Annals of Thoracic Surgery最新文献

英文中文

A Standardized Remediation Approach for the Integrated Cardiothoracic Surgery Trainee: Review of Current Paradigms and Suggested Strategies 综合心胸外科受训者的标准化补救方法：当前范例和建议策略的回顾。

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-07 DOI: 10.1016/j.athoracsur.2025.10.019

Jeremiah Hutson BS , Riya Aggarwal BS , Justin Robinson MD , Warren Naselsky MD, MS , Kimanthi Gicovi MD , Shelby Stewart MD

Background

Effective remediation is essential for the success of residency programs, yet integrated cardiothoracic (I6) surgery training lacks standardized guidelines. Drawing from remediation practices in other surgical subspecialties, this study evaluates existing strategies and proposes a structured remediation framework tailored to I6 trainees.

Methods

A systematic review examining remediation policies in surgical residency programs was conducted through December 2024. Studies meeting inclusion criteria were critically analyzed and key themes were synthesized to inform a standardized approach for I6 trainees.

Results

Of 239 identified articles, 18 met inclusion criteria. Findings emphasized the importance of regular assessments, structured performance evaluations, and collaborative intervention strategies, including faculty mentorship and success teams. Standardized remediation protocols, as seen in neurosurgery and orthopedics, were instrumental in addressing competency deficiencies through competency-based assessments and curriculum refinements.

Conclusions

I6 training demands a multifaceted remediation approach encompassing technical proficiency, clinical acumen, and professional development. By integrating best practices from related surgical fields, this study proposes a tailored, evidence-based remediation framework to enhance surgical education and to support struggling residents. Establishing a standardized remediation policy across I6 programs can optimize training outcomes, ensuring competence and preparedness of future cardiothoracic surgeons.

背景：有效的修复对于住院医师项目的成功至关重要，但综合心胸外科培训缺乏标准化的指导方针。借鉴其他外科专科的修复实践，本研究评估了现有的策略，并提出了适合I6名学员的结构化修复框架。方法：通过2024年12月的系统回顾，检查外科住院医师项目的补救政策。对符合纳入标准的研究进行了严格分析，并对关键主题进行了综合，以便为I6名受训人员提供标准化方法。结果：236篇文献中，18篇符合纳入标准。研究结果强调了定期评估、结构化绩效评估和协作干预策略的重要性，包括教师指导和成功团队。标准化的补救方案，如在神经外科和矫形外科中所见，有助于通过基于能力的评估和课程改进来解决能力缺陷。结论：I6培训需要多方面的补救方法，包括技术熟练程度、临床敏锐度和专业发展。通过整合相关外科领域的最佳实践，本研究提出了一个量身定制的、基于证据的补救框架，以加强外科教育和支持困难的住院医生。在I6项目中建立标准化的补救政策可以优化培训结果，确保未来心胸外科医生的能力和准备。

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引用次数: 0

Cardiac Hemangioma: Getting to the Heart of the Matter 心脏血管瘤：触及问题的核心。

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-11 DOI: 10.1016/j.athoracsur.2025.10.034

Jessica B. Briscoe MD , Uzma Rahman MD , Nkosi H. Alvarez MD , Deven C. Patel MD , Jigesh Baxi MD , AlleaBelle Bradshaw MD , Jeremy Johnson MD, PhD , Ahmet Kilic MD

Cardiac hemangiomas are rare, benign primary tumors that can be locally invasive and cause symptoms. The current recommendation is a complete R0 resection, which may require coronary artery reconstruction. We present a patient with progressive dyspnea who was found to have a large cardiac hemangioma encasing the left anterior descending artery and compressing the left ventricle. To achieve an R0 resection, the mass was removed en bloc with the left anterior descending artery, and the artery was reconstructed using a saphenous vein interposition graft. This case demonstrates the importance of an R0 resection for cardiac hemangioma, which may need nontraditional revascularization techniques.

