Left ventricular reverse remodeling, which is synonymous left ventricular mass regression, after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) is associated with positive clinical outcomes in patients with aortic stenosis. However, the roles of SAVR and TAVR in left ventricular mass regression remain unclear. This study compared the left ventricular mass change between SAVR and TAVR.
Methods
Included were 1939 patients with aortic stenosis who underwent isolated SAVR or TAVR, and 1:1 propensity matching was performed (247 pairs). The primary outcome was the time course change of left ventricular mass between SAVR and TAVR. Left ventricular mass regression was evaluated and calculated up to 1 year of follow-up by echocardiography.
Results
In a matched cohort, SAVR demonstrated better left ventricular mass regression compared with TAVR at 30 days (SAVR vs TAVR: mean, −11.2% [95% CI, −13.4% to −8.9%] vs mean, −2.6% [95% CI, −5.0% to −0.4%], P < .01) and at 1 year (SAVR vs TAVR: mean −23.8% [95% CI, − 26.0% to −21.6%) vs −13.8% [95% CI, −16.6% to −11.0%], P < .01). In multivariable analysis, baseline left ventricular mass index (odds ratio, 1.04; 95% CI, 1.03-1.05; P < .01), SAVR choice (odds ratio, 2.54; 95% CI, 1.46-4.43; P < .01), and paravalvular leakage mild or more (odds ratio, 0.61; 95% CI, 0.44-0.84; P < .01) were associated with left ventricular mass regression.
Conclusions
SAVR demonstrated better left ventricular mass regression than TAVR in a matched cohort. Considering the lifetime management of the patients, selecting the optimal valve is crucial.
背景：主动脉瓣置换术（SAVR）或经导管主动脉瓣置换术（TAVR）后左心室反向重构与主动脉瓣狭窄患者的积极临床结果相关。然而，SAVR和TAVR在左心室肿块消退中的作用尚不清楚。本研究比较了SAVR和TAVR的左心室质量变化。方法纳入1939例主动脉瓣狭窄患者，分别行单纯SAVR或TAVR，进行1:1倾向匹配（247对）。主要观察指标是SAVR和TAVR之间左心室质量的时间变化。通过超声心动图评估和计算随访1年的左心室质量回归。结果在一个匹配的队列中，与TAVR相比，SAVR在30天（SAVR vs TAVR：平均值，- 11.2% [95% CI, - 13.4%至- 8.9%]比平均值，- 2.6% [95% CI, - 5.0%至- 0.4%],P < 01）和1年时（SAVR vs TAVR：平均值- 23.8% [95% CI, - 26.0%至- 21.6%]比- 13.8% [95% CI, - 16.6%至- 11.0%],P < 01）表现出更好的左心室质量回归。在多变量分析中，基线左室质量指数（优势比，1.04;95% CI, 1.03-1.05; P < 0.01）、SAVR选择（优势比，2.54;95% CI, 1.46-4.43; P < 0.01）和轻度或重度瓣旁漏（优势比，0.61;95% CI, 0.44-0.84; P < 0.01）与左室质量回归相关。结论在匹配的队列中，savr比TAVR表现出更好的左心室质量退化。考虑到患者的终身管理，选择最佳瓣膜是至关重要的。
{"title":"Comparing Cardiac Reverse Remodeling in Aortic Stenosis With Surgical and Transcatheter Aortic Valve Replacement","authors":"Koichi Inoue MD , Koichi Maeda MD, PhD , Kyongsun Pak PhD , Kazuo Shimamura MD, PhD , Arudo Hiraoka MD, PhD , Hidenori Yoshitaka MD, PhD , Katsukiyo Kitabayashi MD, PhD , Haruhiko Kondoh MD, PhD , Yukitoshi Sirakawa MD, PhD , Shigeru Miyagawa MD, PhD","doi":"10.1016/j.atssr.2025.03.019","DOIUrl":"10.1016/j.atssr.2025.03.019","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular reverse remodeling, which is synonymous left ventricular mass regression, after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) is associated with positive clinical outcomes in patients with aortic stenosis. However, the roles of SAVR and TAVR in left ventricular mass regression remain unclear. This study compared the left ventricular mass change between SAVR and TAVR.</div></div><div><h3>Methods</h3><div>Included were 1939 patients with aortic stenosis who underwent isolated SAVR or TAVR, and 1:1 propensity matching was performed (247 pairs). The primary outcome was the time course change of left ventricular mass between SAVR and TAVR. Left ventricular mass regression was evaluated and calculated up to 1 year of follow-up by echocardiography.</div></div><div><h3>Results</h3><div>In a matched cohort, SAVR demonstrated better left ventricular mass regression compared with TAVR at 30 days (SAVR vs TAVR: mean, −11.2% [95% CI, −13.4% to −8.9%] vs mean, −2.6% [95% CI, −5.0% to −0.4%], <em>P</em> < .01) and at 1 year (SAVR vs TAVR: mean −23.8% [95% CI, − 26.0% to −21.6%) vs −13.8% [95% CI, −16.6% to −11.0%], <em>P</em> < .01). In multivariable analysis, baseline left ventricular mass index (odds ratio, 1.04; 95% CI, 1.03-1.05; <em>P</em> < .01), SAVR choice (odds ratio, 2.54; 95% CI, 1.46-4.43; <em>P</em> < .01), and paravalvular leakage mild or more (odds ratio, 0.61; 95% CI, 0.44-0.84; <em>P</em> < .01) were associated with left ventricular mass regression.