IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.020

Liz Mann PharmD , Bryan A. Whitson MD, PhD , Eric McLaughlin MS , Laura Andino PharmD, MPH , Alan Rozycki PharmD

Objective

To evaluate bleeding rates among patients who received a mechanical aortic valve replacement (mAVR) treated with warfarin monotherapy versus warfarin with a therapeutic parenteral anticoagulant bridge.

Methods

This retrospective, single-center, observational study included patients at least 18 years old who received an mAVR and had anticoagulation ordered by the end of postoperative day 2. Exclusion criteria included an INR goal other than 2-3, a hypercoagulable state, postoperative mechanical circulatory support, delayed sternal closure, pregnancy or incarceration. The primary outcome was International Society of Thrombosis and Hemostasis major bleeding until hospital discharge or 30 days after valve replacement, whichever came first. Secondary outcomes included thromboembolic events, hospital length of stay, and mortality.

Results

A total of 143 patients were included in the final analysis, 112 patients in the therapeutic anticoagulation bridge group and 31 patients in the warfarin monotherapy (no-bridge) group. Eighty-seven percent of the patients were white and 69.2% were male, and the median age was 49 years (interquartile range [IQR], 41-58 years). Sixteen patients (14.3%) in the bridge group experienced a major bleed, compared to 0 patients in the no-bridge group (P = .02). Thromboembolic events occurred in 6.5% of patients in the no-bridge group versus 2.7% in the bridge group (P = .30). There was no difference in mortality between the 2 groups (P = .99).

Conclusions

The use of therapeutic parenteral anticoagulation with warfarin after mAVR significantly increased the rate of major bleeding compared to warfarin monotherapy. Larger prospective studies are needed to confirm these findings.

目的评价在机械主动脉瓣置换术（mAVR）中接受华法林单药治疗与华法林联合静脉外抗凝桥治疗的出血发生率。方法：这项回顾性、单中心、观察性研究纳入了至少18岁、接受mAVR治疗并在术后第2天嘱行抗凝治疗的患者。排除标准包括非2-3的INR指标、高凝状态、术后机械循环支持、延迟胸骨闭合、妊娠或嵌顿。主要终点是国际血栓和止血学会的大出血，直到出院或瓣膜置换术后30天，以先到者为准。次要结局包括血栓栓塞事件、住院时间和死亡率。结果共纳入143例患者，其中治疗性抗凝桥组112例，华法林单药（无桥）组31例。87%的患者为白人，69.2%为男性，中位年龄为49岁（四分位间距[IQR]， 41-58岁）。搭桥组16例（14.3%）发生大出血，无搭桥组0例（P = 0.02）。无桥组6.5%的患者发生血栓栓塞事件，而桥组2.7% （P = 0.30）。两组患者死亡率差异无统计学意义（P = 0.99）。结论与华法林单药治疗相比，mAVR术后静脉外抗凝联合华法林明显增加了大出血发生率。需要更大规模的前瞻性研究来证实这些发现。

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引用次数: 0

Surgical experience and long-term outcomes of retrograde type A aortic dissection after thoracic endovascular aortic repair 胸血管内主动脉修复术后逆行A型主动脉夹层的手术经验及远期疗效

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.006

Yumeng Ji MD , Kai Zhang MD , Chenyu Zhou MD , Wei Gao MD , Bin Hou MD , Ji Wang MD , Kai Xu MD , Shiqi Gao MD , Juntao Qiu MD , Cuntao Yu MD

Objective

To evaluate and summarize the long-term outcomes of surgical treatment in patients who developed retrograde type A aortic dissection (RTAD) following thoracic endovascular aortic repair (TEVAR).

Methods

Between January 2010 and June 2023, patients who underwent surgical treatment for RTAD following TEVAR at Fuwai Hospital were selected for clinical data collection and long-term follow-up. Both early postoperative outcomes and long-term follow-up results were evaluated.

Results

Among 67 patients who underwent surgical treatment for RTAD following TEVAR (33 acute dissections, 34 chronic dissections), 57 (85.1%) received total arch replacement (TAR) combined with frozen elephant trunk (FET). Entry tears were located predominantly in the aortic arch (73.1%). Early mortality was 6.0% (n = 4). The 1-year and 5-year survival rates were 95.1% and 90.5%, respectively. Cardiovascular reintervention rates were 16.4% at 1 year and 23.8% at 5 years. During follow-up, 5-year survival rates were similar in the acute and chronic dissection groups (90.9% vs 85.5%; P = .9). The TAR with FET group was associated with a significantly lower incidence of composite endpoint events compared to other surgical approaches (28.1% vs 70%; P = .034), with Cox analysis showing a 66% risk reduction for endpoint events in the TAR with FET group.

