Pub Date : 2026-03-01Epub Date: 2025-07-30DOI: 10.1016/j.atssr.2025.07.007
Hemn Abdulrahman Abdullah FIBMS , Darya Nadir Saeed MBChB , Abdullah Hayder Flaih BSc
Use of coronary artery bypass for mitral valve repair in ischemic mitral regurgitation remains controversial. We present a case of a 52-year-old man with significant ischemic mitral regurgitation and coronary artery disease who underwent mitral valve repair and coronary artery bypass grafting using a periareolar technique. The procedure was successful, with early extubation and discharge on postoperative day 4. This minimally invasive approach facilitated successful repair while reducing surgical stress and enhancing recovery. Postoperative echocardiography confirmed the mitral valve's competence. This case highlights the viability of the periareolar approach for combined mitral valve repair and coronary artery bypass grafting.
{"title":"Minimally Invasive Mitral Valve Repair and Coronary Artery Bypass Graft by a Periareolar Approach","authors":"Hemn Abdulrahman Abdullah FIBMS , Darya Nadir Saeed MBChB , Abdullah Hayder Flaih BSc","doi":"10.1016/j.atssr.2025.07.007","DOIUrl":"10.1016/j.atssr.2025.07.007","url":null,"abstract":"<div><div>Use of coronary artery bypass for mitral valve repair in ischemic mitral regurgitation remains controversial. We present a case of a 52-year-old man with significant ischemic mitral regurgitation and coronary artery disease who underwent mitral valve repair and coronary artery bypass grafting using a periareolar technique. The procedure was successful, with early extubation and discharge on postoperative day 4. This minimally invasive approach facilitated successful repair while reducing surgical stress and enhancing recovery. Postoperative echocardiography confirmed the mitral valve's competence. This case highlights the viability of the periareolar approach for combined mitral valve repair and coronary artery bypass grafting.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 1","pages":"Pages 62-64"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414398","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 : 2026-03-01Epub Date: 2025-10-15DOI: 10.1016/j.atssr.2025.09.013
Christina S. Boutros DO , Max Barris BS , Jillian Sinopoli DO , Philip A. Linden MD , Gregory D. Rushing MD , Christopher W. Towe MD
Background
Atrial fibrillation is a common comorbidity in patients undergoing pulmonary resection, increasing the risk of thromboembolic events. Although left atrial appendage (LAA) ligation is typically performed during cardiac surgery, its role in thoracic surgery has not been well defined. We describe our institutional experience with concurrent pulmonary resection, LAA ligation, and epicardial ablation in patients with atrial fibrillation.
Methods
We conducted a retrospective case series of patients who underwent left-sided pulmonary resection, convergent epicardial ablation, and LAA ligation using the AtriClip (AtriCure) device between July 2022 and March 2025. Demographics, operative data, perioperative outcomes, and short-term follow-up were collected.
Results
Four patients met inclusion criteria. All had paroxysmal atrial fibrillation and underwent minimally invasive lung resection with concomitant epicardial ablation and LAA ligation. There were no perioperative strokes, thromboembolic events, or deaths. All patients remained free from atrial fibrillation recurrence during follow-up (range, 1 month-2 years). Three patients discontinued anticoagulation at 6 months. Two were readmitted for self-limited complications.
Conclusions
Concurrent pulmonary resection, epicardial ablation, and LAA ligation is feasible and safe in select patients with atrial fibrillation undergoing thoracic surgery. This combined approach may reduce long-term stroke risk and improve rhythm control without significantly increasing perioperative morbidity.
