JTCVS open最新文献_第4页

Understanding the influence of temporary neurologic dysfunction in the outcomes of aortic surgery 了解暂时性神经功能障碍对主动脉手术结果的影响

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.031

Valeria Jimenez BA , Kavya Rajesh BS , Connor Barrett BA , Megan Chung BA , Yanling Zhao MS, MPH , Paul Kurlansky MD , Joshua Willey MD , Adham Elmously MD , Thomas O'Donnell MD , Virendra Patel MD, MPH , Hiroo Takayama MD, PhD

Objective

Temporary neurologic dysfunction (ND) is common after aortic surgery. The Valve Academic Research Consortium 3 classifies ND as NeuroARC Type 1 (stroke), Type 2 (covert injury), and Type 3 (transient ischemic attack/delirium without injury). This study applies these definitions to aortic surgery, focusing on Type 3.

Methods

A single-center retrospective analysis of adult patients with open thoracic aortic surgery from March 2005 to December 2023 was performed. Primary end points were mortality and major postoperative complications (reoperation for bleeding, respiratory failure, and acute renal failure). Propensity score weighting using overlap weights balanced covariates between Type 3 and no ND groups. Kaplan-Meier curves and Cox regression analyzed mortality. Multivariable logistic regression identified factors associated with Type 3 ND.

Results

Of 2432 patients, 103 (4.2%) had Type 1, 216 (8.9%) Type 3, and 2113 (86.9%) had no ND. Median age was 62 years (range, 52-71 years), 609 (25.0%) were women, and 1839 (75.6%) underwent aneurysm repair. After balancing, major postoperative complication rates were 49.2% versus 27.6% in Type 3 and no ND, respectively (P < .001). There was no difference in 11-year survival (P = .943) and Type 3 was not independently associated with mortality. Variables associated with Type 3: age (OR 1.05, 1.048; P < .001), left ventricular ejection fraction (OR 0.98, 0.984; P = .018), cerebrovascular disease (OR 2.01, 2.011; P = .001), cardiopulmonary bypass time in minutes (OR 1.004, 1.004; P = .002), retrograde cerebral perfusion (OR 4.25, 4.251; P < .001), and major postoperative complications (OR 3.67, P < .001).

Conclusions

Type 3 occurs in about 10% of cases and is associated with in-hospital complications but not mortality. Identified risk factors may aid in prevention.

目的主动脉手术后出现暂时性神经功能障碍（ND）较为常见。Valve学术研究联盟3将ND分为NeuroARC 1型（中风）、2型（隐蔽损伤）和3型（无损伤的短暂性脑缺血发作/谵妄）。本研究将这些定义应用于主动脉手术，重点是3型。方法对2005年3月至2023年12月行开胸主动脉手术的成人患者进行单中心回顾性分析。主要终点是死亡率和主要术后并发症（因出血、呼吸衰竭和急性肾功能衰竭而再次手术）。倾向得分加权使用重叠权平衡协变量之间的3型和非ND组。Kaplan-Meier曲线和Cox回归分析死亡率。多变量logistic回归确定了与3型ND相关的因素。结果2432例患者中，1型103例（4.2%），3型216例（8.9%），无ND 2113例（86.9%）。中位年龄为62岁（52-71岁），女性609例（25.0%），1839例（75.6%）行动脉瘤修复术。经过权衡，3型和非ND组的术后主要并发症发生率分别为49.2%和27.6% （P < .001）。11年生存率无差异（P = 0.943）， 3型与死亡率无独立相关性。与3型相关的变量：年龄（OR 1.05, 1.048; P < .001）、左心室射血分数（OR 0.98, 0.984; P = 0.018）、脑血管疾病（OR 2.01, 2.011; P = .001）、体外循环时间（OR 1.004, 1.004; P = .002）、逆行脑灌注（OR 4.25, 4.251; P < .001）、术后主要并发症（OR 3.67, P < .001）。结论3型发生率约为10%，与院内并发症有关，但与死亡无关。确定的危险因素可能有助于预防。

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引用次数: 0

Constipation in patients undergoing cardiac surgery: Incidence and risk factors 心脏手术患者便秘：发生率和危险因素

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.08.007

Masahiko Narita MD, Masahiro Tsutsui MD, Nobuhiro Mochizuki MD, Fumitaka Suzuki MD, Yuki Setogawa MD, Aina Hirofuji MD, Shingo Kunioka MD, Natsuya Ishikawa MD, PhD, Hiroyuki Kamiya MD, PhD

Objective

Constipation following cardiac surgery is a frequently experienced complication in postoperative management. This study aimed to explore the incidence and risk factors for constipation after cardiac surgery.

