JTCVS open最新文献

英文中文

Robotic-assisted coronary artery bypass grafting simplified: Lessons learned after 20 years 简化机器人辅助冠状动脉旁路移植术：20 年后的经验教训

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.07.023

Mark Lutz BA, Zhandong Zhou MD, Ahmad Nazem MD, G. Randall Green MD, JD, MBA, Anton Cherney MD, Karikehalli Dilip MD, Charles J. Lutz MD

引用次数: 0

Innovative pathways in revascularization for non-ST elevation acute coronary syndrome 非ST段抬高急性冠状动脉综合征血管重建的创新途径

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.07.017

FNU Venjhraj MBBS , Vikram Singh Medical Technologist , Ashvin Kumar MBBS , Aiman Salam Shaikh MBBS

引用次数: 0

Are there etiology-specific risk factors for adverse outcomes in patients on Impella 5.5 support? 使用 Impella 5.5 支持系统的患者出现不良预后是否存在特定病因的风险因素？

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.04.014

Objectives

To identify possible etiology-specific differences in preoperative risk factors for major adverse events during Impella 5.5 support in patients with ischemic (ICM) and nonischemic cardiomyopathy (NICM).

Methods

From October 2019 to January 2023, 228 Impella 5.5 devices were inserted at our institution. Patients were stratified into ICM (n = 124) and NICM (n = 104) cohorts. The primary outcome was a composite of death/stroke/new-onset dialysis while actively receiving Impella 5.5 support. Random forests identified preoperative factors predictive of the primary outcome separately for each cohort, with ranking by variable importance.

Results

The primary outcome occurred in 42 (34%) patients with ICM and 35 (34%) patients with NICM. Twenty-one (17%) patients with ICM and 21 (20%) patients with NICM died on Impella 5.5; stroke occurred in 12 (9.7%) patients with ICM and 3 (2.9%) patients with NICM, and new-onset dialysis was initiated in 23 (19%) patients with ICM and 24 (23%) patients with NICM while actively receiving Impella 5.5 support. Risk factors reflecting systemic and myocardial cellular injury, end-organ and cardiopulmonary failure, right ventricular dysfunction, and smaller left ventricular dimensions were most predictive of adverse outcomes in both cohorts. Indications for Impella 5.5 and device strategy (bridge to recovery, advanced therapies, or decision) were not top risk factors in either cohort.

Conclusions

Risk factors related to preoperative stability, right ventricular dysfunction, and left ventricular size were more predictive of adverse outcomes while actively receiving Impella 5.5 support than indication or device strategy. These factors could help identify high-risk patients who may benefit from additional tailored management to reduce their risk for these impactful adverse outcomes while on Impella 5.5 support.

目的确定缺血性（ICM）和非缺血性心肌病（NICM）患者在接受 Impella 5.5 支持期间发生主要不良事件的术前风险因素可能存在的病因特异性差异。方法从 2019 年 10 月到 2023 年 1 月，我院共植入了 228 台 Impella 5.5 装置。患者被分为 ICM 组（124 人）和 NICM 组（104 人）。主要结果是在积极接受Impella 5.5支持期间死亡/中风/新发透析的复合结果。随机森林分别确定了每个队列中预测主要结局的术前因素，并按变量重要性进行了排序。结果42（34%）名 ICM 患者和 35（34%）名 NICM 患者出现了主要结局。21 名 ICM 患者（17%）和 21 名 NICM 患者（20%）在接受 Impella 5.5 支持期间死亡；12 名 ICM 患者（9.7%）和 3 名 NICM 患者（2.9%）发生中风；23 名 ICM 患者（19%）和 24 名 NICM 患者（23%）在积极接受 Impella 5.5 支持期间开始新发透析。反映全身和心肌细胞损伤、内脏器官和心肺功能衰竭、右心室功能障碍和左心室尺寸较小的风险因素最能预测这两组患者的不良预后。结论与术前稳定性、右心室功能障碍和左心室尺寸相关的风险因素比适应症或设备策略更能预测积极接受Impella 5.5支持时的不良预后。这些因素有助于识别高风险患者，这些患者可能受益于额外的定制化管理，以降低他们在接受Impella 5.5支持时出现这些有影响的不良后果的风险。

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引用次数: 0

Lymphatic vascular invasion: Diagnostic variability and overall survival impact on patients undergoing surgical resection 淋巴管侵犯：诊断变异性和对手术切除患者总体生存的影响

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.08.012

John Varlotto MD , Rick Voland PhD , Negar Rassaei MD , Dani Zander MD , Malcolm M. DeCamp MD , Jai Khatri MD , Yousef Shweihat MD , Kemnasom Nwanwene MD , Maria Tria Tirona MD , Thomas Wright MD , Toni Pacioles MD , Muhammad Jamil MD , Khuram Anwar MD , John Flickinger MD

Objective

The diagnostic criteria of lymphatic vascular invasion have not been standardized. Our investigation assesses the factors associated with lymphatic vascular invasion positive tumors and the impact of lymphatic vascular invasion on overall survival for patients with non–small cell lung cancer undergoing (bi)lobectomy with an adequate node dissection.