心脏血管瘤是一种罕见的良性原发性肿瘤，可局部侵袭并引起症状。目前的建议是完全切除R0，这可能需要冠状动脉重建。我们报告一个进行性呼吸困难的病人，发现有一个大的心脏血管瘤包围左前降支（LAD）并压迫左心室。为了实现R0切除，肿块与LAD一起被整体切除，并使用隐静脉间置移植物重建。本病例证明了R0切除心脏血管瘤的重要性，这可能需要非传统的血运重建技术。

引用次数: 0

Preoperative Frailty Assessments: More Than Meets the Eye 术前虚弱评估：超过满足眼睛。

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery

Pub Date : 2026-03-01 Epub Date: 2026-01-02 DOI: 10.1016/j.athoracsur.2025.12.021

Samuel Creden MD, Rakesh C. Arora MD, PhD

引用次数: 0

Primary Thoracic Synovial Sarcoma: Results of Treatment at a Single Institution 原发性胸滑膜肉瘤：在单一机构治疗的结果。

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery

Pub Date : 2026-03-01 Epub Date: 2025-07-08 DOI: 10.1016/j.athoracsur.2025.06.030

Matthew Aizpuru MD , Samuel E. Broida MD , Yahya Alwatari MD , Stephen D. Cassivi MD , Dennis A. Wigle MD, PhD , Sahar A. Saddoughi MD, PhD , K. Robert Shen MD , Janani S. Reisenauer MD , Matthew T. Houdek MD , Luis F. Tapias MD

Background

Synovial sarcoma (SS) is a rare and aggressive malignancy. There is a paucity of data on treatment outcomes of patients with primary thoracic SS. This study describes an institutional experience with the treatment of primary thoracic SS.

Methods

Patients treated at Mayo Clinic between 1994 and 2022 for primary thoracic SS, excluding thoracic spine involvement, were retrospectively reviewed. Demographics, tumor characteristics, treatments, and outcomes were collected. Overall survival and recurrence-free survival were analyzed using the Kaplan-Meier method and Cox proportional hazards model.

Results

Among 43 patients (mean age, 46 [SD, 16.7] years), tumors originated in the lung (65%), chest wall (12%), mediastinum (9%), pleura (7%), pericardium (5%), and heart (2%). Localized disease at presentation was observed in 77%. Surgical resection was performed in 35 patients, with 37% receiving neoadjuvant chemotherapy and 17% neoadjuvant radiotherapy. Pulmonary resection was the most common operation (66%). Negative margins were achieved in 74% of patients. Median overall survival was 38.1 months, varying by treatment type (nonoperative, 11.8 months; non-R0 resection, 26.0 months; and R0 resection, 46.6 months; P = .008). Worse overall survival after resection was associated with nonpulmonary origin, larger size, and non-R0 resection. Median recurrence-free survival was 14.9 months, with mediastinal or pleural tumor origin and size ≥10 cm as factors associated with recurrence.

Conclusions

Primary thoracic SS are associated with a poor prognosis. Pulmonary and chest wall SS are associated with better outcomes compared with other sites of origin. Complete resection is associated with improved survival, and therefore, should be strongly considered in patients where a negative margin can be achieved.

背景：滑膜肉瘤（SS）是一种罕见的侵袭性恶性肿瘤。关于原发性胸椎SS患者治疗结果的数据缺乏。本研究描述了治疗原发性胸椎SS的机构经验。方法：回顾性分析1994-2022年间在梅奥诊所治疗的原发性胸椎SS患者，不包括胸椎受损伤。收集了人口统计学、肿瘤特征、治疗方法和结果。采用Kaplan-Meier法和Cox比例风险模型分析总生存期（OS）和无复发生存期（RFS）。结果：43例患者（平均年龄46±16.7岁）中，肿瘤起源于肺（65%）、胸壁（12%）、纵隔（9%）、胸膜（7%）、心包（5%）和心脏（2%）。77%的患者有局限性疾病。35例患者行手术切除，其中37%接受新辅助化疗，17%接受新辅助放疗。肺切除术是最常见的手术（66%）。在74%的病例中实现了负边际。中位OS为38.1个月，因治疗方式而异(非手术：11.8个月，非R0切除：26.0个月，R0切除：46.6个月；p = 0.008)。切除后不良OS与非肺源性、较大体积和非r0切除相关。中位RFS为14.9个月，肿瘤起源于纵隔或胸膜，肿瘤大小≥10cm为复发相关因素。结论：原发性胸椎SS预后较差。与其他起源部位相比，肺和胸壁SS与更好的预后相关。完全切除与生存率的提高有关，因此，对于可以达到阴性切缘的患者，应强烈考虑完全切除。

