JTCVS open最新文献

{"title":"National race and socioeconomic disparities in access to minimally invasive lung resection for early-stage lung cancer: Impact on mortality","authors":"Aminah Sallam MD ,&nbsp;Qiudong Chen MD ,&nbsp;Andrew Brownlee MD ,&nbsp;Woo Sik Yu MD ,&nbsp;Kellie Knabe NP ,&nbsp;Sevannah Soukiasian ,&nbsp;Lucas Weiser MD ,&nbsp;Joanna Chikwe MD ,&nbsp;Harmik Soukiasian MD","doi":"10.1016/j.xjon.2024.10.035","DOIUrl":"10.1016/j.xjon.2024.10.035","url":null,"abstract":"<div><h3>Background</h3><div>Adoption of minimally invasive surgery (MIS) for early-stage non–small cell lung cancer (NSCLC) is increasing in the United States. We examined the relationship between sociodemographic factors and receipt of MIS among these patients.</div></div><div><h3>Methods</h3><div>Patients undergoing surgical resection for stage I and II NSCLC between 2010 and 2018 were identified in the National Cancer Database and stratified by surgical approach. Patients were excluded if they had nonanatomic or palliative resection, received neoadjuvant therapy, or lacked relevant clinical and demographic factors or follow-up. Multivariate analysis adjusted for baseline characteristics. The primary outcome was receipt of MIS; secondary outcomes were 30-and 90-day mortality.</div></div><div><h3>Results</h3><div>A total of 130,452 patients underwent open (n = 67,046; 51%), video-assisted thoracic surgery (VATS; n = 43,849; 34%), or robotic (n = 19,557; 15%) surgery. Non-Hispanic black patients were less likely than non-Hispanic white patients to undergo MIS (adjusted odds ratio [aOR], 0.895; 95% CI, 0.858-0.934; <em>P</em> &lt; .001). This was not significant after adjusting for census-tract income (aOR, 0.967; 95% CI, 0.926-1.011; <em>P</em> = .1374). Non-Hispanic black patients were significantly more likely reside in lower income census-tracts and be underinsured; these factors were significantly associated with decreased access to MIS. Open surgery was associated with worse adjusted 30-day mortality (1.89% for open, 1.25% for VATS, 1.24% for robotic) and 90-day mortality (3.4% for open, 2.17% for VATS, 2.08% for robotic) compared to MIS (<em>P</em> &lt; .001). Mortality was significantly associated with census-tract income level and insurance status (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Racial disparities in receipt of MIS among early-stage NSCLC patients are mediated by census-tract income and insurance status. Access to MIS and insurance status are associated with improved 30- and 90-day mortality. Policy efforts are needed to improve access and outcomes for these patients.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 358-368"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465077","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":"Selective antegrade cerebral perfusion: Still favored?","authors":"Safak Alpat MD, PhD, MEBCTS","doi":"10.1016/j.xjon.2024.11.008","DOIUrl":"10.1016/j.xjon.2024.11.008","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 222-223"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465182","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":"Reply: Which cerebral perfusion strategy is best? Only time will tell","authors":"W. Hampton Gray MD,&nbsp;Katherine Sprouse MD,&nbsp;Luz A. Padilla MD, MSPH","doi":"10.1016/j.xjon.2024.12.005","DOIUrl":"10.1016/j.xjon.2024.12.005","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Page 224"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465183","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":"Surgical removal of pulmonary flow restrictors in children with congenital heart disease: What the outcomes reveal","authors":"Raymond N. Haddad MD, MHSc ,&nbsp;Jamie Bentham MD ,&nbsp;Carlos Pardo MD ,&nbsp;Rasha Alloush MD ,&nbsp;Mahmoud Al Soufi MD ,&nbsp;Osama Jaber MD ,&nbsp;Mohamed Kasem MD ,&nbsp;Issam El Rassi MD","doi":"10.1016/j.xjon.2024.11.011","DOIUrl":"10.1016/j.xjon.2024.11.011","url":null,"abstract":"<div><h3>Objective</h3><div>Pulmonary flow restrictors (PFRs) are interesting devices, but their surgical removal outcomes are poorly understood.</div></div><div><h3>Methods</h3><div>Retrospective review of clinical data from children with bilateral PFRs who underwent device removal during follow-up surgery.