Methods

The National Cancer Database was queried from the years 2010 to 2015 to find surgical patients who underwent lobectomy with at least 10 lymph nodes examined (adequate node dissection) and with known lymphatic vascular invasion status. Paired t tests were used to distinguish differences between the patients with and without lymphatic vascular invasion in their specimen. Multivariable analysis was used to determine factors associated with overall survival. Propensity score matching adjusting for overall survival factors was used to determine the lymphatic vascular invasion's overall survival impact by grade, histology, p-T/N/overall stage, and tumor size.

Results

Lymphatic vascular invasion status was reported in 91.6% and positive in 23.4% of 28,842 eligible patients. Academic medical centers, institutions with populations more than 1,000,000, and the mid-Atlantic region reported higher rates of lymphatic vascular invasion positive tumors as well as overall survival compared with other cancer centers. Lymphatic vascular invasion was independently associated with a significant decrement in overall survival as per multivariable analysis and propensity score matching. Propensity score matching demonstrated that lymphatic vascular invasion was associated with a significant decrement in overall survival for all histologies, tumor grades, tumor sizes, and stages, except for more advanced pathologic stages T3/III/N2 and larger tumors greater than 4 cm for which overall survival was trending worse with lymphatic vascular invasion positive.

Conclusions

Lymphatic vascular invasion positive varies based on hospital location/type and population, but it was associated with a decrement in overall survival that was independent of pathologic T/N/overall stage, histology, and tumor grade. Lymphatic vascular invasion must be standardized and considered as a staging variable and should be considered as a sole determinant for prognosis, especially for those with earlier-stage and smaller tumors.

目的淋巴管侵犯的诊断标准尚未统一。我们的调查评估了淋巴管侵犯阳性肿瘤的相关因素，以及淋巴管侵犯对接受（双）肺叶切除术并进行充分结节清扫的非小细胞肺癌患者总生存率的影响。方法查询了2010年至2015年的美国国家癌症数据库，以找到接受肺叶切除术并至少检查了10个淋巴结（充分结节清扫）且已知淋巴管侵犯状态的手术患者。采用配对 t 检验来区分标本中存在和不存在淋巴管侵犯的患者之间的差异。多变量分析用于确定与总生存率相关的因素。根据总生存率因素进行倾向评分匹配调整，以确定淋巴管侵犯对分级、组织学、p-T/N/总分期和肿瘤大小的总生存率的影响。结果在28842例符合条件的患者中，91.6%的患者报告了淋巴管侵犯状态，23.4%的患者报告了阳性。与其他癌症中心相比，学术医疗中心、人口超过100万的机构和大西洋中部地区的淋巴管侵犯阳性肿瘤率和总生存率更高。根据多变量分析和倾向得分匹配，淋巴管侵犯与总生存率的显著下降密切相关。倾向评分匹配显示，淋巴管侵犯与所有组织学、肿瘤分级、肿瘤大小和分期的总生存率显著下降有关，但晚期病理分期T3/III/N2和大于4厘米的较大肿瘤除外，淋巴管侵犯阳性的肿瘤总生存率呈下降趋势。结论淋巴管侵犯阳性因医院位置/类型和人群而异，但它与总生存率下降有关，且与病理T/N/总分期、组织学和肿瘤分级无关。淋巴管侵犯必须标准化，并被视为分期变量，而且应被视为预后的唯一决定因素，尤其是对于早期和较小肿瘤患者。

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引用次数: 0

Alternative discharge destination following lobectomy: Analysis of a national quality improvement database 肺叶切除术后的出院选择：国家质量改进数据库分析

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.06.020

Victoria Yin MD, MPH , Sean C. Wightman MD , Takashi Harano MD , Scott M. Atay MD , Anthony W. Kim MD

Objective

To determine factors significantly associated with alternative discharge destination (ADCD) following lobectomy, including the modified 5-item Frailty Index (mFI-5).

Methods

Patients in the 2017-2020 NSQIP who underwent elective lobectomy and were admitted from home were included, with ADCD defined as a patient who was discharged to any nonhome location. Four multivariable logistic regression models for ADCD were evaluated for predictive power. Model A was created from backward selection of variables significantly associated with ADCD in bivariate analyses, model B was the mFI-5, model C was mFI-5 and a minimally invasive approach, and model D was mFI-5 and age group.

