JTCVS open最新文献_第3页

Does the Dutch trial prove we should “say no” to active surveillance? An in-depth review of the 2025 study on the treatment of esophageal cancer 荷兰的审判是否证明我们应该对主动监控说不？深入回顾2025食管癌治疗研究

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.10.019

Brian N. Housman MD , Stephanie Tuminello PhD, MPH , Raja Flores MD

引用次数: 0

Turning ideas into action: A framework for cardiothoracic trainees and surgeons to launch translational clinical trials 将想法转化为行动：心胸外科实习生和外科医生开展转化临床试验的框架

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.005

Zyriah Robinson BA , Jessica B. Briscoe MD , AlleaBelle Bradshaw MD , Lisa Fornaresio PhD , Jennifer S. Lawton MD

引用次数: 0

Outcome of patients with curative-intent treatment for primary pulmonary sarcoma: Results from an international multicenter retrospective study 原发性肺肉瘤患者治疗意向治疗的结果：来自一项国际多中心回顾性研究的结果

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.06.024

Stephane Collaud MD, MSc , Theresa Stork MD , Dagmar Adamkova MD, PhD , Clemens Aigner MD , Ivan Bravio MD , Antonella Brunello MD, PhD , Luigi Cerbone MD , Hugo Clermidy MD , Lore De Cock MD, PhD , Silvia Gasperoni MD , Nicolas Girard MD , Anna Mariuk-Jarema MD , Rolf Lefering PhD , Enrico Melis MD , Gloria Marquina MD , Filomena Mazzeo MD , Iurii Mykoliuk MD , Maria A. Pantaleo MD , Nicolas Penel MD, PhD , Hans-Ulrich Schildhaus MD , Sebastian Bauer MD

Objective

To evaluate outcome and prognostic factors of patients with primary pulmonary sarcoma (PPS) who underwent curative-intent surgery within multimodality treatment.

Methods

An international, multicenter, retrospective study including patients with PPS was performed through a network of sarcoma experts. Data on demographics, staging, treatment, and outcomes were retrieved. Overall survival was calculated from the date of diagnosis. Prognostic factors were assessed using uni- and multivariate analysis.

Results

Eighteen centers from 9 countries contributed, for a total of 173 patients. One hundred fifteen patients (66%) underwent curative-intent surgery within multimodality treatment. There were 58 male patients (50%). Twenty-two patients (20%) had metastases, mainly to lung (n = 7, 30%) and pleura (n = 9, 39%). Thirty-three patients (30%) underwent preoperative chemotherapy. Extent of lung resection was sublobar (n = 11, 10%), lobar (n = 58, 54%), or bilobar/pneumonectomy (n = 39, 36%). Median tumor size was 85 mm. Sixty-nine patients had grade 3 tumors (71%). Resection was complete in 85 patients (75%). Lymphadenectomy was performed in 70 patients (63%), with nodal involvement in 10 (14%). Thirty-seven (37%) patients received adjuvant chemotherapy, and 27 (27%) patients received adjuvant radiotherapy. Overall survival was 49% and 31% at 5 and 10 years, respectively. Median follow-up was 33 months. Male gender (P = .003), age older than 60 years (P = .021), presence of metastasis (P = . 002), tumor size >40 mm (P = . 046), and incomplete resections (P = . 008) were independent prognostic factors for poor survival.

Conclusions

In patients with curative-intent multimodal treatment for PPS, an encouraging 5-year survival rate of 49% can be achieved in expert centers. Independent prognostic factors may aid in selecting patients for curative treatment.

