JTCVS open最新文献

{"title":"RBT-1 Reduces Blood Product Utilization in Patients Undergoing Non-Emergent Coronary Artery Bypass Grafting and/or Valve Surgery","authors":"Charles A. Mack, M. Jessen, Andre Lamy, Ashish Khanna, Kevin Lobdell, Rakesh Arora, Jeannette Rodriguez, Stacey Ruiz, Bhupinder Singh","doi":"10.1016/j.xjon.2024.06.019","DOIUrl":"https://doi.org/10.1016/j.xjon.2024.06.019","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696725","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":"An evaluation of the outcomes associated with peritoneal catheter use in neonates undergoing cardiac surgery: A multicenter study","authors":"David M. Kwiatkowski MD, MS ,&nbsp;Jeffrey A. Alten MD ,&nbsp;Kenneth E. Mah MD ,&nbsp;David T. Selewski MD ,&nbsp;Tia T. Raymond MD, MBA ,&nbsp;Natasha S. Afonso MD, MPH ,&nbsp;Joshua J. Blinder MD ,&nbsp;Matthew T. Coghill MD ,&nbsp;David S. Cooper MD, MPH ,&nbsp;Joshua D. Koch MD ,&nbsp;Catherine D. Krawczeski MD ,&nbsp;David L.S. Morales MD ,&nbsp;Tara M. Neumayr MD ,&nbsp;A.K.M. Fazlur Rahman PhD ,&nbsp;Garrett Reichle MS ,&nbsp;Sarah Tabbutt MD, PhD ,&nbsp;Tennille N. Webb MD ,&nbsp;Santiago Borasino MD","doi":"10.1016/j.xjon.2024.03.009","DOIUrl":"10.1016/j.xjon.2024.03.009","url":null,"abstract":"<div><h3>Objective</h3><p>The study objective was to determine if intraoperative peritoneal catheter placement is associated with improved outcomes in neonates undergoing high-risk cardiac surgery with cardiopulmonary bypass.</p></div><div><h3>Methods</h3><p>This propensity score–matched retrospective study used data from 22 academic pediatric cardiac intensive care units. Consecutive neonates undergoing Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery category 3 to 5 cardiac surgery with cardiopulmonary bypass at centers participating in the NEonatal and Pediatric Heart Renal Outcomes Network collaborative were studied to determine the association of the use of an intraoperative placed peritoneal catheter for dialysis or passive drainage with clinical outcomes, including the duration of mechanical ventilation.</p></div><div><h3>Results</h3><p>Among 1490 eligible neonates in the NEonatal and Pediatric Heart Renal Outcomes Network dataset, a propensity-matched analysis was used to compare 395 patients with peritoneal catheter placement with 628 patients without peritoneal catheter placement. Time to extubation and most clinical outcomes were similar. Postoperative length of stay was 5 days longer in the peritoneal catheter placement cohort (17 vs 22 days, <em>P</em> = .001). There was a 50% higher incidence of moderate to severe acute kidney injury in the no-peritoneal catheter cohort (12% vs 18%, <em>P</em> = .02). Subgroup analyses between specific treatments and in highest risk patients yielded similar associations.</p></div><div><h3>Conclusions</h3><p>This study does not demonstrate improved outcomes among neonates with placement of a peritoneal catheter during cardiac surgery. Outcomes were similar apart from longer hospital stay in the peritoneal catheter cohort. The no-peritoneal catheter cohort had a 50% higher incidence of moderate to severe acute kidney injury (12% vs 18%). This analysis does not support indiscriminate peritoneal catheter use, although it may support the utility for postoperative fluid removal among neonates at risk for acute kidney injury. A multicenter controlled trial may better elucidate peritoneal catheter effects.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000688/pdfft?md5=c36f936319a101fe5d6c4b4f8d96cfa9&pid=1-s2.0-S2666273624000688-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399684","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":"Long-term outcomes of surgical or endovascular treatment of adult with midaortic syndrome: A single-center retrospective study over a 14-year period","authors":"Hao Liu MD, PhD ,&nbsp;Tianyue Pan MD, PhD ,&nbsp;Bin Chen MD, PhD ,&nbsp;Junhao Jiang MD, PhD ,&nbsp;Weiguo Fu MD, PhD ,&nbsp;Zhihui Dong MD, PhD","doi":"10.1016/j.xjon.2024.03.011","DOIUrl":"10.1016/j.xjon.2024.03.011","url":null,"abstract":"<div><h3>Objective</h3><p>Midaortic syndrome is a rare clinical condition that has been mainly studied in juveniles through case reports and series. This study aims to report the anatomic characteristics and long-term outcomes of 41 adult patients with midaortic syndrome who received open surgical treatment or endovascular treatment over a 14-year period.