</div></div><div><h3>Results</h3><div>Thirty-four PFRs were explanted from 17 patients (41.2% boys) at a median of 2 months (interquartile range [IQR], 1.2-5.2 months) postimplantation, with a median patient age of 2.5 months (IQR, 1.6-5.8 months). One patient experienced life-threatening bilateral pulmonary artery (PA) aneurysms 2 months after PFR implantation, necessitating urgent surgery. Two PFRs were found migrated across the left PA's upper lobe branch origin. Twenty-six were removed intact, 1 in 2 fragments, and 7 piecemeal. No thrombus was noted. Neoendothelium was observed on 11 PFRs. Seven PFRs caused endothelial damage, requiring sharp and blunt dissection for removal. Six right and 4 left PA arteriotomies were patched. Hegar dilators, with median sizes of 7 mm (IQR, 6.8-8.3 mm) for right PA and 7 mm (IQR, 7-8 mm) for left PA, confirmed branch patency. At a median follow-up of 14.8 months (IQR, 10.2-18.3 months), echocardiographic maximum velocities in 13 biventricular patients and 2 awaiting future biventricular repair were 1.5 m/second (IQR, 1.4-1.7 m/second) for the left PA and 1.6 m/second (IQR, 1.4-1.7 m/second) for the right PA. One patient with deferred Norwood had normal PAs and well-positioned PFRs on prestage-II catheterization. A patient who underwent stage-II Norwood 3.2 months post-PFR implantation died from sepsis 1 month later, but post-Glenn angiogram revealed no stenosis.</div></div><div><h3>Conclusions</h3><div>PFR removal is safe and effective. Complications are manageable, with no PA stenosis observed.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 235-244"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465267","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":"Stroke debility during non-full sternotomy versus full sternotomy access cardiac valve operations","authors":"Ahmad S. Abdelrazek MD ,&nbsp;Kevin L. Greason MD ,&nbsp;Alex Lee BS ,&nbsp;Brian D. Lahr MS ,&nbsp;Arman Arghami MD, MPH ,&nbsp;John M. Stulak MD ,&nbsp;Richard C. Daly MD ,&nbsp;Juan A. Crestanello MD ,&nbsp;Hartzell V. Schaff MD","doi":"10.1016/j.xjon.2024.11.005","DOIUrl":"10.1016/j.xjon.2024.11.005","url":null,"abstract":"<div><h3>Objective</h3><div>Previous studies have reported an increased risk of stroke with non-full sternotomy access during cardiac valve operations, but the clinical significance of these strokes has not yet been explored. We sought to determine the incidence and clinical magnitude of postoperative stroke following non-full versus full sternotomy access.</div></div><div><h3>Methods</h3><div>We analyzed the records of 12,406 patients who underwent a cardiac valve operation with full median sternotomy (n = 10,863; 88%), partial sternotomy (n = 219; 1.8%), or thoracotomy (n = 1324; 11%) access between January 1997 and March 2021. The primary outcome was permanent stroke, categorized using the modified Rankin Scale (mRS; score 0-6) at discharge. Multivariable logistic regression analysis was used to assess the risk of stroke.</div></div><div><h3>Results</h3><div>The rate of stroke was 1.0% in the full sternotomy group, 2.7% in the partial sternotomy group, and 1.2% in the thoracotomy group (<em>P</em> = .044). The majority of strokes were mildly disabling (mRS ≤2), both overall (n = 82; 62%) and in each group (range, 60%-69%). There was an increased risk of stroke with partial versus full sternotomy (odds ratio [OR], 3.73; 95% confidence interval [CI], 1.59-8.78; <em>P</em> = .010) but not with thoracotomy versus full sternotomy (OR, 1.34; 95% CI, 0.48-3.77). There was no differential effect of sternotomy type on stroke risk according to type of valve operation (<em>P</em> = .985). Stroke-related mortality was uncommon (1.3%).</div></div><div><h3>Conclusions</h3><div>Partial sternotomy versus full sternotomy is associated with increased risk of stroke, whereas thoracotomy versus full sternotomy is not. The risk of stroke is low, with most strokes being only mildly disabling.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 150-156"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464998","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":"Intercostal nerve cryoablation in lung transplantation: A single-center, propensity score–matched analysis","authors":"Marcelo Salan-Gomez MD ,&nbsp;Ramiro Fernandez MD ,&nbsp;Ethan D'Silva BS ,&nbsp;Belia Camarena BS ,&nbsp;Emma Hills MD ,&nbsp;Andres Leon MD ,&nbsp;Syed B. Peer MD ,&nbsp;Abdussalam Elsenousi MD ,&nbsp;Puneet Garcha MD ,&nbsp;Gabriel Loor MD","doi":"10.1016/j.xjon.2024.10.013","DOIUrl":"10.1016/j.xjon.