Pub Date : 2025-03-01DOI: 10.1016/j.atssr.2024.09.023
Tomoki Sakata MD, PhD , Yuki Nakamura MD, PhD , Keshava Rajagopal MD, PhD , Vakhtang Tchantchaleishvili MD , Konstadinos A. Plestis MD , John W. Entwistle III MD, PhD , Joseph E. Bavaria MD , Rakesh M. Suri MD, DPhil
Background
Temporary mechanical circulatory support (tMCS) may be necessary to treat low cardiac output syndrome after mitral valve surgery (MVS) for chronic severe mitral regurgitation (MR). However, prevalence and predictors remain undetermined.
Methods
This single-center retrospective cohort study included 443 patients who underwent primary MVS for degenerative, ischemic, or functional MR between January 2013 and June 2023. Patients requiring tMCS intraoperatively or postoperatively were compared with patients who did not require tMCS. Multivariable logistic regression identified independent risk factors for tMCS requirement.
Results
tMCS was required in 12 of 443 patients (2.7%), with degenerative (2.1%), functional (1.8%), and ischemic (8.3%) MR. Independent risk factors for tMCS requirement were preoperative left ventricular ejection fraction <50% (odds ratio, 4.94; P = .01) and mitral valve replacement (odds ratio, 5.85; P = .005). MR type was not independently influential. The 30-day mortality was 41.7% (5 of 12) in the tMCS group vs 3.5% (15 of 431) in the non-tMCS group (P < .0001).
Conclusions
Requirements for tMCS after MVS for MR are infrequent, but tMCS is associated with high mortality. Low preoperative left ventricular ejection fraction and mitral valve replacement are independent risk factors, thus suggesting that careful surgical planning and meticulous postoperative monitoring are warranted in high-risk cases.
{"title":"Infrequent Need for Temporary Mechanical Circulatory Support After Mitral Valve Surgery","authors":"Tomoki Sakata MD, PhD , Yuki Nakamura MD, PhD , Keshava Rajagopal MD, PhD , Vakhtang Tchantchaleishvili MD , Konstadinos A. Plestis MD , John W. Entwistle III MD, PhD , Joseph E. Bavaria MD , Rakesh M. Suri MD, DPhil","doi":"10.1016/j.atssr.2024.09.023","DOIUrl":"10.1016/j.atssr.2024.09.023","url":null,"abstract":"<div><h3>Background</h3><div>Temporary mechanical circulatory support (tMCS) may be necessary to treat low cardiac output syndrome after mitral valve surgery (MVS) for chronic severe mitral regurgitation (MR). However, prevalence and predictors remain undetermined.</div></div><div><h3>Methods</h3><div>This single-center retrospective cohort study included 443 patients who underwent primary MVS for degenerative, ischemic, or functional MR between January 2013 and June 2023. Patients requiring tMCS intraoperatively or postoperatively were compared with patients who did not require tMCS. Multivariable logistic regression identified independent risk factors for tMCS requirement.</div></div><div><h3>Results</h3><div>tMCS was required in 12 of 443 patients (2.7%), with degenerative (2.1%), functional (1.8%), and ischemic (8.3%) MR. Independent risk factors for tMCS requirement were preoperative left ventricular ejection fraction <50% (odds ratio, 4.94; <em>P</em> = .01) and mitral valve replacement (odds ratio, 5.85; <em>P</em> = .005). MR type was not independently influential. The 30-day mortality was 41.7% (5 of 12) in the tMCS group vs 3.5% (15 of 431) in the non-tMCS group (<em>P</em> < .0001).</div></div><div><h3>Conclusions</h3><div>Requirements for tMCS after MVS for MR are infrequent, but tMCS is associated with high mortality. Low preoperative left ventricular ejection fraction and mitral valve replacement are independent risk factors, thus suggesting that careful surgical planning and meticulous postoperative monitoring are warranted in high-risk cases.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 52-56"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.atssr.2024.09.017
Kayla N. Laraia MD , Nathaniel Deboever MD , Dylan Nieman MD, PhD , Mara B. Antonoff MD
Background
Focused preparation for the cardiothoracic operating room (CTOR) may optimize intraoperative engagement and medical student interest, but such resources are lacking. We sought to characterize student educational needs in the CTOR to guide resource development.
