Pub Date : 2026-02-01Epub Date: 2025-11-22DOI: 10.1016/j.xjon.2025.10.038
Sara Sakowitz MD, MPH, MBA , Syed Shahyan Bakhtiyar MD, MBE , Yas Sanaiha MD , Saad Mallick MD , Peyman Benharash MD , Jane Yanagawa MD
Objective
Although open thymectomy has traditionally been the gold standard for resection of large thymic tumors, growing evidence has suggested minimally invasive thymectomy to confer comparable survival. However, the influence of incremental increases in tumor size on margin-negative resection and long-term survival following minimally invasive thymectomy remains understudied.
Methods
All patients aged 18 years and older who underwent thymectomy for Stage I through III thymoma were tabulated from the 2010-2022 National Cancer Database. Those undergoing thoracoscopic or robotic procedures comprised the video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS) cohorts, respectively (others: open thymectomy). Tumor size was stratified as ≤4 cm, 4 to 6 cm, 6 to 8 cm, and >8 cm.
Results
Of 5132 patients, 2562 (50%) underwent open thymectomy, 692 (13%) VATS, and 1878 (37%) RATS. Overall, 48% of neoplasms ≤4 cm were performed using RATS, compared with 41% of 4 to 6 cm, 34% of 6 to 8 cm, and 18% of >8 cm in size. Following doubly robust risk-adjustment, RATS remained associated with significantly higher odds of achieving R0 for tumors ≤4 cm (adjusted odds ratio [AOR], 1.78; 95% CI, 1.03-3.10), and equivalent likelihood for neoplasms 4 to 6 cm (AOR, 1.01; 95% CI, 0.63-1.60), 6 to 8 cm (AOR, 1.55; 95% CI, 0.87-2.76), and >8 cm (AOR, 0.73; 95% CI, 0.40-1.47; Reference category: open thymectomy). Among tumors ≤8 cm, VATS was linked with similar R0 odds as open thymectomy. Comparable survival was observed at 5 and 10 years across operative approaches and size strata.
Conclusions
Utilization of RATS has rapidly increased since 2010. Relative to open thymectomy, RATS was associated with at least noninferior likelihood of achieving R0 for lesions ≤4 cm, and equivalent odds for tumors >4 cm, as well as comparable survival. Our findings underscore the safety and efficacy of minimally invasive thymectomy for appropriately selected larger thymomas.
{"title":"Margin-negative resection and long-term survival following robot-assisted thymectomy for thymoma: A tumor size stratified analysis","authors":"Sara Sakowitz MD, MPH, MBA , Syed Shahyan Bakhtiyar MD, MBE , Yas Sanaiha MD , Saad Mallick MD , Peyman Benharash MD , Jane Yanagawa MD","doi":"10.1016/j.xjon.2025.10.038","DOIUrl":"10.1016/j.xjon.2025.10.038","url":null,"abstract":"<div><h3>Objective</h3><div>Although open thymectomy has traditionally been the gold standard for resection of large thymic tumors, growing evidence has suggested minimally invasive thymectomy to confer comparable survival. However, the influence of incremental increases in tumor size on margin-negative resection and long-term survival following minimally invasive thymectomy remains understudied.</div></div><div><h3>Methods</h3><div>All patients aged 18 years and older who underwent thymectomy for Stage I through III thymoma were tabulated from the 2010-2022 National Cancer Database. Those undergoing thoracoscopic or robotic procedures comprised the video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS) cohorts, respectively (others: open thymectomy). Tumor size was stratified as ≤4 cm, 4 to 6 cm, 6 to 8 cm, and >8 cm.</div></div><div><h3>Results</h3><div>Of 5132 patients, 2562 (50%) underwent open thymectomy, 692 (13%) VATS, and 1878 (37%) RATS. Overall, 48% of neoplasms ≤4 cm were performed using RATS, compared with 41% of 4 to 6 cm, 34% of 6 to 8 cm, and 18% of >8 cm in size. Following doubly robust risk-adjustment, RATS remained associated with significantly higher odds of achieving R0 for tumors ≤4 cm (adjusted odds ratio [AOR], 1.78; 95% CI, 1.03-3.10), and equivalent likelihood for neoplasms 4 to 6 cm (AOR, 1.01; 95% CI, 0.63-1.60), 6 to 8 cm (AOR, 1.55; 95% CI, 0.87-2.76), and >8 cm (AOR, 0.73; 95% CI, 0.40-1.47; Reference category: open thymectomy). Among tumors ≤8 cm, VATS was linked with similar R0 odds as open thymectomy. Comparable survival was observed at 5 and 10 years across operative approaches and size strata.</div></div><div><h3>Conclusions</h3><div>Utilization of RATS has rapidly increased since 2010. Relative to open thymectomy, RATS was associated with at least noninferior likelihood of achieving R0 for lesions ≤4 cm, and equivalent odds for tumors >4 cm, as well as comparable survival. Our findings underscore the safety and efficacy of minimally invasive thymectomy for appropriately selected larger thymomas.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101534"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412531","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}
Pub Date : 2026-02-01Epub Date: 2025-12-03DOI: 10.1016/j.xjon.2025.101544
Sara Sakowitz MD, MPH, MBA , Syed Shahyan Bakhtiyar MD, MBE , Yas Sanaiha MD , Konmal Ali BS , Peyman Benharash MD
Objective
Race-based disparities in lung cancer care are well described, such that Black patients face lower access to screening and early diagnosis, and inferior overall survival. We sought to examine race-based differences in referral to Commission on Cancer–accredited hospitals for pulmonary resection.