{"title":"Cut, Clip, Burn: A Combined Approach to Lung Cancer and Atrial Fibrillation","authors":"Christina S. Boutros DO , Max Barris BS , Jillian Sinopoli DO , Philip A. Linden MD , Gregory D. Rushing MD , Christopher W. Towe MD","doi":"10.1016/j.atssr.2025.09.013","DOIUrl":"10.1016/j.atssr.2025.09.013","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation is a common comorbidity in patients undergoing pulmonary resection, increasing the risk of thromboembolic events. Although left atrial appendage (LAA) ligation is typically performed during cardiac surgery, its role in thoracic surgery has not been well defined. We describe our institutional experience with concurrent pulmonary resection, LAA ligation, and epicardial ablation in patients with atrial fibrillation.</div></div><div><h3>Methods</h3><div>We conducted a retrospective case series of patients who underwent left-sided pulmonary resection, convergent epicardial ablation, and LAA ligation using the AtriClip (AtriCure) device between July 2022 and March 2025. Demographics, operative data, perioperative outcomes, and short-term follow-up were collected.</div></div><div><h3>Results</h3><div>Four patients met inclusion criteria. All had paroxysmal atrial fibrillation and underwent minimally invasive lung resection with concomitant epicardial ablation and LAA ligation. There were no perioperative strokes, thromboembolic events, or deaths. All patients remained free from atrial fibrillation recurrence during follow-up (range, 1 month-2 years). Three patients discontinued anticoagulation at 6 months. Two were readmitted for self-limited complications.</div></div><div><h3>Conclusions</h3><div>Concurrent pulmonary resection, epicardial ablation, and LAA ligation is feasible and safe in select patients with atrial fibrillation undergoing thoracic surgery. This combined approach may reduce long-term stroke risk and improve rhythm control without significantly increasing perioperative morbidity.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 1","pages":"Pages 213-217"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414541","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 : 2026-03-01Epub Date: 2025-07-31DOI: 10.1016/j.atssr.2025.07.014
Sowmyanarayanan Thuppal MD, PhD , Kanika Chawla MD , Ryan Bowman MD , Anthony Sleiman MD , Anthony Nestler MD , Daniel J. Ferraro MD, PhD , C. Matthew Bradbury MD, PhD , Stephen Markwell MA , Kristin Delfino PhD , Stephen R. Hazelrigg MD , Traves D. Crabtree MD
Background
We evaluated how National Surgical Quality Improvement Program (NSQIP) risk, frailty, and quality of life influence treatment selection between surgery and stereotactic body radiotherapy (SBRT) in early-stage non-small cell lung cancer (NSCLC).
Methods
Prospectively collected data from treatment-naive adults with early-stage NSCLC included demographics, pulmonary function, NSQIP risk scores, and frailty (index ≥3). Quality of life was assessed by Quality of Life Questionnaire Core 30, Quality of Life Questionnaire Lung Cancer 13, and modified Medical Research Council Dyspnea Scale tools.
Results
SBRT was more likely for frail patients (odds ratio [OR], 4.92), those needing assistance (OR, 5.01), and those with disability (OR, 3.48) or impaired mobility (OR, 4.04). Multivariate analysis found that higher NSQIP mortality risk (OR, 12.60), frailty (OR, 4.80), and lower forced expiratory volume in 1 second predicted SBRT selection. Complications were more frequent after surgery (41% vs 17%; P < .05). Unadjusted overall survival at 6 months, 1 year, and 2 years favored surgery (99.1%, 97.2%, 90.2%) over SBRT (95.7%, 86.5%, 79.2%; P < .05). Recurrence-free survival at 1 year and 2 years was also higher with surgery (95.1%, 82.3%) vs SBRT (87.6%, 63.5%; P < .05). Physical functioning, fatigue, and dyspnea worsened over time in both groups; at 2 years, quality of life was similar except for greater decline in role functioning in SBRT patients. Median 90-day treatment-related costs were lower for SBRT ($11,188 vs $15,018; P < .05) but similar when major complications were excluded.
Conclusions
Frailty, NSQIP risk, and functional metrics help guide treatment selection in early-stage NSCLC. Surgery yields better survival and recurrence outcomes, whereas SBRT offers lower early morbidity and cost in selected patients.