Methods
A web-based survey targeting cardiothoracic surgeons, trainees, and operating room staff was distributed to identify areas for student improvement in the CTOR. Concepts investigated explored common student mistakes and expectations for knowledge and participation in the CTOR. Descriptive analyses were performed on multiple-choice polls and open-ended responses.
Results
Polls received a mean of 317 responses (range, 222-504) and 20 open-ended comments. The most frequently cited student mistake was failure to understand their role in the CTOR (164 [32.5%]), followed by inappropriate chatting (141 [28.0%]) and breaking sterility (132 [26.2%]). Poll respondents valued students’ understanding of how to be helpful in the CTOR (101 [45.5%]) in addition to knowing what can or cannot be touched (47 [21.2%]) and basics of cardiopulmonary bypass (43 [19.4%]). Respondents indicated that students should assume active roles (84 [36.7%]), ask questions (66 [29%]), and help with minor tasks (41 [17.9%]). Respondents reported that students benefited most when they understood patient-specific clinicopathologic factors and basic operative steps.
Conclusions
We identified several areas for student improvement in the CTOR. Development of educational resources addressing these issues may enhance interest and augment recruitment of students to cardiothoracic surgery.
{"title":"Medical Student Role in the Cardiothoracic Operating Room: A Needs Assessment to Optimize Engagement","authors":"Kayla N. Laraia MD , Nathaniel Deboever MD , Dylan Nieman MD, PhD , Mara B. Antonoff MD","doi":"10.1016/j.atssr.2024.09.017","DOIUrl":"10.1016/j.atssr.2024.09.017","url":null,"abstract":"<div><h3>Background</h3><div>Focused preparation for the cardiothoracic operating room (CTOR) may optimize intraoperative engagement and medical student interest, but such resources are lacking. We sought to characterize student educational needs in the CTOR to guide resource development.</div></div><div><h3>Methods</h3><div>A web-based survey targeting cardiothoracic surgeons, trainees, and operating room staff was distributed to identify areas for student improvement in the CTOR. Concepts investigated explored common student mistakes and expectations for knowledge and participation in the CTOR. Descriptive analyses were performed on multiple-choice polls and open-ended responses.</div></div><div><h3>Results</h3><div>Polls received a mean of 317 responses (range, 222-504) and 20 open-ended comments. The most frequently cited student mistake was failure to understand their role in the CTOR (164 [32.5%]), followed by inappropriate chatting (141 [28.0%]) and breaking sterility (132 [26.2%]). Poll respondents valued students’ understanding of how to be helpful in the CTOR (101 [45.5%]) in addition to knowing what can or cannot be touched (47 [21.2%]) and basics of cardiopulmonary bypass (43 [19.4%]). Respondents indicated that students should assume active roles (84 [36.7%]), ask questions (66 [29%]), and help with minor tasks (41 [17.9%]). Respondents reported that students benefited most when they understood patient-specific clinicopathologic factors and basic operative steps.</div></div><div><h3>Conclusions</h3><div>We identified several areas for student improvement in the CTOR. Development of educational resources addressing these issues may enhance interest and augment recruitment of students to cardiothoracic surgery.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 276-280"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.atssr.2024.09.015
Shaelyn Cavanaugh MD, Paul Lawrence Feingold MD, MHS
{"title":"Mediastinoscopy Simulation—A Plastic Stepping Stone","authors":"Shaelyn Cavanaugh MD, Paul Lawrence Feingold MD, MHS","doi":"10.1016/j.atssr.2024.09.015","DOIUrl":"10.1016/j.atssr.2024.09.015","url":null,"abstract":"","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Page 200"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.atssr.2024.07.030
Lye-Yeng Wong MD , Devanish Kamtam MBBS, MS , Jake Kim BA , Bailey Wallen BS , Irmina A. Elliott MD , Brandon A. Guenthart MD , Douglas Z. Liou MD , Leah M. Backhus MD , Mark F. Berry MD , Joseph B. Shrager MD , Natalie S. Lui MD
Background
Esophagogastric anastomosis is a critical step of esophagectomy. We aimed to develop a novel robotic esophagectomy simulator with high rates of fidelity and educational value for trainee surgeons to advance these skills in a low-risk setting.