Methods

We retrospectively analyzed data from 370 adult cardiac surgeries performed at our institution between January 2019 and December 2020. Postoperative constipation was defined as the absence of defecation for >144 hours after surgery. Participants were classified into a postoperative constipation or nonconstipation group. Multivariate logistic regression was performed to estimate the patient-specific perioperative factors associated with postoperative constipation.

Results

A total of 72 (19.5%) patients developed postoperative constipation. Patients in the postoperative constipation group had higher rates of prolonged intubation (P < .001), higher 30-day mortality (P < .001), and longer intensive care unit stay (P < .001) than those in the nonconstipation group. Gastrointestinal complications were more common in the postoperative constipation group; however, the difference was not statistically significant (P = .087). Multivariate analysis demonstrated that peripheral artery disease (odds ratio [OR], 3.18; 95% CI, 1.23-8.24; P = .017), prior percutaneous coronary intervention (OR, 2.34; 95% CI, 1.12-4.89; P = .024), prolonged intubation (OR, 3.14; 95% CI, 1.35-7.29; P = .008), delayed nutrition (OR, 3.40; 95% CI, 1.13-10.26; P = .030), and vasopressin use (OR, 5.79; 95% CI, 1.38-14.52; P = .012) were independently predictive of postoperative constipation.

Conclusions

In patients undergoing cardiac surgery, 5 predictive risk factors for postoperative constipation were identified. Understanding these predictive factors will aid in direct risk assessments and the development of targeted treatments to prevent postoperative constipation.

目的心脏手术后便秘是术后处理中常见的并发症。本研究旨在探讨心脏手术后便秘的发生率及危险因素。方法回顾性分析2019年1月至2020年12月在我院进行的370例成人心脏手术的数据。术后便秘定义为术后144小时内无法排便。参与者被分为术后便秘组和非便秘组。采用多变量logistic回归来估计与术后便秘相关的患者特异性围手术期因素。结果术后便秘72例（19.5%）。术后便秘组患者插管延长率（P < 0.001）、30天死亡率（P < 0.001）和重症监护病房住院时间（P < 0.001）均高于非便秘组。术后便秘组胃肠道并发症较多；但差异无统计学意义（P = 0.087）。多因素分析表明，外周动脉疾病（优势比[OR]， 3.18; 95% CI, 1.23-8.24; P = 0.017）、既往经皮冠状动脉介入治疗（OR, 2.34; 95% CI, 1.12-4.89; P = 0.024）、延长插管时间（OR, 3.14; 95% CI, 1.35-7.29; P = 0.008）、延迟营养（OR, 3.40; 95% CI, 1.13-10.26; P = 0.030）和加压素使用（OR, 5.79; 95% CI, 1.38-14.52; P = 0.012）是术后便秘的独立预测因素。结论在心脏手术患者中，确定了5个预测术后便秘的危险因素。了解这些预测因素将有助于直接的风险评估和制定有针对性的治疗措施，以预防术后便秘。

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引用次数: 0

Longevity of homograft conduits for infant right ventricular outflow tract reconstruction in the modern era 现代婴儿右心室流出道重建中同种移植物导管的寿命

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.015

Chen Chia Wang BS , Nanda Nayak BA , Jennifer D. Garcia BA , George T. Nicholson MD , David Bichell MD

Background

Homograft conduits are widely used for right ventricular outflow tract (RVOT) reconstruction. The literature reports a 50% 2-year freedom from reoperation for infants age <1 year. Recently, decellularized homografts and transcatheter interventions have been purported to prolong conduit longevity. This study evaluated homograft longevity in the modern era.

