JTCVS open最新文献

{"title":"Productivity and pay in cardiovascular medicine and surgery: Is the financial accounting link broken?","authors":"Suyog A. Mokashi MD, MBA , Peter Cappelli PhD","doi":"10.1016/j.xjon.2024.10.025","DOIUrl":"10.1016/j.xjon.2024.10.025","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 210-213"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465266","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":"Aortic valve repair in a middle-income country: Exceptional outcomes and mid-term results","authors":"Gustavo Prieto MD,&nbsp;Johiner Vanegas MD,&nbsp;Néstor Bernal MD,&nbsp;Erick Castro MD,&nbsp;Alexandra Hurtado-Ortiz MD,&nbsp;Zaida Piraquive MD,&nbsp;Lorena Montes MD","doi":"10.1016/j.xjon.2024.12.002","DOIUrl":"10.1016/j.xjon.2024.12.002","url":null,"abstract":"<div><h3>Objective</h3><div>Aortic valve repair has proven to be a low-risk perioperative procedure, with favorable mid-term outcomes and additional benefits linked to the avoidance of prosthetic valves, including freedom from anticoagulation and reintervention, reduced risk of endocarditis, and thromboembolic complications. Furthermore, an aortic valve repair program in Colombia confers potential advantages specific to our population, considering the sociodemographic factors of middle-income countries.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on the clinical and perioperative results, as well as mid-term follow-up data of patients who underwent aortic valve repair surgery at 2 Colombian health institutions between March 2018 and December 2023.</div></div><div><h3>Results</h3><div>A total of 104 patients were treated, with a mean age of 57 years, of whom 82.7% were male. In all cases, the preoperative diagnosis was aortic regurgitation, with 75% exhibiting aortic root or ascending aorta dilation. The median cardiopulmonary bypass and aortic crossclamp times were 140 minutes and 116 minutes, respectively. The 30-day mortality was 1.9%. Follow-up was completed in 95.1% of cases, with survival at 1, 3, and 5 years of 97%, 94.3%, and 90.9%, respectively. Freedom from reintervention and freedom from anticoagulation at 1, 3, and 5 years were 98.6%, 98.6%, and 95.3%, and 84.9%, 77.9%, and 77.9%, respectively.</div></div><div><h3>Conclusions</h3><div>In our study, aortic valve repair emerged as an effective and durable procedure, offering benefits that could be particularly relevant in middle-income countries. Perioperative and follow-up outcomes were comparable to those reported in large series in the literature.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 101-108"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464401","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":"Onlay grafting with or without coronary endarterectomy maintains long-term favorable anastomotic remodeling regardless of the graft materials used","authors":"Naoki Minato MD, PhD ,&nbsp;Takayuki Okada MD, PhD ,&nbsp;Tomohiko Uetsuki MD ,&nbsp;Shintaro Kuwauchi MD ,&nbsp;Shinya Kanemoto MD, PhD ,&nbsp;Nobuya Zempo MD, PhD ,&nbsp;Takayuki Kawaura PhD, EngD ,&nbsp;Tomoki Kitawaki PhD, EngD","doi":"10.1016/j.xjon.2024.11.007","DOIUrl":"10.1016/j.xjon.2024.11.007","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to examine the long-term clinical outcomes, graft patency, and remodeling capacities of onlay anastomoses using 4 different grafts.</div></div><div><h3>Methods</h3><div>The cross-sectional areas of onlay anastomoses were measured using coronary angiography or computed tomography and compared with the estimated standard areas of normal arteries to assess changes in the onlay anastomosis area over time.