JTCVS open最新文献

{"title":"Timing of coronary artery bypass grafting after myocardial infarction influences late survival","authors":"","doi":"10.1016/j.xjon.2024.05.008","DOIUrl":"10.1016/j.xjon.2024.05.008","url":null,"abstract":"<div><h3>Objectives</h3><p>The role of timing of coronary artery bypass grafting after acute myocardial infarction on early and late outcomes remains uncertain.</p></div><div><h3>Methods</h3><p>We reviewed 1631 consecutive adult patients who underwent isolated coronary artery bypass grafting with information on timing of acute myocardial infarction. Early and late mortality were compared between patients receiving coronary artery bypass grafting within 24 hours after acute myocardial infarction, between 1 and 7 days after acute myocardial infarction, and more than 7 days after acute myocardial infarction. Sensitivity analyses were performed in subgroups of patients with ST-segment elevation myocardial infarction or non–ST-segment elevation myocardial infarction, and other high-risk groups.</p></div><div><h3>Results</h3><p>A total of 124 patients (5.7%) underwent coronary artery bypass grafting within 24 hours, 972 patients (51.2%) received coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, and 535 patients (43.2%) underwent coronary artery bypass grafting more than 7 days after acute myocardial infarction. Overall operative mortality was 2.7% with comparable adjusted early mortality among 3 groups. Over a median follow-up of 13.5 years (interquartile range, 8.9-17.1), compared with patients receiving coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, those receiving coronary artery bypass grafting at 7 days had greater adjusted risk for late overall mortality (hazard ratio, 1.39, 95% CI, 1.16-1.67; <em>P &lt;</em> .001), whereas those receiving coronary artery bypass grafting within 24 hours had comparable risk of late overall mortality (hazard ratio, 1.12, 95% CI, 0.86-1.47; <em>P =</em> .39). Timing of coronary artery bypass grafting was associated with late mortality in patients with non–ST-segment elevation myocardial infarction (patients receiving coronary artery bypass grafting at &gt;7 days had a higher risk of late mortality [hazard ratio, 1.38, 95% CI, 1.14-1.67, <em>P</em> &lt; .001] compared with those receiving coronary artery bypass grafting between 1 and 7 days), but not in patients with ST-segment elevation myocardial infarction.</p></div><div><h3>Conclusions</h3><p>Early revascularization through coronary artery bypass grafting within 7 days during the same hospitalization appears beneficial, especially for patients presenting with non–ST-segment elevation myocardial infarction.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001281/pdfft?md5=b852b8ef74d7f9907ec44d4e6128256e&pid=1-s2.0-S2666273624001281-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141139212","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}

{"title":"Outcomes of nonemergency cardiac surgery after overnight operative workload: A statewide experience","authors":"","doi":"10.1016/j.xjon.2024.04.018","DOIUrl":"10.1016/j.xjon.2024.04.018","url":null,"abstract":"<div><h3>Objective</h3><p>Cardiac surgeons experience unpredictable overnight operative responsibilities, with variable rest before same-day, first-start scheduled cases. This study evaluated the frequency and associated impact of a surgeon's overnight operative workload on the outcomes of their same-day, first-start operations.</p></div><div><h3>Methods</h3><p>A statewide cardiac surgery quality database was queried for adult cardiac surgical operations between July 1, 2011, and March 1, 2021. Nonemergency, first-start, Society of Thoracic Surgeons predicted risk of mortality operations were stratified by whether or not the surgeon performed an overnight operation that ended after midnight. A generalized mixed effect model was used to evaluate the effect of overnight operations on a Society of Thoracic Surgeons composite outcome (5 major morbidities or operative mortality) of the first-start operation.</p></div><div><h3>Results</h3><p>Of all first-start operations, 0.4% (239/56,272) had a preceding operation ending after midnight. The Society of Thoracic Surgeons predicted risk of morbidity and mortality was similar for first-start operations whether preceded by an overnight operation or not (overnight operation: 11.3%; no overnight operation: 11.7%, <em>P</em> = .42). Unadjusted rates of the primary outcome were not significantly different after an overnight operation (overnight operation: 13.4%; no overnight operation: 12.3%, <em>P</em> = .59). After adjustment, overnight operations did not significantly impact the risk of major morbidity or mortality for first-start operations (adjusted odds ratio, 1.1, <em>P</em> = .70).</p></div><div><h3>Conclusions</h3><p>First-start cardiac operations performed after an overnight operation represent a small subset of all first-start Society of Thoracic Surgeons predicted risk operations. Overnight operations do not significantly influence the risk of major morbidity or mortality of first-start operations, which suggests that surgeons exercise proper judgment in determining appropriate workloads.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001323/pdfft?md5=8a565e6b4333b3659f512bfb94eb7b11&pid=1-s2.0-S2666273624001323-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141960994","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}