Methods

All infants (age <1 year) receiving a homograft RVOT conduit at a single institution between 2006 and 2024 were reviewed. The cumulative incidence function was used to estimate the cumulative probability of reoperation within 2 years, accounting for the competing risk of death. A Fine-Gray regression model with subdistribution hazard ratios (sHRs) identified predictors for reoperation within 2 years. Data on transcatheter interventions also were collected to aid the analysis.

Results

A total of 74 patients met the inclusion criteria, who had a median age of 1.8 months (interquartile range [IQR], 0.3-5.5 months) and median weight of 4.2 kg (IQR, 3.2-5.8 kg) at homograft implantation. The cumulative incidence was 44.1% for surgical reintervention within 2 years and 12.3% for death before reoperation. Younger age, lower weight, smaller homograft size, and lower homograft z-score were associated with increased early reoperation. Nineteen patients (25.7%) had a transcatheter intervention, including 6 (31.6%) before a surgical reoperation, 6 (31.6%) after a surgical reoperation, and 7 (36.8%) without a surgical reintervention.

Conclusions

Compared with the literature, time to operative reintervention after homograft RVOT reconstruction in infants age <1 year has not changed significantly in the modern era, despite the expanded use of decellularized homografts and catheter-based interventions.

背景同种移植物导管在右心室流出道（RVOT）重建中应用广泛。文献报道1岁婴儿2年再手术自由率为50%。最近，脱细胞同种移植物和经导管介入被认为可以延长导管的寿命。本研究评估了现代同种移植物的寿命。方法回顾性分析2006年至2024年在同一医院接受同种RVOT导管移植的所有婴儿（1岁）。累积发生率函数用于估计2年内再手术的累积概率，并考虑竞争死亡风险。一个带有亚分布风险比（sHRs）的细灰色回归模型确定了2年内再次手术的预测因子。还收集了经导管介入治疗的数据以辅助分析。结果共74例患者符合纳入标准，同种异体移植时的中位年龄为1.8个月（四分位间距[IQR]， 0.3 ~ 5.5个月），中位体重为4.2 kg （IQR, 3.2 ~ 5.8 kg）。2年内再手术的累计发生率为44.1%，再手术前死亡的累计发生率为12.3%。年龄较小、体重较轻、同种移植物尺寸较小、同种移植物z评分较低与早期再手术增加相关。19例（25.7%）患者接受了经导管介入治疗，其中再手术前6例（31.6%），再手术后6例（31.6%），未再手术7例（36.8%）。结论与文献相比，尽管脱细胞异体移植和导管干预的应用越来越广泛，但现代1岁婴儿同种异体移植RVOT重建后再手术干预的时间并没有明显变化。

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引用次数: 0

Guidelines for the management of aortic stenosis: A methodologic review of American college of cardiology/American heart association (ACC/AHA) and the European society of cardiology/European association for cardio-thoracic surgery (ESC/EACTS) recommendations 主动脉瓣狭窄治疗指南：美国心脏病学会/美国心脏协会（ACC/AHA）和欧洲心脏病学会/欧洲心胸外科协会（ESC/EACTS）推荐的方法学综述

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.08.015

Milan Milojevic MD, MSCE, PhD , Michael A. Borger MD, PhD , Aleksandar Nikolic MD, PhD , Patrick O. Myers MD , Faisal G. Bakaeen MD

引用次数: 0

Electrocardiogram-based detection of an atrial cardiomyopathy predicts postoperative supraventricular arrhythmias after lung transplantation 基于心电图检测心房心肌病预测肺移植术后室上心律失常

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.028

Paula C. Kuss MD , Björn C. Frye MD , Ina Hettich MD , Sebastian Fähndrich MD , Daiana Stolz MD , Martin Eichenlaub MD

引用次数: 0

Redo sternotomy in donation after circulatory determination of death and donation after brain death lung donors 脑死亡后肺供体和循环死亡后肺供体再做胸骨切开术

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.033

Lauryn E. Spinetta BA , Suresh Keshavamurthy MD , Brian Jafari BA , Adrian Lawrence MD , Vaidehi Kaza MD, MPH , Matthias Peltz MD , Christopher A. Heid MD , John Murala MD, MBA

