JTCVS open最新文献

{"title":"Extracorporeal membrane oxygenation as a bridge to lung transplant in the composite lung allocation score era: A single-center experience","authors":"Whitney D. Gannon MSN, MS , Enock Adjei MD , John W. Stokes MD , Todd W. Rice MD, MSc , Anil J. Trindade MD , Blaine M. Sklar DNP, AGACNP-BC , Christina A. Jelly MD , Aaron M. Williams MD , Konrad Hoetzenecker MD, PhD , Caitlin T. Demarest MD, PhD , Matthew Bacchetta MD, MBA","doi":"10.1016/j.xjon.2025.10.022","DOIUrl":"10.1016/j.xjon.2025.10.022","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101500"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412318","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}

{"title":"Uncontrolled hypertension contributes to vascular permeability after cardioplegic arrest and cardiopulmonary bypass","authors":"Meghamsh Kanuparthy MD,&nbsp;Christopher R. Stone MD,&nbsp;Rishik Manthana BA,&nbsp;Himanshu Kaushik BS,&nbsp;Kelsey C. Muir MD,&nbsp;Jad Hamze BA,&nbsp;Afshin Ehsan MD, MBA,&nbsp;Neel Sodha MD,&nbsp;Jun Feng MD, PhD,&nbsp;Frank W. Sellke MD","doi":"10.1016/j.xjon.2025.10.039","DOIUrl":"10.1016/j.xjon.2025.10.039","url":null,"abstract":"<div><h3>Objective</h3><div>Vasoplegia and endothelial dysfunction are well-known complications of cardioplegia and cardiopulmonary bypass (CP/CPB). Our lab has previously shown that endothelial adherens junction impairment is driven by vascular endothelial (VE)-cadherin phosphorylation. In this study we investigate the interplay of hypertension and CP/CPB.</div></div><div><h3>Methods</h3><div>Right atrial tissue was harvested pre- and post-CP/CPB from patients undergoing surgery. Patients were stratified into nonhypertensive, controlled hypertension, and uncontrolled hypertension groups based on history and in-office blood pressure measurements. Atrial tissue was sent for transcriptomics. Expression, phosphorylation, and localization of VE-cadherin was assessed by immunoblotting and immunohistochemistry. Atrial microvascular reactivity to adenosine diphosphate was assessed by videomicroscopy.</div></div><div><h3>Results</h3><div>Several genes related to reactive oxygen species handling, nitric oxide signaling, and adherens junctions were suppressed in patients with uncontrolled hypertension versus nonhypertensive patients pre-CP/CPB. By immunoblotting, patients with uncontrolled hypertension had significantly higher levels of phosphorylated VE-cadherin (p-VE cadherin) and higher ratios of p-VE cadherin/VE-cadherin compared with nonhypertensive (<em>P</em> &lt; .05). Perivascular p-VE cadherin density by immunofluorescence was higher in patients with uncontrolled hypertension compared with nonhypertensive patients and patients with controlled hypertension (<em>P</em> &lt; .05). There were significant decreases in vasodilatory response to adenosine diphosphate after CP/CPB (<em>P</em> &lt; .05) in patients with uncontrolled hypertension compared with nonhypertensive patients. Patients with uncontrolled hypertension had significantly higher increases in weight on postoperative day 1 compared with nonhypertensive patients (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Our study supports a 2-hit model in which hypertension primes the endothelium for dysfunction, and CP/CPB amplifies this injury through impaired reactive oxygen species handling, nitric oxide dysregulation, and adherens junction destabilization. These findings highlight the importance of preoperative hypertension management to improve postoperative outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101541"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412666","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}