{"title":"Salvage lung resection after immunotherapy is feasible and safe","authors":"","doi":"10.1016/j.xjon.2024.03.018","DOIUrl":"10.1016/j.xjon.2024.03.018","url":null,"abstract":"<div><h3>Objectives</h3><p>Patients with non–small cell lung cancer treated with immunotherapy and modern chemoradiation regimens show improved progression-free and overall survival. However, patients with limited oligo-progression represent a potential population in which local therapy such as surgery may have a potential role as salvage treatment. The objectives of our study were to evaluate the feasibility and safety of salvage lung resection after immunotherapy in patients with non–small cell lung cancer.</p></div><div><h3>Methods</h3><p>The National Cancer Database was queried for patients diagnosed and treated for non–small cell lung cancer stage I to IV, from 2013 to 2020. Patients who underwent surgery as salvage after immunotherapy were defined as undergoing surgery &gt;5 months from the initiation of immunotherapy. As a sensitivity analysis, patients who underwent surgery as salvage after chemoradiation were also analyzed in a similar fashion. Surgical outcomes such as type of surgery, complete resection (R0) rates, and complete pathologic response rates were determined for feasibility. Length of stay, 30-day readmission rates, and 30-day mortality rates were determined and overall survivals were estimated with Kaplan-Meier analysis to evaluate for safety.</p></div><div><h3>Results</h3><p>Of the 934,093 patients diagnosed with non–small cell lung cancer stage I to IV from 2013 to 2020, 164 patients received immunotherapy and after 5 months underwent surgery. Lobectomy was the most commonly performed operation (74%) and pneumonectomy was required in 9% (n = 15). R0 resection was achieved in 89% (n = 146) and of these patients, 23% (n = 37) had complete pathologic response. Median length of stay was 4 days, 30-day readmission was 5%, and 30-day mortality was 0.6%. In our sensitivity analysis of chemoradiation patients (n = 445), the above data were similar to previously reported cohort studies of patients undergoing chemoradiation and subsequently salvage surgery.</p></div><div><h3>Conclusions</h3><p>Lung resection after immunotherapy appears to be a feasible salvage treatment option, with lobectomy being most common and with high R0 resection rates. Low patient morbidity and mortality rates also suggest the safety of this approach. Salvage surgery may be considered in patients who have oligo-progression after immunotherapy within the context of a comprehensive multidisciplinary treatment plan.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001128/pdfft?md5=ffaf91ee55dcf62366d75060b2116206&pid=1-s2.0-S2666273624001128-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769501","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}

{"title":"Persistent income-based disparities in clinical outcomes of cardiac surgery across the United States: A contemporary appraisal","authors":"","doi":"10.1016/j.xjon.2024.05.015","DOIUrl":"10.1016/j.xjon.2024.05.015","url":null,"abstract":"<div><h3>Objective</h3><p>Although national efforts have aimed to improve the safety of inpatient operations, income-based inequities in surgical outcomes persist, and the evolution of such disparities has not been examined in the contemporary setting. We sought to examine the association of community-level household income with acute outcomes of cardiac procedures over the past decade.</p></div><div><h3>Methods</h3><p>All adult hospitalizations for elective coronary artery bypass grafting/valve operations were tabulated from the 2010-2020 Nationwide Readmissions Database. Patients were stratified into quartiles of income, with records in the 76th to 100th percentile designated as highest and those in the 0 to 25th percentile as lowest. To evaluate the change in adjusted risk of in-hospital mortality, complications, and readmission over the study period, estimates were generated for each income level and year.</p></div><div><h3>Results</h3><p>Of approximately 1,848,755 hospitalizations, 406,216 patients (22.0%) were classified as highest income and 451,988 patients (24.4%) were classified as lowest income. After risk adjustment, lowest income remained associated with greater likelihood of in-hospital mortality (adjusted odds ratio, 1.61, 95% CI, 1.51-1.72), any postoperative complication (adjusted odds ratio, 1.19, CI, 1.15-1.22), and nonelective readmission within 30 days (adjusted odds ratio, 1.07, CI, 1.05-1.10). Overall adjusted risk of mortality, complications, and nonelective readmission decreased for both groups from 2010 to 2020 (<em>P &lt;</em> .001). Further, the difference in risk of mortality between patients of lowest and highest income decreased by 0.2%, whereas the difference in risk of major complications declined by 0.5% (both <em>P</em> &lt; .001).</p></div><div><h3>Conclusions</h3><p>Although overall in-hospital mortality and complication rates have declined, low-income patients continue to face greater postoperative risk. Novel interventions are needed to address continued income-based disparities and ensure equitable surgical outcomes.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001645/pdfft?md5=723790c8994ad7023d4a42089a7ee72d&pid=1-s2.0-S2666273624001645-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961059","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}