引用次数: 0

Association between severe obesity and graft outcomes in pediatric heart transplants 儿童心脏移植中严重肥胖与移植结果的关系

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.07.005

Laksha Lohano , Prem Singh , Arsalan Hyder , Niksha Giyan , FNU Venjhraj

引用次数: 0

Postoperative electroencephalographic anterior asymmetry is associated with neurologic injury and increased morbidity 术后脑电图前侧不对称与神经损伤和发病率增加有关

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.09.014

Michael F. Swartz PhD , Shuichi Yoshitake MD , Laurie E. Seltzer DO , Nechelle Dias BS , Konstantinos S. Mylonas MD , George M. Alfieris MD

Background

Postoperative electroencephalograms (EEGs) are often used to detect seizures after neonatal cardiac surgery. Electroencephalograms can also measure asymmetry, a regional or hemispheric difference in the voltage or frequency that suggests neurologic injury, quantified using the absolute asymmetry spectrogram (AAS). We hypothesized that postoperative asymmetry would be associated with neurologic injury.

Methods

Quantitative EEG monitoring measured the mean AAS from the anterior, posterior, and hemispheric regions at baseline and during postoperative day (POD) 0 to POD 2. Infants were divided into 2 groups: EEG asymmetry, defined as a mean AAS >50% during POD 0, and EEG symmetry, defined as mean AAS ≤50% during POD 0.

Results

In the study cohort of 76 neonates, only the anterior AAS increased significantly from baseline during POD 0 (42.8 ± 7.6% vs 34.6 ± 9.4%; P < .01). Fourteen neonates (18.4%) developed EEG asymmetry on POD 0, all from the anterior region. There were no significant differences in demographic characteristics between the 2 study groups. The EEG asymmetry group had a significantly higher rate of seizures (21.4% vs 3.2%; P = .04) and stroke (28.5% vs 3.2%; P = .009), and longer hospital length of stay (median, 36.5 [interquartile range (IQR), 24.3-87.0] days vs 17.0 [IQR, 11.0-31.3] days; P < .01). Multivariate analysis confirmed that asymmetry was associated with a greater incidence of stroke (odds ratio, 9.116; 95% confidence interval, 1.365-60.870; P = .023).

Conclusions

Asymmetry was associated with neurologic injury and increased morbidity. Quantitative EEG monitoring may be an important adjunct during the early postoperative period to identify neonates at risk for neurologic injury and increased morbidity.

背景术后脑电图（eeg）常用于检测新生儿心脏手术后癫痫发作。脑电图也可以测量不对称性，即电压或频率的区域或半球差异，表明神经损伤，使用绝对不对称谱图（AAS）进行量化。我们假设术后不对称与神经损伤有关。方法定量脑电图监测在基线和术后第0 ~ 2天（POD 0 ~ POD 2）测量前、后、半脑区的平均AAS。将婴儿分为两组：脑电不对称组，定义为POD 0期间平均AAS≤50%；脑电对称组，定义为POD 0期间平均AAS≤50%。结果76例新生儿在POD 0期间，只有前侧AAS较基线显著增加（42.8±7.6% vs 34.6±9.4%;P < 0.01）。14例（18.4%）新生儿在POD 0出现脑电图不对称，均来自前区。两个研究组的人口统计学特征无显著差异。脑电图不对称组癫痫发作率（21.4%比3.2%,P = 0.04）和脑卒中率（28.5%比3.2%,P = 0.009）显著高于对照组，住院时间(中位数，36.5[四分位数间距（IQR）， 24.3-87.0]天比17.0 [IQR, 11.0-31.3]天；P < .01)。多因素分析证实，不对称与卒中发生率增高相关（优势比为9.116；95%可信区间为1.365-60.870;P = 0.023）。结论不对称与神经系统损伤及发病率增高有关。定量脑电图监测可能是术后早期识别新生儿神经损伤风险和发病率增加的重要辅助手段。