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引用次数: 0

Unaddressed Methodological and Statistical Concerns in Assessing Patient-Prosthesis Mismatch After SAVR 评估SAVR术后患者-假体不匹配的方法学和统计学问题。

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery

Pub Date : 2026-03-01 Epub Date: 2025-07-11 DOI: 10.1016/j.athoracsur.2025.06.042

Aabir Imran MBBS, Aaila Haider MBBS

引用次数: 0

Polymorphic Ventricular Tachycardia Related to Inappropriate Sensitivity Threshold of Epicardial Pacing Systems 多形性室性心动过速与心外膜起搏系统不适当的敏感阈值有关。

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery

Pub Date : 2026-03-01 Epub Date: 2025-07-15 DOI: 10.1016/j.athoracsur.2025.06.035

Russell A. Caratenuto MD, Suyog A. Mokashi MD, Glenn J.R. Whitman MD, Isaac R. Whitman MD

引用次数: 0

Melody vs Mechanical Mitral Valve Replacement in Young Children: A Single-Center Propensity Matched Analysis 旋律与机械二尖瓣置换术在幼儿：单中心倾向匹配分析。

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery

Pub Date : 2026-03-01 Epub Date: 2025-08-25 DOI: 10.1016/j.athoracsur.2025.08.007

Morgan K. Moroi MD , Alice V. Vinogradsky MD , Iris Feng BS , Elizabeth M. Cordoves BA , Stéphanie Levasseur MD , Oliver M. Barry MD , Emile A. Bacha MD , David M. Kalfa MD, PhD , Andrew B. Goldstone MD, PhD

Background

To examine outcomes of Melody (Medtronic) vs mechanical mitral valve replacement (MVR) in young children.

Methods

We retrospectively reviewed 36 patients aged <2 years who underwent Melody or mechanical MVR between 2005 and 2023. Propensity score matching was performed to account for baseline differences, yielding 2 groups of 12 patients. Transplant-free survival and cumulative incidence of surgical reintervention were compared. Median follow-up time was 2.3 (interquartile range [IQR], 0.4-6.7) years.

Results

Matched groups were similar across baseline parameters. Median age and weight were 5.2 (IQR, 3.5-10.2) months and 6.5 (IQR, 4.9-7.6) kg. In the mechanical group, 4 (36.4%) patients had a pacemaker requirement at discharge, compared with 0 Melody patients (P = .08). Early surgical reinterventions occurred in both groups (16.7% vs 16.7%, P = 1.00). There were 2 early mortalities: 1 in a Melody patient salvaged from mechanical support and 1 in a patient who developed left atrioventricular groove hematoma due to Melody overdilation. There were no differences in transplant-free survival at 5 years (Melody: 66.7%; Mechanical: 66.0%; P = .96) or cumulative incidence of surgical reintervention at 2 years (Melody: 32.2%; Mechanical: 30.3%; P = .3).

Conclusions

Melody MVR offers a suitable alternative to mechanical MVR, with comparable mid-term morbidity and mortality, while avoiding systemic anticoagulation.

