JTCVS open最新文献

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Commentator Discussion: Fifteen years’ experience of direct bridge with venoarterial extracorporeal membrane oxygenation to heart transplantation 解说员讨论：15年静脉外膜氧合直接桥接心脏移植经验。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.09.018

引用次数: 0

Validation of the inadequate delivery of oxygen index in an adult cardiovascular intensive care unit 成人心血管重症监护病房氧指数输送不足的验证。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.09.006

Heather Holman BS , Dimitar Baronov PhD , Jeff McMurray MD , Arman Kilic MD , Marc Katz MD , Sanford Zeigler MD

Objective

Machine learning (ML) may allow for improved discernment of hemodynamics and oxygen delivery compared to standard invasive monitoring. We hypothesized that an ML algorithm could predict impaired delivery of oxygen (IDO₂) with comparable discrimination to invasive mixed venous oxygen saturation (SvO₂) measurement.

Methods

A total of 230 patients not on mechanical circulatory support (MCS) managed with a pulmonary artery catheter (PAC) were identified from 1012 patients admitted to a single cardiovascular intensive care unit (CVICU) between April 2021 and January 2022. Physiologic data were collected prospectively by the data analytics engine. Inadequate delivery of oxygen (IDO₂) was defined as SvO₂ ≤50%. Fifty-four patients were used to train the model, which was then validated in 176 patients. Three simulated monitoring situations were constructed by downsampling the physiologic data set to exclude all SvO₂ sources (scenario A); all PAC data but allowing for SvO₂ values (scenario B); and all PAC data, including SvO₂ and cardiac index (CI) (scenario C). The ML platform then calculated the likelihood of IDO₂ for rolling 30-minute intervals and compared these values against the gold standard SvO₂ values using receiver operating characteristic (ROC) curve analysis to establish discriminatory power.

Results

A total of 1047 laboratory-validated SvO₂ values were collected for the validation group. The area under the ROC curve for the IDO₂ index was 0.89 (95% confidence interval, 0.87-0.91) with the full data set. When blinded to all PAC and SvO₂ sources, the AUC was 0.78 (95% confidence interval, 0.75-0.81).

Conclusions

The IDO₂ index is capable of detecting SvO₂ ≤50% with good discriminatory function in non-MCS CVICU patients in a variety of monitoring situations. Further investigation of IDO₂ detection and clinical endpoints is needed.

目的：与标准的有创监测相比，机器学习（ML）可以改善血液动力学和氧气输送的识别。我们假设ML算法可以预测氧气输送受损（IDO2），与有创性混合静脉氧饱和度（SvO2）测量具有相当的区别。方法：从2021年4月至2022年1月间入住单一心血管重症监护病房（CVICU）的1012名患者中，共筛选出230名未使用肺动脉导管（PAC）管理的机械循环支持（MCS）患者。通过数据分析引擎前瞻性地收集生理数据。供氧不足（IDO2）定义为SvO2≤50%。54名患者被用来训练模型，然后在176名患者中进行验证。通过对生理数据集进行降采样以排除所有SvO2源（场景A），构建了三种模拟监测情景；所有PAC数据，但允许SvO2值（方案B）；以及所有PAC数据，包括SvO2和心脏指数（CI）（场景C）。然后，ML平台计算滚动30分钟间隔内IDO2的可能性，并使用受试者工作特征（ROC）曲线分析将这些值与金标准SvO2值进行比较，以建立区分力。结果：验证组共收集实验室验证的SvO2值1047个。完整数据集的IDO2指数的ROC曲线下面积为0.89（95%可信区间为0.87-0.91）。当对所有PAC和SvO2源进行盲测时，AUC为0.78（95%置信区间为0.75-0.81）。结论：在多种监测情况下，IDO2指数均能检测出非mcs CVICU患者SvO2≤50%，具有良好的判别功能。需要进一步研究IDO2检测和临床终点。

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引用次数: 0

Discussion to: Association between the proportionality of functional mitral regurgitation and survival after mitral valve operation 讨论到：功能性二尖瓣反流比例与二尖瓣手术后存活率之间的关系

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.07.005

引用次数: 0

Commentator Discussion: Combined simulation and ex-vivo assessment of free-edge length in bicuspidization repair for congenital aortic valve disease 解说员讨论：先天性主动脉瓣疾病双尖修复术中自由边缘长度的联合模拟和离体评估。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.10.005

引用次数: 0

Commentator Discussion: Is concomitant tricuspid valve repair in patients undergoing robotic mitral valve repair safe and effective? 评论员讨论：接受机器人二尖瓣修复的患者同时进行三尖瓣修复安全有效吗？

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.10.009

引用次数: 0

Commentator Discussion: Malnutrition in adult patients treated with venoarterial membrane oxygenation: A descriptive cohort study 讨论：静脉动脉膜氧合治疗的成年患者营养不良：一项描述性队列研究。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.10.011

引用次数: 0

Commentator Discussion: Predicting operative mortality in patients who undergo elective, open thoracoabdominal aortic aneurysm repair 评论员讨论：预测择期胸腹主动脉瘤开腹修补术患者的手术死亡率。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.09.024