Methods
Within the National Cancer Database, we tabulated all patients aged 18 years or more of White or Black race diagnosed with stage IA non–small cell lung cancer who underwent definitive surgical resection from 2010 to 2022. Patients diagnosed at a separate institution from the operating facility were considered “referred,” and those diagnosed and treated at the same center were considered “nonreferred.” Hospitals in the top quartile by cumulative volume were considered high-volume centers (≥30 resections/year).
Results
Of 123,706 patients, 33,218 (27%) were referred for care. After risk adjustment, Black race remained associated with a lower likelihood of referral (adjusted odds ratio, 0.80, CI, 0.77-0.85). Moreover, among those referred, Black race was associated with reduced odds of referral for care at high-volume centers (adjusted odds ratio, 0.91, CI, 0.83-0.99). Referral for care was associated with a longer duration of waiting time from diagnosis to surgery (β + 28 days, CI, 28-29) and greater travel distance (β + 12 miles, CI, 11-13). Additionally, referral was linked with greater likelihood of receiving a minimally invasive operation and reduced odds of perioperative morbidity; referral to high-volume centers was associated with superior 5-year survival.
Conclusions
Black patients faced a lower likelihood of referral for surgical care, reduced access to high-volume centers when referred, and longer waiting times from diagnosis to surgery. National efforts should seek to facilitate referral and ensure equitable access to high-quality care.
{"title":"National race-based disparities in referral to Commission on Cancer centers for lung cancer resection","authors":"Sara Sakowitz MD, MPH, MBA , Syed Shahyan Bakhtiyar MD, MBE , Yas Sanaiha MD , Konmal Ali BS , Peyman Benharash MD","doi":"10.1016/j.xjon.2025.101544","DOIUrl":"10.1016/j.xjon.2025.101544","url":null,"abstract":"<div><h3>Objective</h3><div>Race-based disparities in lung cancer care are well described, such that Black patients face lower access to screening and early diagnosis, and inferior overall survival. We sought to examine race-based differences in referral to Commission on Cancer–accredited hospitals for pulmonary resection.</div></div><div><h3>Methods</h3><div>Within the National Cancer Database, we tabulated all patients aged 18 years or more of White or Black race diagnosed with stage IA non–small cell lung cancer who underwent definitive surgical resection from 2010 to 2022. Patients diagnosed at a separate institution from the operating facility were considered “referred,” and those diagnosed and treated at the same center were considered “nonreferred.” Hospitals in the top quartile by cumulative volume were considered high-volume centers (≥30 resections/year).</div></div><div><h3>Results</h3><div>Of 123,706 patients, 33,218 (27%) were referred for care. After risk adjustment, Black race remained associated with a lower likelihood of referral (adjusted odds ratio, 0.80, CI, 0.77-0.85). Moreover, among those referred, Black race was associated with reduced odds of referral for care at high-volume centers (adjusted odds ratio, 0.91, CI, 0.83-0.99). Referral for care was associated with a longer duration of waiting time from diagnosis to surgery (β + 28 days, CI, 28-29) and greater travel distance (β + 12 miles, CI, 11-13). Additionally, referral was linked with greater likelihood of receiving a minimally invasive operation and reduced odds of perioperative morbidity; referral to high-volume centers was associated with superior 5-year survival.</div></div><div><h3>Conclusions</h3><div>Black patients faced a lower likelihood of referral for surgical care, reduced access to high-volume centers when referred, and longer waiting times from diagnosis to surgery. National efforts should seek to facilitate referral and ensure equitable access to high-quality care.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101544"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411914","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}
Pub Date : 2026-02-01Epub Date: 2025-11-15DOI: 10.1016/j.xjon.2025.11.006
William Hampton Gray MD , Christopher Mason Berry BS , Robert Sorabella MD , Luz A. Padilla MD, MSPH , Carlisle O'Meara CCP, FPP , Matthew G. Clark MD , Stephen Clark MD , Robert J. Dabal MD
Objective
Hypoplasia of the proximal transverse arch (PTA) can be associated with coarctation. Management is via sternotomy with arch reconstruction or thoracotomy with extended end-to-end anastomosis (T-EEEA). Our preferred approach is T-EEEA with expectations that the arch will grow. We hypothesized that T-EEEA is safe, durable, and permits aortic growth.