Results

Among the 15,868 patients, 687 (4.3%) experienced ADCD. Model A identified older age, hypertension, dyspnea, history of chronic obstructive pulmonary disease, and increased length of stay as significantly associated with ADCD. A minimally invasive approach was significantly protective of ADCD. Model A had the best predictive power of the models tested (C-statistic = 0.785). Model B, which assessed mFI-5 alone, had fair predictive power (C-statistic = 0.637). Adding surgical approach (C-statistic = 0.673; model C) or age group (C-statistic = 0.682; model D) as independent variables with mFI-5 improved model fit.

Conclusions

Patients who were frail or age >75 years were more likely to have postlobectomy ADCD. Although the variables identified in model A better predict ADCD, consideration of surgical approach or age with mFI-5 can help surgeons anticipate discharge destination following lobectomy.

目的确定与肺叶切除术后替代出院目的地（ADCD）明显相关的因素，包括改良的 5 项虚弱指数（mFI-5）。方法纳入 2017-2020 年 NSQIP 中接受择期肺叶切除术并从家中入院的患者，ADCD 定义为出院到任何非家庭所在地的患者。评估了 ADCD 的四个多变量逻辑回归模型的预测能力。模型 A 是根据双变量分析中与 ADCD 显著相关的变量逆向选择创建的，模型 B 是 mFI-5，模型 C 是 mFI-5 和微创方法，模型 D 是 mFI-5 和年龄组。模型 A 发现年龄较大、高血压、呼吸困难、慢性阻塞性肺病病史和住院时间延长与 ADCD 显著相关。微创方法对 ADCD 有明显保护作用。在所测试的模型中，模型 A 的预测能力最强（C 统计量 = 0.785）。单独评估 mFI-5 的模型 B 预测能力一般（C 统计量 = 0.637）。将手术方式（C-统计量=0.673；模型 C）或年龄组（C-统计量=0.682；模型 D）作为 mFI-5 的自变量可提高模型的拟合度。虽然模型 A 中确定的变量能更好地预测 ADCD，但考虑手术方式或年龄与 mFI-5 可以帮助外科医生预测肺叶切除术后的出院去向。

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引用次数: 0

Repair of acute type A aortic dissection: The simplest solution is not always the best 急性 A 型主动脉断裂的修复最简单的解决方案不一定是最好的解决方案

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.03.004

引用次数: 0

Commentator Discussion: Tricuspid valve surgery for acute infective endocarditis can be performed with very low operative mortality 评论员讨论：三尖瓣手术治疗急性感染性心内膜炎的手术死亡率极低

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.07.008

引用次数: 0

Commentator Discussion: Autonomous Fontan pump: Computational feasibility study 评论员讨论：自主丰坦泵：计算可行性研究

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.07.010

引用次数: 0

Improving prediction accuracy of spread through air spaces in clinical-stage T1N0 lung adenocarcinoma using computed tomography imaging models 利用计算机断层成像模型提高临床期 T1N0 肺腺癌通过气隙扩散的预测准确性

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.07.018

Shihua Dou MD , Zhuofeng Li BS , Zhenbin Qiu MD , Jing Zhang PhD , Yaxi Chen MD , Shuyuan You MD , Mengmin Wang MD , Hongsheng Xie MD , Xiaoxiang Huang MD , Yun Yi Li , Jingjing Liu MD , Yuxin Wen MD , Jingshan Gong PhD , Fanli Peng MD , Wenzhao Zhong PhD , Xuegong Zhang PhD , Lin Yang PhD

Objectives

To develop computed tomography (CT)-based models to increase the prediction accuracy of spread through air spaces (STAS) in clinical-stage T1N0 lung adenocarcinoma.

Methods

Three cohorts of patients with stage T1N0 lung adenocarcinoma (n = 1258) were analyzed retrospectively. Two models using radiomics and deep neural networks (DNNs) were established to predict the lung adenocarcinoma STAS status. For the radiomic models, features were extracted using PyRadiomics, and 10 features with nonzero coefficients were selected using least absolute shrinkage and selection operator regression to construct the models. For the DNN models, a 2-stage (supervised contrastive learning and fine-tuning) deep-learning model, MultiCL, was constructed using CT images and the STAS status as training data. The area under the curve (AUC) was used to verify the predictive ability of both model types for the STAS status.

