup>). After adjusting for demographics, comorbidities, laboratory values, type and status of the operations, blood pressure, and red blood cell transfusion during bypass, we found that mean DO<sub>2</sub>I was associated with mortality (hazard ratio [HR], 0.997; 95% CI, 0.995-0.999; <em>P</em> = .001). When cumulative DO<sub>2</sub>I deficit was added to the model, it replaced mean DO<sub>2</sub>I (HR, 1.031; 95% CI, 1.018-1.045; <em>P</em> < .001) of dying for each liter of O<sub>2</sub>/m<sup>2</sup> deficit, with a small time-varying component (HR, 0.994; 95% CI, 0.990-0.999) per year of follow-up (<em>P</em> = .010). After adjustment, red blood cell transfusion did not remain in the models.</div></div><div><h3>Conclusions</h3><div>There is an inverse relationship between decreased DO<sub>2</sub>I (measured as mean or cumulative deficit) and long-term mortality. Red blood cell transfusion did not significantly modify the relationship between DO<sub>2</sub>I and mortality.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 716-723"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145508066","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 : 2026-03-01Epub Date: 2025-11-15DOI: 10.1016/j.athoracsur.2025.11.006
Marvin D. Atkins MD, Michael J. Reardon MD
{"title":"Cardiac Hemangioma","authors":"Marvin D. Atkins MD, Michael J. Reardon MD","doi":"10.1016/j.athoracsur.2025.11.006","DOIUrl":"10.1016/j.athoracsur.2025.11.006","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Page 756"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543734","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 : 2026-03-01Epub Date: 2025-11-24DOI: 10.1016/j.athoracsur.2025.11.016
John M. Campbell MD , Kari Chansky MS , Wentao Fang MD , Eric Vallières MD , Frank C. Detterbeck MD , James Huang MD , Brian E. Louie MD, MPH
Background
Total thymectomy (TT) has been the standard treatment for thymoma. However, many thymomas may be amenable to partial thymectomy (PT), which can achieve similar R0 resection frequency with favorable perioperative outcomes. We sought to determine whether PT results in oncologic outcomes similar to TT for noninvasive thymomas.
Methods
We queried the International Thymic Malignancy Interest Group retrospective database from 2000 to 2014 for patients with stage I thymomas without myasthenia gravis undergoing TT or PT. Outcomes were freedom from recurrence (weighted for age and T category 1a vs 1b) and overall survival, with inverse probability weights of patient factors as predictors of TT.
Results
Included were 692 patients, with 158 PT (23%) and 534 TT (77%). PT patients were younger with better performance status. R0 resection and histology were similar. The PT group had more T1b thymomas. Adjuvant chemotherapy and radiotherapy were more frequent after PT. There was no difference in new-onset myasthenia gravis. Weighted freedom from recurrence (hazard ratio, 1.09; P = .81) and overall survival (hazard ratio, 0.62; P = .11) was similar for PT compared with TT.
Conclusions
PT for stage I thymomas without myasthenia resulted in statistically similar recurrence and survival, and no difference in the development of new-onset myasthenia gravis, compared with TT. These results add to a growing body of literature around PT, suggesting it may be considered for stage I thymomas when R0 resection can reasonably be achieved. Surgeons performing PT are encouraged to report their outcomes to continue this discussion.