Conclusions

Surgical management of RTAD after TEVAR shows comparable outcomes between acute and chronic cases. TAR with FET was associated with favorable long-term results in our cohort, suggesting that it may be a reasonable approach to consider for these patients. Vigilant follow-up remains essential as RTAD risk persists well beyond the conventional 1-month post-TEVAR period.

目的评价和总结胸血管内主动脉修复术（TEVAR）后发生逆行性A型主动脉夹层（RTAD）手术治疗的远期疗效。方法选择2010年1月至2023年6月阜外医院TEVAR术后行RTAD手术治疗的患者进行临床资料收集和长期随访。对术后早期结果和长期随访结果进行评估。结果在67例TEVAR术后RTAD患者中（急性夹层33例，慢性夹层34例），57例（85.1%）采用全足弓置换术联合冷冻象鼻（FET）。进入性撕裂主要位于主动脉弓（73.1%）。早期死亡率为6.0% （n = 4）。1年和5年生存率分别为95.1%和90.5%。1年心血管再干预率为16.4%，5年为23.8%。随访期间，急慢性夹层组5年生存率相近（90.9% vs 85.5%, P = 0.9）。与其他手术入路相比，TAR + FET组的复合终点事件发生率显著降低（28.1% vs 70%; P = 0.034）， Cox分析显示TAR + FET组的终点事件风险降低66%。结论TEVAR术后RTAD的手术治疗在急性和慢性病例之间具有可比性。在我们的队列中，TAR联合FET与良好的长期结果相关，这表明对于这些患者来说，这可能是一种合理的治疗方法。由于RTAD风险在tevar后的常规1个月之后仍然存在，因此保持警惕的随访至关重要。

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引用次数: 0

Predictors of intraoperative donor heart turndown after initial acceptance for transplantation 初次接受移植后术中供体心脏骤停的预测因素

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.049

Armaan F. Akbar MD, Alice L. Zhou MD, Jessica M. Ruck MD, PhD, Sorush Rokui MD, Dane Paneitz MD, Ahmet Kilic MD

Objective

Because of the low use of potential heart donors, it is important to maximize transplantation and minimize discard of accepted offers. We analyzed national registry data to investigate risk factors for intraoperative turndown of donor hearts that were initially accepted for transplantation.

Methods

All adult deceased donors who donated ≥1 organs during the period from January 2005 to March 2023 in the United Network for Organ Sharing database and received an acceptance or provisional acceptance by a heart team were categorized by heart allograft use versus intraoperative turndown (ITD). We investigated risk factors for ITD using multivariable logistic regression adjusted for covariates with P < .2 on univariate analysis.

Results

Of 48,240 potential adult donors who received an acceptance from a heart transplant center, 43,401 (90.0%) of donors resulted in heart use, 1262 (2.6%) resulted in heart ITD, and 3577 (7.4%) resulted in heart nonuse for other reasons. ITD increased from 0.75% in 2005 to 2.2% in 2023 as a proportion of potential heart recoveries annually (P-trend = .02). On adjusted analysis, the strongest independent risk factor for ITD was donation after circulatory death (adjusted odds ratio, 2.60; 95% confidence interval, 1.86-3.62; P < .001), followed by older donor age (age ≥50 [vs <30] years [adjusted odds ratio, 2.02; 95% confidence interval, 1.59-2.56], P < .001). Additional independent risk factors included left ventricular ejection fraction ≤50%, >10 transfusions during terminal hospitalization, Hispanic and Other (vs White) race/ethnicity, death attributable to stroke, and hypertension.

Conclusions

We identified several factors associated with intraoperative turndown that can inform anticipatory intraoperative evaluation and team coordination while preserving access to donor hearts.