</div></div><div><h3>Conclusions</h3><div>SAVR demonstrated better left ventricular mass regression than TAVR in a matched cohort. Considering the lifetime management of the patients, selecting the optimal valve is crucial.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 3","pages":"Pages 624-628"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.atssr.2025.01.012
Adrian Acuna Higaki BS , Irbaz Hameed MD , Ely Erez MD , Kevin G. Hu BS , Sem Asmelash BS , Devina Chatterjee BS , Benjamin Shou BS , Mohammad Zafar MBBS , Roland Assi MD, MMS , Prashanth Vallabhajosyula MD, MS
Background
The optimal initial management for uncomplicated acute type B aortic dissection (uATBAD) remains unclear. We evaluated 1-year aortic remodeling and clinical outcomes of thoracic endovascular aortic repair (TEVAR) vs exclusively optimal medical therapy for uATBAD.
Methods
Patients with uATBAD were retrospectively grouped by initial treatment modality, with 52 patients treated with TEVAR and 142 with optimal medical therapy. Clinical outcomes and aortic remodeling were compared at presentation and 1-year follow-up. Aortic remodeling parameters, including change in true lumen diameter, full lumen diameter, and true lumen index, and extent of false lumen thrombosis were assessed at 12 thoracoabdominal levels and compared between treatment groups.
Results
TEVAR had lower 30-day/in-hospital mortality than optimal medical therapy (0% vs 11.3%; P < .01). Reintervention rates did not differ between groups (P > .05). Thirty-one TEVAR and 42 optimal medical therapy patients were included in remodeling analysis with a median follow-up of 6.9 months (interquartile range, 3.6-10.8 months). Change in true lumen diameter and true lumen index was greater in TEVAR than in optimal medical therapy from left subclavian artery to the diaphragm (P < .001). Change in full lumen diameter showed no difference between groups except at the superior mesenteric artery (P = .04). At the thoracic aortic levels, TEVAR showed significant shift toward full false lumen thrombosis (P < .001).
Conclusions
TEVAR was associated with favorable aortic remodeling as well as short-term and midterm outcomes compared with optimal medical therapy in patients with uATBAD. The positive remodeling is more pronounced at thoracic aortic levels.
背景：无并发症急性B型主动脉夹层（uATBAD）的最佳初始治疗尚不清楚。我们评估了1年主动脉重塑和胸腔血管内主动脉修复（TEVAR）与uATBAD的最佳药物治疗的临床结果。方法对uATBAD患者按初始治疗方式进行回顾性分组，其中52例采用TEVAR治疗，142例采用最佳药物治疗。临床结果和主动脉重塑在就诊和1年随访时进行比较。在12个胸腹水平评估主动脉重塑参数，包括真管腔直径、全管腔直径、真管腔指数和假管腔血栓形成程度的变化，并比较治疗组之间的差异。结果治疗组30天/住院死亡率低于最佳药物治疗组（0% vs 11.3%; P < 0.01）。两组间再干预率无差异（P > 0.05）。重构分析纳入了31例TEVAR患者和42例最佳药物治疗患者，中位随访时间为6.9个月（四分位数间距为3.6-10.8个月）。从左锁骨下动脉到横膈膜，TEVAR组真管腔直径和真管腔指数的变化大于最佳药物治疗组（P < 0.001）。除肠系膜上动脉外，两组间全腔直径变化无显著差异（P = 0.04）。在胸主动脉水平，TEVAR显示明显向完全假腔血栓转变（P < .001）。结论：与最佳药物治疗相比，在uATBAD患者中，stevar与良好的主动脉重塑以及短期和中期预后相关。正性重构在胸主动脉段更为明显。
{"title":"Endovascular Repair vs Medical Therapy for Uncomplicated Acute Type B Dissection: Aortic Remodeling","authors":"Adrian Acuna Higaki BS , Irbaz Hameed MD , Ely Erez MD , Kevin G. Hu BS , Sem Asmelash BS , Devina Chatterjee BS , Benjamin Shou BS , Mohammad Zafar MBBS , Roland Assi MD, MMS , Prashanth Vallabhajosyula MD, MS","doi":"10.1016/j.atssr.2025.01.012","DOIUrl":"10.1016/j.atssr.2025.01.012","url":null,"abstract":"<div><h3>Background</h3><div>The optimal initial management for uncomplicated acute type B aortic dissection (uATBAD) remains unclear. We evaluated 1-year aortic remodeling and clinical outcomes of thoracic endovascular aortic repair (TEVAR) vs exclusively optimal medical therapy for uATBAD.