{"title":"Early outcomes of a formal robotic congenital cardiac surgery program","authors":"Jack J. Scala BS ,&nbsp;David Blitzer MD ,&nbsp;Michael LaLonde MHA, PA-C ,&nbsp;Shonette Hing RN ,&nbsp;Andrew B. Goldstone MD, PhD ,&nbsp;Emile Bacha MD ,&nbsp;Arnar Geirsson MD ,&nbsp;David M. Kalfa MD, PhD","doi":"10.1016/j.xjon.2025.101564","DOIUrl":"10.1016/j.xjon.2025.101564","url":null,"abstract":"<div><h3>Background</h3><div>Robotic cardiac surgery for congenital disease has been limited mainly to adult patients. Here we describe cardiac repairs in pediatric and adult patients with a variety of congenital lesions performed in a robotic cardiac surgery program.</div></div><div><h3>Methods</h3><div>All patients undergoing robotic repair of congenital anomalies at the Children's Hospital of New York and Milstein Hospital between November 2023 and April 2025 were included. Cardiopulmonary bypass was achieved using open or percutaneous femoral arterial and venous access, along with jugular venous access.</div></div><div><h3>Results</h3><div>Twenty-six patients were identified, including 11 pediatric patients (range, age 6-19 years) and 15 adults (range, 22-63 years). The most frequent indications were secundum atrial septal defect (n = 14; 53.8%) and partial anomalous pulmonary venous return (n = 7; 26.9%), including sinus venosus atrial septal defect (n = 4; 15.4%) and scimitar syndrome (n = 3; 11.5%). The median patient age and weight were 27.0 years (interquartile range [IQR], 12.3-39.5 years) and 65.7 kg (IQR: 53.2-76.7 kg). The median length of stay was 4 days (IQR, 3-4.8 days). Aortic cross-clamping was achieved using a transthoracic clamp (n = 10) or endoaortic balloon (n = 15). No death, conversion to sternotomy, or reoperation occurred. Three cases of pleural effusion and 2 cases of pericarditis occurred.</div></div><div><h3>Conclusions</h3><div>Robotic surgery is a safe and efficacious strategy for repairing selected congenital heart lesions across the lifespan. Adoption of robotic surgery in congenital heart disease likely will expand as comfort with the technology evolves.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101564"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413000","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}

{"title":"Computed tomography–derived elastic modulus as a noninvasive marker of aortic wall integrity: Correlation with histopathology in the ascending aorta","authors":"Fumio Yamana MD ,&nbsp;Kazuo Shimamura MD, PhD ,&nbsp;Takuji Kawamura MD, PhD ,&nbsp;Takashi Shirakawa MD, PhD ,&nbsp;Junki Yokota MD ,&nbsp;Kansuke Kido MD, PhD ,&nbsp;Ryoto Sakaniwa MD, MPH, PhD ,&nbsp;Shunsuke Saito MD, PhD ,&nbsp;Kizuku Yamashita MD, PhD ,&nbsp;Akima Harada BS ,&nbsp;Yoshiki Watanabe MD, PhD ,&nbsp;Satoshi Sakakibara MD, PhD ,&nbsp;Daisuke Yoshioka MD, PhD ,&nbsp;Eiichi Morii MD, PhD ,&nbsp;Shigeru Miyagawa MD, PhD","doi":"10.1016/j.xjon.2025.10.033","DOIUrl":"10.1016/j.xjon.2025.10.033","url":null,"abstract":"<div><h3>Background</h3><div>Ascending aortic aneurysms and dissections are life-threatening conditions often requiring prophylactic surgeries. Current guidelines rely primarily on aortic diameter for intervention; however, many dissections occur without severe dilation. Mechanical properties, such as elastic modulus, have emerged as potential predictors of disease progression; nonetheless, noninvasive clinical applications remain limited. This study evaluated the relationship between the computed tomography (CT)-derived elastic modulus of the ascending aorta and the histopathologic characteristics of the aortic media.</div></div><div><h3>Methods</h3><div>Thirty patients who underwent surgical ascending aorta replacement were included in this study. Preoperative CT was used to calculate the aortic elastic modulus based on geometric measurements and pulse pressure. Resected aortic specimens were subjected to histologic and immunohistochemical analyses to assess elastin, collagen, vascular smooth muscle cells (VSMCs), and smoothelin expression. Correlation analyses between the CT-derived elastic modulus and aortic media composition were conducted after adjusting for age and aortic diameter.</div></div><div><h3>Results</h3><div>The CT-derived elastic modulus exhibited a significant negative correlation with elastin area and a positive correlation with collagen area. Additionally, a moderate negative correlation was observed between the elastic modulus and elastin fiber waviness. A strong negative correlation was detected between the elastic modulus and the proportion of contractile-type (ie, smoothelin-positive) VSMCs. These findings remained significant after adjusting for confounders.