Results

Among the radiomic models, the linear discriminant analysis model exhibited the best performance, with AUC values of 0.8944 (95% confidence interval [CI], 0.8241-0.9502) and 0.7796 (95% CI, 0.7089-0.8448) for predicting the STAS status on the test and external validation cohorts, respectively. Among the DNN models, MultiCL exhibited the best performance, with AUC values of 0.8434 (95% CI, 0.7580-0.9154) for the test cohort and 0.7686 (95% CI, 0.6991-0.8316) for the external validation cohort.

Conclusions

CT-based imaging models (radiomics and DNNs) can accurately identify the STAS status of clinical-stage T1N0 lung adenocarcinoma, potentially guiding surgical decision making and improving patient outcomes.

方法回顾性分析了三组 T1N0 期肺腺癌患者（n = 1258）。利用放射组学和深度神经网络（DNN）建立了两个模型来预测肺腺癌的 STAS 状态。在放射组学模型中，使用 PyRadiomics 提取特征，并使用最小绝对收缩和选择算子回归法选出 10 个系数不为零的特征来构建模型。对于 DNN 模型，使用 CT 图像和 STAS 状态作为训练数据，构建了一个两阶段（监督对比学习和微调）深度学习模型 MultiCL。结果在放射学模型中，线性判别分析模型表现最佳，其预测测试组和外部验证组 STAS 状态的 AUC 值分别为 0.8944（95% 置信区间 [CI]，0.8241-0.9502）和 0.7796（95% CI，0.7089-0.8448）。结论基于CT的成像模型（放射组学和DNN）可以准确识别临床期T1N0肺腺癌的STAS状态，从而为手术决策提供指导并改善患者预后。

{"title":"Improving prediction accuracy of spread through air spaces in clinical-stage T1N0 lung adenocarcinoma using computed tomography imaging models","authors":"Shihua Dou MD , Zhuofeng Li BS , Zhenbin Qiu MD , Jing Zhang PhD , Yaxi Chen MD , Shuyuan You MD , Mengmin Wang MD , Hongsheng Xie MD , Xiaoxiang Huang MD , Yun Yi Li , Jingjing Liu MD , Yuxin Wen MD , Jingshan Gong PhD , Fanli Peng MD , Wenzhao Zhong PhD , Xuegong Zhang PhD , Lin Yang PhD","doi":"10.1016/j.xjon.2024.07.018","DOIUrl":"10.1016/j.xjon.2024.07.018","url":null,"abstract":"<div><h3>Objectives</h3><div>To develop computed tomography (CT)-based models to increase the prediction accuracy of spread through air spaces (STAS) in clinical-stage T1N0 lung adenocarcinoma.</div></div><div><h3>Methods</h3><div>Three cohorts of patients with stage T1N0 lung adenocarcinoma (n = 1258) were analyzed retrospectively. Two models using radiomics and deep neural networks (DNNs) were established to predict the lung adenocarcinoma STAS status. For the radiomic models, features were extracted using PyRadiomics, and 10 features with nonzero coefficients were selected using least absolute shrinkage and selection operator regression to construct the models. For the DNN models, a 2-stage (supervised contrastive learning and fine-tuning) deep-learning model, MultiCL, was constructed using CT images and the STAS status as training data. The area under the curve (AUC) was used to verify the predictive ability of both model types for the STAS status.</div></div><div><h3>Results</h3><div>Among the radiomic models, the linear discriminant analysis model exhibited the best performance, with AUC values of 0.8944 (95% confidence interval [CI], 0.8241-0.9502) and 0.7796 (95% CI, 0.7089-0.8448) for predicting the STAS status on the test and external validation cohorts, respectively. Among the DNN models, MultiCL exhibited the best performance, with AUC values of 0.8434 (95% CI, 0.7580-0.9154) for the test cohort and 0.7686 (95% CI, 0.6991-0.8316) for the external validation cohort.</div></div><div><h3>Conclusions</h3><div>CT-based imaging models (radiomics and DNNs) can accurately identify the STAS status of clinical-stage T1N0 lung adenocarcinoma, potentially guiding surgical decision making and improving patient outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 290-303"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553336","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}

引用次数: 0

Disparities in mortality rates from aortic aneurysm and dissection by country-level income status and sex 按国家收入水平和性别分列的主动脉瘤和夹层死亡率差异

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.08.004

Makoto Hibino MD, MPH, PhD , Nitish K. Dhingra MD , Raj Verma , Christoph A. Nienaber MD , Bobby Yanagawa MD, PhD , Subodh Verma MD, PhD

Objective

To investigate the impact of national income level and sex on mortality trends from aortic aneurysm and dissection in addition to all aortic disease as a whole.