目的评价原发性肺肉瘤（PPS）患者在多模式治疗下接受治疗目的手术的预后及影响预后的因素。方法通过肉瘤专家网络对PPS患者进行一项国际、多中心、回顾性研究。检索了人口统计学、分期、治疗和结果的数据。总生存期自诊断之日起计算。采用单因素和多因素分析评估预后因素。结果来自9个国家的18个中心参与了研究，共计173例患者。115名患者（66%）在多模式治疗中接受了治愈目的手术。男性58例（50%）。22例（20%）发生转移，主要转移到肺（n = 7, 30%）和胸膜（n = 9, 39%）。术前化疗33例（30%）。肺切除术的范围为叶下（n = 11.10%）、叶下（n = 58.54%）或双叶/全肺切除术（n = 39.36%）。中位肿瘤大小为85 mm。3级肿瘤69例（71%）。85例（75%）患者完全切除。70例（63%）患者行淋巴结切除术，10例（14%）患者行淋巴结切除术。37例（37%）患者接受辅助化疗，27例（27%）患者接受辅助放疗。5年和10年的总生存率分别为49%和31%。中位随访时间为33个月。男性（P = 0.003），年龄大于60岁（P = 0.021），有无转移（P = 0.003）。002)，肿瘤大小>；40 mm (P =。046)和不完全切除(P =。008)是不良生存的独立预后因素。结论采用多模式治疗的PPS患者在专家中心的5年生存率为49%，令人鼓舞。独立的预后因素可能有助于选择患者进行根治性治疗。

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引用次数: 0

Total Tau protein as a novel biomarker for detection of neural injury following cardiopulmonary bypass in pediatric congenital heart surgery patients 总Tau蛋白作为检测小儿先天性心脏手术患者体外循环后神经损伤的新生物标志物

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.08.012

Marc J. Lussier BS , Daniel J. McKeone MD , Eric Scott Halstead MD, PhD , Allen R. Kunselman MA , Jason R. Imundo MD , John L. Myers MD , Akif Ündar PhD

Objective

To investigate the association of Tau protein levels with postoperative evidence of neural injury following cardiopulmonary bypass (CPB) in pediatric cardiac surgery patients.

Methods

One hundred forty-four consecutive pediatric cardiac surgery patients were recruited. Whole blood (3 mL) was collected in EDTA tubes from an arterial line at 5 time points: pre-midline incision, at 3 to 5 minutes on CPB, just prior to weaning from CPB, at 1 hour post-CPB, and at 24 hours post-CPB. Plasma was analyzed via an automated immunoassay for total Tau, a protein linked to brain injury. Tau levels over time were compared between 2 patient groups: age (neonates/infants age <365 days vs children age ≥365 days) and type of heart disease (cyanotic vs acyanotic).

Results

Thirty-six patients had postoperative evidence of neural injury. Tau levels over time differed between the 2 groups. At the end of CPB and at 1 hour post-CPB, there were significant differences between patients stratified by age (neonates and infants vs older children; P < .001) and by type of congenital heart disease (cyanotic vs acyanotic; P < .05). At 24 hours post-CPB, each 10-pg/mL increase in total Tau corresponded to a 12% increased risk of neural injury (odds ratio, 1.122; 95% confidence interval, 1.043-1.206; P = .002). When stratified by neural injury, age, and type of congenital heart disease, Tau remained persistently elevated in all patients post-CPB compared to respective baseline levels (P < .001).

Conclusions

24-hour post-CPB plasma Tau may be a reliable marker of neural injury in the pediatric congenital heart surgery population.

目的探讨小儿心脏手术患者体外循环（CPB）术后神经损伤与Tau蛋白水平的关系。方法连续招募144例小儿心脏手术患者。在5个时间点从动脉线收集EDTA管全血（3ml）：中线切开前、CPB 3 - 5分钟、CPB脱机前、CPB后1小时和CPB后24小时。血浆通过自动免疫分析法分析总Tau蛋白，一种与脑损伤有关的蛋白质。比较两组患者随时间的Tau水平：年龄（新生儿/婴儿年龄≥365天vs儿童年龄≥365天）和心脏病类型（青紫vs无青紫）。结果36例患者术后出现神经损伤。随着时间的推移，两组之间的Tau水平有所不同。CPB结束时和CPB后1小时，按年龄（新生儿和婴儿vs大龄儿童；P < 001）和按先天性心脏病类型（紫绀vs无紫绀；P < 05）分层的患者之间存在显著差异。cpb后24小时，总Tau蛋白每增加10 pg/mL，神经损伤风险增加12%（优势比为1.122；95%可信区间为1.043-1.206;P = 0.002）。当按神经损伤、年龄和先天性心脏病类型分层时，与各自的基线水平相比，所有cpb后患者的Tau持续升高（P < .001）。结论cpb后24小时血浆Tau可能是儿童先天性心脏手术人群神经损伤的可靠标志。