</div></div><div><h3>Conclusions</h3><div>CT-derived elastic modulus of the ascending aorta reflects underlying pathologic changes, including extracellular matrix remodeling and VSMC phenotypic modulation. Noninvasive assessment of aortic mechanical properties may provide novel insights into aortic disease progression and therapeutic responses.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101518"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413013","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}

{"title":"Training left-handed cardiothoracic surgeons in a right-handed world: Perspectives, experiences, and educational opportunities","authors":"Zamaan Hooda MD ,&nbsp;Shanique Ries MD ,&nbsp;Thomas Fabian MD ,&nbsp;Kirsten Freeman MD ,&nbsp;Wayne Hofstetter MD ,&nbsp;Jessica Hudson MD ,&nbsp;Reza Mehran MD ,&nbsp;Ravi Rajaram MD, MSc ,&nbsp;David Rice MD ,&nbsp;Stephen Swisher MD ,&nbsp;Ara Vaporciyan MD ,&nbsp;Garrett Walsh MD ,&nbsp;Kyle G. Mitchell MD, MSc ,&nbsp;Bledi Zaku MD ,&nbsp;Mara B. Antonoff MD","doi":"10.1016/j.xjon.2025.11.023","DOIUrl":"10.1016/j.xjon.2025.11.023","url":null,"abstract":"<div><h3>Objective</h3><div>Operative environments, typically designed for right-handed (RH) surgeons, create educational challenges for both left-handed (LH) cardiothoracic surgery (CTS) trainees and surgical educators. This study aimed to characterize experiences of CTS faculty with training learners relative to concordance of hand dominance, serving as a needs assessment for curricular development.</div></div><div><h3>Methods</h3><div>A 15-item survey was developed and distributed to CTS teaching faculty, assessing experiences with educating LH trainees. Responses were analyzed using χ², Fisher exact test, and independent <em>t</em> tests.</div></div><div><h3>Results</h3><div>In total, 91 cardiothoracic surgeons completed the survey (15.4% response rate) with 17 (18.7%) LH and 74 (81.3%) RH respondents. Although 10 (58.8%) LH surgeons predominantly operate with their left hands, all (100%) RH surgeons operate primarily with their right hands (<em>P</em> &lt; .01). LH surgeons reported less difficulty in training opposite-handed individuals than RH surgeons on a Likert scale of 1 to 10, with median scores of 4 versus 5.5, respectively (<em>P</em> = .03). Most respondents believe that LH trainees face bias in CTS (LH, n = 13/17, 76.5%; RH, n = 39/74, 52.7%, <em>P</em> = .05). However, 6 (35.3%) LH surgeons believed that LH trainees have an advantage of learning to ambidextrously operate, whereas 31 (41.9%, <em>P</em> = .01) RH surgeons felt that LH CTS trainees may require additional mentorship. The overwhelming majority of RH surgeons (n = 62/74, 83.8%) expressed interest in resources for training opposite-handed individuals, compared with 9 (52.9%, <em>P</em> &lt; .01) LH surgeons.</div></div><div><h3>Conclusions</h3><div>Creating resources to help RH surgeons in teaching LH individuals and elucidating LH CTS trainee perspectives may help mitigate challenges impeding their education.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101539"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412314","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}

{"title":"National trends in adult cardiac surgery inpatient costs: A decade in review","authors":"Troy N. Coaston MSCR ,&nbsp;Amulya Vadlakonda MD ,&nbsp;Kevin Tabibian BS ,&nbsp;Esteban Aguayo MD ,&nbsp;Sara Sakowitz MD, MPH ,&nbsp;Saad Mallick MD ,&nbsp;Richard J. Shemin MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.xjon.2025.101551","DOIUrl":"10.1016/j.xjon.2025.101551","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize national trends in inpatient costs associated with adult cardiac surgery from 2013 to 2022 and identify factors independently associated with increased hospitalization expenditures.