</div></div><div><h3>Results</h3><div>One hundred eight patients underwent onlay grafting (with coronary endarterectomy: 43 arteries; without: 84). The operative mortality rate was 1.85%, and the average follow-up period was 102.8 ± 52.4 months (range, 6-217 months). The reintervention-free rate was 99.2%, and late death occurred in 30 patients, including 6 cardiac deaths. The estimated survival rates were 93.6%, 79.0%, 71.3%, 56.1%, and 48.1% at 1, 5, 10, 14, and 18 years, respectively. Early angiography in 93 patients resulted in a 98.1% patency rate. Follow-up angiography on 78 patients showed a distant patency rate of 96.6% at an average of 52.7 ± 42.5 months (range, 6-180 months). Early enlargement of the onlay anastomosis reduced its size to match the native standard lumen long-term, regardless of the graft material used.</div></div><div><h3>Conclusions</h3><div>Onlay grafting, with or without endarterectomy, maintained anastomotic patency with major branch preservation and favorable long-term remodeling of the anastomoses, leading to luminal equalization and smoothing.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 157-170"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464999","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":"Impact of sex on ergonomic challenges in cardiothoracic surgery: Inequities in work-related injuries","authors":"Deniz Piyadeoglu MD ,&nbsp;Marianna Papageorge MD, MPH ,&nbsp;Rachel M. Lee MD ,&nbsp;Mara B. Antonoff MD","doi":"10.1016/j.xjon.2024.11.015","DOIUrl":"10.1016/j.xjon.2024.11.015","url":null,"abstract":"<div><h3>Background</h3><div>Ergonomic challenges resulting in work-related injuries are highly prevalent, and women surgeons encounter more ergonomic difficulties and resultant injuries than men. Cardiothoracic (CT) surgery requires intense physical demands, and it is unknown how surgeon's sex may impact these challenges. Therefore, we sought to explore the impact of sex on ergonomic-related issues faced by CT surgeons.</div></div><div><h3>Methods</h3><div>An anonymous web-based survey was designed and administered via a web-based platform from April 9, 2024, to April 25, 2024. Survey items addressed demographic and anthropometric data, ergonomic difficulties, pain symptoms, and associated treatments related to ergonomics in the operating room. Comparative analytics were performed between the sexes.</div></div><div><h3>Results</h3><div>Fifty-one participants completed the survey, including 29 practicing CT surgeons (56.9%) and 22 trainees (43.1%). The respondents included 21 women (41.2%). There was no difference in mean age by sex (40.5 years vs 40.7 years; <em>P</em> = .94). Women were shorter (65.3 inches vs 70.6 inches; <em>P</em> &lt; .01) and had smaller hands (glove size, 6.2 vs 7.4; <em>P</em> &lt; .01). Eighteen women (85.7%) reported pain compared to 20 men (66.7%; <em>P</em> = .23) Women more often reported an impact on daily life (83.3% [n = 15] vs 50.0% [n = 10]; <em>P</em> = .06). Women frequently reported needing treatment (61.1%) and time off work due to injury (27.7%). Notably, 76.2% of women (n = 16) attributed their discomfort to instruments and/or operating room setup, compared to 36.7% of men (n = 11; <em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>The impact of work-related pain on CT surgeons is substantial, with evidence of sex differences in rates and severity. Emphasis must be placed on limiting injuries for all while specifically supporting the anthropometric diversity of our future workforce.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 214-221"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465181","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 the lateral caval flap and conventional techniques for repair of right-sided partial anomalous pulmonary venous connection in adults","authors":"William C. Frankel MD ,&nbsp;Bogdan A. Kindzelski MD, MS ,&nbsp;Benjamin Yang MD ,&nbsp;Rashed Mahboubi MD ,&nbsp;Miza Salim Hammoud MD ,&nbsp;Andrew J. Toth MS ,&nbsp;Hani K. Najm MD, MSc ,&nbsp;Gösta B. Pettersson MD, PhD ,&nbsp;Tara Karamlou MD, MSc","doi":"10.1016/j.xjon.2024.10.023","DOIUrl":"10.1016/j.xjon.2024.10.023","url":null,"abstract":"<div><h3>Objective</h3><div>In an effort to overcome limitations of conventional techniques for surgical repair of partial anomalous pulmonary venous connection (PAPVC), we developed the lateral caval flap (LCF) technique, which leverages a native endocardial surface to create unobstructed recruitment of the anomalous pulmonary veins to the left atrium. In this study, we report the long-term outcomes of the LCF and conventional techniques for repair of right-sided PAPVC.