JTCVS open最新文献

{"title":"The role of diagnostic laparoscopy in staging distal esophageal adenocarcinoma","authors":"Stella T. Tsui MD ,&nbsp;Nanruoyi Zhou MD ,&nbsp;Kay See Tan PhD ,&nbsp;Junting Zheng MS ,&nbsp;Katherine D. Gray MD ,&nbsp;Smita Sihag MD ,&nbsp;Valerie W. Rusch MD ,&nbsp;Manjit S. Bains MD ,&nbsp;Bernard J. Park MD ,&nbsp;Matthew J. Bott MD ,&nbsp;James Huang MD ,&nbsp;Prasad S. Adusumilli MD ,&nbsp;Laura H. Tang MD, PhD ,&nbsp;Daniela Molena MD ,&nbsp;David R. Jones MD","doi":"10.1016/j.xjon.2025.09.010","DOIUrl":"10.1016/j.xjon.2025.09.010","url":null,"abstract":"<div><h3>Objectives</h3><div>The study objectives were to determine whether diagnostic laparoscopy improves staging accuracy in selected patients with distal esophageal adenocarcinoma and to identify clinicopathologic features associated with positive diagnostic laparoscopy.</div></div><div><h3>Methods</h3><div>Patients with distal esophageal adenocarcinoma who underwent diagnostic laparoscopy from 2000 to 2023 at a single institution were identified from a prospectively maintained surgical database. Exclusion criteria included performance of diagnostic laparoscopy after systemic therapy, absence of staging positron computed tomography/computed tomography, and M1 disease before diagnostic laparoscopy. Fisher exact test and Wilcoxon rank-sum test were used to compare categorical and continuous variables, respectively, between patients with negative and positive diagnostic laparoscopy. Clinicopathologic features were assessed using multivariable logistic regression.</div></div><div><h3>Results</h3><div>In total, 226 of 2131 patients with distal esophageal adenocarcinoma (11%) underwent diagnostic laparoscopy; 93% of these patients (211/226) had clinical T stage 3 or more. Most patients had clinical stage III disease before diagnostic laparoscopy (205/226 [91%]). In total, 183 patients (81%) had negative diagnostic laparoscopy, and 43 patients (19%) had positive diagnostic laparoscopy. In 40 patients (20%), disease was upstaged from III to IVB after positive diagnostic laparoscopy. Distal esophageal adenocarcinoma with signet ring feature (odds ratio, 2.45, 95% CI, 1.05-5.86; <em>P =</em> .040) was associated with positive diagnostic laparoscopy. Cardia involvement (<em>P =</em> .581), clinical T stage (<em>P &gt;</em> .999), presence of clinical nodal disease (<em>P =</em> .550), clinical stage before diagnostic laparoscopy (<em>P &gt;</em> .999), maximum standardized uptake value (<em>P =</em> .124), and poor differentiation without signet ring feature (<em>P =</em> .341) were not associated with positive diagnostic laparoscopy.</div></div><div><h3>Conclusions</h3><div>Signet ring feature is associated with peritoneal disease. The use of diagnostic laparoscopy in these patients may lead to better staging and more appropriate treatment strategies.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 625-631"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697794","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 state of educational research in cardiothoracic surgery: A review of the literature","authors":"Amirtha Shekar BS ,&nbsp;Victoria Hart BS ,&nbsp;John Treffalls MD ,&nbsp;Travis J. Miles MD ,&nbsp;Todd K. Rosengart MD ,&nbsp;Marc R. Moon MD ,&nbsp;Joseph S. Coselli MD ,&nbsp;Lauren M. Barron MD ,&nbsp;Shawn S. Groth MD ,&nbsp;Shanda H. Blackmon MD ,&nbsp;Ravi K. Ghanta MD ,&nbsp;Dawn S. Hui MD ,&nbsp;Subhasis Chatterjee MD","doi":"10.1016/j.xjon.2025.10.010","DOIUrl":"10.1016/j.xjon.2025.10.010","url":null,"abstract":"<div><h3>Objective</h3><div>Evolving training paradigms in cardiothoracic surgery (CTS) are changing the educational needs of integrated residents and traditional fellows. Educational research is important for evaluating specialty training. This study assessed CTS education articles to analyze their prevalence, content, and reach.</div></div><div><h3>Methods</h3><div>In a cross-sectional observational study of education articles published on North American CTS programs from January 2013 through December 2023, articles were identified by querying PubMed, other databases, and journals. Articles that passed an initial abstract review underwent full-text review. Articles were organized by content into 9 categories: curriculum, simulation, trainee assessment, program evaluation, wellness/burnout, diversity/inclusion, mentorship/career, outcomes, and trainee perceptions. Data were analyzed with univariate statistics and the Mann-Kendall test.