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引用次数: 0

Left atrioventricular valve durability in atrioventricular septal defects: Impact of systolic blood pressure 房室间隔缺损左房室瓣膜耐久性：收缩压的影响

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.022

Christina L. Greene MD, Teklay Desta MD, Anjali Sharma BS, David Mauchley MD, Lyubomyr Bohuta MD, D. Michael McMullan MD

Objective

To evaluate the impact of systolic blood pressure (SBP) on the durability of left atrioventricular valve (LAVV) repair in the early postoperative period.

Methods

Single-center, retrospective review of 88 consecutive patients undergoing atrioventricular septal defect (AVSD) repair over 5 years. Postoperative transesophageal echocardiogram and discharge transthoracic echocardiogram were compared, and patients who experienced deterioration in valve function were identified.

Results

Primary diagnosis was complete AVSD in 63 patients (72%), transitional AVSD in 14 (16%), and partial AVSD in 11 (12%). Overall survival was 98% (n = 86) at a median follow-up of 1.9 years (interquartile range [IQR], 0.6-3.15 years). Patients with a peak SBP >160 mm Hg sustained for as little as 10 seconds had a higher rate of valve deterioration compared to those with a peak SBP <160 mm Hg (70% vs 43%; P = .012), conferring a 3-fold increased risk of valve deterioration (odds ratio, 2.96; 95% confidence interval, 1.16-7.57; P = .023). Incremental increases in peak SBP were linearly associated with valve deterioration starting at a peak SBP >150 mm Hg. SBP >160 mm Hg was identified as an independent predictor of valve deterioration on multivariate logistic regression, while patient weight, gestational age, primary diagnosis, cardiopulmonary bypass time, cross-clamp time, and cleft closure were not predictive of valve deterioration.

Conclusions

Elevated SBP during the early postoperative period is associated with functional LAVV deterioration. Elevated peak SBP >160 mm Hg was associated with worse LAVV function. Strict control of blood pressure to avoid even transient elevations in SBP during the postoperative period may improve LAVV durability.

目的探讨收缩压（SBP）对术后早期左房室瓣膜（LAVV）修复耐久性的影响。方法对连续5年行房室间隔缺损（AVSD）修复术的88例患者进行单中心回顾性分析。比较术后经食管超声心动图和出院经胸超声心动图，确定瓣膜功能恶化的患者。结果原发性完全性AVSD 63例（72%），过渡性AVSD 14例（16%），部分性AVSD 11例（12%）。总生存率为98% (n = 86)，中位随访时间为1.9年（四分位数间距[IQR]， 0.6-3.15年）。与收缩压160毫米汞柱峰值持续10秒的患者相比，收缩压160毫米汞柱峰值患者的瓣膜恶化率更高（70% vs 43%; P = 0.012），瓣膜恶化的风险增加了3倍（优势比，2.96；95%置信区间，1.16-7.57;P = 0.023）。收缩压峰值的增量增加与从收缩压峰值150 mm Hg开始的瓣膜恶化呈线性相关。收缩压160 mm Hg被多因素logistic回归确定为瓣膜恶化的独立预测因子，而患者体重、胎龄、初次诊断、体外循环时间、交叉钳时间和腭裂闭合不能预测瓣膜恶化。结论术后早期收缩压升高与LAVV功能恶化有关。收缩压峰值升高（160 mm Hg）与LAVV功能恶化相关。术后严格控制血压，避免短暂性收缩压升高，可提高LAVV的持久性。

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引用次数: 0

Surgical treatment for acute aortic dissection with coronary malperfusion in Japan: Nationwide database analysis 日本急性主动脉夹层合并冠状动脉灌注不良的手术治疗：全国数据库分析

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.10.014

Toshiki Fujiyoshi MD, PhD , Hiraku Kumamaru MD, ScD , Hitoshi Ogino MD, PhD , Naoko Kinukawa PhD , Yusuke Shimahara MD, PhD , Noboru Motomura MD, PhD

Objective

To assess the surgical outcomes of acute aortic dissection (AAD) with coronary malperfusion (CM) in Japan through the Japan Cardiovascular Surgery Database.