</div></div><div><h3>Methods</h3><div>In total, 109 adult patients (mean age 48 years; 57% male) who underwent right-sided PAPVC repair (53 LCF, 34 single-patch, 13 double-patch, 7 pericardial roll, and 2 Warden procedure) from 1997 to 2022 were retrospectively reviewed. Outcomes included operative mortality, major morbidity, arrythmias, systemic and pulmonary venous pathway obstruction, survival, and reintervention.</div></div><div><h3>Results</h3><div>Operative mortality was 1% and there were no in-hospital deaths after LCF repair; 4 patients had strokes (4%) including 2 nondisabling strokes after LCF repair (4%), 19 patients developed new postoperative atrial fibrillation/flutter (24%) including 9 after LCF repair (24%), and 27 patients developed new early sinus node dysfunction (26%) including 13 after LCF repair (26%). Although sinus-node dysfunction was transient in most patients, 7 required permanent pacemaker implantation (7%). Survival at 1, 5, 10, and 15 years was 95%, 89%, 86%, and 81%, respectively. At a median follow-up of 6 years, 9 patients developed systemic or pulmonary venous pathway obstruction. Freedom from cardiac reintervention at 5 years was 89% overall and 98% after LCF repair.</div></div><div><h3>Conclusions</h3><div>All of the described techniques for repair of right-sided PAPVC yielded acceptable short- and long-term outcomes. LCF is a valid technique for right-sided PAPVC repair with a low risk of venous pathway obstruction compared with conventional techniques. Sinus node dysfunction and atrial tachyarrhythmias remain challenges.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 225-234"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465184","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":"Commercial hybrid graft versus traditional arch replacement with frozen elephant trunk: A multi-institutional comparison","authors":"Markian M. Bojko MD, MPH ,&nbsp;William Oslund MD ,&nbsp;Michael J. Kirsch MD ,&nbsp;Adam M. Carroll MD ,&nbsp;Emma Longo BS ,&nbsp;Jessica S. Clothier MD ,&nbsp;Kamso Okonkwo BA ,&nbsp;Nithya Rajeev BS ,&nbsp;Arjune Dhanekula MD ,&nbsp;Fenton McCarthy MD ,&nbsp;Anthony Cafarelli MD ,&nbsp;Jason Glotzbach MD ,&nbsp;Christopher R. Burke MD ,&nbsp;T. Brett Reece MD, MBA ,&nbsp;Serge Kobsa MD, PhD ,&nbsp;Fernando Fleischman MD","doi":"10.1016/j.xjon.2024.10.027","DOIUrl":"10.1016/j.xjon.2024.10.027","url":null,"abstract":"<div><h3>Objective</h3><div>Traditional total arch replacement with frozen elephant trunk requires 2 separate grafts in the descending thoracic aorta and arch, and frequently requires a graft-to-graft anastomosis, which is prone to bleeding. The Thoraflex (Terumo Aortic) device treats the arch and descending thoracic aorta in a single device but has not been compared directly to traditional total arch replacement with frozen elephant trunk and has not been studied in a real-world context in the United States.</div></div><div><h3>Methods</h3><div>A consecutive sample of total arch replacement with frozen elephant trunk patients across 5 different institutions between January 2018 and January 2024, identified 438 patients of which 83 out of 438 (18.9%) had a Thoraflex device. Propensity score matching in a 1:2 ratio identified 166 well-matched controls. Groups were compared across perioperative outcomes.