{"title":"Postoperative electroencephalographic anterior asymmetry is associated with neurologic injury and increased morbidity","authors":"Michael F. Swartz PhD , Shuichi Yoshitake MD , Laurie E. Seltzer DO , Nechelle Dias BS , Konstantinos S. Mylonas MD , George M. Alfieris MD","doi":"10.1016/j.xjon.2025.09.014","DOIUrl":"10.1016/j.xjon.2025.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative electroencephalograms (EEGs) are often used to detect seizures after neonatal cardiac surgery. Electroencephalograms can also measure asymmetry, a regional or hemispheric difference in the voltage or frequency that suggests neurologic injury, quantified using the absolute asymmetry spectrogram (AAS). We hypothesized that postoperative asymmetry would be associated with neurologic injury.</div></div><div><h3>Methods</h3><div>Quantitative EEG monitoring measured the mean AAS from the anterior, posterior, and hemispheric regions at baseline and during postoperative day (POD) 0 to POD 2. Infants were divided into 2 groups: EEG asymmetry, defined as a mean AAS >50% during POD 0, and EEG symmetry, defined as mean AAS ≤50% during POD 0.</div></div><div><h3>Results</h3><div>In the study cohort of 76 neonates, only the anterior AAS increased significantly from baseline during POD 0 (42.8 ± 7.6% vs 34.6 ± 9.4%; <em>P</em> < .01). Fourteen neonates (18.4%) developed EEG asymmetry on POD 0, all from the anterior region. There were no significant differences in demographic characteristics between the 2 study groups. The EEG asymmetry group had a significantly higher rate of seizures (21.4% vs 3.2%; <em>P</em> = .04) and stroke (28.5% vs 3.2%; <em>P</em> = .009), and longer hospital length of stay (median, 36.5 [interquartile range (IQR), 24.3-87.0] days vs 17.0 [IQR, 11.0-31.3] days; <em>P</em> < .01). Multivariate analysis confirmed that asymmetry was associated with a greater incidence of stroke (odds ratio, 9.116; 95% confidence interval, 1.365-60.870; <em>P</em> = .023).</div></div><div><h3>Conclusions</h3><div>Asymmetry was associated with neurologic injury and increased morbidity. Quantitative EEG monitoring may be an important adjunct during the early postoperative period to identify neonates at risk for neurologic injury and increased morbidity.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 517-525"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697715","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

Understanding our thoracic surgery workforce: Who, what, and where we practice 了解我们的胸外科工作人员：谁，做什么，在哪里工作

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.08.016

Jacob Daniel , Malcolm DeCamp MD , Jennifer Romano MD , Betty Tong MD , Michael Moulton MD , John Mitchell MD , Carl Backer MD , Joseph Cleveland MD , David T. Cooke MD , Raphael Kella DO , Joseph Coselli MD , Jessica Donington MD , Stephanie Fuller MD , Adil Husain MD , Chris Malaisrie MD , Sandra Starnes MD , John Stulak MD , Cameron Wright MD , Michael Mack MD , Tom C. Nguyen MD

Objective

The makeup of the thoracic surgical workforce can influence policy, training, and certification, but it is not well defined. Using data from the American Board of Thoracic Surgery, this study explored practice-based demographics concerning geography, gender, age, subspecialty, and university affiliation.

Methods

American Board of Thoracic Surgery Diplomates taking the 10-year Maintenance of Certification examination opted for the cardiac, general thoracic, cardiothoracic, or congenital modular exam. Using module selection as a surrogate for the examinee's predominant clinical practice, we explored the relationship regarding type of practice, geography (metropolitan vs other), gender, age, and university affiliation.

Results

A total of 2273 American Board of Thoracic Surgery Diplomates took the Maintenance of Certification exam from 2018 to 2024. Adult cardiac surgery was the predominant subspecialty (46%), followed by cardiothoracic (24%), general thoracic (22%), and congenital surgery (8%). Significant gender disparity persisted, with women constituting 7% of certified Diplomates and 5% of adult cardiac surgeons. Mean ages ranged from 58.0 years (general thoracic) to 63.3 years (cardiothoracic), with younger surgeons trending toward specialized practices (cardiac P = .01, congenital P = .04). Most surgeons practiced in metropolitan areas (80%), particularly congenital surgeons (96%). Surgeons practicing in university (47%) and nonuniversity settings (53%) were nearly evenly distributed.