目的由于潜在心脏供体的使用率较低，最大限度地扩大移植和减少已接受供体的丢弃是很重要的。我们分析了国家登记数据，以调查最初接受移植的供体心脏术中降血压的危险因素。方法对2005年1月至2023年3月在美国器官共享网络（United Network for Organ Sharing）数据库中捐献≥1个器官并获得心脏小组接受或临时接受的成年死亡供体按同种异体心脏移植使用与术中拒绝（ITD）进行分类。在单因素分析中，我们使用P <； 2校正协变量的多变量逻辑回归来调查ITD的危险因素。结果48240名接受心脏移植中心的潜在成年捐赠者中，43401名（90.0%）捐赠者使用了心脏，1262名（2.6%）捐赠者发生了心脏过渡段，3577名（7.4%）捐赠者因其他原因没有使用心脏。作为每年潜在心脏恢复的比例，ITD从2005年的0.75%增加到2023年的2.2% （p趋势= 0.02）。经校正分析，ITD的最大独立危险因素是循环死亡后捐献（校正优势比为2.60；95%可信区间为1.86-3.62;P < 0.001），其次是年龄较大的捐献者（年龄≥50 [vs <；30]岁[校正优势比为2.02；95%可信区间为1.59-2.56],P < 001）。其他独立危险因素包括左室射血分数≤50%、住院末期输注次数≤10次、西班牙裔和其他（相对于白人）种族/民族、脑卒中死亡和高血压。结论：我们确定了与术中拒接率相关的几个因素，这些因素可以在保留供体心脏通道的同时，为预期的术中评估和团队协调提供信息。

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引用次数: 0

Reply: Clarifying the role of severe obesity in pediatric heart transplant outcomes 回答：明确严重肥胖在儿童心脏移植结果中的作用

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.003

Joshua D. Sparks MD , Bahaaldin Alsoufi MD

引用次数: 0

Simulation-guided design of leaflet height in bicuspidization of the aortic valve 主动脉瓣二尖瓣成形术中小叶高度的模拟引导设计

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.038

Alexander D. Kaiser PhD , Perry S. Choi MD , Amit Sharir BS , Alison L. Marsden PhD , Michael R. Ma MD

Background

Bicuspidization repair is typically applied to severe congenital aortic valve lesions. Increasingly, this repair is recognized as an effective and durable surgical approach. The consequences of postoperative leaflet geometry in this repair are relatively unstudied, especially compared with current understanding of optimal geometry for a trileaflet valve. In this work, a computational approach was systematically applied to study the effect of changes in leaflet geometric height in symmetric bicuspidization repair.

Methods

Eight model valves with 4 geometric heights spanning a range of typically observed values were constructed at 2 free-edge lengths. Heights varied when loaded in diastole from approximately one-half the annular diameter to just below the annular diameter. Fluid–structure interaction simulations were performed to study the coupled dynamics of the valve and blood. Models were evaluated for stenosis, regurgitation, hemodynamics, mechanics, and diastolic gross morphology.

Results

Cases with loaded geometric height 0.64 to 0.79 times the annular diameter showed the overall best performance, with a coaptation reserve of 4 to 7 mm. Cases with geometric height approximately one-half the annular diameter showed severe regurgitation. Cases with geometric height 0.86 to 0.95 times the annular diameter showed less “crisp” coaptation alignment and the appearance of excessive leaflet material.

Conclusions

The intermediate range of geometric height appeared best, with insufficient height causing regurgitation. More geometric height was not always clearly better, as excessively tall leaflets showed less alignment in the coaptation regions.

背景：双尖瓣修复术通常应用于严重的先天性主动脉瓣病变。越来越多地，这种修复被认为是有效和持久的手术方法。术后小叶几何形状在这种修复中的影响相对未被研究，特别是与目前对三叶瓣膜最佳几何形状的理解相比。在这项工作中，系统地应用计算方法研究了对称双尖化修复中小叶几何高度变化的影响。方法在2种自由边缘长度上构建8个具有4种几何高度的典型观测值范围的模型阀。当在舒张期加载时，高度从大约环径的一半到略低于环径。通过流固耦合仿真研究瓣膜与血液的耦合动力学。评估模型的狭窄、反流、血流动力学、力学和舒张大体形态。结果负载几何高度为环径0.64 ~ 0.79倍的病例整体表现最佳，适应储备为4 ~ 7 mm。几何高度约为环径一半的病例返流严重。几何高度为环径0.86 ~ 0.95倍的病例，表现出较不“脆”的配合排列，出现过多的小叶物质。结论几何高度中间区间表现最佳，高度不足引起反流。几何高度并不总是越高越好，因为过高的小叶在适应区域显示出较少的排列。

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引用次数: 0

Thoracic endovascular aortic repair for advanced esophageal cancer invading the aorta: A prognosis analysis among 124 patients 124例晚期食管癌侵犯主动脉的胸部血管内主动脉修补术的预后分析

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.021

Hsiao-Hung Lu MD , Ke-Cheng Chen MD, PhD , Chih-Yang Chang MD, PhD , Pei-Ming Huang MD, PhD , Mong-Wei Lin MD, PhD , Shuenn-Wen Kuo MD, PhD , I-Hui Wu MD, PhD , Jang-Ming Lee MD, PhD

Objectives

Advanced esophageal cancer invading the aorta is considered an unresectable disease with a poor prognosis. We evaluated the clinical impact of elective thoracic endovascular aortic repair implantation on the prognosis of such patients.