Methods
A porcine esophagus-stomach block was secured on a platform resembling the anatomy during an esophagectomy, and a da Vinci Xi (Intuitive Surgical) robotic system was docked above it. Participants completed 5 key steps (creating the gastric conduit, transecting the esophagus, making the gastrotomy and esophagotomy, creating the anastomosis, and sewing the common enterotomy). The model was assessed through surveys under domains of fidelity (surgical field, reality of materials, anatomy, and experience) and value as a training tool on a scale of 1 to 5 (strongly disagree to strongly agree).
Results
Of 14 participants, 8 (57.1%) were women, 9 (64.3%) were integrated cardiothoracic surgery residents, 1 (7.1%) was a thoracic-track resident, and 10 (71.4%) were in postgraduate year 4 or higher. Participants thought most aspects of the model had high fidelity, including the anatomy of conduit (4.8 ± 0.4) and proximal esophagus (4.9 ± 0.4), realism of the stomach (4.9 ± 0.4) and esophagus (4.9 ± 0.4), stapling (4.7 ± 0.6), suturing (4.8 ± 0.4), and tissue handling (4.4 ± 0.6). Participants rated the model highly overall (4.7 ± 0.5) and as a training tool (4.9 ± 0.4), with strong interrater reliability (0.69).
Conclusions
The robotic esophagogastric simulation model demonstrated high fidelity and value as a training tool, suggesting its potential effectiveness for surgeons with limited experience. However, it warrants further refinement to address limitations and to optimize its value as a training tool.
{"title":"Novel Robotic Esophagogastric Anastomosis Simulation Model for Skill Development and Training","authors":"Lye-Yeng Wong MD , Devanish Kamtam MBBS, MS , Jake Kim BA , Bailey Wallen BS , Irmina A. Elliott MD , Brandon A. Guenthart MD , Douglas Z. Liou MD , Leah M. Backhus MD , Mark F. Berry MD , Joseph B. Shrager MD , Natalie S. Lui MD","doi":"10.1016/j.atssr.2024.07.030","DOIUrl":"10.1016/j.atssr.2024.07.030","url":null,"abstract":"<div><h3>Background</h3><div>Esophagogastric anastomosis is a critical step of esophagectomy. We aimed to develop a novel robotic esophagectomy simulator with high rates of fidelity and educational value for trainee surgeons to advance these skills in a low-risk setting.</div></div><div><h3>Methods</h3><div>A porcine esophagus-stomach block was secured on a platform resembling the anatomy during an esophagectomy, and a da Vinci Xi (Intuitive Surgical) robotic system was docked above it. Participants completed 5 key steps (creating the gastric conduit, transecting the esophagus, making the gastrotomy and esophagotomy, creating the anastomosis, and sewing the common enterotomy). The model was assessed through surveys under domains of fidelity (surgical field, reality of materials, anatomy, and experience) and value as a training tool on a scale of 1 to 5 (strongly disagree to strongly agree).</div></div><div><h3>Results</h3><div>Of 14 participants, 8 (57.1%) were women, 9 (64.3%) were integrated cardiothoracic surgery residents, 1 (7.1%) was a thoracic-track resident, and 10 (71.4%) were in postgraduate year 4 or higher. Participants thought most aspects of the model had high fidelity, including the anatomy of conduit (4.8 ± 0.4) and proximal esophagus (4.9 ± 0.4), realism of the stomach (4.9 ± 0.4) and esophagus (4.9 ± 0.4), stapling (4.7 ± 0.6), suturing (4.8 ± 0.4), and tissue handling (4.4 ± 0.6). Participants rated the model highly overall (4.7 ± 0.5) and as a training tool (4.9 ± 0.4), with strong interrater reliability (0.69).</div></div><div><h3>Conclusions</h3><div>The robotic esophagogastric simulation model demonstrated high fidelity and value as a training tool, suggesting its potential effectiveness for surgeons with limited experience. However, it warrants further refinement to address limitations and to optimize its value as a training tool.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 206-211"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.atssr.2024.05.007