Conclusions

Thoracic surgery is increasingly subspecializing, with younger surgeons choosing cardiac, general thoracic, or congenital surgery modular Maintenance of Certification exams. The percentage of female Diplomates remains low. Maintenance of Certification exam-eligible diplomates constitute a predominantly older workforce with noticeable urbanization. Understanding our workforce provides important insight for American Board of Thoracic Surgery certification, the development of training paradigms, and anticipating workforce needs.

目的胸外科工作人员的构成可以影响政策、培训和认证，但目前还没有很好的定义。使用来自美国胸外科委员会的数据，本研究探讨了基于实践的人口统计数据，包括地理、性别、年龄、亚专业和大学隶属关系。方法美国胸外科文凭委员会参加10年维护认证考试，选择心脏、普通胸科、心胸科或先天性模块考试。使用模块选择作为替代考生的主要临床实践，我们探讨了与实践类型，地理（大都市vs其他），性别，年龄和大学所属的关系。结果2018年至2024年，共有2273名美国胸外科委员会认证人员参加了认证维护考试。成人心脏外科是主要的亚专科（46%），其次是心胸外科（24%）、普通心胸外科（22%）和先天性外科（8%）。显著的性别差异仍然存在，女性占认证文凭的7%，占成年心脏外科医生的5%。平均年龄从58.0岁（普通胸科）到63.3岁（心胸科），年轻外科医生倾向于专科治疗（心脏P = 0.01，先天性P = 0.04）。大多数外科医生在大都市地区执业（80%），尤其是先天性外科医生（96%）。在大学（47%）和非大学（53%）执业的外科医生几乎均匀分布。结论胸外科越来越专科化，年轻的外科医生选择心脏、普通胸外科或先天性手术的模块维护认证考试。女外交官的比例仍然很低。具有证书考试资格的文凭的维护构成了明显城市化的主要老年劳动力。了解我们的员工对美国胸外科委员会的认证、培训模式的发展和预测员工需求提供了重要的见解。

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引用次数: 0

Neighborhood socioeconomic status predicts long-term outcomes after acute type A aortic dissection repair in a propensity-matched cohort 在一个倾向匹配的队列中，社区社会经济状况预测急性A型主动脉夹层修复后的长期预后

IF 1.9

JTCVS open

Pub Date : 2025-12-01 DOI: 10.1016/j.xjon.2025.07.020

Michael A. Catalano MD, Lauren Gillinov BS, Kendall M. Lawrence MD, Omar Toubat MD, PhD, Nicholas J. Goel MD, William L. Patrick MD, Alexandra E. Sperry MD, Chase R. Brown MD, Wilson Y. Szeto MD, Nimesh Desai MD, PhD

Objective

Socioeconomic status is associated with outcomes after various cardiac surgical procedures, including repair of acute type A aortic dissection; however, existing data are limited to short-term follow-up and incomplete markers of disparity. We sought to apply a comprehensive, validated score of neighborhood-level socioeconomic status to explore the impact of resource deprivation on long-term outcomes of patients undergoing acute type A aortic dissection repair.

Methods

A retrospective review of our institution's database of type A aortic dissections was conducted to identify patients undergoing acute type A aortic dissection repair from 1993 to 2022. Socioeconomic status was quantified using the Area Deprivation Index, a weighted score that incorporates 17 markers of disparities to determine overall deprivation at the neighborhood block level. Patients were divided into 4 quartiles based on Area Deprivation Index, with Q1 representing the most deprived and Q4 representing the least deprived. Fifteen-year survival was compared between the first and fourth quartiles in a propensity-matched survival analysis and a multivariable Cox proportional hazards model.

Results

Of 1199 patients with addresses available for Area Deprivation Index linking who underwent acute type A aortic dissection repair, 294 patients were in Q1 and 306 patients were in Q4. Patients in the lowest quartile were younger, more likely to be female, and less likely to be White. After propensity matching, Kaplan–Meier survival analysis revealed significantly reduced 15-year survival among patients in Q1 (P = .025). Cox proportional hazards assessment confirmed the national Area Deprivation Index percentile as a continuous variable as a predictor of mortality (hazard ratio, 1.006; P = .002).