</div></div><div><h3>Results</h3><div>One hundred forty out of 438 (32%) patients presented with acute type A dissection, 112 out of 438 (26%) had an aneurysm, and 87 out of 438 (20%) had chronic dissection with a previous proximal repair. One hundred thirty-two out of 438 (30%) underwent surgery on an emergency or emergency/salvage basis. Median (interquartile range [IQR]) crossclamp times in the Thoraflex and traditional matched groups were 71 (IQR, 48-105) and 82 (IQR, 62-123), respectively, (<em>P</em> = .012). Total circulatory arrest times were 19 minutes (IQR, 13-32 minutes) and 23 minutes (IQR, 17-37 minutes), respectively (<em>P</em> = .009). Total procedure times were 6.1 hours (IQR, 5.2-7.3 hours) and 6.8 hours (IQR, 5.7-8.2 hours), respectively (<em>P</em> = .012). The operative mortality, stroke, and paralysis rates were 11 out of 83 (13%), 16 out of 83 (19%), and 4 out of 83 (5%), respectively, in the Thoraflex group and were not significantly different than matched controls.</div></div><div><h3>Conclusions</h3><div>The Thoraflex hybrid device facilitates shorter crossclamp and circulatory arrest times for arch replacement, with similar observed mortality and stroke rates compared with matched controls.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 19-33"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465186","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 resection of diffuse pulmonary arteriovenous malformations (PAVMs)","authors":"Aden R. Falk ,&nbsp;Lindsay J. Nitsche BS ,&nbsp;Colleen E. Bontrager BA ,&nbsp;Sarah Bond PA-C ,&nbsp;Lauren A. Beslow MD, MSCE ,&nbsp;Alexandra J. Borst MD ,&nbsp;Jennifer Pogoriler MD, PhD ,&nbsp;Paul J. Devlin MD ,&nbsp;Elizabeth Goldmuntz MD ,&nbsp;Sunil Singhal MD ,&nbsp;Scott O. Trerotola MD ,&nbsp;Stephanie M. Fuller MD, MS","doi":"10.1016/j.xjon.2024.11.002","DOIUrl":"10.1016/j.xjon.2024.11.002","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with pulmonary arteriovenous malformations (PAVM) can have significant morbidity and mortality. Surgical resection in isolation or with embolization is reported to treat diffuse-type PAVMs. Herein, we describe outcomes for children and adults for whom PAVMs were managed with elective surgical resection.</div></div><div><h3>Methods</h3><div>This retrospective analysis includes all patients treated with surgical resection for PAVM from August 1, 2009, to July 20, 2023. Demographic, diagnostic, treatment, and follow-up information were abstracted from medical records. Descriptive statistics were used.</div></div><div><h3>Results</h3><div>Among 18 patients who underwent surgical resection of PAVMs, 12 had hereditary hemorrhagic telangiectasia. Primary indications for surgery included hemoptysis (n = 4), dyspnea (n = 8), persistence of PAVM following embolotherapy (n = 5), and stroke (n = 1). Selected PAVMs were diffuse-type (n = 14) or highly complex (n = 4). Eight patients underwent embolotherapy before surgery. Most resections were performed via thoracotomy (16/18), with 2 video-assisted thoracoscopic surgeries. Resection consisted of lobectomy (n = 14), segmentectomy (n = 3), or pneumectomy (n = 1). Median oxygen saturation improved from 90% preoperatively to 97% postoperatively. The majority (17/18) of patients were extubated in the operating room, with no major complications. The median hospital length of stay was 4.5 days (range, 2-9 days), with a median of 1 intensive care unit day (range, 1-5 days). At median follow-up of 16 months (range, 6 months-12.1 years), median oxygen saturation was 98%, no bleeding recurred, and 100% survived.</div></div><div><h3>Conclusions</h3><div>Although embolization has been the main therapy for most PAVMs, surgical resection of diffuse-type PAVMs is safe and effective. Outcomes were excellent with improvement of oxygen saturation and functional status.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 309-317"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465191","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":"Total aortic arch replacement versus proximal aortic repair for acute type a aortic dissection: A single-center 30-year experience","authors":"Delano J. de Oliveira Marreiros BS ,&nbsp;Bardia Arabkhani MD, PhD ,&nbsp;Jos L. Verhoef MS ,&nbsp;Niels Keekstra MD ,&nbsp;Joost R. van der Vorst MD, PhD ,&nbsp;Jan van Schaik MD ,&nbsp;Jerry Braun MD, PhD ,&nbsp;Robert J.M. Klautz MD, PhD ,&nbsp;Rolf H.H. Groenwold MD, PhD ,&nbsp;Jesper Hjortnaes MD, PhD","doi":"10.1016/j.xjon.2024.11.014","DOIUrl":"10.1016/j.xjon.2024.11.014","url":null,"abstract":"<div><h3>Objective</h3><div>Optimal surgical management of the aortic arch for acute type A aortic dissection remains contentious. We assessed clinical outcomes after total arch replacement and proximal aortic repair (ascending aortic ± hemiarch replacement) for acute type A aortic dissection.