Jesus C. Jaile IV MD , Jacquelyn D. Brady PA , Patrick Nelson PA , Wesam Sourour MD , Melvin C. Almodovar MD , Scott Macicek MD , Timothy W. Pettitt MD , Frank A. Pigula MD
An infant with DiGeorge syndrome, multiple comorbidities, and truncus arteriosus type II underwent repair complicated by heart block necessitating placement of a dual-chamber bipolar pacing system with right ventricular leads and subsequent resynchronization with placement of left ventricular apical pacing leads. Resynchronization therapy improved QRS duration from 180 ms to 100 ms and ejection fraction from 25% to 54% over the course of 4 weeks with gradual return to normal function and eventual discharge.
{"title":"Cardiac Resynchronization Therapy for Pacing-Related Dysfunction Post Cardiac Surgery in Neonates","authors":"Jesus C. Jaile IV MD , Jacquelyn D. Brady PA , Patrick Nelson PA , Wesam Sourour MD , Melvin C. Almodovar MD , Scott Macicek MD , Timothy W. Pettitt MD , Frank A. Pigula MD","doi":"10.1016/j.atssr.2024.05.007","DOIUrl":"10.1016/j.atssr.2024.05.007","url":null,"abstract":"<div><div>An infant with DiGeorge syndrome, multiple comorbidities, and truncus arteriosus type II underwent repair complicated by heart block necessitating placement of a dual-chamber bipolar pacing system with right ventricular leads and subsequent resynchronization with placement of left ventricular apical pacing leads. Resynchronization therapy improved QRS duration from 180 ms to 100 ms and ejection fraction from 25% to 54% over the course of 4 weeks with gradual return to normal function and eventual discharge.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 825-828"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141397589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.atssr.2024.06.018
Kevin W. Lobdell MD , Shannon Crotwell BS, CCRN , Larry T. Watts MD , Bradley LeNoir MD , Eric R. Skipper MD , Thomas Maxey MD , Gregory B. Russell MS , Robert Habib PhD , Geoffrey A. Rose MD , John Frederick MD
Background
Our remote patient monitoring (RPM) program for adult cardiac surgery patients aims to remove barriers to access, provide continuity of expert care, and increase their time-at-home. The RPM program integrates novel biosensors, an application for audiovisual visits, messaging, biometric data tracking, patient-reported outcomes, and scheduling with the aim of reducing postoperative length of stay and 30-day readmissions, while simultaneously increasing the rate of patients discharged to home.
Methods
Our institutional database was utilized for this retrospective review of 1000 consecutive RPM patients who underwent coronary artery bypass, valve, and coronary artery bypass + valve, at 3 hospitals from July 2019 through April 2023. The study cohort was compared with 1000 propensity-matched controls from the same three hospitals (1:1, nearest neighbor matching where propensity scores were generated with RPM as the outcome measure). Patient characteristics, procedures, and outcomes are defined as per The Society of Thoracic Surgeons Adult Cardiac Database.
Results
RPM patients experienced statistically significant shorter median postoperative length of stay (1 day less, a 16.7% relative difference; P < .0001) and a 33% relative reduction in 30-day readmission (7.0 ± 0.8 vs 4.7 ± 0.7, P = .027), while 5.6% more patients were discharged to home (97.8% vs 92.2%, P < .0001) when compared with the non-RPM cohort.