背景：我们评估了国家外科质量改进计划（NSQIP）的风险、虚弱和生活质量对早期非小细胞肺癌（NSCLC）手术和立体定向放疗（SBRT）治疗选择的影响。方法前瞻性收集未接受治疗的早期NSCLC成年患者的数据，包括人口统计学、肺功能、NSQIP风险评分和虚弱（指数≥3）。通过生活质量问卷核心30、肺癌生活质量问卷13和改良的医学研究委员会呼吸困难量表工具评估生活质量。结果brt更可能发生在体弱患者（优势比[OR]， 4.92）、需要帮助的患者（OR, 5.01）、残疾患者（OR, 3.48）或行动不便患者（OR, 4.04）。多变量分析发现，较高的NSQIP死亡率风险（OR, 12.60）、虚弱（OR, 4.80）和1秒内较低的用力呼气量预测了SBRT的选择。术后并发症发生率较高（41% vs 17%; P < 0.05）。6个月、1年和2年的未调整总生存率（99.1%、97.2%、90.2%）优于SBRT（95.7%、86.5%、79.2%;P < 0.05）。手术的1年和2年无复发生存率（95.1%,82.3%）也高于SBRT （87.6%, 63.5%; P < 0.05）。两组的身体功能、疲劳和呼吸困难都随着时间的推移而恶化；2年后，除了SBRT患者的角色功能下降更大外，生活质量相似。SBRT的90天治疗相关费用中位数较低（11,188美元对15,018美元；P < 0.05），但在排除主要并发症时相似。结论脆弱性、NSQIP风险和功能指标有助于指导早期NSCLC的治疗选择。手术有更好的生存率和复发率，而SBRT在特定患者中提供更低的早期发病率和成本。
{"title":"Clinical, Quality, and Cost Outcomes of Patients With Early-Stage Non-Small Cell Lung Cancer Undergoing Surgery or Stereotactic Body Radiation Therapy","authors":"Sowmyanarayanan Thuppal MD, PhD , Kanika Chawla MD , Ryan Bowman MD , Anthony Sleiman MD , Anthony Nestler MD , Daniel J. Ferraro MD, PhD , C. Matthew Bradbury MD, PhD , Stephen Markwell MA , Kristin Delfino PhD , Stephen R. Hazelrigg MD , Traves D. Crabtree MD","doi":"10.1016/j.atssr.2025.07.014","DOIUrl":"10.1016/j.atssr.2025.07.014","url":null,"abstract":"<div><h3>Background</h3><div>We evaluated how National Surgical Quality Improvement Program (NSQIP) risk, frailty, and quality of life influence treatment selection between surgery and stereotactic body radiotherapy (SBRT) in early-stage non-small cell lung cancer (NSCLC).</div></div><div><h3>Methods</h3><div>Prospectively collected data from treatment-naive adults with early-stage NSCLC included demographics, pulmonary function, NSQIP risk scores, and frailty (index ≥3). Quality of life was assessed by Quality of Life Questionnaire Core 30, Quality of Life Questionnaire Lung Cancer 13, and modified Medical Research Council Dyspnea Scale tools.</div></div><div><h3>Results</h3><div>SBRT was more likely for frail patients (odds ratio [OR], 4.92), those needing assistance (OR, 5.01), and those with disability (OR, 3.48) or impaired mobility (OR, 4.04). Multivariate analysis found that higher NSQIP mortality risk (OR, 12.60), frailty (OR, 4.80), and lower forced expiratory volume in 1 second predicted SBRT selection. Complications were more frequent after surgery (41% vs 17%; <em>P</em> < .05). Unadjusted overall survival at 6 months, 1 year, and 2 years favored surgery (99.1%, 97.2%, 90.2%) over SBRT (95.7%, 86.5%, 79.2%; <em>P</em> < .05). Recurrence-free survival at 1 year and 2 years was also higher with surgery (95.1%, 82.3%) vs SBRT (87.6%, 63.5%; <em>P</em> < .05). Physical functioning, fatigue, and dyspnea worsened over time in both groups; at 2 years, quality of life was similar except for greater decline in role functioning in SBRT patients. Median 90-day treatment-related costs were lower for SBRT ($11,188 vs $15,018; <em>P</em> < .05) but similar when major complications were excluded.</div></div><div><h3>Conclusions</h3><div>Frailty, NSQIP risk, and functional metrics help guide treatment selection in early-stage NSCLC. Surgery yields better survival and recurrence outcomes, whereas SBRT offers lower early morbidity and cost in selected patients.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 1","pages":"Pages 218-223"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414543","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 : 2026-03-01Epub Date: 2025-08-29DOI: 10.1016/j.atssr.2025.08.003
Sandra L. Carpenter MD , Jae M. Cho MD , Justin S. Heidel MD , Fleming Mathew MBBS , Brendha Cacao Coimbra MD , James Wallace MD , Michael S. Kent MD , Sidharta P. Gangadharan MD, MHCM , Jennifer L. Wilson MD, MPH
Background
Excessive central airway collapse involves increased collapsibility of the central airways. The definitive treatment is surgical stabilization of the airway, or tracheobronchoplasty. In 2020, our institution (Beth Israel Deaconess Medical Center, Boston, MA) began offering the robotic approach to select patients. Here, we describe perioperative outcomes for the first 43 consecutive patients to undergo robotic tracheobronchoplasty (rTBP).
Methods
A retrospective review of all patients who underwent rTBP from February 2020 to May 2023 was conducted.