Conclusions

Socioeconomic status is associated with long-term mortality after acute type A aortic dissection repair, despite no difference in initial presentation or early postoperative outcomes.

目的：社会经济地位与各种心脏外科手术后的预后相关，包括急性A型主动脉夹层的修复；然而，现有数据仅限于短期随访和不完整的差异标记。我们试图应用一个全面的、有效的社区社会经济地位评分来探讨资源剥夺对急性a型主动脉夹层修复患者长期预后的影响。方法回顾性分析我院1993年至2022年进行急性A型主动脉夹层修复的A型主动脉夹层患者数据库。社会经济地位是用区域剥夺指数（Area Deprivation Index）来量化的，这是一个加权分数，包含了17个差异标记，以确定社区层面的总体剥夺程度。根据区域剥夺指数将患者分为4个四分位数，Q1代表最剥夺，Q4代表最不剥夺。在倾向匹配生存分析和多变量Cox比例风险模型中比较第一和第四个四分位数的15年生存率。结果1199例有区域剥夺指数链接地址的急性A型主动脉夹层修复患者中，Q1期294例，Q4期306例。最低四分之一的患者更年轻，更有可能是女性，白人的可能性更小。倾向匹配后，Kaplan-Meier生存分析显示第一季度患者15年生存率显著降低（P = 0.025）。Cox比例风险评估证实，国家地区剥夺指数百分位数作为死亡率预测因子是一个连续变量（风险比，1.006;P = 0.002）。结论：社会经济地位与急性A型主动脉夹层修复术后的长期死亡率相关，尽管初始表现和早期术后结果没有差异。

{"title":"Neighborhood socioeconomic status predicts long-term outcomes after acute type A aortic dissection repair in a propensity-matched cohort","authors":"Michael A. Catalano MD, Lauren Gillinov BS, Kendall M. Lawrence MD, Omar Toubat MD, PhD, Nicholas J. Goel MD, William L. Patrick MD, Alexandra E. Sperry MD, Chase R. Brown MD, Wilson Y. Szeto MD, Nimesh Desai MD, PhD","doi":"10.1016/j.xjon.2025.07.020","DOIUrl":"10.1016/j.xjon.2025.07.020","url":null,"abstract":"<div><h3>Objective</h3><div>Socioeconomic status is associated with outcomes after various cardiac surgical procedures, including repair of acute type A aortic dissection; however, existing data are limited to short-term follow-up and incomplete markers of disparity. We sought to apply a comprehensive, validated score of neighborhood-level socioeconomic status to explore the impact of resource deprivation on long-term outcomes of patients undergoing acute type A aortic dissection repair.</div></div><div><h3>Methods</h3><div>A retrospective review of our institution's database of type A aortic dissections was conducted to identify patients undergoing acute type A aortic dissection repair from 1993 to 2022. Socioeconomic status was quantified using the Area Deprivation Index, a weighted score that incorporates 17 markers of disparities to determine overall deprivation at the neighborhood block level. Patients were divided into 4 quartiles based on Area Deprivation Index, with Q1 representing the most deprived and Q4 representing the least deprived. Fifteen-year survival was compared between the first and fourth quartiles in a propensity-matched survival analysis and a multivariable Cox proportional hazards model.</div></div><div><h3>Results</h3><div>Of 1199 patients with addresses available for Area Deprivation Index linking who underwent acute type A aortic dissection repair, 294 patients were in Q1 and 306 patients were in Q4. Patients in the lowest quartile were younger, more likely to be female, and less likely to be White. After propensity matching, Kaplan–Meier survival analysis revealed significantly reduced 15-year survival among patients in Q1 (<em>P =</em> .025). Cox proportional hazards assessment confirmed the national Area Deprivation Index percentile as a continuous variable as a predictor of mortality (hazard ratio, 1.006; <em>P =</em> .002).</div></div><div><h3>Conclusions</h3><div>Socioeconomic status is associated with long-term mortality after acute type A aortic dissection repair, despite no difference in initial presentation or early postoperative outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 97-108"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698071","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