</p></div><div><h3>Methods</h3><p>A consecutive cohort of 41 adult patients diagnosed with midaortic syndrome at our center between January 2008 and November 2021 were enrolled in the study. Patients’ baseline and anatomic characteristics were collected and analyzed. Primary follow-up outcomes included death and reintervention. Other follow-up outcomes included hypertension and complications.</p></div><div><h3>Results</h3><p>The study enrolled 41 adult patients with midaortic syndrome with a mean age of 37.5 ± 13.4 years. Twenty-five patients received open surgical treatment, and 16 patients received endovascular treatment. Isolated infrarenal lesions were more likely to be found in the endovascular treatment group (<em>P = .</em>005), whereas patients with multiple (<em>P = .</em>002) or intravisceral involvement (<em>P = .</em>001) were more likely to be found in the open surgical treatment group. The open surgical treatment group was more likely to have a lower postoperative peak systolic pressure gradient (<em>P = .</em>020). The 5- and 10-year reintervention-free survivals were 87.7% and 71.7% in the open surgical treatment group and 92.3% and 79.1% in the endovascular treatment group, respectively.</p></div><div><h3>Conclusions</h3><p>Both open surgical treatment and endovascular treatment showed satisfactory long-term efficacy outcomes for adult patients with midaortic syndrome. Given the patients’ relatively young age and long life expectancy, strict and regular lifelong follow-up is necessary.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000901/pdfft?md5=c66160fa35c72c9abeb3ef82a7d4063b&pid=1-s2.0-S2666273624000901-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140401330","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":"Left ventricular reverse remodeling after aortic valve replacement or repair in bicuspid aortic valve with moderate or greater aortic regurgitation","authors":"Jonathan D. Kochav MD ,&nbsp;Hiroo Takayama MD, PhD ,&nbsp;Andrew Goldstone MD, PhD ,&nbsp;David Kalfa MD, PhD ,&nbsp;Emile Bacha MD ,&nbsp;Marlon Rosenbaum MD ,&nbsp;Matthew J. Lewis MD, MPH","doi":"10.1016/j.xjon.2024.03.006","DOIUrl":"10.1016/j.xjon.2024.03.006","url":null,"abstract":"<div><h3>Objective</h3><p>Bicuspid aortic valve (AV) patients with aortic regurgitation (AR) differ from tricuspid AV patients given younger age, greater left ventricle (LV) compliance, and more prevalent aortic stenosis (AS). Bicuspid AV-specific data to guide timing of AV replacement or repair are lacking.</p></div><div><h3>Methods</h3><p>Adults with bicuspid AV and moderate or greater AR who underwent aortic valve replacement or repair at our center were studied. The presurgical echocardiogram, and echocardiograms within 3 years postoperatively were evaluated for LV geometry/function, and AV function. Semiquantitative AS/AR assessment was performed in all patients with adequate imaging.</p></div><div><h3>Results</h3><p>One hundred thirty-five patients (85% men, aged 44.5 ± 15.9 years) were studied (63% pure AR, 37% mixed AS/AR). Following aortic valve replacement or repair, change in LV end-diastolic dimension and change in LV end-diastolic volume were associated with preoperative LV end-diastolic dimension (β = 0.62 Δcm/cm; 95% CI, 0.43-0.73 Δcm/cm; <em>P</em> &lt; .001), and LV end-diastolic volume (β = 0.6 ΔmL/mL; 95% CI, 0.4-0.7 ΔmL/mL; <em>P</em> &lt; .001), respectively, each independent of AR/AS severity (<em>P</em> = not significant). Baseline LV size predicted postoperative normalization (LV end-diastolic dimension: odds ratio, 3.75/cm; 95% CI, 1.61-8.75/cm, LV end-diastolic