Methods

Between 2019 and 2021, 15,509 patients underwent surgical treatment for AAD. CM occurred in 304 (2.0%), of which 188 were analyzed.

Results

The mean age of patients was 65 ± 11.8 years. Preoperative acute myocardial infarction, cardiopulmonary arrest, and mechanical circulatory support (MCS) were found in 49.5%, 16.5%, and 9.6%, respectively. The 30-day operative mortality rate was 33.0%. The left CM (33.5%) was associated with greater mortality rates (41.3%), particularly as Neri classification advanced to type B and type C. Conversely, right CM (56.4%) had a lower mortality rate (25.0%), regardless of Neri classification. Preoperative percutaneous coronary intervention was performed in 14.9% and concomitant coronary artery bypass grafting was performed in 57.4%. The 30-day operative mortality rate for coronary intervention showed no difference between percutaneous coronary intervention (41.7%) and coronary artery bypass grafting (38.0%), regardless of Neri classification. The median time from onset to coronary reperfusion was 361.5 minutes. Preoperative acute myocardial infarction, cardiopulmonary arrest, and the requirement for MCS as independent risk factors for 30-day operative mortality.

Conclusions

The surgical mortality rate for AAD with CM remains high, particularly in cases with left CM, with this trend becoming more pronounced as the Neri's classification advanced to type B and type C. Patients in critical conditions, such as those requiring cardiopulmonary resuscitation or MCS, were at significantly greater risk of mortality.

目的通过日本心血管外科数据库评估日本急性主动脉夹层（AAD）合并冠状动脉灌注不良（CM）的手术效果。方法2019年至2021年间，15509例AAD患者接受了手术治疗。CM 304例（2.0%），其中分析188例。结果患者平均年龄65±11.8岁。术前急性心肌梗死、心肺骤停和机械循环支持（MCS）分别占49.5%、16.5%和9.6%。30天手术死亡率为33.0%。左侧CM（33.5%）与较高的死亡率（41.3%）相关，特别是当Neri分类进展到B型和c型时。相反，无论Neri分类如何，右侧CM（56.4%）的死亡率较低（25.0%）。术前经皮冠状动脉介入治疗占14.9%，同时行冠状动脉旁路移植术占57.4%。冠状动脉介入治疗的30天手术死亡率与经皮冠状动脉介入治疗（41.7%）和冠状动脉旁路移植术（38.0%）无差异，与Neri分类无关。从发病到冠状动脉再灌注的中位时间为361.5分钟。术前急性心肌梗死、心肺骤停和MCS要求作为30天手术死亡率的独立危险因素。AAD合并CM的手术死亡率仍然很高，特别是左侧CM，随着Neri分类升级到B型和c型，这一趋势变得更加明显。危重患者，如需要心肺复苏或MCS的患者，死亡风险显著增加。