Results
A total of 43 patients underwent rTBP during the study period. Most patients were female (60%), the median age was 61 years (interquartile range [IQR], 50-69 years), and the most common comorbidity was gastroesophageal reflux disease (95%). Median operative time was 8.4 hours (IQR, 7.2-9.6 hours), and there were 4 intraoperative complications (9%). Postoperatively, 25 (58%) patients experienced at least 1 complication, and 6 patients had a new respiratory infection (14%). Nine patients (21%) experienced a major postoperative complication (Clavien Dindo ≥IIIa). There were no fatalities within 30 days. The median intensive care unit and hospital lengths of stay were 1 day (IQR, 1-3.5 days) and 5 days (IQR, 4-8 days), respectively. Most patients (88%) were discharged to home. There were significant improvements in quality of life scores at 3 months.
Conclusions
Overall, rTBP is safe, although it is associated with a high number of complications. Continued evaluation of perioperative and long-term outcomes is needed to ensure that the minimally invasive approach is appropriately offered to this complex patient population.
背景：过度的中央气道塌陷包括中央气道塌陷性增加。最终的治疗是手术稳定气道，或气管支气管成形术。2020年，我们的机构（Beth Israel Deaconess Medical Center, Boston， MA）开始提供机器人方法来选择患者。在这里，我们描述了前43名连续接受机器人气管支气管成形术（rTBP）患者的围手术期结果。方法回顾性分析2020年2月至2023年5月所有接受rTBP治疗的患者。结果研究期间共43例患者接受了rTBP。大多数患者为女性（60%），中位年龄为61岁（四分位数范围[IQR]， 50-69岁），最常见的合并症为胃食管反流病（95%）。中位手术时间8.4小时（IQR, 7.2 ~ 9.6小时），术中并发症4例（9%）。术后25例（58%）患者出现了至少1种并发症，6例患者出现了新的呼吸道感染（14%）。9例患者（21%）出现严重术后并发症（Clavien Dindo≥IIIa）。30天内没有人员死亡。重症监护病房和住院时间的中位数分别为1天（IQR, 1-3.5天）和5天（IQR， 4-8天）。大多数患者（88%）出院回家。3个月时生活质量评分有显著改善。结论总的来说，rTBP是安全的，尽管它与大量的并发症相关。需要持续评估围手术期和长期结果，以确保微创入路适合这种复杂的患者群体。
{"title":"Perioperative Outcomes of 43 Robotic Tracheobronchoplasties for Excessive Dynamic Airway Collapse","authors":"Sandra L. Carpenter MD , Jae M. Cho MD , Justin S. Heidel MD , Fleming Mathew MBBS , Brendha Cacao Coimbra MD , James Wallace MD , Michael S. Kent MD , Sidharta P. Gangadharan MD, MHCM , Jennifer L. Wilson MD, MPH","doi":"10.1016/j.atssr.2025.08.003","DOIUrl":"10.1016/j.atssr.2025.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Excessive central airway collapse involves increased collapsibility of the central airways. The definitive treatment is surgical stabilization of the airway, or tracheobronchoplasty. In 2020, our institution (Beth Israel Deaconess Medical Center, Boston, MA) began offering the robotic approach to select patients. Here, we describe perioperative outcomes for the first 43 consecutive patients to undergo robotic tracheobronchoplasty (rTBP).</div></div><div><h3>Methods</h3><div>A retrospective review of all patients who underwent rTBP from February 2020 to May 2023 was conducted.</div></div><div><h3>Results</h3><div>A total of 43 patients underwent rTBP during the study period. Most patients were female (60%), the median age was 61 years (interquartile range [IQR], 50-69 years), and the most common comorbidity was gastroesophageal reflux disease (95%). Median operative time was 8.4 hours (IQR, 7.2-9.6 hours), and there were 4 intraoperative complications (9%). Postoperatively, 25 (58%) patients experienced at least 1 complication, and 6 patients had a new respiratory infection (14%). Nine patients (21%) experienced a major postoperative complication (Clavien Dindo ≥IIIa). There were no fatalities within 30 days. The median intensive care unit and hospital lengths of stay were 1 day (IQR, 1-3.5 days) and 5 days (IQR, 4-8 days), respectively. Most patients (88%) were discharged to home. There were significant improvements in quality of life scores at 3 months.</div></div><div><h3>Conclusions</h3><div>Overall, rTBP is safe, although it is associated with a high number of complications. Continued evaluation of perioperative and long-term outcomes is needed to ensure that the minimally invasive approach is appropriately offered to this complex patient population.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 1","pages":"Pages 273-277"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147415230","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}
Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm; pulmonary cases can become massive and hypervascular, increasing surgical risk. A 71-year-old woman with a giant pulmonary SFT underwent preoperative angiography, which identified the internal thoracic artery as the dominant feeder. Selective embolization was performed, followed by total left pneumonectomy without cardiopulmonary support. Pathology confirmed margin-negative (R0) resection without pulmonary infiltration or nodal involvement. The postoperative course was uneventful, and no recurrence has been observed for 2.5 years. Preoperative angiographic evaluation and embolization are effective strategies to enhance surgical safety in managing hypervascular giant pulmonary SFTs.