volume: odds ratio, 1.01/mL; 95% CI, 1.004-1.019/mL, both <em>P</em> values &lt; .01) whereas AR/AS severity did not (<em>P</em> = not significant). Indexed LV end diastolic volume outperformed LV end-diastolic dimension in predicting postoperative LV normalization (area under the curve = 0.74 vs 0.61) with optimal diagnostic cutoffs of 99 mL/m² and 6.1 cm, respectively. Postoperative indexed LV end diastolic volume dilatation was associated with increased risk of death, transplant/ventricular assist device, ventricular arrhythmia, and reoperation (hazard ratio, 6.1; 95% CI, 1.7-21.5; <em>P</em> &lt; .01).</p></div><div><h3>Conclusions</h3><p>Remodeling extent following surgery in patients with bicuspid AV and AR relates to preoperative LV size independent of valve disease phenotype or severity. Many patients with LV end-diastolic dimension below current surgical thresholds did not normalize LV size. LV volumetric assessment offered superior diagnostic performance for predicting residual LV dilatation, and postoperative indexed LV end diastolic volume dilatation was associated with adverse prognosis.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000652/pdfft?md5=228f2024c58b19ea8c78046c1a5112de&pid=1-s2.0-S2666273624000652-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402467","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":"Thoracic aortic surgery in low- and middle-income countries: Time to bridge the gap?","authors":"Dominique Vervoort MD, MPH, MBA ,&nbsp;Dimitri Tchienga MD ,&nbsp;Maral Ouzounian MD, PhD ,&nbsp;Charles Mve Mvondo MD","doi":"10.1016/j.xjon.2024.03.002","DOIUrl":"10.1016/j.xjon.2024.03.002","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000603/pdfft?md5=f5a4957ce040d73404d49e8ccb1e1691&pid=1-s2.0-S2666273624000603-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278045","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: The art of winning an unfair game: Immediate aortic repair for mesenteric malperfusion syndrome","authors":"James A. Brown MD, MS ,&nbsp;Ibrahim Sultan MD","doi":"10.1016/j.xjon.2024.04.013","DOIUrl":"10.1016/j.xjon.2024.04.013","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001165/pdfft?md5=5ede001a5889f1a8537059923d79d0a8&pid=1-s2.0-S2666273624001165-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775020","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":"POBS-Card, a new score of severe bleeding after cardiac surgery: Construction and external validation","authors":"Emmanuel Besnier MD, PhD ,&nbsp;Pierre Schmidely MD ,&nbsp;Guillaume Dubois MD ,&nbsp;Prisca Lemonne MD ,&nbsp;Lucie Todesco MD ,&nbsp;Chadi Aludaat MD ,&nbsp;Thierry Caus MD, PHD ,&nbsp;Jean Selim MD, PhD ,&nbsp;Emmanuel Lorne MD, PhD ,&nbsp;Osama Abou-Arab MD, PhD","doi":"10.1016/j.xjon.2024.04.008","DOIUrl":"10.1016/j.xjon.2024.04.008","url":null,"abstract":"<div><h3>Objective</h3><p>Bleeding after cardiac surgery leads to poor outcomes. The objective of the study was to build the PeriOperative Bleeding Score in Cardiac surgery (POBS-Card) to predict bleeding after cardiac surgery.</p></div><div><h3>Methods</h3><p>We conducted a retrospective cohort study in 2 academic hospitals (2016-2019). Inclusion criteria were adult patients after cardiac surgery under cardiopulmonary bypass. Exclusion criteria were heart transplantation, assistance, aortic dissection, and preoperative hemostasis diseases. Bleeding was defined by the universal definition for perioperative bleeding score ≥2. POBS-Card score was built using multivariate regression (derivation cohort, one center). The performance diagnosis was assessed using the area under the curve in a validation cohort (2 centers) and compared with other scores.