</div></div><div><h3>Methods</h3><div>Patients with uATBAD were retrospectively grouped by initial treatment modality, with 52 patients treated with TEVAR and 142 with optimal medical therapy. Clinical outcomes and aortic remodeling were compared at presentation and 1-year follow-up. Aortic remodeling parameters, including change in true lumen diameter, full lumen diameter, and true lumen index, and extent of false lumen thrombosis were assessed at 12 thoracoabdominal levels and compared between treatment groups.</div></div><div><h3>Results</h3><div>TEVAR had lower 30-day/in-hospital mortality than optimal medical therapy (0% vs 11.3%; <em>P</em> < .01). Reintervention rates did not differ between groups (<em>P</em> > .05). Thirty-one TEVAR and 42 optimal medical therapy patients were included in remodeling analysis with a median follow-up of 6.9 months (interquartile range, 3.6-10.8 months). Change in true lumen diameter and true lumen index was greater in TEVAR than in optimal medical therapy from left subclavian artery to the diaphragm (<em>P</em> < .001). Change in full lumen diameter showed no difference between groups except at the superior mesenteric artery (<em>P</em> = .04). At the thoracic aortic levels, TEVAR showed significant shift toward full false lumen thrombosis (<em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>TEVAR was associated with favorable aortic remodeling as well as short-term and midterm outcomes compared with optimal medical therapy in patients with uATBAD. The positive remodeling is more pronounced at thoracic aortic levels.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 3","pages":"Pages 555-560"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.atssr.2025.03.011
Muath Bishawi MD, PhD , Christopher Jensen MD , Andrew Vekstein MD , Andrzej S. Kosinski PhD , Fred L. Grover MD , J. Kevin Harrison MD , Vinod H. Thourani MD , Ajay J. Kirtane MD , Joseph E. Bavaria MD , Sreekanth Vemulapalli MD , G. Chad Hughes MD
Background
Mortality after transcatheter aortic valve replacement (TAVR) varies among centers. “Failure to rescue” (FTR) patients from post-TAVR complications may represent an unexplored opportunity for TAVR process improvement.
Methods
The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry was queried for patients undergoing transfemoral TAVR between 2011 and 2016. Hospital FTR rate was derived from the ratio of observed-to-expected procedural mortality. Multivariable logistic regression models assessed the association between FTR and hospital mortality. Adjusted FTR rates were compared across tertiles of hospital mortality.
Results
The analysis included 61,804 patients (429 sites). Post-TAVR mortality at low-, middle-, and high-mortality hospitals was 1.8%, 3.3%, and 5.6% (P < .01), respectively. Risk-adjusted complication rates differed only slightly between tertiles (22.2% vs 24.5% vs 27.0%, P < .001). However, adjusted FTR rates were significantly worse in high- and medium-mortality hospitals than in low-mortality centers (14.6% vs 9.5% vs 5.4%, P < .001). This was true for all investigated complications, including conversion to open surgery (high-mortality: odds ratio [OR], 9.04 [95% CI, 4.12-19.83], P < .001; medium-mortality: OR 2.99 [95% CI, 1.48-6.07], P < .003), stroke (high-mortality: OR, 3.15 [95% CI, 1.97-5.04], P < .001; medium-mortality: OR, 1.67 [95% CI, 1.05-2.67], P < .032), and cardiac arrest (high-mortality: OR, 3.54 [95% CI, 2.57-4.87], P < .001; medium-mortality: OR, 1.67 [95% CI, 1.24-2.24], P < .001).
Conclusions
National TAVR mortality rates vary significantly across centers, despite comparable rates of postoperative complications. Patients at medium- and high-mortality centers face a disproportionately higher risk of death due to FTR. These findings highlight the need for a closer evaluation of post-TAVR care processes to address this disparity.