{"title":"Surgical treatment for acute aortic dissection with coronary malperfusion in Japan: Nationwide database analysis","authors":"Toshiki Fujiyoshi MD, PhD , Hiraku Kumamaru MD, ScD , Hitoshi Ogino MD, PhD , Naoko Kinukawa PhD , Yusuke Shimahara MD, PhD , Noboru Motomura MD, PhD","doi":"10.1016/j.xjon.2025.10.014","DOIUrl":"10.1016/j.xjon.2025.10.014","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the surgical outcomes of acute aortic dissection (AAD) with coronary malperfusion (CM) in Japan through the Japan Cardiovascular Surgery Database.</div></div><div><h3>Methods</h3><div>Between 2019 and 2021, 15,509 patients underwent surgical treatment for AAD. CM occurred in 304 (2.0%), of which 188 were analyzed.</div></div><div><h3>Results</h3><div>The mean age of patients was 65 ± 11.8 years. Preoperative acute myocardial infarction, cardiopulmonary arrest, and mechanical circulatory support (MCS) were found in 49.5%, 16.5%, and 9.6%, respectively. The 30-day operative mortality rate was 33.0%. The left CM (33.5%) was associated with greater mortality rates (41.3%), particularly as Neri classification advanced to type B and type C. Conversely, right CM (56.4%) had a lower mortality rate (25.0%), regardless of Neri classification. Preoperative percutaneous coronary intervention was performed in 14.9% and concomitant coronary artery bypass grafting was performed in 57.4%. The 30-day operative mortality rate for coronary intervention showed no difference between percutaneous coronary intervention (41.7%) and coronary artery bypass grafting (38.0%), regardless of Neri classification. The median time from onset to coronary reperfusion was 361.5 minutes. Preoperative acute myocardial infarction, cardiopulmonary arrest, and the requirement for MCS as independent risk factors for 30-day operative mortality.</div></div><div><h3>Conclusions</h3><div>The surgical mortality rate for AAD with CM remains high, particularly in cases with left CM, with this trend becoming more pronounced as the Neri's classification advanced to type B and type C. Patients in critical conditions, such as those requiring cardiopulmonary resuscitation or MCS, were at significantly greater risk of mortality.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 24-35"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697923","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 impact of low body mass index on clinical outcomes after coronary artery bypass graft surgery 低体重指数对冠状动脉搭桥术后临床结果的影响

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.08.003

Yuki Kuroda MD , Hiroki Shiomi MD , Takeshi Morimoto MD , Takeshi Shimamoto MD , Takehiko Matsuo MD , Koh Ono MD , Takeshi Kimura MD , Kenji Minatoya MD

Objective

To clarify the effects of being underweight on clinical outcomes after coronary artery bypass grafting (CABG) and possible associated sex differences.

Methods

The study population included 5914 patients who underwent their first isolated CABG; patients with acute myocardial infarction were excluded. Clinical outcomes within and beyond 30 days after CABG were compared across groups on the basis of preoperative body mass index (BMI): underweight (BMI <18.5; n = 318), normal (18.5 ≤ BMI < 25; n = 3835), overweight (25 ≤ BMI < 30; n = 1580), and obese (BMI ≥30; n = 181).

Results

The cumulative 30-day incidence of all-cause death was 3.2%, 1.2%, 0.4%, and 1.1% in the underweight, normal, overweight, and obese groups, respectively (log-rank P < .001). This trend was more prominent in men than in women (4.0%, 1.3%, 0.4%, and 1.6%, log-rank P < .001; 1.7%, 0.9%, 1.1%, and 0.0%, log-rank P = .74). The cumulative 5-year incidence of all-cause death >30 days after CABG was significantly greater in the underweight group (27.1%, 16.6%, 10.1%, and 6.5%; log-rank P < .001). The greater risk of being underweight and the lower risk of being overweight or obese relative to normal were significant for all-cause death (adjusted hazard ratio, 1.22 [95% confidence interval, 1.00-1.49]; 0.77 [0.68-0.89]; and 0.63 [0.42-0.95], respectively). Furthermore, the excess mortality risk of being underweight relative to normal was significant in men (1.32 [1.03-1.68]) but not in women (1.14 [0.80-1.63]) (interaction P = .01).

Conclusions

Being underweight was associated with increased short- and long-term mortality after CABG, especially in men, whereas being overweight or obese was associated with decreased long-term mortality after CABG.