</div></div><div><h3>Methods</h3><div>All hospitalizations entailing major cardiac operations (coronary artery bypass grafting, valve procedures [open and transcatheter], aortic repair) were identified in the 2013-2022 National Inpatient Sample. Temporal trends were evaluated using the Cuzick test for trend (nptrend), and multivariable linear regression was used to identify factors associated contemporary costs (2022).</div></div><div><h3>Results</h3><div>Among an estimated 3,323,645 admissions, annual volume increased from 293,645 to 361,355 (nptrend = 0.01). Elective hospitalization costs increased from $8.1 to $12.9 billion (nptrend &lt; 0.001), with median per-admission costs increasing from $41,000 to $48,000 (nptrend &lt; 0.001). For nonelective hospitalizations, total costs rose from $8.3 to $10.4 billion (nptrend = 0.01), and median per-admission costs from $51,000 to $63,000 (nptrend &lt; 0.001). The proportion of transcatheter valve procedures rose from 6.4% to 38.9% (nptrend &lt; 0.001), whereas their median per-admission costs decreased. In 2022, Black race (β $9,300, 95% confidence interval [CI], $6700-$11,800) and care in the Western United States (β $12,800, 95% CI, $7600-$17,900) were associated with increased costs. Elective admission (β –$26,000, 95% CI, –$27,900 to –$24,200), older age (β –$1400 per decade, 95% CI, –$2100 to –$800), and lowest income quartile (β –$3200, 95% CI, –$5700 to –$800; ref: highest) were associated with lower costs.</div></div><div><h3>Conclusions</h3><div>Inpatient cardiac surgery costs increased significantly over the decade. These trends, alongside increased use of transcatheter techniques and persistent disparities, underscore the need for systemic reform to ensure sustainable and equitable care.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101551"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412580","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}

{"title":"Analysis of failure to rescue in adult patients who undergo open, proximal aortic repair","authors":"Kyle W. Blackburn BS ,&nbsp;Joseph S. Coselli MD ,&nbsp;Armin Farazdaghi MD ,&nbsp;Lynna Nguyen MS ,&nbsp;Susan Y. Green MPH ,&nbsp;Anna Xue MD ,&nbsp;Vicente Orozco-Sevilla MD ,&nbsp;Scott M. Leikin DO ,&nbsp;Marc R. Moon MD ,&nbsp;Subhasis Chatterjee MD","doi":"10.1016/j.xjon.2025.101573","DOIUrl":"10.1016/j.xjon.2025.101573","url":null,"abstract":"<div><h3>Objective</h3><div>Failure to rescue (FTR) is a metric of postoperative care, measuring a center’s ability to prevent operative death after a surgical complication. We evaluated trends in and contributors to FTR after proximal aortic surgery at a high-volume institution.</div></div><div><h3>Methods</h3><div>Of 4180 patients in our single practice who underwent open proximal aortic repair from 1990 to 2024, 1304 (31.2%) had at least 1 of 4 FTR-related complications identified by the Society of Thoracic Surgeons (STS). Operative death was defined as death within 30 days of surgery or before hospital discharge or transfer. We analyzed FTR rate by specific complication, including the number and combination of complications. We then evaluated the association of elective versus emergency repair and aortic dissection with FTR rate. Finally, a multivariable model was built to predict FTR in these patients.</div></div><div><h3>Results</h3><div>Of 1304 patients with an STS complication, 303 (23.2%) had operative death and thus an FTR. The FTR rate was 13% for patients with 1 complication and increased to 48%, 68%, and 100% with each additional complication. The 2 STS complications most associated with FTR were stroke (odds ratio, 5.92; <em>P</em> &lt; .001) and renal failure necessitating dialysis (odds ratio, 8.24; <em>P</em> &lt; .001). Neither emergency repair nor acute aortic dissection were significant FTR predictors after adjustment for covariates. A 6-variable predictive model to predict FTR achieved a test C-statistic of 0.79 (0.77-0.81).</div></div><div><h3>Conclusions</h3><div>The FTR rate significantly increased with each additional complication. We built a model that can effectively predict FTR. Better understanding of FTR rates can identify areas for improvement in postoperative care.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101573"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412582","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}