</p></div><div><h3>Results</h3><p>In total, 1704 patients were included in the derivation cohort, 344 (20%) with bleeding. Preoperative factors were body mass index &lt;25 kg/m² (odds ratio [OR], 1.48 [1.14-1.93]), type of surgery (redo: OR, 1.76 [1.07-2.82]; combined: OR, 1.81 [1.19-2.74]; ascendant aorta: OR, 1.56 [1.02-2.38]), ongoing antiplatelet therapy (single: OR, 1.50 [1.09-2.05]; double: OR, 2.00 [1.15-3.37]), activated thromboplastin time ratio &gt;1.2 (OR, 1.44 [1.03-1.99]), prothrombin ratio &lt;60% (OR, 1.91 [1.21-2.97]), platelet count &lt;150 g/L (OR, 1.74 [1.17-2.57]), and fibrinogen &lt;3 g/L (OR, 1.33 [1.02-1.73]). In the validation cohort of 597 patients, the area under the curve was 0.645 [0.605-0.683] and was superior to other scores (WILL-BLEED, Papworth, TRUST, TRACK). A threshold &gt;14 predicted bleeding with a sensitivity of 50% and a specificity of 73%.</p></div><div><h3>Conclusions</h3><p>POBS-Card score was superior to other scores in predicting severe bleeding after cardiac surgery. Performances remained modest, questioning the place of these scores in the perioperative strategy of bleeding-sparing.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001104/pdfft?md5=4b42f2c29a6781090215a943bfd8bbb0&pid=1-s2.0-S2666273624001104-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756817","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":"Current definitions of hemodynamic structural valve deterioration after bioprosthetic aortic valve replacement lack consistency","authors":"Bart J.J. Velders MD ,&nbsp;Michiel D. Vriesendorp MD, PhD ,&nbsp;Federico M. Asch MD ,&nbsp;Michael J. Reardon MD ,&nbsp;Francois Dagenais MD ,&nbsp;Michael G. Moront MD ,&nbsp;Joseph F. Sabik III MD ,&nbsp;Rolf H.H. Groenwold MD, PhD ,&nbsp;Robert J.M. Klautz MD, PhD","doi":"10.1016/j.xjon.2024.02.023","DOIUrl":"10.1016/j.xjon.2024.02.023","url":null,"abstract":"<div><h3>Objective</h3><p>New echocardiographic definitions have been proposed for hemodynamic structural valve deterioration. We aimed to study their consistency in classifying structural valve deterioration after surgical aortic valve replacement.</p></div><div><h3>Methods</h3><p>Data were used of patients undergoing surgical aortic valve replacement in a multicenter, prospective cohort study with a 5-year follow-up. All patients received the same stented bioprosthesis. Echocardiographic parameters were assessed by an independent core laboratory. Moderate or greater stenotic hemodynamic structural valve deterioration was defined according to Capodanno and colleagues, Dvir and colleagues, and the Valve Academic Research Consortium 3; regurgitation data were not considered in this analysis. Consistency was quantified on the basis of structural valve deterioration classification at subsequent time points.</p></div><div><h3>Results</h3><p>A total of 1118 patients received implants. Patients’ mean age was 70 years, and 75% were male. Hemodynamic structural valve deterioration at any visit was present in 51 patients (4.6%), 32 patients (2.9%), and 34 patients (3.0%) according to Capodanno, Dvir, and Valve Academic Research Consortium 3. A total of 1064 patients (95%) were never labeled with structural valve deterioration by any definition. After the first classification with structural valve deterioration, 59%, 59%, and 65% had no subsequent structural valve deterioration classification according to Capodanno, Dvir, and Valve Academic Research Consortium 3, respectively.</p></div><div><h3>Conclusions</h3><p>The current definitions of hemodynamic structural valve deterioration are strong negative predictors but inconsistent positive discriminators for the detection of stenotic hemodynamic structural valve deterioration. Although the diagnosis of structural valve deterioration may be categorical, echocardiographic indices lack this degree of precision in the first 5 years after surgical aortic valve replacement. The inconsistency of current structural valve deterioration definitions impedes the detection of true valve degeneration, which challenges the clinical usefulness of these definitions.