</div></div><div><h3>Results</h3><div>A total of 124 CTS education articles from 20 journals were identified, comprising 0.15% of the 84,005 articles published across these journals. The greatest volume of articles came from <em>Annals of Thoracic Surgery</em> (41%) and <em>Journal of Thoracic and Cardiovascular Surgery</em> (26%). PlumX metrics revealed that each article had a median of 11 interaction citations (interquartile range, 6.0-22.0; n = 113) and 23 captures (interquartile range, 11-47; n = 101). Common topics were curriculum (n = 39, 32%) and simulation training (n = 19, 15%). Manuscripts with ≥11 citations had greater PlumX metrics (<em>P</em> &lt; .001). The annual CTS publication volume of educational articles averaged 11.3 ± 4.0; excluding pandemic years, this volume showed no significant increase from 2013-2019 to 2023 (<em>P</em> = .80).</div></div><div><h3>Conclusions</h3><div>Approximately 10 articles per year are published on CTS education and training. Increased efforts in the CTS community are needed to encourage and disseminate education research.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 728-735"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697869","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":"Surgical skills assessment during resident selection process: Survey of American cardiothoracic and Canadian cardiac surgery program directors","authors":"Klaudiusz Stoklosa MD ,&nbsp;Elie Fadel MDCM(c) ,&nbsp;Terrence M. Yau MDCM, MSc","doi":"10.1016/j.xjon.2025.08.009","DOIUrl":"10.1016/j.xjon.2025.08.009","url":null,"abstract":"<div><h3>Objective</h3><div>Matching into cardiothoracic and cardiac surgery training programs is highly competitive. As surgical simulation becomes increasingly accessible, we present the various perspectives of program directors (PDs) on the potential assessment of surgical skills during the resident selection process.</div></div><div><h3>Methods</h3><div>A 21-question survey was distributed to all 128 accredited American cardiothoracic (75 indirect-entry 5 + 2, 19 indirect-entry 4 + 3, and 34 direct-entry I-6 programs) and 12 Canadian direct-entry cardiac surgery residency programs. Questions were focused on respondent demographic characteristics, sentiments toward integration of surgical skills assessment in resident selection, and perceptions of residents’ technical skills at different stages of training. A similar questionnaire was distributed to all 360 American and Canadian general surgery PDs given its foundation for indirect-entry cardiothoracic surgery fellowships. Data were analyzed descriptively and quantitatively.</div></div><div><h3>Results</h3><div>Forty-nine American cardiothoracic (38%), 10 Canadian cardiac (83%), 50 American general (15%), and 10 Canadian general (59%) surgery PDs completed the survey. Cardiothoracic and cardiac surgery PDs were divided on whether surgical skill assessment should be part of the selection process (yes: 52.5%; n = 31). Although 35.6% (n = 21) believed residents were slightly underperforming at the start of training, 50.9% (n = 30) believed residents were slightly or significantly overperforming by the end. Similar patterns were seen among general surgery responses.</div></div><div><h3>Conclusions</h3><div>Surgical skills assessment during the resident selection process is divisive among cardiothoracic and cardiac surgery PDs. Surgical skills remain largely untested before residency but are developed throughout training.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 768-788"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697925","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":"Considerations for the equitable selection of thoracic surgery residents and fellows","authors":"Ahmet Kilic MD ,&nbsp;Mara B. Antonoff MD ,&nbsp;Kathleen S. Berfield MD ,&nbsp;David T. Cooke MD ,&nbsp;Thomas K. Varghese MD, MS, MBA ,&nbsp;Mark Orringer MD","doi":"10.1016/j.xjon.2025.09.042","DOIUrl":"10.1016/j.xjon.2025.09.042","url":null,"abstract":"<div><h3>Background</h3><div>Equitable selection of surgical trainees is essential to maintaining the integrity and excellence that is central to cardiothoracic surgical education. Selection processes must ensure that all candidates are evaluated fairly and consistently, minimizing bias while identifying those with the greatest potential for technical competence, clinical excellence, and upholding the principles of professionalism. Despite progress, many current approaches remain overly reliant on academic metrics that do not fully capture the attributes required for success in surgical training and practice.