{"title":"Involving the next generation of cardiovascular surgeons","authors":"","doi":"10.1016/j.xjon.2024.05.012","DOIUrl":"10.1016/j.xjon.2024.05.012","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001335/pdfft?md5=8033c79bed00a27961ffc9df5eb1c620&pid=1-s2.0-S2666273624001335-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961058","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}

{"title":"Patient-reported outcome measures after minimally invasive mitral valve surgery: The benefit may be early","authors":"","doi":"10.1016/j.xjon.2024.05.010","DOIUrl":"10.1016/j.xjon.2024.05.010","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266627362400130X/pdfft?md5=479745961e97555770e1f148eae456d8&pid=1-s2.0-S266627362400130X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961060","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}

{"title":"Oncologic outcomes after minimally invasive segmentectomy or lobectomy in patients with hypermetabolic clinical stage IA1-2 non–small cell lung cancer","authors":"","doi":"10.1016/j.xjon.2024.05.002","DOIUrl":"10.1016/j.xjon.2024.05.002","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the oncologic outcome of patients with hypermetabolic tumors resected by segmentectomy or lobectomy.</p></div><div><h3>Methods</h3><p>This was a retrospective analysis of all consecutive patients with peripheral clinical stage IA1-2 non–small cell lung cancer (January 2017-June 2023) who underwent resection by segmentectomy or lobectomy in a single center. A hypermetabolic tumor was defined as a tumor with a positron emission tomography (PET) maximum standardized uptake value &gt;2.5. Propensity score case-matching analysis was used to generate 2 balanced groups of patients with hypermetabolic tumors operated by segmentectomy or lobectomy. Four-year overall survival (OS), event-free survival (EFS), and cancer-specific survival were compared between the matched groups.</p></div><div><h3>Results</h3><p>A total of 164 segmentectomies and 234 lobectomies were analyzed. There were 91 (55%) hypermetabolic tumors in the segmentectomy group versus 178 in the lobectomy group (76%), <em>P</em> &lt; .001. The comparison of the matched groups with hypermetabolic tumors showed a better 4-year OS after lobectomy compared with segmentectomy (lobectomy 87%; 95% confidence interval [CI], 76-93; segmentectomy, 67%; 95% CI, 49-80; <em>P</em> = .029). The 4-year EFS appeared to have a better trend after lobectomy (77%; 95% CI, 65-85) compared with segmentectomy (58%; 95% CI, 39-72), <em>P</em> = .088. The 4-year cancer-specific survival, however, was similar between the matched groups (lobectomy, 95%; 95% CI, 86-98 vs segmentectomy, 94%; 95% CI, 78-99, <em>P</em> = .79).</p></div><div><h3>Conclusions</h3><p>Early-stage peripheral hypermetabolic tumors are associated with poorer oncologic outcomes compared with less PET-avid tumors. Despite poorer OS and EFS after segmentectomy likely caused by cancer-unrelated deaths, cancer-specific survival in this high-risk group was similar after lobectomy or segmentectomy. In well-selected patients, a high PET maximum standardized uptake value should not be considered a contraindication to segmentectomy.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001220/pdfft?md5=40682cf1a1bc1e6fc266fe416da171a5&pid=1-s2.0-S2666273624001220-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141141281","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}