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>Achieving adequate pain control after lung transplantation is an essential milestone in a patient's recovery. We compared postoperative opioid use, clinical outcomes, and respiratory function in lung transplant recipients treated with intercostal nerve cryoablation (INC) compared to those receiving standard pain management.</div></div><div><h3>Methods</h3><div>We reviewed all adult lung transplants performed at our center between January 2016 and December 2022. We excluded cases performed through median sternotomy and patients with prior thoracotomies, multiorgan transplants, and redo transplants. We performed a propensity score–matched analysis, comparing patients who received INC versus those who received standard pain management. The primary outcome was cumulative postoperative opioid use in morphine milligram equivalents (MME) by postoperative day (POD) 14. Secondary outcomes included opioid use on POD5 and POD10, perioperative outcomes, 1-year survival, and longitudinal measurement of respiratory function.</div></div><div><h3>Results</h3><div>Propensity score matching resulted in 85 patients in each group. Compared to the standard pain management group, the INC group had a lower cumulative opioid use by POD14 (509 MME vs 864 MME; <em>P</em> = .032). In addition, the INC group had less opioid use at POD5, POD10, and POD14; no difference in perioperative outcomes; and similar 1-year survival. The INC group had better respiratory function at 6 and 12 months post-transplant compared to the standard pain management group.</div></div><div><h3>Conclusions</h3><div>In our single-center analysis, INC was associated with less opioid use and improved respiratory function after lung transplant. This report adds to the growing literature supporting the use of INC in multimodal pain management strategies and enhanced recovery protocols in lung transplant.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 328-334"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465195","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":"Decreased bleeding and thrombotic complications on extracorporeal membrane oxygenation support following an updated anticoagulation protocol","authors":"Michael Dorsey MD ,&nbsp;Katherine Phillips MD ,&nbsp;Les James MD ,&nbsp;Emily Kelley BSN, RN ,&nbsp;Erica Duff MSN, RN ,&nbsp;Tyler Lewis PharmD, BCCCP ,&nbsp;Cristian Merchan PharmD, BCCCP ,&nbsp;Neil Menghani MS ,&nbsp;Justin Chan MD ,&nbsp;Stephanie Chang MD ,&nbsp;Travis Geraci MD ,&nbsp;Nader Moazami MD ,&nbsp;Deane Smith MD","doi":"10.1016/j.xjon.2024.11.019","DOIUrl":"10.1016/j.xjon.2024.11.019","url":null,"abstract":"<div><h3>Objective</h3><div>Anticoagulation monitoring in patients supported on extracorporeal membrane oxygenation is challenging given the risks of both bleeding and thrombotic complications. Based on our early clinical experience, we revised our heparin protocol by reducing our target anti-factor Xa assay from 0.3 to 0.7 U/mL to 0.15 to 0.5 U/mL, while instituting a partial thromboplastin time cutoff of 70 seconds. We evaluated the impact of this change on bleeding/thrombotic complications.</div></div><div><h3>Methods</h3><div>A single-center retrospective study of adult patients on extracorporeal membrane oxygenation support was conducted from January 2015 to August 2022. Patients were stratified into groups based on protocol revision: Pre-Revision (2015-2018) or Post-Revision (2019-2022). Our primary end point was the incidence of bleeding/thrombotic complications. Time in therapeutic range was calculated to determine protocol adherence. Poisson regression was performed to correlate time in therapeutic range with the likelihood of complication.