Methods

Using data from the World Health Organization mortality database, we conducted an analysis of mortality trends from aortic disease between 2000 and 2019, Countries were categorized into middle-income and high-income countries (MICs and HICs) on the basis of income level. Age-standardized and sex-specific age-standardized mortality rates per 100,000 persons, along with male-to-female mortality ratios, were calculated. Trends over the study period were analyzed using joinpoint regression.

Results

Our analysis comprised 29 MICs and 46 HICs, with an average population of 595 million and 1042 million during the observation period. During the observation period, age-standardized mortality rates from aortic disease decreased to 2.21 (2.17-2.25) and 2.28 (2.26-2.30) in MICs and HICs, respectively (average annual percentage change of −0.5% in MICs and −1.8% in HICs, P < .05 for both). However, mortality rates from aortic dissection increased in HICs from 2000 to 2019 (average annual percentage change of 1.3%, P < .001). Mortality from aortic disease, aortic dissection, and aortic aneurysm were male dominant in MICs and HICs but decreasing trends during the observation periods except for aortic dissection in MICs.

Conclusions

We present the contemporary and comprehensive analysis of global socioeconomic status and aortic diseases mortality. Although trends of mortality from aortic diseases are on the decline in both MICs and HICs, there is a striking increase in mortality for aortic dissection, specifically in HICs.

方法利用世界卫生组织死亡率数据库的数据，我们对 2000 年至 2019 年间主动脉疾病的死亡率趋势进行了分析，根据收入水平将国家分为中等收入国家和高收入国家（MICs 和 HICs）。计算了每 10 万人的年龄标准化死亡率和特定性别死亡率，以及男女死亡率比。结果我们的分析包括 29 个中等收入国家和 46 个高收入国家，观察期内的平均人口分别为 5.95 亿和 1.04 亿。在观察期内，中等收入国家和高收入国家的主动脉疾病年龄标准化死亡率分别降至 2.21（2.17-2.25）和 2.28（2.26-2.30）（中等收入国家的年均百分比变化为-0.5%，高收入国家的年均百分比变化为-1.8%，两者的 P 均为 0.05）。然而，从 2000 年到 2019 年，高收入国家的主动脉夹层死亡率有所上升（年均百分比变化为 1.3%，P < .001）。在中等收入国家和高收入国家，主动脉疾病、主动脉夹层和主动脉瘤的死亡率以男性为主，但在观察期内，除中等收入国家的主动脉夹层外，主动脉疾病、主动脉夹层和主动脉瘤的死亡率呈下降趋势。尽管在中等收入国家和高收入国家，主动脉疾病的死亡率呈下降趋势，但主动脉夹层的死亡率却显著上升，尤其是在高收入国家。

{"title":"Disparities in mortality rates from aortic aneurysm and dissection by country-level income status and sex","authors":"Makoto Hibino MD, MPH, PhD , Nitish K. Dhingra MD , Raj Verma , Christoph A. Nienaber MD , Bobby Yanagawa MD, PhD , Subodh Verma MD, PhD","doi":"10.1016/j.xjon.2024.08.004","DOIUrl":"10.1016/j.xjon.2024.08.004","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the impact of national income level and sex on mortality trends from aortic aneurysm and dissection in addition to all aortic disease as a whole.</div></div><div><h3>Methods</h3><div>Using data from the World Health Organization mortality database, we conducted an analysis of mortality trends from aortic disease between 2000 and 2019, Countries were categorized into middle-income and high-income countries (MICs and HICs) on the basis of income level. Age-standardized and sex-specific age-standardized mortality rates per 100,000 persons, along with male-to-female mortality ratios, were calculated. Trends over the study period were analyzed using joinpoint regression.</div></div><div><h3>Results</h3><div>Our analysis comprised 29 MICs and 46 HICs, with an average population of 595 million and 1042 million during the observation period. During the observation period, age-standardized mortality rates from aortic disease decreased to 2.21 (2.17-2.25) and 2.28 (2.26-2.30) in MICs and HICs, respectively (average annual percentage change of −0.5% in MICs and −1.8% in HICs, <em>P</em> < .05 for both). However, mortality rates from aortic dissection increased in HICs from 2000 to 2019 (average annual percentage change of 1.3%, <em>P</em> < .001). Mortality from aortic disease, aortic dissection, and aortic aneurysm were male dominant in MICs and HICs but decreasing trends during the observation periods except for aortic dissection in MICs.</div></div><div><h3>Conclusions</h3><div>We present the contemporary and comprehensive analysis of global socioeconomic status and aortic diseases mortality. Although trends of mortality from aortic diseases are on the decline in both MICs and HICs, there is a striking increase in mortality for aortic dissection, specifically in HICs.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 224-238"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553452","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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