</div></div><div><h3>Methods</h3><div>All patients surgically treated for acute type A aortic dissection at our institution between 1992 and 2021 were included. Study end points included all-cause mortality, distal aortic reintervention, stroke, and malperfusion syndrome.</div></div><div><h3>Results</h3><div>A total of 357 patients underwent surgery for acute type A aortic dissection; 76 (21.3%) received total arch replacement, and 281 (78.7%) received proximal aortic repair. The frequency of total arch replacement increased over time (<em>P &lt; .</em>01). In-hospital mortality was higher for total arch replacement between 1992 and 2009 (39.2% vs 20.3%, <em>P = .</em>03), but became more comparable to proximal aortic repair from 2010 onward (16.7% vs 13.0%, <em>P = .</em>53). For total arch replacement and proximal aortic repair, 10-year cumulative survival was 64.3% (95% CI, 52.3-76.2) and 54.3% (95% CI, 47.6-61.0), respectively. After initial 30-day postoperative survival, long-term mortality risk appeared lower for total arch replacement (hazard ratio, 0.49, 95% CI, 0.23-1.07), although not statistically significant. No significant differences in distal aortic reinterventions were observed (hazard ratio, 1.38; 95% CI, 0.67-2.82). The incidence of in-hospital stroke (17.1% vs 17.1%, <em>P</em> = 1.00) and malperfusion syndrome (28.9% vs 28.2%, <em>P</em> = .90) was comparable between both groups.</div></div><div><h3>Conclusions</h3><div>In-hospital mortality after acute type A aortic dissection decreased over time despite the implementation of an aggressive approach to the dissected aortic arch. Long-term survival appears favorable after total arch replacement, but remains contingent on early postoperative survival. The surgical approach should be based on the patient's clinical presentation, while considering total arch replacement in patients at risk of aortic arch reinterventions.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 69-80"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464398","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":"Association of intraoperative transfusion of blood products with postoperative outcomes and midterm survival in acute type A aortic dissection repair","authors":"Elizabeth L. Norton MD,&nbsp;Akul Arora MD,&nbsp;Busra Cangut MD, MS,&nbsp;Divyaam Satija BS,&nbsp;Marc Titsworth BS,&nbsp;Rana-Armaghan Ahmad BS,&nbsp;Carol Ling MSc, PhD,&nbsp;Karen Kim MD,&nbsp;Shinichi Fukuhara MD,&nbsp;Himanshu J. Patel MD,&nbsp;Bo Yang MD, PhD","doi":"10.1016/j.xjon.2024.10.033","DOIUrl":"10.1016/j.xjon.2024.10.033","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to evaluate the impact of intraoperative blood product on postoperative outcomes and midterm survival in acute type A aortic dissection repair.</div></div><div><h3>Methods</h3><div>Patients undergoing open acute type A aortic dissection repair from January 2010 to April 2020 were divided into 2 groups: patients receiving intraoperative blood products and no intraoperative blood products, with a final propensity-matched cohort of 90 matched pairs by matching sex, age, body mass index, preoperative hemoglobin, coronary artery disease, renal failure, stroke, prior cardiac surgery, cardiogenic shock, cardiopulmonary bypass time, crossclamp time, peripheral vascular disease, and aortic insufficiency.