Conclusions
Patient engagement and management with a RPM platform are feasible and associated with significantly shorter postoperative length of stay, fewer 30-day readmissions, and an increased rate of discharge to home.
{"title":"Remote Perioperative Monitoring in Adult Cardiac Surgery: The Impact on 1000 Consecutive Patients","authors":"Kevin W. Lobdell MD , Shannon Crotwell BS, CCRN , Larry T. Watts MD , Bradley LeNoir MD , Eric R. Skipper MD , Thomas Maxey MD , Gregory B. Russell MS , Robert Habib PhD , Geoffrey A. Rose MD , John Frederick MD","doi":"10.1016/j.atssr.2024.06.018","DOIUrl":"10.1016/j.atssr.2024.06.018","url":null,"abstract":"<div><h3>Background</h3><div>Our remote patient monitoring (RPM) program for adult cardiac surgery patients aims to remove barriers to access, provide continuity of expert care, and increase their time-at-home. The RPM program integrates novel biosensors, an application for audiovisual visits, messaging, biometric data tracking, patient-reported outcomes, and scheduling with the aim of reducing postoperative length of stay and 30-day readmissions, while simultaneously increasing the rate of patients discharged to home.</div></div><div><h3>Methods</h3><div>Our institutional database was utilized for this retrospective review of 1000 consecutive RPM patients who underwent coronary artery bypass, valve, and coronary artery bypass + valve, at 3 hospitals from July 2019 through April 2023. The study cohort was compared with 1000 propensity-matched controls from the same three hospitals (1:1, nearest neighbor matching where propensity scores were generated with RPM as the outcome measure). Patient characteristics, procedures, and outcomes are defined as per The Society of Thoracic Surgeons Adult Cardiac Database.</div></div><div><h3>Results</h3><div>RPM patients experienced statistically significant shorter median postoperative length of stay (1 day less, a 16.7% relative difference; <em>P</em> < .0001) and a 33% relative reduction in 30-day readmission (7.0 ± 0.8 vs 4.7 ± 0.7, <em>P</em> = .027), while 5.6% more patients were discharged to home (97.8% vs 92.2%, <em>P</em> < .0001) when compared with the non-RPM cohort.</div></div><div><h3>Conclusions</h3><div>Patient engagement and management with a RPM platform are feasible and associated with significantly shorter postoperative length of stay, fewer 30-day readmissions, and an increased rate of discharge to home.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 860-864"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.atssr.2024.06.025
Kendal M. Endicott MD , Hannah Pambianchi BA , David Spinosa MD , Liam Ryan MD
Background
DeBakey type I aortic dissections (AD) are most frequently treated with hemiarch repair. A subset of patients demonstrates persistent distal end-organ ischemia secondary to persistent true lumen (TL) compression. We describe the use of bare metal stent grafting across the residual arch dissection with the Zenith Dissection Endovascular Stent (ZDES, Cook Medical) in 7 patients with type I AD that was repaired in a hemiarch configuration with a compromised distal TL and organ malperfusion.
Methods
Seven patients underwent ZDES placement from a hemiarch repair across the arch with extension to the aortic bifurcation in the acute and subacute phases. Pressure gradients between the ascending aorta and the femoral access were recorded. Preprocedure and postprocedure computed tomographic images were analyzed using centerline reconstruction. TL and false lumen areas were calculated on the basis of manually performed measurements on 8 points along the aorta.
Results
All 7 cases were technically successful, without evidence of perioperative stroke or intraoperative death. There was a statistically significant increase in median TL area at all locations except 1 cm above the aortic bifurcation (P <.05). Pressure gradients between the ascending aorta and the femoral access in measured cases improved after stenting.
Conclusions
Bare metal stenting across the aortic arch after hemiarch repair in the setting of persistent distal TL compression is a technically viable strategy and may promote long-term aortic remodeling. This treatment strategy may represent another option for treatment of type I AD in patients presenting with distal malperfusion.