背景：探讨梅洛迪二尖瓣置换术与机械二尖瓣置换术（MVR）在幼儿中的疗效。方法：我们回顾性分析了36例患者。结果：匹配组的基线参数相似。中位年龄和体重为5.2个月[IQR: 3.5,10.2]和6.5 kg [IQR: 4.9,7.6]。在机械组，4例（36.4%）患者出院时需要起搏器，而旋律组为0例（P=0.08）。两组患者均出现早期手术再干预（16.7% vs. 16.7%， P=1.00）。有2例早期死亡，一例是美乐蒂患者，从机械支持中抢救出来，另一例是美乐蒂过度扩张导致左房室沟血肿。5年无移植生存率（Melody: 66.7%; Mechanical: 66.0%； P=0.96）和2年手术再干预的累积发生率（Melody: 32.2%; Mechanical: 30.3%； P=0.3）无差异。结论：旋律MVR是机械MVR的合适选择，中期发病率和死亡率相当，同时避免了全身抗凝。

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引用次数: 0

Surgery for Failed Mitral Valve Repair for Degenerative Disease 退行性疾病二尖瓣修复失败的手术治疗。

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery

Pub Date : 2026-03-01 Epub Date: 2025-12-30 DOI: 10.1016/j.athoracsur.2025.12.012

Tirone E. David MD

引用次数: 0

Mechanical Valves in Young Women in Low-Income Countries: How Does Rwanda Succeed? 低收入国家年轻女性使用机械阀：卢旺达如何成功？

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery

Pub Date : 2026-03-01 Epub Date: 2025-07-11 DOI: 10.1016/j.athoracsur.2025.06.041

Valdano Manuel MD, PhD

引用次数: 0

Late Aortic Reinterventions After Surgery for Acute Type A Aortic Dissection 急性A型主动脉夹层术后晚期主动脉再介入治疗。

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery

Pub Date : 2026-03-01 Epub Date: 2025-08-06 DOI: 10.1016/j.athoracsur.2025.07.021

Markus Bjurbom MD , Kristina Ma MS , Magnus Dalén MD, PhD , Anders Franco-Cereceda MD, PhD , Christian Olsson MD, PhD

Background

This study was conducted to outline patterns, prevalence, and outcomes of aortic reinterventions after surgical repair for acute type A aortic dissection (ATAAD) and to identify factors associated with proximal and distal aortic reinterventions.

Methods

All patients (n = 225) undergoing surgical ATAAD repair at a single center at least 10 years ago (2005-2013) were included. All aortic reinterventions were reported. A Fine-Gray multivariable model, treating death and contraindication as competing risks, was used to investigate factors associated with aortic reintervention.

Results

Median follow-up time was 10.3 years (interquartile range, 5.0-13.4 years). Thirty-seven patients underwent ≥1 aortic reintervention at median 7.9 years (up to 15 years) after the index procedure. Factors associated with proximal aortic reintervention were root diameter >45 mm without root replacement at index repair (subhazard ratio [SHR], 6.9l; 95% CI, 1.8-27; P = .005), bicuspid aortic valve (SHR, 8.4; 95% CI, 1.5-47; P = .016), and age (SHR, 0.93; 95% CI, 0.89-0.98; P = .006). Factors associated with distal aortic reinterventions were failure to completely resect the primary tear (SHR, 2.7; 95% CI, 1.2-6.0; P = .014) and connective tissue disease (SHR, 24; 95% CI, 8.1-72; P < .001). There were no periprocedural deaths at reintervention. Event-free survival at 1, 5, 10, and 15 years was 82% (95% CI, 77%-87%), 72% (95% CI, 65%-77%), 48% (95% CI, 41%-54%), and 33% (95% CI, 26%-40%), respectively.

Conclusions

With sufficient follow-up, event-free survival after ATAAD repair appears substantially impaired. However, in selected patients, aortic reinterventions were performed with favorable outcomes. Replacing a moderately dilated aortic root and ensuring complete resection of the primary tear may decrease the need for future aortic reinterventions.