背景：全胸腺切除术（TT）一直是胸腺瘤的标准治疗方法。然而，许多胸腺瘤可能适合部分胸腺切除术（PT），它可以达到相似的R0切除频率和良好的围手术期预后。我们试图确定PT是否与非侵袭性胸腺瘤的TT有相似的肿瘤学结果。方法：我们查询了国际胸腺恶性肿瘤兴趣组2000-2014年无重症肌无力的I期胸腺瘤患者接受TT或PT的回顾性数据库。结果是无复发（年龄和T类别加权[1a vs 1b]）和以患者因素的逆概率权重作为TT预测因子的总生存率。结果：共纳入692例患者，其中PT 158例（23%），TT 534例（77%）。患者较年轻，表现状态较好。R0切除及组织学相似。PT组有更多的T1b胸腺瘤。术后辅助化疗和放疗频率更高。新发重症肌无力两组无差异。与TT相比，PT的加权复发自由度（风险比：1.09,p=0.81）和总生存率（风险比：0.62,p=0.11）相似。结论：无重症肌无力的I期胸腺瘤经PT治疗的复发率和生存率在统计学上相似，新发重症肌无力的发生与TT治疗无差异。这些结果增加了越来越多的关于PT的文献，表明当R0切除可以合理实现时，可以考虑将其用于I期胸腺瘤。我们鼓励施行PT的外科医生报告他们的治疗结果以继续讨论。
{"title":"Comparison of Oncologic Outcomes After Partial and Total Thymectomy for Stage I Thymomas","authors":"John M. Campbell MD , Kari Chansky MS , Wentao Fang MD , Eric Vallières MD , Frank C. Detterbeck MD , James Huang MD , Brian E. Louie MD, MPH","doi":"10.1016/j.athoracsur.2025.11.016","DOIUrl":"10.1016/j.athoracsur.2025.11.016","url":null,"abstract":"<div><h3>Background</h3><div>Total thymectomy (TT) has been the standard treatment for thymoma. However, many thymomas may be amenable to partial thymectomy (PT), which can achieve similar R0 resection frequency with favorable perioperative outcomes. We sought to determine whether PT results in oncologic outcomes similar to TT for noninvasive thymomas.</div></div><div><h3>Methods</h3><div>We queried the International Thymic Malignancy Interest Group retrospective database from 2000 to 2014 for patients with stage I thymomas without myasthenia gravis undergoing TT or PT. Outcomes were freedom from recurrence (weighted for age and T category 1a vs 1b) and overall survival, with inverse probability weights of patient factors as predictors of TT.</div></div><div><h3>Results</h3><div>Included were 692 patients, with 158 PT (23%) and 534 TT (77%). PT patients were younger with better performance status. R0 resection and histology were similar. The PT group had more T1b thymomas. Adjuvant chemotherapy and radiotherapy were more frequent after PT. There was no difference in new-onset myasthenia gravis. Weighted freedom from recurrence (hazard ratio, 1.09; <em>P</em> = .81) and overall survival (hazard ratio, 0.62; <em>P</em> = .11) was similar for PT compared with TT.</div></div><div><h3>Conclusions</h3><div>PT for stage I thymomas without myasthenia resulted in statistically similar recurrence and survival, and no difference in the development of new-onset myasthenia gravis, compared with TT. These results add to a growing body of literature around PT, suggesting it may be considered for stage I thymomas when R0 resection can reasonably be achieved. Surgeons performing PT are encouraged to report their outcomes to continue this discussion.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 671-678"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642312","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 : 2026-03-01Epub Date: 2026-01-10DOI: 10.1016/j.athoracsur.2026.01.001
Kevin W. Lobdell MD, Shuddhadeb Ray MD, MPHS, Thomas A. Schwann MD, MBA
{"title":"Integrated Impact","authors":"Kevin W. Lobdell MD, Shuddhadeb Ray MD, MPHS, Thomas A. Schwann MD, MBA","doi":"10.1016/j.athoracsur.2026.01.001","DOIUrl":"10.1016/j.athoracsur.2026.01.001","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 723-724"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960763","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 : 2026-03-01Epub Date: 2025-06-17DOI: 10.1016/j.athoracsur.2025.05.037
Elizabeth M. Bird PhD , Jenny Z. Yang MD , Edward W. Mims MD , Kim M. Kerr MD , Demosthenes G. Papamatheakis MD , David S. Poch MD , Peter F. Fedullo MD , Atul Malhotra MD , Lori B. Daniels MD, MAS , Anna McDivit-Mizzell MD , Nicholas Phreaner MD , Nick H. Kim MD , Victor G. Pretorius MBChB , Michael M. Madani MD , Timothy M. Fernandes MD, MPH
Background
Chronic thromboembolic disease (CTED) is characterized by pulmonary vascular thromboembolic occlusions without elevation in pulmonary artery pressures or pulmonary vascular resistance at rest. Many patients have dyspnea on exertion despite normal resting hemodynamics and symptomatic improvement after pulmonary thromboendarterectomy surgery. We hypothesize that the safety and efficacy of pulmonary thromboendarterectomy in CTED will be similar to that in chronic thromboembolic pulmonary hypertension (CTEPH), which currently has a better characterized risk-benefit profile.
Methods
Patients who underwent pulmonary thromboendarterectomy for CTED from 2009 through 2022 had preoperative and postoperative pulmonary hemodynamics and postoperative course (n = 163) compared with a reference CTEPH cohort who underwent pulmonary thromboendarterectomy from 2017 to 2022 (n = 870). Preoperative rest hemodynamics were compared with both preoperative exercise and postoperative rest hemodynamics in patients with CTED who had measurements for all 3 conditions.