</div></div><div><h3>Objective</h3><div>This expert opinion article examines contemporary challenges and evolving priorities in achieving a fair and equitable selection of surgical trainees, drawing on experience in surgical education, program leadership, and performance assessment.</div></div><div><h3>Results</h3><div>Traditional selection metrics—such as academic achievement, standardized test scores, and research productivity—remain valuable but insufficient predictors of operative aptitude, resilience, teamwork, and ethical judgment. Emerging evidence supports a more comprehensive evaluation framework that incorporates behavioral and situational assessments, structured interviews, and evaluation of professional attributes such as integrity, adaptability, and commitment to improvement. This article proposes a multidimensional selection model designed to improve predictive validity and fairness in trainee recruitment and assessment.</div></div><div><h3>Conclusions</h3><div>The future of surgical education depends on refining selection processes to identify candidates with both technical potential and the personal characteristics essential for excellence in cardiothoracic surgery. An evidence-informed, transparent, and equitable approach to trainee selection will strengthen the specialty and ensure the continued delivery of high-quality patient care.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 753-759"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697968","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":"Outcomes after postcardiotomy venoarterial extracorporeal membrane oxygenation in young patients: An individual patient data meta-analysis","authors":"Ilaria Giambuzzi MD ,&nbsp;Fausto Biancari MD, PhD ,&nbsp;Giorgio Mastroiacovo MD ,&nbsp;Alexander Kaserer MD ,&nbsp;Camilla L'Acqua MD ,&nbsp;Vito G. Ruggieri MD, PhD ,&nbsp;Sung-Min Cho MD, PhD ,&nbsp;Magnus Dalén MD, PhD ,&nbsp;Henryk Welp MD ,&nbsp;Kristján Jónsson MD ,&nbsp;Sigurdur Ragnarsson MD, PhD ,&nbsp;Francisco J. Hernández Pérez MD ,&nbsp;Giuseppe Gatti MD ,&nbsp;Khalid Alkhamees MD ,&nbsp;Antonio Loforte MD, PhD ,&nbsp;Andrea Lechiancole MD ,&nbsp;Paola D'Errigo MSc ,&nbsp;Stefano Rosato MSc ,&nbsp;Cristiano Spadaccio MD ,&nbsp;Matteo Pettinari MD ,&nbsp;Giorgia Bonalumi MD","doi":"10.1016/j.xjon.2025.09.046","DOIUrl":"10.1016/j.xjon.2025.09.046","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to evaluate the early and midterm mortality of young patients treated for cardiogenic shock with venoarterial extracorporeal membrane oxygenation (VA-ECMO) after adult cardiac surgery.</div></div><div><h3>Methods</h3><div>Studies reporting the outcome after postcardiotomy VA-ECMO in adult patients were identified through a systematic review of the literature. Individual patient-level data were provided by the authors of 10 studies.</div></div><div><h3>Results</h3><div>Data on 1268 patients treated at 25 hospitals were included in this study. Adjusted analysis identified 40 years of age as a cutoff value for in-hospital and mid-term mortality. Patients aged &gt;40 years had significantly greater in-hospital mortality (1129 patients, crude rates 68.8% vs 43.1%, adjusted odds ratio, 3.267; 95% confidence interval, 1.970-5.425) and mortality at 24-month (109 patients, crude rates 73.7% vs 45.0%, adjusted hazard ratio, 3.530, 95% confidence interval, 2.571-4.844). Twelve (11.0%) patients aged ≤40 years received a ventricular assist device and heart transplantation, whereas this strategy was adopted in 33 (2.9%) patients aged &gt;40 years (<em>P</em> &lt; .001). Eventually, 7 (6.4%) patients aged ≤40 years and 12 (1.1%) patients aged &gt;40 years underwent heart transplantation (<em>P</em> &lt; .001). Heart transplantation tended to decrease in-hospital mortality in patients aged ≤40 years (14.3% vs 45.1%, <em>P</em> = .138), whereas this difference reached statistical significance in patients aged &gt;40 years (25.0% vs 69.3%, <em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>The present findings suggest that early and midterm mortality after postcardiotomy VA-ECMO is significantly lower in patients aged ≤40 years compared to older patients. However, mortality remains substantial also among these young patients and heart-replacement therapies are infrequently performed in this subset of patients likely because of severe perioperative complications.