{"title":"Preoperative Embolization and Total Left Pneumonectomy for a Giant Pulmonary Solitary Fibrous Tumor","authors":"Eitetsu Koh MD , Yasuo Sekine MD , Tadao Nakazawa MD , Kenzo Hiroshima MD","doi":"10.1016/j.atssr.2025.09.017","DOIUrl":"10.1016/j.atssr.2025.09.017","url":null,"abstract":"<div><div>Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm; pulmonary cases can become massive and hypervascular, increasing surgical risk. A 71-year-old woman with a giant pulmonary SFT underwent preoperative angiography, which identified the internal thoracic artery as the dominant feeder. Selective embolization was performed, followed by total left pneumonectomy without cardiopulmonary support. Pathology confirmed margin-negative (R0) resection without pulmonary infiltration or nodal involvement. The postoperative course was uneventful, and no recurrence has been observed for 2.5 years. Preoperative angiographic evaluation and embolization are effective strategies to enhance surgical safety in managing hypervascular giant pulmonary SFTs.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 1","pages":"Pages 256-259"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147415235","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 : 2026-03-01Epub Date: 2025-07-29DOI: 10.1016/j.atssr.2025.07.001
Pedro J. Furtado Neves MD , Aline H. Ishida MD , Emily A. Malgor MD , Muhammad Aftab MD , T. Brett Reece MD, MBA , Rafael D. Malgor MD, MBA
Background
The natural history of penetrating aortic ulcers (PAUs) with high-risk radiologic features after thoracic endovascular aortic repair (TEVAR) remains incompletely characterized. This study assessed aortic remodeling and midterm outcomes after TEVAR for such lesions.
Methods
We retrospectively reviewed patients undergoing TEVAR for high-risk PAUs between 2016 and 2022. Of 220 TEVAR cases, 12 patients (5.5%) met inclusion criteria with appropriate follow-up. Aortic remodeling was assessed per current societal guidelines.
Results
The cohort included 8 men (66%) with a median age of 73 years and a median follow-up of 31 months (interquartile range, 12.75-59 months). Most PAUs (58%) were located in zone 3; 33% had multiple ulcers, often with >1 high-risk feature. Pre- and post-TEVAR main PAU + intramural hematoma depth averaged 10.1 ± 4.5 mm and 10.1 ± 8.1 mm, respectively. Aortic diameter increased from 41.3 ± 6.0 mm to 45.3 ± 10.4 mm. Complete thrombosis of the main PAU was observed in 92% of patients. Aortic remodeling was positive in 25% and stable in 58% of cases. No 30-day mortality occurred; however, 3 patients (25%) died of nonaortic causes during follow-up. Two reinterventions (17%) were performed for type 2 endoleak and new PAU formation due to cocaine use.
Conclusions
TEVAR for PAUs with high-risk features results in complete thrombosis in most cases. Whereas positive aortic remodeling occurred in a subset, most patients experienced stabilization of aortic dimensions during midterm follow-up.