Methods

We retrospectively evaluated patients with advanced esophageal cancer and aortic invasion who underwent thoracic endovascular aortic repair to assess its prognostic impact under multimodal treatment.

Results

Overall, 124 patients were enrolled. Among these, 16 patients underwent salvage thoracic endovascular aortic repair in response to bleeding from an aorto-esophageal fistula, 46 patients received elective thoracic endovascular aortic repair with esophagectomy after diagnosing aortic invasion by a tumor, and 62 patients underwent elective thoracic endovascular aortic repair without esophagectomy after diagnosing aortic invasion by a tumor. The median overall survival time was 3.57, 6.90, and 16.90 months for patients who underwent salvage thoracic endovascular aortic repair, elective thoracic endovascular aortic repair without esophagectomy, and elective thoracic endovascular aortic repair with esophagectomy, respectively (P < .001). Under multivariate analysis, compared with patients who underwent salvage thoracic endovascular aortic repair, those who received elective thoracic endovascular aortic repair with and without esophagectomy had reduced odds ratios of mortality (95% CI) of 0.21 (0.11-0.41) and 0.38 (0.20-0.74), respectively.

Conclusions

Compared with salvage thoracic endovascular aortic repair, elective thoracic endovascular aortic repair implanted after diagnosis for esophageal cancer with aortic invasion is associated with improved overall survival. It provides the opportunity for esophagectomy, further prolonging survival compared with those without esophagectomy.

目的晚期食管癌侵犯主动脉是一种预后较差的不可切除的疾病。我们评估择期胸腔血管内主动脉修复植入术对此类患者预后的临床影响。方法回顾性分析晚期食管癌合并主动脉侵犯行胸腔血管内主动脉修复术的患者，评估多种治疗方式对其预后的影响。结果共纳入124例患者。其中16例因主动脉-食管瘘出血行补救性胸主动脉腔内修复术，46例诊断为肿瘤侵犯后行选择性胸主动脉腔内修复术合并食管切除术，62例诊断为肿瘤侵犯后行选择性胸主动脉腔内修复术不切除食管。救救性胸椎血管内主动脉修复术、择期胸椎血管内主动脉修复术不加食管切除术和择期胸椎血管内主动脉修复术合并食管切除术患者的中位总生存时间分别为3.57、6.90和16.90个月（P < .001）。在多因素分析中，与接受补救性胸腔血管内主动脉修复术的患者相比，接受择期胸腔血管内主动脉修复术合并和不合并食管切除术的患者死亡率优势比（95% CI）分别为0.21（0.11-0.41）和0.38（0.20-0.74）。结论食管癌合并主动脉侵犯诊断后择期植入胸腔血管内主动脉修复术与补救性胸腔血管内主动脉修复术相比可提高总生存率。它为食管切除术提供了机会，与未行食管切除术的患者相比，进一步延长了生存期。

{"title":"Thoracic endovascular aortic repair for advanced esophageal cancer invading the aorta: A prognosis analysis among 124 patients","authors":"Hsiao-Hung Lu MD , Ke-Cheng Chen MD, PhD , Chih-Yang Chang MD, PhD , Pei-Ming Huang MD, PhD , Mong-Wei Lin MD, PhD , Shuenn-Wen Kuo MD, PhD , I-Hui Wu MD, PhD , Jang-Ming Lee MD, PhD","doi":"10.1016/j.xjon.2025.09.021","DOIUrl":"10.1016/j.xjon.2025.09.021","url":null,"abstract":"<div><h3>Objectives</h3><div>Advanced esophageal cancer invading the aorta is considered an unresectable disease with a poor prognosis. We evaluated the clinical impact of elective thoracic endovascular aortic repair implantation on the prognosis of such patients.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated patients with advanced esophageal cancer and aortic invasion who underwent thoracic endovascular aortic repair to assess its prognostic impact under multimodal treatment.</div></div><div><h3>Results</h3><div>Overall, 124 patients were enrolled. Among these, 16 patients underwent salvage thoracic endovascular aortic repair in response to bleeding from an aorto-esophageal fistula, 46 patients received elective thoracic endovascular aortic repair with esophagectomy after diagnosing aortic invasion by a tumor, and 62 patients underwent elective thoracic endovascular aortic repair without esophagectomy after diagnosing aortic invasion by a tumor. The median overall survival time was 3.57, 6.90, and 16.90 months for patients who underwent salvage thoracic endovascular aortic repair, elective thoracic endovascular aortic repair without esophagectomy, and elective thoracic endovascular aortic repair with esophagectomy, respectively (<em>P</em> < .001). Under multivariate analysis, compared with patients who underwent salvage thoracic endovascular aortic repair, those who received elective thoracic endovascular aortic repair with and without esophagectomy had reduced odds ratios of mortality (95% CI) of 0.21 (0.11-0.41) and 0.38 (0.20-0.74), respectively.</div></div><div><h3>Conclusions</h3><div>Compared with salvage thoracic endovascular aortic repair, elective thoracic endovascular aortic repair implanted after diagnosis for esophageal cancer with aortic invasion is associated with improved overall survival. It provides the opportunity for esophagectomy, further prolonging survival compared with those without esophagectomy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 615-624"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697793","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}