目的探讨体重过轻对冠状动脉旁路移植术（CABG）术后临床预后的影响及可能存在的性别差异。方法研究人群包括5914例首次行孤立性冠脉搭桥的患者；排除急性心肌梗死患者。根据术前体重指数（BMI）比较各组CABG术后30天内及以后的临床结果：体重过轻（BMI <18.5; n = 318）、正常（18.5≤BMI < 25; n = 3835）、超重（25≤BMI < 30; n = 1580）、肥胖（BMI≥30;n = 181）。结果体重过轻组、正常组、超重组和肥胖组的30天累计全因死亡率分别为3.2%、1.2%、0.4%和1.1% （log-rank P < .001）。这一趋势在男性中比女性更为突出（4.0%、1.3%、0.4%和1.6%,log-rank P = .001; 1.7%、0.9%、1.1%和0.0%,log-rank P = .74）。体重过轻组在CABG术后30天的5年累计全因死亡发生率显著高于对照组（27.1%、16.6%、10.1%和6.5%;log-rank P < 0.001）。与正常相比，体重过轻的风险较高，超重或肥胖的风险较低，这对全因死亡具有显著意义（调整后的风险比分别为1.22[95%置信区间，1.00-1.49]、0.77[0.68-0.89]和0.63[0.42-0.95]）。此外，相对于正常体重，体重过轻造成的额外死亡风险在男性中显著（1.32[1.03-1.68]），但在女性中不显著（1.14[0.80-1.63]）（相互作用P = 0.01）。结论：体重过轻与冠状动脉搭桥术后短期和长期死亡率增加相关，尤其是男性，而超重或肥胖与冠状动脉搭桥术后长期死亡率降低相关。

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引用次数: 0

Preoperative dual antiplatelet therapy increases risk after urgent coronary bypass surgery: A Netherlands heart registration study 术前双重抗血小板治疗增加紧急冠状动脉搭桥手术后的风险：荷兰心脏登记研究

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.045

Heleen J.C.L. Apostel MD , Maaike M. Roefs Msc , Amon Heijne MD , Ewald M. Bronkhorst PhD , Edgar J. Daeter MD , Wilson W.L. Li MD , Cardiothoracic Surgery and PCI Registration Committee of the Netherlands Heart Registration

Objective

Dual antiplatelet therapy (DAPT) is standard care after acute coronary syndrome, but its perioperative management before urgent coronary artery bypass grafting (CABG) remains controversial. By using data from the Netherlands Heart Registration, a nationwide Dutch registry, we sought to assess the impact of recent preoperative DAPT on surgical and postoperative outcomes in patients undergoing urgent CABG after acute coronary syndrome.

Methods

In this multicenter retrospective cohort study, 6913 patients undergoing urgent isolated CABG within 90 days of acute coronary syndrome were analyzed. Patients receiving DAPT (aspirin + P2Y12 inhibitor within 48 hours preoperatively) were compared with those on aspirin alone. Propensity score matching and multivariable logistic regression were used to adjust for confounding.

Results

Recent DAPT use was independently associated with increased perioperative bleeding complications, including greater rates of reintervention (odds ratio [OR], 1.78), transfusion (OR, 1.85), and surgical mortality (OR, 2.02). Considerable interhospital variation in DAPT use (12%-84%) underscores inconsistent practices across Dutch cardiac surgery centers.

Conclusions

Recent DAPT before urgent CABG is independently associated with significantly increased perioperative bleeding risk, transfusion requirements, and mortality. The substantial interhospital variation in DAPT use across Dutch cardiac surgery centers further underscores the need for standardized, evidence-based guidelines to optimize antiplatelet management in high-risk patients with coronary syndrome requiring surgical revascularization.

目的双重抗血小板治疗（DAPT）是急性冠状动脉综合征后的标准治疗，但其在紧急冠状动脉旁路移植术（CABG）前的围手术期管理仍存在争议。通过使用荷兰心脏登记（一个全国性的荷兰登记）的数据，我们试图评估近期术前DAPT对急性冠状动脉综合征后接受紧急冠脉搭桥患者手术和术后预后的影响。方法在本多中心回顾性队列研究中，对6913例急性冠状动脉综合征患者在90天内行紧急孤立性冠脉搭桥进行分析。术前48小时内接受DAPT（阿司匹林+ P2Y12抑制剂）的患者与单独服用阿司匹林的患者进行比较。使用倾向评分匹配和多变量逻辑回归来调整混杂。结果近期DAPT的使用与围手术期出血并发症的增加独立相关，包括更高的再干预率（优势比[OR]， 1.78）、输血率（OR, 1.85）和手术死亡率（OR, 2.02）。医院间DAPT使用的相当大的差异（12%-84%）强调了荷兰心脏手术中心实践的不一致。结论急诊冠脉搭桥前近期DAPT与围手术期出血风险、输血需求和死亡率显著增加独立相关。荷兰心脏外科中心在DAPT应用方面的巨大医院间差异进一步强调了标准化、循证指南的必要性，以优化需要手术血运重建术的高危冠状动脉综合征患者的抗血小板管理。