{"title":"Aortic Remodeling in Patients Undergoing Endovascular Repair for Penetrating Aortic Ulcer With High-Risk Features","authors":"Pedro J. Furtado Neves MD , Aline H. Ishida MD , Emily A. Malgor MD , Muhammad Aftab MD , T. Brett Reece MD, MBA , Rafael D. Malgor MD, MBA","doi":"10.1016/j.atssr.2025.07.001","DOIUrl":"10.1016/j.atssr.2025.07.001","url":null,"abstract":"<div><h3>Background</h3><div>The natural history of penetrating aortic ulcers (PAUs) with high-risk radiologic features after thoracic endovascular aortic repair (TEVAR) remains incompletely characterized. This study assessed aortic remodeling and midterm outcomes after TEVAR for such lesions.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients undergoing TEVAR for high-risk PAUs between 2016 and 2022. Of 220 TEVAR cases, 12 patients (5.5%) met inclusion criteria with appropriate follow-up. Aortic remodeling was assessed per current societal guidelines.</div></div><div><h3>Results</h3><div>The cohort included 8 men (66%) with a median age of 73 years and a median follow-up of 31 months (interquartile range, 12.75-59 months). Most PAUs (58%) were located in zone 3; 33% had multiple ulcers, often with >1 high-risk feature. Pre- and post-TEVAR main PAU + intramural hematoma depth averaged 10.1 ± 4.5 mm and 10.1 ± 8.1 mm, respectively. Aortic diameter increased from 41.3 ± 6.0 mm to 45.3 ± 10.4 mm. Complete thrombosis of the main PAU was observed in 92% of patients. Aortic remodeling was positive in 25% and stable in 58% of cases. No 30-day mortality occurred; however, 3 patients (25%) died of nonaortic causes during follow-up. Two reinterventions (17%) were performed for type 2 endoleak and new PAU formation due to cocaine use.</div></div><div><h3>Conclusions</h3><div>TEVAR for PAUs with high-risk features results in complete thrombosis in most cases. Whereas positive aortic remodeling occurred in a subset, most patients experienced stabilization of aortic dimensions during midterm follow-up.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 1","pages":"Pages 17-21"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147415244","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}
We report on midterm follow-up of the EPI-Flex postmarket study in France, assessing the safety of the Thoraflex on a nationwide scale.
Methods
A prospective, multicenter trial was conducted of all frozen elephant trunk procedures using Thoraflex in France between April 4, 2016, and April 3, 2019. Patients were divided into elective surgery (n = 214) and nonelective surgery (n = 137). We defined safety end points as age-adjusted 3-year survival including in-hospital mortality and a composite secondary end point including new stroke, spinal cord injury, acute kidney injury requiring dialysis, recurrent laryngeal nerve palsy, massive blood transfusion (>10 packs of red blood cells), and unexpected repeated thoracic endovascular aortic repair or aortic surgery within 30 days.
Results
We included 351 patients (73% male; median age, 61 years; interquartile range, 55-70 years). In-hospital mortality rate was 54 of 351 (15.4%) and did not differ between elective and nonelective cases (P = .1). Classification random forest analysis, trained for 16 preoperative and perioperative covariates with 500 trees, identified age, deep hypothermia, and each time of cardiopulmonary bypass, visceral ischemia, or myocardial ischemia as the most influential factors associated with in-hospital mortality. Including in-hospital mortality, 3-year age-adjusted survival rates for elective and nonelective patients were 76% ± 6% and 70% ± 8%, respectively (P = .23). The composite end point significantly affected in-hospital mortality (P = 10−5) and 3-year age-adjusted survival rates (P = 10−3).
Conclusions
Our results highlight that frozen elephant trunk with a Thoraflex remains a complex and evolving strategy for aortic arch diseases. Careful patient selection and optimized procedure engineering are essential to mitigate procedural risks.
{"title":"Frozen Elephant Trunk With Terumo Hybrid Plexus Prosthesis: A French Postmarket Longitudinal Study With Midterm Results","authors":"Thierry Caus MD, PhD , Yuthiline Chabry MD, PhD , Arvind Appa MD , Vito Giovanni Ruggieri MD, PhD , Marc Villaret PhD , Bertrand Marcheix MD, PhD , Paul Achouh MD, PhD , Fabien Koskas MD, PhD","doi":"10.1016/j.atssr.2025.07.024","DOIUrl":"10.1016/j.atssr.2025.07.024","url":null,"abstract":"<div><h3>Background</h3><div>We report on midterm follow-up of the EPI-Flex postmarket study in France, assessing the safety of the Thoraflex on a nationwide scale.</div></div><div><h3>Methods</h3><div>A prospective, multicenter trial was conducted of all frozen elephant trunk procedures using Thoraflex in France between April 4, 2016, and April 3, 2019. Patients were divided into elective surgery (n = 214) and nonelective surgery (n = 137). We defined safety end points as age-adjusted 3-year survival including in-hospital mortality and a composite secondary end point including new stroke, spinal cord injury, acute kidney injury requiring dialysis, recurrent laryngeal nerve palsy, massive blood transfusion (>10 packs of red blood cells), and unexpected repeated thoracic endovascular aortic repair or aortic surgery within 30 days.