背景：经导管主动脉瓣置换术（TAVR）后的死亡率在各中心有所不同。TAVR术后并发症的“抢救失败”（FTR）患者可能是TAVR过程改进的一个未被探索的机会。方法查询2011 - 2016年胸外科学会/美国心脏病学会经导管瓣膜治疗登记的经股TAVR患者。医院FTR率来源于观察到的与预期的手术死亡率之比。多变量logistic回归模型评估了FTR与住院死亡率之间的关系。调整后的FTR率在医院死亡率的各分位数之间进行比较。结果共纳入61804例患者（429个部位）。tavr术后低、中、高死亡率医院的死亡率分别为1.8%、3.3%和5.6% （P < 0.01）。两组间经风险调整后的并发症发生率仅略有差异（22.2% vs 24.5% vs 27.0%, P < 001）。然而，调整后的FTR率在高死亡率和中等死亡率医院明显低于低死亡率中心（14.6% vs 9.5% vs 5.4%, P < 0.001）。这是适用于所有调查并发症,包括转换为开放手术(高死亡率:比值比(或),9.04(95%可信区间,4.12 - -19.83),P & lt;措施;medium-mortality:或2.99 (95% CI, 1.48 - -6.07), P & lt; .003),中风(高死亡率:或者,3.15(95%可信区间,1.97 - -5.04),P & lt;措施;medium-mortality:或者,1.67(95%可信区间,1.05 - -2.67),P & lt; .032),和心脏骤停(高死亡率:或者,3.54(95%可信区间,2.57 - -4.87),P & lt;措施;medium-mortality:或者,1.67(95%可信区间,1.24 - -2.24),P & lt;措施)。结论：尽管术后并发症发生率相当，但全国各中心TAVR死亡率差异显著。中死亡率和高死亡率中心的患者因FTR而面临不成比例的更高死亡风险。这些发现强调需要对tavr后护理过程进行更密切的评估，以解决这一差异。
{"title":"Influence of Failure to Rescue on Mortality After Transcatheter Aortic Valve Replacement","authors":"Muath Bishawi MD, PhD , Christopher Jensen MD , Andrew Vekstein MD , Andrzej S. Kosinski PhD , Fred L. Grover MD , J. Kevin Harrison MD , Vinod H. Thourani MD , Ajay J. Kirtane MD , Joseph E. Bavaria MD , Sreekanth Vemulapalli MD , G. Chad Hughes MD","doi":"10.1016/j.atssr.2025.03.011","DOIUrl":"10.1016/j.atssr.2025.03.011","url":null,"abstract":"<div><h3>Background</h3><div>Mortality after transcatheter aortic valve replacement (TAVR) varies among centers. “Failure to rescue” (FTR) patients from post-TAVR complications may represent an unexplored opportunity for TAVR process improvement.</div></div><div><h3>Methods</h3><div>The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry was queried for patients undergoing transfemoral TAVR between 2011 and 2016. Hospital FTR rate was derived from the ratio of observed-to-expected procedural mortality. Multivariable logistic regression models assessed the association between FTR and hospital mortality. Adjusted FTR rates were compared across tertiles of hospital mortality.</div></div><div><h3>Results</h3><div>The analysis included 61,804 patients (429 sites). Post-TAVR mortality at low-, middle-, and high-mortality hospitals was 1.8%, 3.3%, and 5.6% (<em>P</em> < .01), respectively. Risk-adjusted complication rates differed only slightly between tertiles (22.2% vs 24.5% vs 27.0%, <em>P</em> < .001). However, adjusted FTR rates were significantly worse in high- and medium-mortality hospitals than in low-mortality centers (14.6% vs 9.5% vs 5.4%, <em>P</em> < .001). This was true for all investigated complications, including conversion to open surgery (high-mortality: odds ratio [OR], 9.04 [95% CI, 4.12-19.83], <em>P</em> < .001; medium-mortality: OR 2.99 [95% CI, 1.48-6.07], <em>P</em> < .003), stroke (high-mortality: OR, 3.15 [95% CI, 1.97-5.04], <em>P</em> < .001; medium-mortality: OR, 1.67 [95% CI, 1.05-2.67], <em>P</em> < .032), and cardiac arrest (high-mortality: OR, 3.54 [95% CI, 2.57-4.87], <em>P</em> < .001; medium-mortality: OR, 1.67 [95% CI, 1.24-2.24], <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>National TAVR mortality rates vary significantly across centers, despite comparable rates of postoperative complications. Patients at medium- and high-mortality centers face a disproportionately higher risk of death due to FTR. These findings highlight the need for a closer evaluation of post-TAVR care processes to address this disparity.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 3","pages":"Pages 617-623"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.atssr.2025.01.005
Nataly Montano Vargas ScM , Danielle M. Mullis BS , Matthew Wingo MD , Alyssa C. Garrison MS , T. Robert Feng MD , John W. MacArthur MD
This case report describes the rare case of cardiovascular collapse and coronary ostial stenosis secondary to syphilitic aortitis in a previously healthy 47-year-old woman. To avoid manipulation of a vasculitic aorta, anaortic coronary artery bypass grafting was performed. Syphilitic aortitis with coronary occlusive disease is rare since the advent of antibiotics, but this case report highlights the importance of including syphilitic aortitis on the differential diagnosis for coronary artery lesions.