</div></div><div><h3>Results</h3><div>A total of 302 patients were supported on extracorporeal membrane oxygenation during the study period: 67 Pre-Revision and 235 Post-Revision, median age 57 years. Post-Revision, patients experienced longer extracorporeal membrane oxygenation durations with an increase in the percentage of venovenous extracorporeal membrane oxygenation configurations. The incidence of bleeding complications decreased for all categories, reaching significance for surgical site bleeds (5% vs 14%, <em>P = .</em>013) and gastrointestinal hemorrhage (2% vs 6%, <em>P = .</em>049). Likewise, thrombotic complications decreased for all categories except fasciotomy, which was unchanged. Time in therapeutic range for anti-factor Xa assay and partial thromboplastin time were similar across time periods. On Poisson regression, the Post-Revision anti-factor Xa assay range significantly correlated with decreases in bleeding (<em>P = .</em>023) and a composite of bleeding/thrombotic complications (<em>P = .</em>008).</div></div><div><h3>Conclusions</h3><div>A modified heparin monitoring protocol defined by a lower therapeutic anti-factor Xa assay target and a set partial thromboplastin time cutoff correlated with decreases in bleeding/thrombotic complications in patients on extracorporeal membrane oxygenation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 199-209"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465265","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":"Clamshell thoracosternotomy for single-stage repair of select aortic arch pathologies","authors":"Neel K. Prabhu MD,&nbsp;Andrew M. Vekstein MD,&nbsp;Christopher W. Jensen MD, MS,&nbsp;Adam R. Williams MD,&nbsp;Jeffrey G. Gaca MD,&nbsp;G. Chad Hughes MD","doi":"10.1016/j.xjon.2024.10.032","DOIUrl":"10.1016/j.xjon.2024.10.032","url":null,"abstract":"<div><h3>Objective</h3><div>Although median sternotomy is widely used for aortic arch repair, the distal extent of arch replacement is limited with this approach. Bilateral thoracosternotomy (clamshell) represents an alternate and underappreciated strategy that allows for single-stage repair of the aortic arch and descending thoracic aorta. We report our institutional experience with this approach.</div></div><div><h3>Methods</h3><div>Patients who underwent clamshell thoracosternotomy for aortic arch surgery from 2005 to 2022 were identified from a prospectively maintained institutional aortic surgery database. The primary outcomes were 30-day/in-hospital mortality and major morbidity, including stroke, paraplegia, and renal failure requiring hemodialysis. Secondary outcomes included late overall survival, aorta-specific survival, and freedom from aortic reintervention.</div></div><div><h3>Results</h3><div>Clamshell thoracosternotomy was performed in 18 patients (67% men) with median age 52 years; 50% (n = 9) had heritable thoracic aortic disease. Clamshell repair indications included focal arch dissection (44%; n = 8), extensive arch aneurysm or pseudoaneurysm (33%; n = 6), complex pediatric coarctation (17%; n = 3), and adult coarctation with ascending aneurysm (6%; n = 1). Operative mortality occurred in 1 patient (6%). No patients developed stroke, paraplegia, or renal failure. Overall actuarial survival was 94% at 1 year and 72% at 5 years, whereas aorta-specific survival was 94% at 1 and 5 years. There were no reinterventions on the contiguous aorta at a median follow-up of 60 months (range, 18-85 months).</div></div><div><h3>Conclusions</h3><div>Clamshell thoracosternotomy is a safe approach for single-stage complex open arch with or without descending repair, especially for those with heritable thoracic aortic disease or anatomy not amenable to endovascular therapies.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 44-50"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464436","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":"Epicardial cryoablation during cardiopulmonary bypass in a pig survival model","authors":"Federica Serra PhD ,&nbsp;Jonathan M. Philpott MD ,&nbsp;Anna Bulysheva PhD ,&nbsp;Christian W. Zemlin PhD","doi":"10.1016/j.xjon.2024.12.003","DOIUrl":"10.1016/j.xjon.2024.12.003","url":null,"abstract":"<div><h3>Objective</h3><div>Atrial cryolesions usually are created from the endocardium with the heart arrested. Some cardiac surgeons have used cryoablation epicardially during cardiopulmonary bypass, which is convenient because it does not require an incision into the atrial wall. We analyzed the transmurality of epicardial cryoablations created during cardiopulmonary bypass in an arrested heart 30 days after ablation.