</div></div><div><h3>Results</h3><div>We included 351 patients (73% male; median age, 61 years; interquartile range, 55-70 years). In-hospital mortality rate was 54 of 351 (15.4%) and did not differ between elective and nonelective cases (<em>P</em> = .1). Classification random forest analysis, trained for 16 preoperative and perioperative covariates with 500 trees, identified age, deep hypothermia, and each time of cardiopulmonary bypass, visceral ischemia, or myocardial ischemia as the most influential factors associated with in-hospital mortality. Including in-hospital mortality, 3-year age-adjusted survival rates for elective and nonelective patients were 76% ± 6% and 70% ± 8%, respectively (<em>P</em> = .23). The composite end point significantly affected in-hospital mortality (<em>P</em> = 10<sup>−5</sup>) and 3-year age-adjusted survival rates (<em>P</em> = 10<sup>−3</sup>).</div></div><div><h3>Conclusions</h3><div>Our results highlight that frozen elephant trunk with a Thoraflex remains a complex and evolving strategy for aortic arch diseases. Careful patient selection and optimized procedure engineering are essential to mitigate procedural risks.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 1","pages":"Pages 6-11"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147415248","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 : 2026-03-01Epub Date: 2025-07-31DOI: 10.1016/j.atssr.2025.07.012
Regina Doonan DNP, APRN-NP , Kelsy Rice PA-C , Jessica Baldwin PA-C , Morgan Whisenhunt RN-BSN , Alicia Clarke RN-BSN , Kate Winkler APRN-NP , George Zorn III MD , Todd C. Crawford MD
Background
Unplanned readmissions negatively affect hospital reimbursement and mortality. The purpose of this study was to describe the inception of a multidisciplinary readmissions group designed to reduce unplanned cardiac surgery readmissions.
Methods
Unplanned cardiac surgery readmissions within 30 days of discharge between 2021 and 2024 were analyzed by the University of Kansas Cardiac Surgery Readmissions Committee, consisting of inpatient and outpatient advanced practice providers, data managers, emergency department personnel, and cardiac surgeons. In 2023, a goal-oriented working group was established to reduce readmissions. Cardiac surgery readmissions are reviewed daily, and the readmissions committee meets quarterly to discuss their findings and opportunities for improvement.
Results
The working group’s detailed investigation determined that arrhythmias, pleural effusions, and deep vein thrombosis or pulmonary embolism were the most common causes of readmission. The group then instituted postoperative amiodarone prophylaxis in their cardiac surgery patients, pursued aggressive postoperative drainage of the pleural spaces, and started prophylactic subcutaneous heparin on postoperative day 3 to reduce thromboembolic events. The group created a discharge checklist addressing rhythm issues, fluid balance, wound care, and clinic and on-call contact information. From 2021 to 2024, cardiac surgery readmissions declined from 10.9% to 9.6%, and similarly isolated readmissions after coronary artery bypass grafting declined from 10.2% to 6.1%, despite an increase in total operative volume and an increased case-mix index.
Conclusions
The creation of an integrated, multidisciplinary Cardiac Surgery Readmissions Committee Working Group allowed the group to design targeted interventions for the most common reasons for readmission, which in turn led to a reduction in readmission rates.
{"title":"The University of Kansas Cardiac Surgery Readmissions Committee: A Multidisciplinary Collaborative to Reduce Unplanned Readmissions","authors":"Regina Doonan DNP, APRN-NP , Kelsy Rice PA-C , Jessica Baldwin PA-C , Morgan Whisenhunt RN-BSN , Alicia Clarke RN-BSN , Kate Winkler APRN-NP , George Zorn III MD , Todd C. Crawford MD","doi":"10.1016/j.atssr.2025.07.012","DOIUrl":"10.1016/j.atssr.2025.07.012","url":null,"abstract":"<div><h3>Background</h3><div>Unplanned readmissions negatively affect hospital reimbursement and mortality. The purpose of this study was to describe the inception of a multidisciplinary readmissions group designed to reduce unplanned cardiac surgery readmissions.</div></div><div><h3>Methods</h3><div>Unplanned cardiac surgery readmissions within 30 days of discharge between 2021 and 2024 were analyzed by the University of Kansas Cardiac Surgery Readmissions Committee, consisting of inpatient and outpatient advanced practice providers, data managers, emergency department personnel, and cardiac surgeons. In 2023, a goal-oriented working group was established to reduce readmissions. Cardiac surgery readmissions are reviewed daily, and the readmissions committee meets quarterly to discuss their findings and opportunities for improvement.