{"title":"Anaortic Coronary Artery Bypass Grafting After Cardiovascular Collapse From Severe Syphilitic Aortitis With Coronary Obstruction","authors":"Nataly Montano Vargas ScM , Danielle M. Mullis BS , Matthew Wingo MD , Alyssa C. Garrison MS , T. Robert Feng MD , John W. MacArthur MD","doi":"10.1016/j.atssr.2025.01.005","DOIUrl":"10.1016/j.atssr.2025.01.005","url":null,"abstract":"<div><div>This case report describes the rare case of cardiovascular collapse and coronary ostial stenosis secondary to syphilitic aortitis in a previously healthy 47-year-old woman. To avoid manipulation of a vasculitic aorta, anaortic coronary artery bypass grafting was performed. Syphilitic aortitis with coronary occlusive disease is rare since the advent of antibiotics, but this case report highlights the importance of including syphilitic aortitis on the differential diagnosis for coronary artery lesions.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 3","pages":"Pages 576-579"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.atssr.2025.03.003
Megan White MD , Kimberly O’Brien BS , Katy Marino MD , Jason Muesse MD , Emre Vural MD
Ectopic parathyroids account for 6% to 16% of primary hyperparathyroidism cases, which are definitively managed with surgical resection. Preoperative localization techniques, including ultrasonography, technetium-99m sestamibi scintigraphy, and single-photon emission computed tomography, are well-described but far fewer intraoperative localization techniques within the mediastinum are described. We present a 3-pronged approach to intraoperative ectopic parathyroid localization in a 66-year-old woman referred after preoperative technetium-99m sestamibi scintigraphy demonstrated anterior mediastinal uptake. Intraoperatively, the adenoma was identified with intravenous administration of indocyanine green, a delta parathyroid hormone assay >50%, and a postresection qualitative densitometry test. This method mitigates unnecessary dissection and reduces operative time.
{"title":"Sinking Stones and Fluorescent Undertones: Intraoperative Parathyroid Identification Technique","authors":"Megan White MD , Kimberly O’Brien BS , Katy Marino MD , Jason Muesse MD , Emre Vural MD","doi":"10.1016/j.atssr.2025.03.003","DOIUrl":"10.1016/j.atssr.2025.03.003","url":null,"abstract":"<div><div>Ectopic parathyroids account for 6% to 16% of primary hyperparathyroidism cases, which are definitively managed with surgical resection. Preoperative localization techniques, including ultrasonography, technetium-99m sestamibi scintigraphy, and single-photon emission computed tomography, are well-described but far fewer intraoperative localization techniques within the mediastinum are described. We present a 3-pronged approach to intraoperative ectopic parathyroid localization in a 66-year-old woman referred after preoperative technetium-99m sestamibi scintigraphy demonstrated anterior mediastinal uptake. Intraoperatively, the adenoma was identified with intravenous administration of indocyanine green, a delta parathyroid hormone assay >50%, and a postresection qualitative densitometry test. This method mitigates unnecessary dissection and reduces operative time.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 3","pages":"Pages 746-748"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.atssr.2025.02.006
Armita Kabirpour MD , J. Ross Wheeler MD , Jerry Saunders MD , Sara Edwards MD , Solomon Bienstock MD , Mary B. Beasley MD , Robin Varghese MD
We report a case of a 41-year-old female who was found to have a 2.7-cm right atrial mass during the third trimester of her pregnancy. She underwent successful surgical resection 4 months after an uneventful delivery. Pathologic examination revealed an ectopic liver, a remarkably rare finding in this anatomic location. The potential for malignant transformation, embolization, obstruction and the need for histologic diagnosis necessitated surgical removal of the intracardiac ectopic liver. We discuss the role of cardiovascular imaging and considerations for surgical planning. In addition, we review the hormonal alterations during pregnancy that may promote growth of hepatic tissue.