Results
The CTED cohort had 99 patients with complete preoperative rest, preoperative exercise, and postoperative hemodynamic measurements. Mean pulmonary artery pressure, pulmonary vascular resistance, and pulmonary artery compliance all changed abnormally with preoperative exercise but improved after surgery (21 [SD, 4], 36 [SD, 10], 18 [interquartile range {IQR}15-21] mm Hg; 175 [SD, 87], 205 [SD, 149], 126 [SD, 55] dyne·s·cm−5; 3.6 [IQR, 3.1-4.4], 2.7 [IQR, 2.1-3.6], 4.8 [IQR, 3.7–6.0] mL/mm Hg; preoperative rest, exercise, and postoperative for mean pulmonary artery pressure, pulmonary vascular resistance, and compliance; P < .001 for all comparisons, mean [SD] if normally distributed, otherwise median [IQR]). CTED patients had no in-hospital mortality and shorter hospital and intensive care unit lengths of stay (P < .001 for both) compared with the CTEPH cohort.
Conclusions
Pulmonary thromboendarterectomy is safe and well-tolerated in patients with CTED, improving pulmonary hemodynamics and pulmonary artery compliance.
{"title":"Safety and Immediate Efficacy of Pulmonary Thromboendarterectomy for Chronic Thromboembolic Disease","authors":"Elizabeth M. Bird PhD , Jenny Z. Yang MD , Edward W. Mims MD , Kim M. Kerr MD , Demosthenes G. Papamatheakis MD , David S. Poch MD , Peter F. Fedullo MD , Atul Malhotra MD , Lori B. Daniels MD, MAS , Anna McDivit-Mizzell MD , Nicholas Phreaner MD , Nick H. Kim MD , Victor G. Pretorius MBChB , Michael M. Madani MD , Timothy M. Fernandes MD, MPH","doi":"10.1016/j.athoracsur.2025.05.037","DOIUrl":"10.1016/j.athoracsur.2025.05.037","url":null,"abstract":"<div><h3>Background</h3><div>Chronic thromboembolic disease (CTED) is characterized by pulmonary vascular thromboembolic occlusions without elevation in pulmonary artery pressures or pulmonary vascular resistance at rest. Many patients have dyspnea on exertion despite normal resting hemodynamics and symptomatic improvement after pulmonary thromboendarterectomy surgery. We hypothesize that the safety and efficacy of pulmonary thromboendarterectomy in CTED will be similar to that in chronic thromboembolic pulmonary hypertension (CTEPH), which currently has a better characterized risk-benefit profile.</div></div><div><h3>Methods</h3><div>Patients who underwent pulmonary thromboendarterectomy for CTED from 2009 through 2022 had preoperative and postoperative pulmonary hemodynamics and postoperative course (n = 163) compared with a reference CTEPH cohort who underwent pulmonary thromboendarterectomy from 2017 to 2022 (n = 870). Preoperative rest hemodynamics were compared with both preoperative exercise and postoperative rest hemodynamics in patients with CTED who had measurements for all 3 conditions.</div></div><div><h3>Results</h3><div>The CTED cohort had 99 patients with complete preoperative rest, preoperative exercise, and postoperative hemodynamic measurements. Mean pulmonary artery pressure, pulmonary vascular resistance, and pulmonary artery compliance all changed abnormally with preoperative exercise but improved after surgery (21 [SD, 4], 36 [SD, 10], 18 [interquartile range {IQR}15-21] mm Hg; 175 [SD, 87], 205 [SD, 149], 126 [SD, 55] dyne·s·cm<sup>−5</sup>; 3.6 [IQR, 3.1-4.4], 2.7 [IQR, 2.1-3.6], 4.8 [IQR, 3.7–6.0] mL/mm Hg; preoperative rest, exercise, and postoperative for mean pulmonary artery pressure, pulmonary vascular resistance, and compliance; <em>P</em> < .001 for all comparisons, mean [SD] if normally distributed, otherwise median [IQR]). CTED patients had no in-hospital mortality and shorter hospital and intensive care unit lengths of stay (<em>P</em> < .001 for both) compared with the CTEPH cohort.</div></div><div><h3>Conclusions</h3><div>Pulmonary thromboendarterectomy is safe and well-tolerated in patients with CTED, improving pulmonary hemodynamics and pulmonary artery compliance.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 663-670"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486877","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}
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