</div></div><div><h3>Results</h3><div>The working group’s detailed investigation determined that arrhythmias, pleural effusions, and deep vein thrombosis or pulmonary embolism were the most common causes of readmission. The group then instituted postoperative amiodarone prophylaxis in their cardiac surgery patients, pursued aggressive postoperative drainage of the pleural spaces, and started prophylactic subcutaneous heparin on postoperative day 3 to reduce thromboembolic events. The group created a discharge checklist addressing rhythm issues, fluid balance, wound care, and clinic and on-call contact information. From 2021 to 2024, cardiac surgery readmissions declined from 10.9% to 9.6%, and similarly isolated readmissions after coronary artery bypass grafting declined from 10.2% to 6.1%, despite an increase in total operative volume and an increased case-mix index.</div></div><div><h3>Conclusions</h3><div>The creation of an integrated, multidisciplinary Cardiac Surgery Readmissions Committee Working Group allowed the group to design targeted interventions for the most common reasons for readmission, which in turn led to a reduction in readmission rates.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 1","pages":"Pages 340-345"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147415282","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 : 2026-03-01Epub Date: 2025-08-29DOI: 10.1016/j.atssr.2025.08.004
Ruth Ackah MD , Hunter Triplett BS , Ryan Rimer MD , Yvonne M. Carter MD
The inability to access distal bronchopleural fistulas with standard bronchoscopes limits the use of endobronchial occlusion techniques. A 43-year-old woman experienced fatigue and cough 1 month after a left lower lobectomy. A chest roentgenogram revealed a new air-fluid level concerning for a bronchopleural fistula. Robotic navigational bronchoscopy identified a small (∼2 mm) opening on the bronchial stump. The fistula was closed by injecting embolic sealant and endovascular coils. Robotic navigational bronchoscopy is an effective tool for localizing distal bronchopleural fistulas, thus allowing for minimally invasive closure techniques.
{"title":"Distal Bronchopleural Fistula Closure With Robotic Bronchoscopy","authors":"Ruth Ackah MD , Hunter Triplett BS , Ryan Rimer MD , Yvonne M. Carter MD","doi":"10.1016/j.atssr.2025.08.004","DOIUrl":"10.1016/j.atssr.2025.08.004","url":null,"abstract":"<div><div>The inability to access distal bronchopleural fistulas with standard bronchoscopes limits the use of endobronchial occlusion techniques. A 43-year-old woman experienced fatigue and cough 1 month after a left lower lobectomy. A chest roentgenogram revealed a new air-fluid level concerning for a bronchopleural fistula. Robotic navigational bronchoscopy identified a small (∼2 mm) opening on the bronchial stump. The fistula was closed by injecting embolic sealant and endovascular coils. Robotic navigational bronchoscopy is an effective tool for localizing distal bronchopleural fistulas, thus allowing for minimally invasive closure techniques.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 1","pages":"Pages 241-244"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414516","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}
Aortic regurgitation (AR) arising from cusp disease poses a significant surgical challenge. In this single-center study, we evaluated a partial Ozaki technique, involving reconstruction of only the diseased cusp, and performed concomitant aortic root procedures guided by contrast-enhanced computed tomography assessment of lunule coaptation and root dimensions. Sixteen patients with severe AR who underwent partial Ozaki repair were stratified by lunule coaptation and root dimensions. No operative deaths or major complications occurred. At discharge, patients’ AR was mild. Postoperative computed tomography showed increased coaptation in the native-native and reconstructed-native groups. The partial Ozaki technique was safe and effective for cusp-insufficient AR.
{"title":"Application of the Partial Ozaki Procedure for Aortic Regurgitation","authors":"Masatoshi Hata MD , Keita Inoguchi MD , Junki Yokota MD , Noriko Kodani MD , Tomohiko Sakamoto MD , Toru Kuratani MD, PhD , Yoshiki Sawa MD, PhD","doi":"10.1016/j.atssr.2025.08.001","DOIUrl":"10.1016/j.atssr.2025.08.001","url":null,"abstract":"<div><div>Aortic regurgitation (AR) arising from cusp disease poses a significant surgical challenge. In this single-center study, we evaluated a partial Ozaki technique, involving reconstruction of only the diseased cusp, and performed concomitant aortic root procedures guided by contrast-enhanced computed tomography assessment of lunule coaptation and root dimensions. Sixteen patients with severe AR who underwent partial Ozaki repair were stratified by lunule coaptation and root dimensions. No operative deaths or major complications occurred. At discharge, patients’ AR was mild. Postoperative computed tomography showed increased coaptation in the native-native and reconstructed-native groups. The partial Ozaki technique was safe and effective for cusp-insufficient AR.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 1","pages":"Pages 127-130"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414903","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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