{"title":"Atrial Mass in Pregnancy: A Rare Case of Intracardiac Ectopic Liver","authors":"Armita Kabirpour MD , J. Ross Wheeler MD , Jerry Saunders MD , Sara Edwards MD , Solomon Bienstock MD , Mary B. Beasley MD , Robin Varghese MD","doi":"10.1016/j.atssr.2025.02.006","DOIUrl":"10.1016/j.atssr.2025.02.006","url":null,"abstract":"<div><div>We report a case of a 41-year-old female who was found to have a 2.7-cm right atrial mass during the third trimester of her pregnancy. She underwent successful surgical resection 4 months after an uneventful delivery. Pathologic examination revealed an ectopic liver, a remarkably rare finding in this anatomic location. The potential for malignant transformation, embolization, obstruction and the need for histologic diagnosis necessitated surgical removal of the intracardiac ectopic liver. We discuss the role of cardiovascular imaging and considerations for surgical planning. In addition, we review the hormonal alterations during pregnancy that may promote growth of hepatic tissue.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 3","pages":"Pages 629-632"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chordomas, rare malignant bone tumors originating from the residual embryonic notochord with a high propensity for local recurrence, require complete resection along with surrounding tissue removal. We report a case of an 18-year-old woman with a chordoma invading the sixth thoracic vertebral body. Because the descending aorta was present along the resection line, tumor resection with partial vertebrectomy was performed using a bilateral thoracic approach with the patient in the prone position. Fifteen months postoperatively, the patient remained recurrence free. This novel surgical approach enabled safe resection without injuring the descending aorta, thus highlighting its potential applicability for complex chordomas involving the thoracic spine.
{"title":"Posterior Mediastinal Chordoma Resected With Anterior Thoracic Vertebral Body Through Prone Bilateral Thoracic Approaches","authors":"Risa Kuboi MD , Hiroaki Harada MD, PhD , Koichi Akayama MD, PhD , Yuki Fujioka MD, PhD , Takuya Hattori MD, PhD , Hideki Tomiyoshi MD , Hiroshi Kondo MD , Hideaki Imada MD, PhD , Satoshi Shibata MD, PhD","doi":"10.1016/j.atssr.2025.03.015","DOIUrl":"10.1016/j.atssr.2025.03.015","url":null,"abstract":"<div><div>Chordomas, rare malignant bone tumors originating from the residual embryonic notochord with a high propensity for local recurrence, require complete resection along with surrounding tissue removal. We report a case of an 18-year-old woman with a chordoma invading the sixth thoracic vertebral body. Because the descending aorta was present along the resection line, tumor resection with partial vertebrectomy was performed using a bilateral thoracic approach with the patient in the prone position. Fifteen months postoperatively, the patient remained recurrence free. This novel surgical approach enabled safe resection without injuring the descending aorta, thus highlighting its potential applicability for complex chordomas involving the thoracic spine.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 3","pages":"Pages 757-760"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.atssr.2025.03.008
Justin C.Y. Chan MD, MPhil , Travis C. Geraci MD , Luis F. Angel MD , Stephanie H. Chang MD, MSCI
We describe the case of a 36-year-old woman who underwent redo lung transplantation AFTER a heart-lung transplant 3.5 years prior. The retransplantation was performed through sequential left posterolateral thoracotomy followed by right anterior thoracotomy, without sternal division and without the use of extracorporeal membrane oxygenation or cardiopulmonary bypass support. The patient was found to have undergone an extensive pericardiectomy at the time of the initial heart-lung transplant. The patient recovered uneventfully and complete healing of the airway anastomosis was demonstrated. This novel technique avoids some potential pitfalls of redo lung transplantation after heart-lung transplant.
{"title":"Redo Lung Transplantation After Heart-lung Transplantation","authors":"Justin C.Y. Chan MD, MPhil , Travis C. Geraci MD , Luis F. Angel MD , Stephanie H. Chang MD, MSCI","doi":"10.1016/j.atssr.2025.03.008","DOIUrl":"10.1016/j.atssr.2025.03.008","url":null,"abstract":"<div><div>We describe the case of a 36-year-old woman who underwent redo lung transplantation AFTER a heart-lung transplant 3.5 years prior. The retransplantation was performed through sequential left posterolateral thoracotomy followed by right anterior thoracotomy, without sternal division and without the use of extracorporeal membrane oxygenation or cardiopulmonary bypass support. The patient was found to have undergone an extensive pericardiectomy at the time of the initial heart-lung transplant. The patient recovered uneventfully and complete healing of the airway anastomosis was demonstrated. This novel technique avoids some potential pitfalls of redo lung transplantation after heart-lung transplant.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 3","pages":"Pages 780-783"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.atssr.2025.02.015
Taylor Pickering DO , John Eisenga MD , Cody Dorton DO , Kyle McCullough MD , Jasjit Banwait PhD , Jenelle Sheasby MSN , J. Michael DiMaio MD , Aasim Afzal MD , Timothy J. George MD
Background
Outcomes of postcardiotomy extracorporeal membrane oxygenation (ECMO) are well studied, but preoperative ECMO bridging is less studied. This single-center review evaluates outcomes of patients supported with ECMO as a bridge to definitive cardiac surgery.