引用次数: 0

The effect of surgeon experience on the short-term outcomes of aortic annular enlargement 外科医生经验对主动脉环扩大短期疗效的影响

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.039

Alexander Makkinejad MD , Barbara C.S. Hamilton MD, MS , Robert B. Hawkins MD, MSc , Shinichi Fukuhara MD , Karen Kim MD , Paul Tang MD, PhD , Himanshu J. Patel MD , Francis Pagani MD , Gorav Ailawadi MD, MBA , Bo Yang MD, PhD

Objective

To determine whether surgeon case volume influences short-term outcomes after aortic annular enlargement (AAE).

Methods

From January 2019 to December 2023, 202 patients underwent isolated first-time aortic valve replacement with aortic annular enlargement by 11 surgeons. Two performed ≥25 AAEs per year (high case volume surgeons), whereas the other 9 performed <25 AAEs per year (low case volume surgeons). The short-term outcomes were compared between the high case volume surgeons (n = 126) and the low case volume surgeons (n = 76).

Results

The groups were similar in age, sex, body surface area, and all measured preoperative comorbidities, including Society of Thoracic Surgeons Predicted Risk of Mortality scores. Preoperative aortic valve mean gradients and aortic valve areas did not significantly differ between the groups. The high case-volume surgeons implanted prostheses that were on average one size larger (size 27 vs size 25). All measured perioperative outcomes including operative mortality were not statistically different between groups. Kaplan-Meier estimation of survival at 4 years was 96.0% among the patients of the high case-volume surgeons and 92.5% among those of the low case-volume surgeons (P = .57). On follow-up echocardiography, patients of the high case-volume surgeons had lower aortic valve mean gradients (7 mm Hg vs 8 mm Hg, P = .005), larger aortic valve areas (2.2 cm² vs 1.9 cm², P = .039), and less patient-prosthesis mismatch (6.9% [5/72] vs 26% [11/43], P = .005).

Conclusions

AAE can be performed safely by surgeons with less experience with the procedure, but surgeons who perform AAE more frequently implant larger valves with better hemodynamics.

目的探讨手术病例量对主动脉环扩大术后短期预后的影响。方法2019年1月至2023年12月，11名外科医生对202例首次主动脉瓣置换术患者行主动脉环扩大术。其中2例每年进行≥25次ae（高病例量外科医生），而其他9例每年进行25次ae（低病例量外科医生）。比较高病例量外科医生（n = 126）和低病例量外科医生（n = 76）的短期预后。结果两组在年龄、性别、体表面积和所有术前合并症（包括胸外科学会预测死亡风险评分）方面相似。术前主动脉瓣平均梯度和主动脉瓣面积组间无显著差异。高病例量的外科医生植入的假体平均大1号（27号对25号）。两组围手术期的所有测量结果包括手术死亡率均无统计学差异。Kaplan-Meier估计的4年生存率在高病例量外科医生中为96.0%，在低病例量外科医生中为92.5% （P = 0.57）。在随访超声心动图中，高病例量外科医生的患者主动脉瓣平均梯度较低（7 mm Hg vs 8 mm Hg, P = 0.005），主动脉瓣面积较大（2.2 cm2 vs 1.9 cm2, P = 0.039），患者与假体不匹配较少（6.9% [5/72]vs 26% [11/43], P = 0.005）。结论经验不足的外科医生可以安全的进行瓣膜置换术，但进行瓣膜置换术次数越多的外科医生植入的瓣膜越大，血流动力学就越好。