{"title":"Framework for estimating the financial contribution of a benign foregut practice: What general thoracic surgeons need to know","authors":"Arman Ashrafi MD ,&nbsp;Brooks V. Udelsman MD, MHS ,&nbsp;Graeme M. Rosenberg MD ,&nbsp;Sean C. Wightman MD ,&nbsp;Takashi Harano MD ,&nbsp;Anthony W. Kim MD, MS ,&nbsp;Scott M. Atay MD","doi":"10.1016/j.xjon.2025.10.031","DOIUrl":"10.1016/j.xjon.2025.10.031","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to estimate payor-specific reimbursements for foregut surgery and determine the relative contribution compared with pulmonary procedures.</div></div><div><h3>Methods</h3><div>Medical records of patients undergoing foregut surgery, identified by Diagnosis-Related Group codes 326, 327, and 328, by thoracic surgeons from January 2018 to December 2019 were reviewed. Esophagectomies and primary neoplasm diagnoses were excluded. Volume of surgeries, preoperative and postoperative studies, and clinic visits were measured. Reimbursements were estimated using Current Procedural Terminology and Diagnosis-Related Group Medicare data, cost-to-charge ratios, and Private:Medicare/Medicaid:Medicare payment ratios. Average payments for foregut and equivalent complexity pulmonary Diagnosis-Related Group codes were compared to calculate relative contribution.</div></div><div><h3>Results</h3><div>A total of 72 patients met inclusion criteria and underwent 73 operations (hiatal hernia in 62 [85%] and esophageal diverticulectomy or myotomy in 11 [15%]), 538 studies, and 284 clinic visits. This volume equated to $12.7M in charges and $2.0M in Medicare reimbursement. Adjusting for a 59% Private, 32% Medicare, and 9% Medicaid payor mix, total reimbursement was $3.7M. Average reimbursement per surgery was $60k for Private, $35k for Medicare, and $28k for Medicaid. Total costs and operating income were $3.2M and $503k (ie, 14% operating margin), respectively. Compared with pulmonary procedures, foregut averaged greater reimbursement for the highest complexity cohort but less reimbursement for lower complexity cases (<em>P</em> ≤ .02).</div></div><div><h3>Conclusions</h3><div>This framework can estimate payor-specific reimbursements, costs, and operating margins for both foregut and pulmonary surgeries. There are no financial disadvantages to having a diverse practice model. Balance of payor mix, case complexity, and a focus on reduced perioperative cost and increased care efficiency can improve margins and throughput.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101512"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412578","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}

{"title":"The correlation of lactate/albumin ratio and their association for short-term and long-term mortality in patients with acute aortic dissection","authors":"Mingcheng Xu MS ,&nbsp;Zhenyu Liao MS ,&nbsp;Zhaorui Liu MS ,&nbsp;Jiuling Chen MD, PhD ,&nbsp;Ning Zhang MS ,&nbsp;Yike Wang MS ,&nbsp;Song Zhang MD, PhD","doi":"10.1016/j.xjon.2025.101568","DOIUrl":"10.1016/j.xjon.2025.101568","url":null,"abstract":"<div><h3>Objective</h3><div>The direct impact on survival of lactate-to-albumin ratio (LAR) in acute aortic dissection (AAD) remains uncertain.</div></div><div><h3>Methods</h3><div>Medical electric records of 919 patients in the intensive care unit (ICU) who diagnosed with AAD were extracted from the MIMIC-IV database. These patients were subsequently divided into quartiles according to their LAR. Multivariable Cox regression incorporating restricted cubic spline terms was applied to examine how LAR relates to all-cause death at 30-, 90-, and 365-day intervals after ICU admission. To probe possible nonlinearities, we used smoothed curve analyses and fitted segmented (2-piece) linear models where appropriate.