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000597/pdfft?md5=b09e5cceb462850bc2444a7be1282d40&pid=1-s2.0-S2666273624000597-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140274921","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":"Noncomplex ventricular arrhythmia associated with greater freedom from recurrent ectopy at 1 year after mitral repair surgery","authors":"Dimosthenis Pandis MD, MSc ,&nbsp;Navindra David BS ,&nbsp;Ahmed EI-Eshmawi MD ,&nbsp;Marc A. Miller MD ,&nbsp;Percy Boateng MD ,&nbsp;Ana Claudia Costa MD, PhD ,&nbsp;Philip Robson PhD ,&nbsp;Maria Giovanna Trivieri MD ,&nbsp;Zahi Fayad PhD ,&nbsp;Anelechi C. Anyanwu MD, MSc ,&nbsp;David H. Adams MD","doi":"10.1016/j.xjon.2024.04.005","DOIUrl":"10.1016/j.xjon.2024.04.005","url":null,"abstract":"<div><h3>Objective</h3><p>The effect of mitral valve (MV) surgery on the natural history of ventricular arrhythmia (VA) in patients with arrhythmic MV prolapse remains unknown. We sought to evaluate the cumulative incidence of VA at 1 year after surgical mitral repair.</p></div><div><h3>Methods</h3><p>A retrospective review of progressively captured data identified 204 consecutive patients who underwent elective MV repair for significant degenerative mitral regurgitation as a first-time cardiovascular intervention in a quaternary reference center between January 2018 and December 2020. A subset of 62 consecutive patients with diagnosed arrhythmic MV prolapse was further evaluated for recurrent VA after MV repair.</p></div><div><h3>Results</h3><p>The median age was 62 years (range, 27-77 years) and 26 of 62 (41.9%) were female. The median time from initial mitral regurgitation/MV prolaspe diagnosis-to-referral was 13.8 years (interquartile range [IQR], 5.4-25) and from VA diagnosis-to-referral was 8 years (IQR, 3-10.6). Using the Lown-Wolf classification, complex VA (Lown grade ≥3) was identified in 36 of 62 patients (58%) at baseline, whereas 8 of 62 (13%) had a cardioverter/defibrillator implanted for primary (4/8) or secondary (4/8) prevention. Left ventricular myocardial scar was confirmed in 23 of 34 (68%) of patients scanned at baseline. The prevailing valve phenotype was bileaflet Barlow (59/62; 95.2%). All patients underwent surgical MV repair by the same team. Surgical repair was stabilized with an annuloplasty prosthesis (median size 36 mm [IQR, 34-38]). Concomitant procedures included tricuspid valve repair (51/62; 82.3%), cryo-maze ± left atrial appendage exclusion (14/62, 23%), and endocardial cryoablation of VA ectopy (4/62; 6.5%). The 30-day and 1-year freedom from recurrent VA were 98.4% and 75.9%, respectively. Absent VA after mitral repair was uniformly observed in patients with minor VA at baseline. Absent VA after mitral repair was uniformly observed in patients with minor VA preoperatively. Complex baseline VA was the strongest predictor of recurrent VA (hazard ratio, 10.8; 95% confidence interval, 1.4-84.2; <em>P</em> = .024), irrespective of myocardial fibrosis.</p></div><div><h3>Conclusions</h3><p>In a series of 62 consecutive patients operated electively for arrhythmic mitral prolapse, VA remained undetected in 75.9% of patients at 1 year. Freedom from recurrent VA was greater among patients without complex VA preoperatively, whereas baseline Lown grade ≥3 was the strongest independent risk factor for recurrent VA at 1 year. These findings attest to the importance of early recognition and prompt referral of patients with mitral prolapse and progressive VA to specialty interdisciplinary care.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001074/pdfft?md5=654dde242501a48612881a9d15e1694d&pid=1-s2.0-S2666273624001074-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140771302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-specific and organ-centric approach in malperfusion in acute type A dissection","authors":"Bashisth Mishra Mch ,&nbsp;Simiyu R. Namungu MMED ,&nbsp;Abdifatah A. Mohamed MD","doi":"10.1016/j.xjon.2024.04.002","DOIUrl":"10.1016/j.xjon.2024.04.002","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001049/pdfft?md5=57653fce47760fd7e905da7c0c7bb4a2&pid=1-s2.0-S2666273624001049-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781329","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}