引用次数: 0

Evaluating the long-term efficacy of primary surgical repair in communicating Debakey IIIB chronic dissecting aortic aneurysms 原发性手术修复交通性Debakey IIIB型慢性夹层主动脉瘤的远期疗效评价。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.08.001

FNU Venjhraj MBBS , Ajeet Singh MBBS , Ravi Das MBBS , Ashvin Kumar MBBS

引用次数: 0

RBT-1 reduces blood product utilization in patients undergoing nonemergency coronary artery bypass grafting and/or valve surgery RBT-1 可减少接受非急诊冠状动脉旁路移植术和/或瓣膜手术患者的血液制品使用量

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.06.019

Charles A. Mack MD , Michael Jessen MD , Andre Lamy MD , Ashish K. Khanna MD , Kevin Lobdell MD , Rakesh Arora MD , Jeannette Rodriguez PhD , Stacey Ruiz PhD , Bhupinder Singh MD

引用次数: 0

The relationship of sex and aortic diameter at the time of acute type A aortic dissection 急性A型主动脉夹层时性别与主动脉直径的关系。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.07.022

Lamia Harik MD, Mario Gaudino MD, PhD, Mohammed Rahouma MD, Arnaldo Dimagli MD, Roberto Perezgrovas-Olaria MD, Kevin R. An MD, Talal Alzghari MD, Giovanni Soletti Jr. MD, Jordan Leith BS, Gianmarco Cancelli MD, Charles Mack MD, Leonard N. Girardi MD, Christopher Lau MD

Objective

Evaluate sex differences in patients undergoing repair of acute type A aortic dissection (ATAAD).

Methods

Sex-stratified, single-center cohort study of patients undergoing ATAAD repair from 1997 to 2022. The primary outcome was aortic diameter at time of presentation with ATAAD. Secondary outcomes were mortality, myocardial infraction, stroke, hemodialysis, tracheostomy, re-exploration for bleeding, a composite of major adverse events, and long-term survival.

Results

In 390 consecutive patients (150 women), men were younger than women (61.0 years; interquartile range [IQR], 50-70 years vs 70.5 years; IQR, 59-78 years; P < .001), had higher body mass index (28.6; IQR, 25.1-32.3 vs 25.4; IQR, 21.9-29.2; P < .001), more frequent peripheral vascular disease (11.7% vs 4.7%; P = .03), renal insufficiency (36.7% vs 22%; P = .003), malperfusion (34.2% vs 18.7%; P = .007), and smoking history (65% vs 44%; P < .001). There was no sex difference in median aortic diameter at the time of ATAAD (men: 5.3 cm; IQR, 4.9-6.1 cm and women: 5.2 cm; IQR, 4.6-5.9 cm; P = .12) even when adjusted for body mass index (men: 5.7 cm; IQR, 5.4-6.1 cm and women: 5.4 cm; IQR, 5.4-6.1 cm; P = .19). There was no sex difference in mortality (4.6% vs 6.0%; P = .70), major adverse events, or 10-year survival (50.3% vs 58.5%; P = .13). On multivariable analysis, there was no interaction between aneurysm size and sex (interaction P = .62). Sex was not associated with major adverse events (odds ratio, 0.75; 95% CI, 0.07-7.39; P = .81).

Conclusions

There was no sex difference in aneurysm size at the time of presentation of ATAAD, even after adjustment for body mass index, and no interaction between aneurysm size and sex, suggesting that aortic diameter remains a reasonable criterion for intervention irrespective of sex.

目的：探讨急性A型主动脉夹层（ATAAD）修复术患者的性别差异。方法：对1997年至2022年接受ATAAD修复的患者进行性别分层、单中心队列研究。主要结局是出现ATAAD时的主动脉直径。次要结局是死亡率、心肌梗死、中风、血液透析、气管切开术、再次探查出血、主要不良事件的综合和长期生存。结果：390例连续患者（150例女性）中，男性年龄小于女性(61.0岁；四分位间距[IQR]， 50-70岁vs 70.5岁；59-78岁；P P P = .03)，肾功能不全(36.7% vs 22%；P = 0.003)，灌注不良(34.2% vs 18.7%；P = .007)和吸烟史(65% vs 44%；P = .12)，即使校正了体重指数(男性：5.7 cm；男性：5.4-6.1厘米，女性：5.4厘米；IQR, 5.4-6.1 cm；p = .19)。死亡率没有性别差异(4.6% vs 6.0%；P = 0.70)、主要不良事件或10年生存率(50.3% vs 58.5%；p = .13)。在多变量分析中，动脉瘤大小和性别之间没有相互作用（相互作用P = 0.62）。性别与主要不良事件无关(优势比，0.75；95% ci, 0.07-7.39；p = .81)。结论：在出现ATAAD时，即使调整了体重指数，动脉瘤大小也没有性别差异，动脉瘤大小与性别之间也没有相互作用，提示主动脉直径仍然是一个合理的干预标准，无论性别如何。

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引用次数: 0

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