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引用次数: 0

Propensity-matched analysis of the impact of saphenous vein graft external stenting on clinical outcomes in coronary bypass surgery: The RESTART study 隐静脉移植物外支架置入术对冠状动脉搭桥手术临床结果影响的倾向匹配分析：RESTART研究

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.048

Luca P. Weltert MD , Eric A. Secemsky MD , Gil Bolotin MD , Tom Friedman MD , Paolo Centofanti MD , Viviana Sebastiano MD , Samuel Fusca MD , Sigrid E. Sandner MD , Marija Pljakova MD , Stefanos Demertzis MD , Tiziano Torre MD , John T. Donovan MD , Ivar Friedrich MD , Siling Li MSc , Marcus Flather MD , Stephen Gerry MSc , David P. Taggart MD

Objective

External saphenous vein graft stenting has been shown to reduce intimal hyperplasia, lumen irregularities, and flow disturbances after coronary artery bypass grafting (CABG). The objective of this study is to evaluate the effect of saphenous vein graft external stenting on clinical outcomes up to 5 years.

Methods

Outcomes for patients who received external vein graft stenting in an international, real-world cohort were compared in a propensity matched analysis with patients from the Arterial Revascularization Trial (ISRCTN46552265). All eligible patients required an internal mammary artery graft to the left anterior descending coronary artery, received at least one vein graft, and survived to discharge. The primary end point was major adverse cardiovascular and cerebrovascular events at 1 year after surgery, consisting of all-cause mortality, myocardial infarction, repeat revascularization, and cerebrovascular accident. Secondary end points included 5-year major adverse cardiovascular and cerebrovascular events with and without stroke and annualized target vessel revascularization.

Results

In total, 789 treated and 2205 control patients were included. At 1 year after CABG, the weighted hazard ratio comparing outcomes between treated and control patients was 0.60 (90% confidence interval, 0.38-0.94, P = .03). The benefits associated with external stenting for the composite outcome persisted through 5 years’ post-CABG (hazard ratio, 0.70; 95% confidence interval, 0.51-0.98, P = .04). Annual target vessel revascularization rates in vein grafts were significantly lower in the venous external support cohort at 2 to 5 years after surgery (P = .009-.03).

Conclusions

The current study demonstrates that external vein graft stenting is associated with a significantly lower risk of experiencing adverse clinical outcomes up to 5 years after surgery compared with standard of care.

目的外隐静脉支架植入术可以减少冠状动脉旁路移植术（CABG）后的内膜增生、管腔不规则和血流障碍。本研究的目的是评估隐静脉移植物外支架植入术对5年临床结果的影响。方法：通过倾向匹配分析，将国际现实世界队列中接受外静脉移植支架植入术的患者的结果与动脉血管重建术试验（ISRCTN46552265）的患者进行比较。所有符合条件的患者都需要将乳腺内动脉移植到左冠状动脉前降支，接受至少一次静脉移植，并存活至出院。主要终点是术后1年的主要心脑血管不良事件，包括全因死亡率、心肌梗死、重复血运重建术和脑血管意外。次要终点包括伴有或不伴有卒中的5年主要心脑血管不良事件和年化靶血管重建术。结果共纳入治疗组789例，对照组2205例。CABG术后1年，治疗组和对照组患者的加权风险比为0.60（90%可信区间，0.38-0.94,P = 0.03）。体外支架置入术对复合结果的益处持续到cabg后5年（风险比，0.70；95%可信区间，0.51-0.98,P = 0.04）。静脉外支持组术后2 - 5年静脉移植物的年目标血管重建率显著低于静脉外支持组（P = 0.009 - 0.03）。结论：目前的研究表明，与标准治疗相比，外静脉支架植入术与术后5年内出现不良临床结果的风险显著降低有关。