</div></div><div><h3>Methods</h3><div>In Yucatan minipigs (n = 5), hearts were exposed via sternotomy. Both caval veins were cannulated to collect blood for the cardiopulmonary bypass. Cryolesions were created applying a cryoprobe for 4 minutes per lesion. Hearts were harvested 30 days after the surgery. The transmurality of each lesion was determined for 3 transversal sections using triphenyl tetrazolium chloride staining. The structure of the lesions was assessed with Gomori trichrome stains.</div></div><div><h3>Results</h3><div>We created a total of 20 atrial lesions and stained 175 sections. Transmurality was achieved in 96% of the sections and 75% of lesions. A significant fraction of the sections (12%) was transmural but had a width of less than 1.5 mm.</div></div><div><h3>Conclusions</h3><div>Although epicardial cryoablation during bypass achieved better results than epicardial cryoablation of beating hearts, it falls short of conventional cryoablation and radiofrequency ablation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 128-133"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465179","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":"Effect of chronic lung allograft dysfunction phenotypes on the outcome after lung retransplantation: A retrospective single-center data analysis","authors":"Sophia Auner MD ,&nbsp;Panja Maria Boehm MD ,&nbsp;Caroline Hillebrand MD ,&nbsp;Stefan Schwarz MD, PhD ,&nbsp;Anna Elisabeth Frick MD, PhD ,&nbsp;Zsofia Kovacs MD ,&nbsp;Thomas Schweiger MD, PhD ,&nbsp;Gabriella Murakoezy MD, PhD ,&nbsp;Eva Schaden MD ,&nbsp;Andreas Bacher MD ,&nbsp;Peter Faybik MD ,&nbsp;Edda Tschernko MD ,&nbsp;Shahrokh Taghavi MD ,&nbsp;Peter Jaksch MD ,&nbsp;Clemens Aigner MD ,&nbsp;Konrad Hoetzenecker MD, PhD ,&nbsp;Alberto Benazzo MD, PhD","doi":"10.1016/j.xjon.2024.10.034","DOIUrl":"10.1016/j.xjon.2024.10.034","url":null,"abstract":"<div><h3>Objective</h3><div>Although retransplantation is the main therapeutic option for end-stage chronic lung allograft dysfunction, several transplant centers consider the “restrictive allograft syndrome” phenotype a contraindication. This selection policy is based on a limited body of literature. The aim of this study was to investigate the association of chronic lung allograft dysfunction phenotypes according to new chronic lung allograft dysfunction definitions with outcomes after retransplantation.</div></div><div><h3>Methods</h3><div>This study was a retrospective single-center analysis including patients undergoing lung retransplantation due to chronic lung allograft dysfunction between 2000 and 2021.</div></div><div><h3>Results</h3><div>Seventy patients were included in the analysis, 73% had bronchiolitis obliterans syndrome, 20% had a mixed phenotype, and 7% had restrictive allograft syndrome. The length of surgery was comparable between the groups. No difference was observed in terms of intraoperative use of packed red blood cells (<em>P</em> = .407), fresh-frozen plasma (<em>P</em> = .173), platelets (<em>P</em> = .300), prothrombin complex concentrates (<em>P</em> = .381), and fibrinogen (<em>P</em> = .808). Patients with non–bronchiolitis obliterans syndrome were more often graded with primary graft dysfunction 3 at arrival to the intensive care unit, and this trend remained at 72 hours after transplantation. After 72 hours, 60% of the cohort was extubated or had primary graft dysfunction grade 0. Early postoperative outcome was comparable between the groups. Survival between the groups did not differ with overall survivals at 1, 5, and 10 years of 72%, 53%, and 51% for bronchiolitis obliterans syndrome and 71%, 56%, and 42% for non–bronchiolitis obliterans syndrome, respectively (<em>P</em> = .841).</div></div><div><h3>Conclusions</h3><div>This analysis showed that retransplantation remains a challenging procedure. However, careful patient selection allows excellent outcomes irrespective of chronic lung allograft dysfunction phenotypes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 335-348"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465196","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}