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 278-295"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698152","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":"Multiple applications of the Florida sleeve procedure in aortic root surgery","authors":"Liu Chenyu MD,&nbsp;Li Haochao MD,&nbsp;Chen Pengfei MD,&nbsp;Wang Liqing MD,&nbsp;Luo Xinjin MD","doi":"10.1016/j.xjon.2025.09.035","DOIUrl":"10.1016/j.xjon.2025.09.035","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 109-116"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698072","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":"Design, benefits, and use of a hybrid aortic arch stent graft","authors":"Ryaan EL-Andari MD,&nbsp;Michael C. Moon MD","doi":"10.1016/j.xjon.2025.08.011","DOIUrl":"10.1016/j.xjon.2025.08.011","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 121-125"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698074","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":"Endoscopic hydrodissection for vein harvesting in coronary artery bypass grafting: The minimally invasive no-touch (MINT) technique","authors":"John F. Gallagher MD ,&nbsp;Victor Garcia PhD ,&nbsp;Steven Escaravage MHS, PA-C ,&nbsp;Pamela Gallagher MD ,&nbsp;Paul J. Gallagher MSc ,&nbsp;Danielle Diegisser PhD ,&nbsp;William Davalan ,&nbsp;Walid Ben Ali MD, PhD ,&nbsp;Maximilian Y. Emmert MD, PhD ,&nbsp;Daniel Fusco MD ,&nbsp;Louis P. Perrault MD, PhD","doi":"10.1016/j.xjon.2025.08.017","DOIUrl":"10.1016/j.xjon.2025.08.017","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 238-241"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698149","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":"Reply: Issues regarding graft selection and surgical strategy","authors":"Yuki Kuroda MD ,&nbsp;Hiroki Shiomi MD ,&nbsp;Kenji Minatoya MD","doi":"10.1016/j.xjon.2025.09.037","DOIUrl":"10.1016/j.xjon.2025.09.037","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Page 277"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698151","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":"Resectable non−small cell lung cancer in women: A disease-specific entity?","authors":"Marisa Sewell MD ,&nbsp;Thomas Boerner MD ,&nbsp;Nicolas Toumbacaris MSPH ,&nbsp;Kay See Tan PhD ,&nbsp;Giye Choe MD ,&nbsp;Caitlin Harrington MD ,&nbsp;Smita Sihag MD ,&nbsp;Prasad S. Adusumilli MD ,&nbsp;Matthew J. Bott MD ,&nbsp;Robert J. Downey MD ,&nbsp;James Huang MD ,&nbsp;James M. Isbell MD ,&nbsp;Bernard J. Park MD ,&nbsp;Gaetano Rocco MD ,&nbsp;Katherine Gray MD ,&nbsp;Valerie W. Rusch MD ,&nbsp;David R. Jones MD ,&nbsp;Daniela Molena MD","doi":"10.1016/j.xjon.2025.09.002","DOIUrl":"10.1016/j.xjon.2025.09.002","url":null,"abstract":"<div><h3>Objective</h3><div>There may be important sex-specific differences among patients with non−small cell lung cancer (NSCLC). Despite this, women are underrepresented in prospective clinical trials. We evaluated sex-specific differences in clinicopathologic and genetic factors and survival among patients with NSCLC.</div></div><div><h3>Methods</h3><div>This is a single-center study at a high-volume dedicated cancer hospital. Patients with NSCLC who underwent complete surgical resection from 2010 to 2018 were included. Primary outcomes include cumulative incidence of recurrence and overall survival, stratified by sex.</div></div><div><h3>Results</h3><div>Overall, 3452 patients were included; 2033 (59%) were women. More women than men were never-smokers (24% vs 13%; <em>P</em> &lt; .001). Among patients who smoked, women had a significantly shorter pack-year history (30 vs 40 years; <em>P</em> &lt; .001). Comorbid pulmonary (29% vs 35%; <em>P</em> &lt; .001) and cardiac (53% vs 66%; <em>P</em> &lt; .001) conditions were less common among women. Women had lower rates of clinical stage II or III disease (<em>P</em> &lt; .001) and were more likely to have <em>EGFR</em> (28% vs 18%; <em>P</em> &lt; .001) or <em>KRAS</em> (36% vs 29%; <em>P</em> = .018) mutations. Median overall survival among women was 11 years (95% confidence interval [CI], 10 years to not reached), compared with 7.9 years among men (95% CI, 7.5-8.6). This longer survival was sustained on multivariable analysis (hazard ratio, 0.86; 95% CI, 0.76-0.97; <em>P</em> = .013). Cumulative incidence of recurrence was not statistically different by sex (hazard ratio, 0.95; 95% CI, 0.82-1.09; <em>P</em> = .43).</div></div><div><h3>Conclusions</h3><div>Clinicopathologic and genetic factors and survival among patients with NSCLC differ on the basis of sex. NSCLC in women should be considered a disease-specific entity.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 526-540"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697716","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}