{"title":"Arch Bare Metal Stent Grafting in Type I Aortic Dissections After Hemiarch Repair","authors":"Kendal M. Endicott MD , Hannah Pambianchi BA , David Spinosa MD , Liam Ryan MD","doi":"10.1016/j.atssr.2024.06.025","DOIUrl":"10.1016/j.atssr.2024.06.025","url":null,"abstract":"<div><h3>Background</h3><div>DeBakey type I aortic dissections (AD) are most frequently treated with hemiarch repair. A subset of patients demonstrates persistent distal end-organ ischemia secondary to persistent true lumen (TL) compression. We describe the use of bare metal stent grafting across the residual arch dissection with the Zenith Dissection Endovascular Stent (ZDES, Cook Medical) in 7 patients with type I AD that was repaired in a hemiarch configuration with a compromised distal TL and organ malperfusion.</div></div><div><h3>Methods</h3><div>Seven patients underwent ZDES placement from a hemiarch repair across the arch with extension to the aortic bifurcation in the acute and subacute phases. Pressure gradients between the ascending aorta and the femoral access were recorded. Preprocedure and postprocedure computed tomographic images were analyzed using centerline reconstruction. TL and false lumen areas were calculated on the basis of manually performed measurements on 8 points along the aorta.</div></div><div><h3>Results</h3><div>All 7 cases were technically successful, without evidence of perioperative stroke or intraoperative death. There was a statistically significant increase in median TL area at all locations except 1 cm above the aortic bifurcation (<em>P</em> <.05). Pressure gradients between the ascending aorta and the femoral access in measured cases improved after stenting.</div></div><div><h3>Conclusions</h3><div>Bare metal stenting across the aortic arch after hemiarch repair in the setting of persistent distal TL compression is a technically viable strategy and may promote long-term aortic remodeling. This treatment strategy may represent another option for treatment of type I AD in patients presenting with distal malperfusion.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 712-717"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.atssr.2024.04.003
Kelly L. Wiltse Nicely PhD, CRNA , Ronald Friend PhD , Chad Robichaux MPH , Jonathan Alex Edwards MSPH , Jeannie P. Cimiotti PhD, RN , Kim Dupree Jones PhD, FNP
Background
As the opioid epidemic continues, a better understanding of the use of opioids in surgery is needed. We examined whether intraoperative opioid administration was associated with greater postoperative opioid use prior to discharge in opioid-naïve patients undergoing thoracic surgery. Further, we sought to determine predictors of higher intra- and postoperative opioid use including demographic and patient factors and hospital.
Methods
Data on patients who underwent elective thoracic surgery between January 1, 2018, and December 31, 2019, were extracted from a data repository at a large health system in the Southeast United States. All patients and data on total intraoperative and postoperative (prior to discharge) opioid administration were included. A total of 126 patient encounters were analyzed.
Results
Increased intraoperative morphine milligram equivalent was associated with increased postoperative administration, where each unit increase in intraoperative morphine milligram equivalent was associated with 0.57 increased units in postoperative use (B = 0.57; 95% CI, 0.29-0.87, P < .0003), controlling for patient race, sex, age, weight, Elixhauser comorbidity score, and hospital. Younger age (P < .002), comorbidity (P < .054), and weight (P < .026) were associated with higher intra- and postoperative opioid use, but race (P < .320) and sex (P < .980) were not associated with opioid administration.
Conclusions
Intraoperative opioid use had a significant impact on postoperative opioid use in patients undergoing elective thoracic surgery, even when controlling for age, weight, comorbidities, race, and sex. Substantial variation in both intra- and postoperative opioid administration was noted.