</div></div><div><h3>Results</h3><div>Patients were similar in demographic and preoperative characteristics. The complexity of the surgery, including the extent of aortic root and arch repair, was similar between the groups. The intraoperative blood product group had longer intubation time (77 hours vs 44 hours, <em>P</em> = .023), longer postoperative (14 vs 10 days, <em>P</em> = .0001) and total (15 vs 10 days, <em>P</em> &lt; .0001) length of stays, and a higher rate of acute renal failure postoperatively (16.7% vs 6.7%, <em>P</em> = .037). The 6-year survival was similar between the intraoperative blood product group and no intraoperative blood product group (76.5% vs 83.3%, <em>P</em> = .48). The multivariate Cox proportional hazard model showed a statistically insignificant hazard ratio of 1.27 in the intraoperative blood product group for midterm mortality (95% CI, 0.64-2.54, <em>P</em> = .50).</div></div><div><h3>Conclusions</h3><div>Intraoperative blood product use during acute type A aortic dissection repair did not impact midterm survival but increased postoperative complications. Intraoperative blood product transfusion can be safely and cautiously used during acute type A aortic dissection repair.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 51-59"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464437","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":"Protective biomechanical and histological changes in the false lumen wall in chronic type B aortic dissection","authors":"Hai Dong PhD ,&nbsp;Minliang Liu PhD ,&nbsp;Hannah L. Cebull PhD ,&nbsp;Arshiya Chhabra BE ,&nbsp;Yumeng Zhou BE ,&nbsp;Marina Piccinelli PhD ,&nbsp;John N. Oshinski PhD ,&nbsp;John A. Elefteriades MD, PhD (Hon) ,&nbsp;Rudolph L. Gleason Jr. PhD ,&nbsp;Bradley G. Leshnower MD","doi":"10.1016/j.xjon.2024.11.012","DOIUrl":"10.1016/j.xjon.2024.11.012","url":null,"abstract":"<div><h3>Objective</h3><div>The outer false lumen wall (FLW) changes from thin/compliant to thick/rigid as aortic dissection transitions from the acute to chronic phase. This study investigates biomechanical stiffness and histological changes of the FLW as the dissected aorta ages.</div></div><div><h3>Methods</h3><div>The free outer FLW from human tissue was analyzed from chronic type B dissection (chronic-FLW) n = 10, acute type A dissection (acute-FLW) n = 10, and transplant donor descending aorta that was manually peeled into 2 layers (control-FLW) n = 17. Biaxial tension testing in the longitudinal and circumferential directions was performed and stress-strain curves were obtained. A lower and higher tangent modulus was determined to assess stiffness. Quantification of collagen and elastin was performed by calculating the fibers’ volume fraction from Z-stack scans.</div></div><div><h3>Results</h3><div>The higher tangent modulus of chronic-FLW is larger (<em>P</em> &lt; .01) than the acute-FLW and control-FLW in longitudinal (5.09 ± 0.9 MPa vs 1.72 ± 0.56 MPa and 1.17 ± 0.22 MPa) and circumferential (4.16 ± 0.67 MPa vs 1.04 ± 0.24 MPa and 1.07 ± 0.16 MPa) directions. The lower tangent modulus of chronic-FLW is larger (<em>P</em> &lt; .05) than acute-FLW and control-FLW in both directions (longitudinal: 0.72 ± 0.24 MPa vs 0.13 ± 0.02 MPa and 0.27 ± 0.03 MPa circumferential:0.44 ± 0.13 MPa vs 0.12 ± 0.01 MPa and 0.21 ± 0.02 MPa). The volume fraction of collagen was increased (<em>P</em> &lt; .01) and the volume fraction of elastin was decreased (<em>P</em> &lt; .001) when comparing chronic-FLW, acute-FLW, and control-FLW (collagen-volume fraction: 0.24 ± 0.03 vs 0.12 ± 0.03 and 0.08 ± 0.02; elastin-volume fraction: 0.09 ± 0.03 vs 0.28 ± 0.03 and 0.39 ± 0.04).</div></div><div><h3>Conclusions</h3><div>As the acutely dissected aorta transitions to the chronic phase, the FL remodels by increasing collagen, decreasing elastin, and increasing aortic stiffness and thickness. This change in the chronic-FLW may be a protective adaptation to prevent FL enlargement and rupture in type B aortic dissection.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 60-68"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464438","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}