Methods
We retrospectively reviewed all patients who underwent ECMO as a bridge to cardiac surgery between 2013 and 2024. Patients decannulated before surgery or bridged to advanced heart failure therapies were excluded. The primary outcome was survival to hospital discharge. Secondary outcomes included survival to ECMO decannulation, total ECMO duration, and postoperative complications such as hemodialysis, tracheostomy, stroke, reoperation, and survival at 30 days and 1 year.
Results
Sixteen patients were analyzed, of whom 15 (94%) were cannulated for acute heart failure, 1 (6%) for respiratory failure, and 2 (13%) as an adjunct to cardiopulmonary resuscitation. The cohort was 56% female, with a median age of 59.5 years (interquartile range [IQR], 49.3-65.8 years). Surgical procedures included valve surgery (63%), ventricular septal defect repair (31%), and coronary artery bypass grafting (6%). The median ECMO duration was 7 days [IQR, 4-10.5 days]. Survival to decannulation occurred in 81.3%, and 50% survived through hospital discharge. Survivors had lower rates of postoperative dialysis (37.5% vs 87.5%; P = .04) but a longer length of stay (25 days vs 9.5 days; P = .01).
Conclusions
Preoperative ECMO as a bridge to cardiac surgery is a viable strategy for select high-risk patients, with acceptable survival rates. Larger multicenter studies are needed to refine patient selection and optimize management strategies.
研究背景：心脏开心术后体外膜氧合（ECMO）的预后已经得到了很好的研究，但术前ECMO桥接的研究较少。本单中心综述评估了ECMO作为最终心脏手术的桥梁支持的患者的结果。方法回顾性分析2013年至2024年间所有接受ECMO作为心脏手术过渡的患者。手术前脱管或接受高级心力衰竭治疗的患者被排除在外。主要终点是存活至出院。次要结局包括到ECMO脱管的生存、ECMO总持续时间、术后并发症如血液透析、气管切开术、卒中、再手术、30天和1年的生存。结果16例患者中，因急性心力衰竭插管15例（94%），因呼吸衰竭插管1例（6%），因辅助心肺复苏插管2例（13%）。队列中56%为女性，中位年龄为59.5岁（四分位数间距[IQR]， 49.3-65.8岁）。外科手术包括瓣膜手术（63%）、室间隔缺损修复（31%）和冠状动脉搭桥术（6%）。ECMO的中位持续时间为7天[IQR， 4-10.5天]。81.3%的患者存活至去管，50%的患者存活至出院。幸存者术后透析率较低（37.5% vs 87.5%; P = 0.04），但住院时间较长（25天vs 9.5天；P = 0.01）。结论术前ECMO作为心脏外科手术的桥梁，对于高危患者是一种可行的策略，生存率可接受。需要更大规模的多中心研究来完善患者选择和优化管理策略。
{"title":"Preoperative Extracorporeal Membrane Oxygenation as a Bridge to Cardiac Surgery: Outcomes and Challenges","authors":"Taylor Pickering DO , John Eisenga MD , Cody Dorton DO , Kyle McCullough MD , Jasjit Banwait PhD , Jenelle Sheasby MSN , J. Michael DiMaio MD , Aasim Afzal MD , Timothy J. George MD","doi":"10.1016/j.atssr.2025.02.015","DOIUrl":"10.1016/j.atssr.2025.02.015","url":null,"abstract":"<div><h3>Background</h3><div>Outcomes of postcardiotomy extracorporeal membrane oxygenation (ECMO) are well studied, but preoperative ECMO bridging is less studied. This single-center review evaluates outcomes of patients supported with ECMO as a bridge to definitive cardiac surgery.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all patients who underwent ECMO as a bridge to cardiac surgery between 2013 and 2024. Patients decannulated before surgery or bridged to advanced heart failure therapies were excluded. The primary outcome was survival to hospital discharge. Secondary outcomes included survival to ECMO decannulation, total ECMO duration, and postoperative complications such as hemodialysis, tracheostomy, stroke, reoperation, and survival at 30 days and 1 year.</div></div><div><h3>Results</h3><div>Sixteen patients were analyzed, of whom 15 (94%) were cannulated for acute heart failure, 1 (6%) for respiratory failure, and 2 (13%) as an adjunct to cardiopulmonary resuscitation. The cohort was 56% female, with a median age of 59.5 years (interquartile range [IQR], 49.3-65.8 years). Surgical procedures included valve surgery (63%), ventricular septal defect repair (31%), and coronary artery bypass grafting (6%). The median ECMO duration was 7 days [IQR, 4-10.5 days]. Survival to decannulation occurred in 81.3%, and 50% survived through hospital discharge. Survivors had lower rates of postoperative dialysis (37.5% vs 87.5%; <em>P</em> = .04) but a longer length of stay (25 days vs 9.5 days; <em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>Preoperative ECMO as a bridge to cardiac surgery is a viable strategy for select high-risk patients, with acceptable survival rates. Larger multicenter studies are needed to refine patient selection and optimize management strategies.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 3","pages":"Pages 772-776"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.atssr.2025.01.022