{"title":"The effect of surgeon experience on the short-term outcomes of aortic annular enlargement","authors":"Alexander Makkinejad MD , Barbara C.S. Hamilton MD, MS , Robert B. Hawkins MD, MSc , Shinichi Fukuhara MD , Karen Kim MD , Paul Tang MD, PhD , Himanshu J. Patel MD , Francis Pagani MD , Gorav Ailawadi MD, MBA , Bo Yang MD, PhD","doi":"10.1016/j.xjon.2025.09.039","DOIUrl":"10.1016/j.xjon.2025.09.039","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether surgeon case volume influences short-term outcomes after aortic annular enlargement (AAE).</div></div><div><h3>Methods</h3><div>From January 2019 to December 2023, 202 patients underwent isolated first-time aortic valve replacement with aortic annular enlargement by 11 surgeons. Two performed ≥25 AAEs per year (high case volume surgeons), whereas the other 9 performed <25 AAEs per year (low case volume surgeons). The short-term outcomes were compared between the high case volume surgeons (n = 126) and the low case volume surgeons (n = 76).</div></div><div><h3>Results</h3><div>The groups were similar in age, sex, body surface area, and all measured preoperative comorbidities, including Society of Thoracic Surgeons Predicted Risk of Mortality scores. Preoperative aortic valve mean gradients and aortic valve areas did not significantly differ between the groups. The high case-volume surgeons implanted prostheses that were on average one size larger (size 27 vs size 25). All measured perioperative outcomes including operative mortality were not statistically different between groups. Kaplan-Meier estimation of survival at 4 years was 96.0% among the patients of the high case-volume surgeons and 92.5% among those of the low case-volume surgeons (<em>P</em> = .57). On follow-up echocardiography, patients of the high case-volume surgeons had lower aortic valve mean gradients (7 mm Hg vs 8 mm Hg, <em>P</em> = .005), larger aortic valve areas (2.2 cm<sup>2</sup> vs 1.9 cm<sup>2</sup>, <em>P</em> = .039), and less patient-prosthesis mismatch (6.9% [5/72] vs 26% [11/43], <em>P</em> = .005).</div></div><div><h3>Conclusions</h3><div>AAE can be performed safely by surgeons with less experience with the procedure, but surgeons who perform AAE more frequently implant larger valves with better hemodynamics.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 36-44"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697927","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}

引用次数: 0

Real-world perioperative outcomes of neoadjuvant chemoimmunotherapy in non–small cell lung cancer 非小细胞肺癌新辅助化疗免疫治疗的围手术期疗效

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.016

Giorgio Caturegli MD, Michael F. Kaminski MD, Maureen Canavan PhD, Oluwaseun F. Ayoade MD, MSHA, Benjamin J. Resio MD, Daniel J. Boffa MD, MBA

Objective

Approximately 30% of non–small cell lung cancers will recur after surgery, highlighting a need for additional perioperative therapies. Several recent clinical trials demonstrated a reduction in non–small cell lung cancer recurrence with the use of neoadjuvant chemoimmunotherapy. Recognizing that trial results may not always be replicated in the general population, our objective was to evaluate perioperative outcomes of immunotherapy in the real-world setting.

Methods

Adult patients diagnosed with clinical stage I to III non–small cell lung cancer in the National Cancer Database between 2018 and 2022 were included. Perioperative outcomes were evaluated in the following groups: neoadjuvant chemoimmunotherapy, neoadjuvant chemotherapy, or neoadjuvant chemoradiotherapy.

Results

Overall, 3956 patients were identified, including 1051 treated with neoadjuvant chemoimmunotherapy (33.2%), 1590 treated with chemotherapy (40.1%), and 1315 treated with neoadjuvant chemoradiotherapy (26.5%). The pneumonectomy rate after induction chemoimmunotherapy was 6.2%, which was lower than after chemotherapy (10.0%, P = .001) but similar to after chemoradiotherapy (7.9%, P = .11). Postoperative 90-day mortality among patients receiving chemoimmunotherapy was less than 1.0%, which was lower than both chemotherapy (2.0%, P < .001) and chemoradiotherapy (3.5%, P < .001). Nodal downstaging was seen in 43.9% of patients receiving chemoimmunotherapy. The pathologic complete response rate was 30.2%, which was higher than chemotherapy (9.1%, P < .001) but comparable to chemoradiotherapy (26.8%, P = .13). Results from adjusted logistic regressions were consistent with findings of unadjusted analyses.

Conclusions

Real-world outcomes suggest that the reassuring safety and impressive downstaging effect of neoadjuvant chemoimmunotherapy seen in clinical trials can be reproduced in the general population with non–small cell lung cancer. Further study to understand the impact of perioperative chemoimmunotherapy in the real-world setting is justified.