</div></div><div><h3>Results</h3><div>Kaplan-Meier curves showed progressively poorer survival among patients in the highest LAR quartile. Multivariable Cox proportional-hazards analysis shown the greatest quartile exhibited adjusted hazard ratios of 1.329 (95% confidence interval [CI], 1.118-1.579) at 30 days, 1.314 (95% CI, 1.130-1.527) at 90 days and 1.263 (95% CI, 1.096-1.455) at 365 days compared with the lowest quartile. Restricted cubic spline modeling revealed a positive association between increasing LAR and mortality risk in critically ill patients with AAD. Consistent patterns emerged across all clinically relevant subgroups. Smooth-curve fitting suggested a nonlinear relationship between LAR and mortality risk; subsequent piecewise linear regression identified inflection points for all-cause death at 30, 90, and 365 days of 0.769, 0.385, and 0.381, respectively.</div></div><div><h3>Conclusions</h3><div>Even after multivariable adjustment, the LAR demonstrated a robust association with all-cause mortality at 30, 90, and 365 days in patients with AAD in the ICU.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101568"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413011","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}

{"title":"What should lung cancer patients know before surgery? A Delphi consensus study","authors":"Woorin Jang BS ,&nbsp;Mark K. Ferguson MD ,&nbsp;Mara Antonoff MD ,&nbsp;Mark Block MD ,&nbsp;Malcolm DeCamp Jr. MD ,&nbsp;Elisabeth Dexter MD ,&nbsp;Jessica Donington MD, MSCR ,&nbsp;Melanie Edwards MD ,&nbsp;Crystal Erickson MD ,&nbsp;David Tyler Greenfield MD ,&nbsp;Eric L. Grogan MD, MPH ,&nbsp;Jeffrey Hagen MD ,&nbsp;Matthew L. Inra MD ,&nbsp;Jody Kaban MD ,&nbsp;Peter J. Kneuertz MD ,&nbsp;Sean Kwon MD ,&nbsp;Geoffrey Lam MD ,&nbsp;Keith Mortman MD ,&nbsp;Keith Naunheim MD ,&nbsp;Brian Pettiford MD ,&nbsp;Maria Lucia L. Madariaga MD","doi":"10.1016/j.xjon.2025.10.037","DOIUrl":"10.1016/j.xjon.2025.10.037","url":null,"abstract":"<div><h3>Objective</h3><div>Preoperative patient education improves surgical outcomes but high variability of existing patient education materials (PEMs) exists. This study establishes thoracic surgeon consensus on essential content included in PEMs to help patients to prepare for lung cancer surgery.</div></div><div><h3>Methods</h3><div>Board-certified thoracic surgeons were recruited to participate through email invitations. Statements about the inclusion of topics in preoperative PEMs were crafted and divided into 6 categories. During 3 rounds of Delphi voting, surgeons gave anonymized feedback, and statements were iteratively revised. Results and comments of each round were shared with all surgeons for the next round of voting. Statements were considered to reach consensus if they achieved more than 80% agreement. Thematic qualitative analysis was performed on the comments provided.</div></div><div><h3>Results</h3><div>A total of 41 board certified thoracic surgeons averaging 17.1 years in practice and 133 lung resections per year were recruited. Response rates were 93% (38 out of 41) for round 1, 88% (34 out of 38) for round 2, and 91% (31 out of 34) for round 3. The initial 25 statements were revised into 19 statements, of which 13 (68%) reached consensus. Statements with details about the operation itself had the highest consensus, whereas details about the day of surgery and recovery had the lowest consensus rates. Thematic analysis showed that statements were likely to be accepted if they were supported by evidence to improve surgical outcomes, set patient expectations, or alleviated anxiety. Statements were likely to be rejected if they were perceived to be irrelevant, could vary depending on practice, or could overwhelm patients.</div></div><div><h3>Conclusions</h3><div>This study provides consensus-based guidelines on content that should be included in preoperative lung cancer surgery PEMs from thoracic surgeons’ perspective. Surgeon consensus gives valuable insight on topics that need expert opinion, whereas other topics require patient input. Patient preferences should be evaluated before finalizing guidelines.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101525"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411917","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}