Anand Maligireddy MD , Ahmad Jabri MD , Chaitanya Rojulpote MD , Laith Alhuneafat MD , Herbert Aronow MD, MPH , Jonathan Haft MD , Pedro Villablanca MD , Rana Awdish MD, MS , Bryan Kelly DO , Domingo Franco-Palacios MD , Farhan Nasser MD , Gillian Grafton DO , Hassan Nemeh MD , Kyle Miletic MD , Lisa Allenspach MD , Vikas Aggarwal MD, MPH
Background
Pulmonary hypertension is a significant challenge in patients requiring a lung transplant, often being manifested with severe complications such as high pulmonary vascular resistance (PVR). Although medical treatments have extended median survival, pulmonary hypertension remains a progressive and life-threatening condition. Lung transplantation offers potential for improved outcomes, supported by advancements in surgical techniques, donor lung preservation, immunosuppression, and posttransplantation care.
Methods
Using the United Network for Organ Sharing database, we analyzed adult patients undergoing double lung transplantation from October 1, 2002, to September 30, 2022. Our focus was on patients with elevated PVR (≥6 Wood units), with or without underlying lung parenchymal disease. Trends in transplantation, survival rates, and impact of center volume on outcomes were examined.
Results
Of 24,921 double lung transplant recipients, 2755 patients had PVR ≥6 Wood units. There was a significant upward trend in annual procedures, with increased use of extracorporeal support during surgery. Higher volume centers (performing >33 transplants annually) demonstrated better survival rates. Elevated PVR was independently associated with higher mortality, highlighting its importance in patient selection and management.
Conclusions
Lung transplantation remains a critical option for patients with end-stage lung disease, including those with high PVR. Improved outcomes at high-volume centers underscore the importance of institutional experience and expertise.
{"title":"Lung Transplantation With Elevated Pulmonary Vascular Resistance: Insights From the United Network for Organ Sharing Database","authors":"Anand Maligireddy MD , Ahmad Jabri MD , Chaitanya Rojulpote MD , Laith Alhuneafat MD , Herbert Aronow MD, MPH , Jonathan Haft MD , Pedro Villablanca MD , Rana Awdish MD, MS , Bryan Kelly DO , Domingo Franco-Palacios MD , Farhan Nasser MD , Gillian Grafton DO , Hassan Nemeh MD , Kyle Miletic MD , Lisa Allenspach MD , Vikas Aggarwal MD, MPH","doi":"10.1016/j.atssr.2025.01.022","DOIUrl":"10.1016/j.atssr.2025.01.022","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary hypertension is a significant challenge in patients requiring a lung transplant, often being manifested with severe complications such as high pulmonary vascular resistance (PVR). Although medical treatments have extended median survival, pulmonary hypertension remains a progressive and life-threatening condition. Lung transplantation offers potential for improved outcomes, supported by advancements in surgical techniques, donor lung preservation, immunosuppression, and posttransplantation care.</div></div><div><h3>Methods</h3><div>Using the United Network for Organ Sharing database, we analyzed adult patients undergoing double lung transplantation from October 1, 2002, to September 30, 2022. Our focus was on patients with elevated PVR (≥6 Wood units), with or without underlying lung parenchymal disease. Trends in transplantation, survival rates, and impact of center volume on outcomes were examined.</div></div><div><h3>Results</h3><div>Of 24,921 double lung transplant recipients, 2755 patients had PVR ≥6 Wood units. There was a significant upward trend in annual procedures, with increased use of extracorporeal support during surgery. Higher volume centers (performing >33 transplants annually) demonstrated better survival rates. Elevated PVR was independently associated with higher mortality, highlighting its importance in patient selection and management.</div></div><div><h3>Conclusions</h3><div>Lung transplantation remains a critical option for patients with end-stage lung disease, including those with high PVR. Improved outcomes at high-volume centers underscore the importance of institutional experience and expertise.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 3","pages":"Pages 784-790"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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