目的：约30%的非小细胞肺癌在手术后会复发，这突出了围手术期治疗的必要性。最近的几项临床试验表明，使用新辅助化疗免疫治疗可以减少非小细胞肺癌的复发。认识到试验结果可能并不总是在一般人群中复制，我们的目标是在现实环境中评估免疫治疗的围手术期结果。方法纳入2018年至2022年国家癌症数据库中诊断为临床I至III期非小细胞肺癌的成年患者。围手术期结果评估如下组：新辅助化疗免疫治疗，新辅助化疗，或新辅助放化疗。结果共发现3956例患者，其中新辅助化疗免疫治疗1051例（33.2%），化疗1590例（40.1%），新辅助放化疗1315例（26.5%）。诱导免疫化疗后全肺切除率为6.2%，低于化疗后（10.0%,P = .001），与放化疗后（7.9%,P = .11）相近。化疗免疫组患者术后90天死亡率低于1.0%，低于化疗组（2.0%,P < 0.001）和放化疗组（3.5%,P < 0.001）。43.9%接受化学免疫治疗的患者出现淋巴结分期降低。病理完全缓解率为30.2%，高于化疗（9.1%,P < .001），但与放化疗（26.8%,P = .13）相当。调整后的逻辑回归结果与未调整分析的结果一致。现实世界的结果表明，临床试验中新辅助化学免疫治疗令人放心的安全性和令人印象深刻的降低分期效果可以在普通非小细胞肺癌患者中重现。进一步研究了解围手术期化疗免疫治疗在现实世界中的影响是合理的。

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引用次数: 0

A novel robotic-assisted lung lobectomy simulation model 一种新型机器人辅助肺叶切除术模拟模型

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.10.006

Carolyn C. Chang MD , Ntemena Kapula MAS , Jake J. Kim BA , Ashley Choi MD , Irmina A. Elliott MD , Douglas Z. Liou MD , Leah M. Backhus MD , Mark F. Berry MD , Joseph B. Shrager MD , Brandon A. Guenthart MD , Natalie S. Lui MD

Objective

Although most thoracic surgery programs seek robotic-competent partners, more than one half of graduating residents report needing more training. We aimed to develop a reproducible, high-fidelity model that serves as an effective training tool for surgeons at all levels.

Methods

Porcine heart-lung blocks were prepped for a left upper lobectomy and cannulated to distend the vasculature using an artificial blood substitute capable of simulating bleeding. A linear actuator was positioned beneath a platform to simulate a heartbeat, and a da Vinci Xi robotic system (Intuitive Surgical) was docked above it. Participants performed 3 key steps of a left upper lobectomy, then evaluated fidelity of model features and training value using the Likert scale. Pre- and postsimulation confidence were reported (institutional review board approval no. 76506).

Results

Among 20 participants, 15 were trainees (75%) and 5 were faculty (25%). Trainees reported a median of 26 bedside (interquartile range, 15-48) and 5 console cases (interquartile range, 3-30). Faculty experience ranged from <5 to >20 years. The model was rated highly for fidelity, with 100% (n = 9) of features receiving a Likert score ≥4 from faculty, with stapling rated highest (5.0 ± 0.0). Trainees rated 89% of features ≥4, with stapling (4.7 ± 0.4) and lung tissue handling (4.7 ± 0.5) rated highest. Both groups rated the simulation as highly valuable, with trainee confidence significantly improving postsimulation (2.5-3.9, P = .0014).

Conclusions

The model was rated highly for fidelity and value by both trainees and faculty, and significantly improved trainee confidence. This model offers an effective and reproducible training tool for individual program implementation.

虽然大多数胸外科项目都在寻找有能力的机器人合作伙伴，但超过一半的毕业住院医师报告需要更多的培训。我们的目标是开发一个可重复的、高保真的模型，作为各级外科医生的有效培训工具。方法采用模拟出血的人工血液代用品插管扩张血管，为左上肺叶切除术预备孢素心肺阻滞。一个线性执行器被放置在一个平台的下面来模拟心跳，一个达芬奇Xi机器人系统（Intuitive Surgical）被停靠在它的上面。参与者完成左上叶切除术的3个关键步骤，然后使用Likert量表评估模型特征的保真度和训练价值。报告了模拟前后的置信度(机构审查委员会批准号：76506)。结果20名参与者中，学员15人（75%），教师5人（25%）。受训者报告的中位数为26例床边病例（四分位数范围15-48）和5例控制台病例（四分位数范围3-30）。教师经验从5年到20年不等。该模型的保真度评价很高，100% （n = 9）的特征得到教师的Likert评分≥4分，其中钉接评分最高（5.0±0.0）。学员对89%的特征评分≥4，其中装订（4.7±0.4）和肺组织处理（4.7±0.5）评分最高。两组都认为模拟非常有价值，学员的信心在模拟后显著提高（2.5-3.9,P = 0.0014）。结论学员和教师对该模型的保真度和价值评价较高，显著提高了学员的自信心。该模型为个别项目的实施提供了有效且可重复的培训工具。