{"title":"Discussion to: Salvage lung resection after immunotherapy is feasible and safe","authors":"","doi":"10.1016/j.xjon.2024.04.012","DOIUrl":"10.1016/j.xjon.2024.04.012","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001153/pdfft?md5=0724d0347417e8f1197b53d3b0a2e350&pid=1-s2.0-S2666273624001153-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756826","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}

{"title":"Greater ipsilateral rectus muscle atrophy after robotic thoracic surgery compared with open and video-assisted thoracoscopic surgery approaches","authors":"","doi":"10.1016/j.xjon.2024.05.011","DOIUrl":"10.1016/j.xjon.2024.05.011","url":null,"abstract":"<div><h3>Objective</h3><p>Robotic thoracic surgery provides another minimally invasive approach in addition to video-assisted thoracoscopic surgery (VATS) that yields less pain and faster recovery compared with open surgery. However, robotic incisions are generally placed more inferiorly, which may increase the risk of intercostal nerve injury that affects the abdominal wall. We hypothesized that a robotic approach causes greater ipsilateral rectus muscle atrophy compared with open and VATS approaches.</p></div><div><h3>Methods</h3><p>The cross-sectional area and density of bilateral rectus abdominis muscles were measured on computed tomography scans in patients who underwent lobectomy in 2018. The differences between the contralateral and ipsilateral muscles were compared between preoperative and 6-month surveillance scans. Changes were compared among the open, VATS, and robotic approaches through a mixed effects model after adjustments of correlation and covariates.</p></div><div><h3>Results</h3><p>Of 99 lobectomies, 25 (25.3%) were open, 56 (56.6%) VATS, and 18 (18.1%) robotic. The difference between the contralateral and ipsilateral rectus muscle cross-sectional area was significantly larger at 6 months after robotic surgery compared with open (31.4% vs 9.5%, <em>P</em> = .049) and VATS (31.4% vs 14.1%, <em>P</em> = .021). There were no significant differences in the cross-sectional area between the open and VATS approach.</p></div><div><h3>Conclusions</h3><p>In this retrospective analysis, there was greater ipsilateral rectus muscle atrophy associated with robotic thoracic surgery compared with open or VATS approaches. These findings should be correlated with clinical symptoms and followed to assess for resolution or persistence.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001311/pdfft?md5=b8117a758f48bb0120e84f964c3dc660&pid=1-s2.0-S2666273624001311-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961057","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}

{"title":"Tricuspid valve surgery following septal myectomy in patients with a cardiac implantable electronic device","authors":"","doi":"10.1016/j.xjon.2024.06.011","DOIUrl":"10.1016/j.xjon.2024.06.011","url":null,"abstract":"<div><h3>Background</h3><p>Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of developing cardiac arrhythmias and have a high prevalence of cardiac implantable electronic device (CIED) use. Tricuspid regurgitation (TR) is a potential complication of device leads and can be severe enough to prompt surgical intervention.</p></div><div><h3>Methods</h3><p>We identified 21 consecutive patients who underwent tricuspid valve (TV) surgery for device lead-induced TR late following septal myectomy (SM) for obstructive HCM. The primary endpoint was long-term all-cause mortality.</p></div><div><h3>Results</h3><p>The median patient age was 63 years (range, 55-71 years), 19 patients (91%) had New York Heart Association class III or IV limitation, and all patients were receiving diuretics for right heart failure. The median interval between device implantation and TV surgery was 4 years (range, 1.5-8.5 years). Eight patients (38%) underwent pacemaker implantation due to complete heart block following SM. Preoperatively, TR was severe in 81% of the patients. The primary mechanism of lead-induced TR was leaflet impingement without adherence (n = 15; 75%). Nine patients (43%) underwent TV replacement, and 12 patients (57%) underwent repair. Only 1 patient died early postoperatively. Patients with lead-induced TR had markedly reduced long-term survival compared to the overall population of patients undergoing SM; 5-year survival was 58%, compared to 96% for the contemporary SM group.</p></div><div><h3>Conclusions</h3><p>Late lead-induced TR is a potential complication of CIEDs in patients with HCM who have undergone SM. Although TV repair and replacement can be done with acceptable early mortality, late patient survival is poor.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001712/pdfft?md5=641af9c689d2d204d387914ed0975b63&pid=1-s2.0-S2666273624001712-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961061","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}