Annals of Thoracic Surgery最新文献

Background: Variables associated with permanent pacemaker (PPM) implantation post-heart transplantation and the relationship between PPM placement and mortality, are poorly understood. This study evaluates factors contributing to PPM insertion and subsequent mortality rates, with emphasis on the timing of implantation.

Methods: The United Network for Organ Sharing registry was queried for adult heart transplant recipients from 2010-2023. A multi-state model was constructed, assessing the probability of three transitions, 1) transplant to pacemaker, 2) pacemaker to death, and 3) transplant to death. Multivariable Cox proportional hazards models evaluated clinical factors influencing transitions, including early and late PPM (≤30, >30 days) implantation.

Results: Of the 30,566 patients included in the model, 1,698 (5.6%) received a PPM, with most occurring in the late period (n=1,354, 79.7%). At 5 years, late PPM recipients had a significantly higher cardiac allograft vasculopathy burden (30.3%) than non-PPM (14.9%) and early PPM (15.7%) recipients. Factors associated with increased probability of PPM insertion included antiarrhythmic use (hazard ratio [HR] =1.19, 1.02-1.40), ischemic time (HR=1.08 per hour, 1.03-1.12), and older donor age (HR=1.02 per year, 1.01-1.02). Bicaval anastomosis decreased the likelihood of PPM insertion (HR=0.69, 0.62-0.78). Factors associated with increased probability of transition from PPM to death included late PPM insertion (HR=2.58, 1.93-3.46), recipient diabetes (HR=1.29, 1.05-1.58), and ischemic cardiomyopathy (HR=1.25, 1.01-1.54).

Conclusions: Longer ischemic time and antiarrhythmic use increased PPM likelihood. Late PPM recipients had a significantly higher probability of transitioning from implantation to death, warranting further investigation into contributing factors and its relationship with cardiac allograft vasculopathy.

The Society of Thoracic Surgeons (STS) 2026 Expert Consensus Pathway on Robotic Cardiac Training outlines principles for the safe initial introduction and subsequent expansion of robotic cardiac programs. The 25-year history of robotic cardiac surgery has established safety and efficacy while providing multiple innovations. There is currently a unique opportunity to coalesce best practices and evidence to inform a recent global surge in interest in incorporating robotic techniques into standard cardiac surgical practice. This consensus is a collaborative effort between the STS Workforce on Evidence Based Surgery, the STS Robotic Cardiac Surgery Taskforce, and multinational leaders in robotic cardiac surgery that aims to standardize initial core principles of preparatory elements, followed by 4 phases of robotic cardiac training to proceed from program commencement to mastery.

The Society of Cardiovascular Anesthesiologists (SCA) along with The Society of Thoracic Surgeons (STS) sought to improve the care of adult patients undergoing cardiac surgery who are taking direct oral anticoagulants (DOACs), such as factor Xa and direct thrombin inhibitors. To fulfill this, a systematic review of the literature on cessation of DOACs before cardiac surgery, options for monitoring DOACs, the need for bridging, reversal agents, and resuming the medications after surgery was performed. Additionally, an expert consensus around the management of these patients was completed. Summary statements were created using evidence and expert consensus to guide care of patients in each of these domains, with the ultimate goal to enhance patient safety and outcomes.