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引用次数: 0

Real-world use of adjuvant nivolumab among patients with esophageal and gastroesophageal junction cancer at a large integrated health system 在一个大型综合医疗系统中，在食管癌和胃食管癌患者中实际使用辅助性纳武单抗

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.10.003

Andrea M. Gochi MD, MS , Sydney Jeffs BS , Yun-Yi Hung PhD , Jingrong Yang MA , Tony Wang PharmD, JD , Gary Okano PhD , Lisa Rosenblatt MD, MPH , Reginald Villacorta PhD , Jeffrey B. Velotta MD

Objectives

To assess real-world use of adjuvant nivolumab in patients with esophageal/gastroesophageal junction cancer.

Methods

This was a retrospective, non-interventional cohort study of electronic health record data in the Kaiser Permanente Northern California cancer registry (June 1, 2020, to October 31, 2024). Index was chemoradiation therapy date between December 1, 2020, and August 31, 2023, with 6 months baseline and ≥12 months’ follow-up. Included patients were aged ≥18 years at index; had stage II/III esophageal/gastroesophageal junction cancer; were receiving chemoradiation within the index period; had evidence of local disease after neoadjuvant chemoradiation; and were classified as Eastern Cooperative Oncology Group performance score 0-1 at index. Patient demographic and clinical characteristics, as well as clinical and patient journey outcomes, were extracted from electronic medical records, confirmed by chart review. Descriptive statistics describe outcomes with Kaplan-Meier method used for time-to-event outcomes.

Results

Included patients (n = 44; median age 66.0 years; interquartile range, 61.5-73.0 years) were followed for median 19.1 months (interquartile range, 10.6-25.3 months) from nivolumab first dose. Median overall survival was not reached. The 24-month overall survival rate was 72.3% (95% confidence interval, 58.7%-89.1%). Median disease-free survival was 20.8 months, and median distant metastases-free survival was 23.7 months (95% confidence interval, 13.0-not reached). All patients underwent minimally invasive esophagectomy and had R0 resection status. Median time from index to nivolumab initiation was 165 days (interquartile range, 138.5-194.0 days). Median duration of nivolumab treatment was 322 days (interquartile range, 148.5-364.0 days); 52.3% of patients completed 1 year of nivolumab treatment.

Conclusions

This study demonstrates survival benefits of adjuvant nivolumab in line with clinical studies.

目的评估纳武单抗在食管/胃食管结癌患者中的实际应用。方法：这是一项回顾性、非介入性队列研究，研究对象是Kaiser Permanente北加州癌症登记处（2020年6月1日至2024年10月31日）的电子健康记录数据。指标为2020年12月1日至2023年8月31日的放化疗日期，基线6个月，随访≥12个月。纳入的患者在指数时年龄≥18岁；II/III期食管/胃食管交界处癌；在指标期内接受放化疗；新辅助放化疗后有局部病变的证据；按指标分为东方合作肿瘤集团绩效评分0-1。从电子病历中提取患者人口统计和临床特征，以及临床和患者旅程结果，并通过图表审查加以确认。描述性统计用Kaplan-Meier方法描述事件时间结果。结果纳入的患者（n = 44，中位年龄66.0岁，四分位数范围61.5-73.0岁）从纳武单抗首次给药开始，随访中位19.1个月（四分位数范围10.6-25.3个月）。中位总生存期未达到。24个月总生存率为72.3%（95%可信区间，58.7%-89.1%）。中位无病生存期为20.8个月，中位无远处转移生存期为23.7个月（95%置信区间为13.0-未达到）。所有患者均行微创食管切除术，R0切除状态。从指数到纳武单抗启动的中位时间为165天（四分位数范围为138.5-194.0天）。纳武单抗治疗的中位持续时间为322天（四分位数范围为148.5-364.0天）；52.3%的患者完成了1年的纳武单抗治疗。结论：本研究证实了辅助纳武单抗的生存获益与临床研究一致。

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