背景：概述急性A型主动脉夹层（ATAAD）手术修复后主动脉再介入的模式、患病率和结果，并确定主动脉近端和远端再介入的相关因素。方法：纳入至少10年前（2005-2013年）在单一中心接受ATAAD手术修复的所有患者（n=225）。所有主动脉再介入均被报道。采用细灰色多变量模型，将死亡和禁忌症视为相互竞争的风险，研究与主动脉再介入相关的因素。结果：中位随访时间为10.3年（5.0 ~ 13.4年）。37例患者在指数手术后中位7.9年（最长15年）接受了≥1次主动脉再介入治疗。与主动脉近端再介入相关的因素有：指数修复时无根置换的根直径> ~ 45mm（亚危险比[SHR] 6.9, 95% CI 1.8 ~ 27, p=0.005）、二尖瓣主动脉瓣（SHR 8.4, 95% CI 1.5 ~ 47, p=0.016）和年龄（SHR 0.93, 95% CI 0.89 ~ 0.98, p=0.006）。与主动脉远端再介入相关的因素是未能完全切除原发撕裂（SHR为2.7,95% CI为1.2-6.0,p=0.014）和结缔组织疾病（SHR为24,95% CI为8.1-72）。结论：通过充分的随访，ATAAD修复后的无事件生存期明显受损。然而，在选定的患者中，主动脉再介入治疗的结果良好。更换适度扩张的主动脉根部并确保完全切除原发撕裂可能减少未来主动脉再次介入治疗的需要。

{"title":"Late Aortic Reinterventions After Surgery for Acute Type A Aortic Dissection","authors":"Markus Bjurbom MD , Kristina Ma MS , Magnus Dalén MD, PhD , Anders Franco-Cereceda MD, PhD , Christian Olsson MD, PhD","doi":"10.1016/j.athoracsur.2025.07.021","DOIUrl":"10.1016/j.athoracsur.2025.07.021","url":null,"abstract":"<div><h3>Background</h3><div>This study was conducted to outline patterns, prevalence, and outcomes of aortic reinterventions after surgical repair for acute type A aortic dissection (ATAAD) and to identify factors associated with proximal and distal aortic reinterventions.</div></div><div><h3>Methods</h3><div>All patients (n = 225) undergoing surgical ATAAD repair at a single center at least 10 years ago (2005-2013) were included. All aortic reinterventions were reported. A Fine-Gray multivariable model, treating death and contraindication as competing risks, was used to investigate factors associated with aortic reintervention.</div></div><div><h3>Results</h3><div>Median follow-up time was 10.3 years (interquartile range, 5.0-13.4 years). Thirty-seven patients underwent ≥1 aortic reintervention at median 7.9 years (up to 15 years) after the index procedure. Factors associated with proximal aortic reintervention were root diameter >45 mm without root replacement at index repair (subhazard ratio [SHR], 6.9l; 95% CI, 1.8-27; <em>P</em> = .005), bicuspid aortic valve (SHR, 8.4; 95% CI, 1.5-47; <em>P</em> = .016), and age (SHR, 0.93; 95% CI, 0.89-0.98; <em>P</em> = .006). Factors associated with distal aortic reinterventions were failure to completely resect the primary tear (SHR, 2.7; 95% CI, 1.2-6.0; <em>P</em> = .014) and connective tissue disease (SHR, 24; 95% CI, 8.1-72; <em>P</em> < .001). There were no periprocedural deaths at reintervention. Event-free survival at 1, 5, 10, and 15 years was 82% (95% CI, 77%-87%), 72% (95% CI, 65%-77%), 48% (95% CI, 41%-54%), and 33% (95% CI, 26%-40%), respectively.</div></div><div><h3>Conclusions</h3><div>With sufficient follow-up, event-free survival after ATAAD repair appears substantially impaired. However, in selected patients, aortic reinterventions were performed with favorable outcomes. Replacing a moderately dilated aortic root and ensuring complete resection of the primary tear may decrease the need for future aortic reinterventions.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 548-556"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805249","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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