{"title":"Association Between Intra- and Postoperative Opioids in Opioid-Naïve Patients in Thoracic Surgery","authors":"Kelly L. Wiltse Nicely PhD, CRNA , Ronald Friend PhD , Chad Robichaux MPH , Jonathan Alex Edwards MSPH , Jeannie P. Cimiotti PhD, RN , Kim Dupree Jones PhD, FNP","doi":"10.1016/j.atssr.2024.04.003","DOIUrl":"10.1016/j.atssr.2024.04.003","url":null,"abstract":"<div><h3>Background</h3><div>As the opioid epidemic continues, a better understanding of the use of opioids in surgery is needed. We examined whether intraoperative opioid administration was associated with greater postoperative opioid use prior to discharge in opioid-naïve patients undergoing thoracic surgery. Further, we sought to determine predictors of higher intra- and postoperative opioid use including demographic and patient factors and hospital.</div></div><div><h3>Methods</h3><div>Data on patients who underwent elective thoracic surgery between January 1, 2018, and December 31, 2019, were extracted from a data repository at a large health system in the Southeast United States. All patients and data on total intraoperative and postoperative (prior to discharge) opioid administration were included. A total of 126 patient encounters were analyzed.</div></div><div><h3>Results</h3><div>Increased intraoperative morphine milligram equivalent was associated with increased postoperative administration, where each unit increase in intraoperative morphine milligram equivalent was associated with 0.57 increased units in postoperative use (B = 0.57; 95% CI, 0.29-0.87, <em>P</em> < .0003), controlling for patient race, sex, age, weight, Elixhauser comorbidity score, and hospital. Younger age (<em>P</em> < .002), comorbidity (<em>P</em> < .054), and weight (<em>P</em> < .026) were associated with higher intra- and postoperative opioid use, but race (<em>P</em> < .320) and sex (<em>P</em> < .980) were not associated with opioid administration.</div></div><div><h3>Conclusions</h3><div>Intraoperative opioid use had a significant impact on postoperative opioid use in patients undergoing elective thoracic surgery, even when controlling for age, weight, comorbidities, race, and sex. Substantial variation in both intra- and postoperative opioid administration was noted.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 865-870"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140794318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) era, implanting a larger-sized valve during the initial aortic valve replacement is important. For smaller aortic annuli, combining aortic annular and left ventricular outflow tract (LVOT) enlargement is essential. The Y-incision procedure helps achieve implantation of a 2-size larger valve. However, it can lead to size discrepancies between the valve and the LVOT, thus resulting in a residual pressure gradient, and the risk of coronary obstruction after ViV-TAVR remains because the initial surgical valve is implanted tilted inward. To resolve these concerns, we combined the Y-incision and Nicks procedures.
{"title":"A New Technique for Aortic Annular and Outflow Enlargement: Combined Y-Incision and Nicks Procedures","authors":"Kosuke Nakamae MD , Hiroshi Niinami MD, PhD , Satoru Domoto MD, PhD , Takeshi Shinkawa MD, PhD , Kozo Morita MD","doi":"10.1016/j.atssr.2024.04.011","DOIUrl":"10.1016/j.atssr.2024.04.011","url":null,"abstract":"<div><div>In the valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) era, implanting a larger-sized valve during the initial aortic valve replacement is important. For smaller aortic annuli, combining aortic annular and left ventricular outflow tract (LVOT) enlargement is essential. The Y-incision procedure helps achieve implantation of a 2-size larger valve. However, it can lead to size discrepancies between the valve and the LVOT, thus resulting in a residual pressure gradient, and the risk of coronary obstruction after ViV-TAVR remains because the initial surgical valve is implanted tilted inward. To resolve these concerns, we combined the Y-incision and Nicks procedures.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 799-803"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.atssr.2024.08.005
Allison L. Weiderhold BA, MS, Lauren M. Barron MD
{"title":"Artificial Intelligence: Adult Supervision Required","authors":"Allison L. Weiderhold BA, MS, Lauren M. Barron MD","doi":"10.1016/j.atssr.2024.08.005","DOIUrl":"10.1016/j.atssr.2024.08.005","url":null,"abstract":"","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Page 747"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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