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引用次数: 0

The influence of socioeconomic status on the decision to use bilateral internal mammary artery grafting in coronary artery bypass surgery 社会经济状况对冠状动脉搭桥术中双侧乳腺内动脉移植决定的影响

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.10.021

Yu Hohri MD, PhD, Tanner Powley MS, Chunhui Wang MD, MPH, Pengchen Wang MS, Paul Kurlansky MD, Koji Takeda MD, PhD

Objective

The influence of socioeconomic status on the decision to use bilateral internal mammary artery (BIMA) grafting versus single IMA (SIMA) grafting remains uncertain. In this study, we examine the association between Distressed Communities Index scores and the decision to use BIMA grafting.

Methods

This multicenter retrospective study includes patients who underwent primary coronary artery bypass grafting with BIMA or SIMA between 2015 and 2024. Patients with 1 distal anastomosis and without an IMA graft were excluded. The Distressed Communities Index is a validated, zip code-based metric that reflects socioeconomic distress using 7 indicators, with higher scores indicating greater distress. It was used to assess the association between socioeconomic factors and both the likelihood of receiving BIMA grafting and postoperative outcomes.

Results

Of 17,110 patients, 13,692 patients (80.0%) received SIMA grafting, whereas 3418 patients (20.0%) received BIMA grafting. The median age was different between 2 groups (63.0 years; range, 56.0-70.0 years vs 68.0 years; range, 61.0-74.0 years; P < .001), and BIMA was more frequently used in patients with fewer comorbidities than SIMA (all P values < .05). The median Distressed Communities Index score was 45.80 (range, 24.29-70.63) in BIMA and 44.03 (range, 23.39-68.47) in SIMA grafting (P < .001). Multivariable logistic regression revealed that Distressed Communities Index score was associated with the likelihood of receiving BIMA grafting (odds ratio, 0.997; 95% CI, 0.995-0.99; P < .001), but not with any postoperative outcomes (all P values > .05).

Conclusions

Patients from more distressed communities are less likely to receive BIMA grafting. This suggests that surgeons may unknowingly consider socioeconomic factors as part of their decision making for BIMA grafting.

目的社会经济状况对双侧乳腺内动脉（BIMA）移植术与单侧乳腺内动脉（SIMA）移植术的影响尚不确定。在本研究中，我们研究了贫困社区指数得分与使用BIMA嫁接的决定之间的关系。方法本研究是一项多中心回顾性研究，纳入了2015年至2024年期间接受BIMA或SIMA冠状动脉搭桥术的患者。排除有1个远端吻合且没有IMA移植的患者。贫困社区指数是一个经过验证的、基于邮政编码的指标，它使用7个指标来反映社会经济困境，得分越高表明困境越严重。它被用来评估社会经济因素与接受BIMA移植的可能性和术后结果之间的关系。结果17110例患者中，13692例（80.0%）行SIMA移植，3418例（20.0%）行BIMA移植。两组患者的中位年龄差异较大（63.0岁；范围56.0 ~ 70.0岁vs 68.0岁；范围61.0 ~ 74.0岁；P < 0.001），且BIMA在合合症较少的患者中使用频率高于SIMA （P值均为0.05）。BIMA组和SIMA组的苦恼社区指数中位数分别为45.80分（24.29 ~ 70.63分）和44.03分（23.39 ~ 68.47分）（P < .001）。多变量logistic回归显示，痛苦社区指数评分与接受BIMA移植的可能性相关（优势比为0.997；95% CI为0.995-0.99;P < .001），但与任何术后结果无关（P值均为>； 0.05）。结论来自贫困社区的患者接受BIMA移植的可能性较小。这表明外科医生可能在不知情的情况下考虑社会经济因素作为他们决定BIMA移植的一部分。

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