Methods
We retrospectively identified neonates (<1 month of age) treated from 2012 to 2023 for coarctation and PTA hypoplasia (z score <−2.5), and no other cardiac lesion that would mandate sternotomy and cardiopulmonary bypass. We compared sternotomy with arch augmentation versus T-EEEA. Outcomes included morbidity, mortality, freedom from reintervention, and echocardiographic measurements at last follow-up.
Results
Of 91 neonates, 76 (83.5%) underwent T-EEEA and 15 (17%) sternotomy at an overall median age of 12 days and weight of 3.2 kg. Prematurity (19%), cardiogenic shock (23%), and mechanical ventilation (29%) were similar between groups. Preoperative proximal arch z score was −3.9 for the entire cohort and was different between groups (T-EEEA −3.9 vs sternotomy −5.2; P = .01). Median ventilator and discharge times were shorter with T-EEEA (1 vs 4 days, P < .0001; 11 vs 22 days, P = .0015; respectively). Two hospital deaths occurred (1 per group). Morbidities included 7 recurrent nerve injuries, 1 chylothorax, and 1 stroke. Eight patients (T-EEEA 7, 9% vs sternotomy 1, 7%; P = .75) required reintervention (5 catheter, 3 surgical). All 3 surgical reinterventions occurred in patients who underwent T-EEEA with preoperative PTA z scores <−4.5. Freedom from reintervention at 5 years was similar between groups (T-EEEA 92% vs sternotomy 94%) and at a median follow-up of 58 months, there was adequate growth of the proximal arch with a median z score of −1.6 (T-EEEA −1.7, sternotomy −1.3, P = .13).
Conclusions
Repair of neonatal coarctation via thoracotomy with proximal arch hypoplasia up to a z score of −4.5 is safe, durable, with low rate of reintervention. Patients with a proximal arch z score <−4.5 should undergo aortic arch reconstruction via sternotomy.
{"title":"Neonatal coarctation repair via thoracotomy with proximal arch hypoplasia up to a z score of −4.5 is safe and durable","authors":"William Hampton Gray MD , Christopher Mason Berry BS , Robert Sorabella MD , Luz A. Padilla MD, MSPH , Carlisle O'Meara CCP, FPP , Matthew G. Clark MD , Stephen Clark MD , Robert J. Dabal MD","doi":"10.1016/j.xjon.2025.11.006","DOIUrl":"10.1016/j.xjon.2025.11.006","url":null,"abstract":"<div><h3>Objective</h3><div>Hypoplasia of the proximal transverse arch (PTA) can be associated with coarctation. Management is via sternotomy with arch reconstruction or thoracotomy with extended end-to-end anastomosis (T-EEEA). Our preferred approach is T-EEEA with expectations that the arch will grow. We hypothesized that T-EEEA is safe, durable, and permits aortic growth.</div></div><div><h3>Methods</h3><div>We retrospectively identified neonates (<1 month of age) treated from 2012 to 2023 for coarctation and PTA hypoplasia (z score <−2.5), and no other cardiac lesion that would mandate sternotomy and cardiopulmonary bypass. We compared sternotomy with arch augmentation versus T-EEEA. Outcomes included morbidity, mortality, freedom from reintervention, and echocardiographic measurements at last follow-up.</div></div><div><h3>Results</h3><div>Of 91 neonates, 76 (83.5%) underwent T-EEEA and 15 (17%) sternotomy at an overall median age of 12 days and weight of 3.2 kg. Prematurity (19%), cardiogenic shock (23%), and mechanical ventilation (29%) were similar between groups. Preoperative proximal arch z score was −3.9 for the entire cohort and was different between groups (T-EEEA −3.9 vs sternotomy −5.2; <em>P</em> = .01). Median ventilator and discharge times were shorter with T-EEEA (1 vs 4 days, <em>P</em> < .0001; 11 vs 22 days, <em>P</em> = .0015; respectively). Two hospital deaths occurred (1 per group). Morbidities included 7 recurrent nerve injuries, 1 chylothorax, and 1 stroke. Eight patients (T-EEEA 7, 9% vs sternotomy 1, 7%; <em>P</em> = .75) required reintervention (5 catheter, 3 surgical). All 3 surgical reinterventions occurred in patients who underwent T-EEEA with preoperative PTA z scores <−4.5. Freedom from reintervention at 5 years was similar between groups (T-EEEA 92% vs sternotomy 94%) and at a median follow-up of 58 months, there was adequate growth of the proximal arch with a median z score of −1.6 (T-EEEA −1.7, sternotomy −1.3, <em>P</em> = .13).</div></div><div><h3>Conclusions</h3><div>Repair of neonatal coarctation via thoracotomy with proximal arch hypoplasia up to a z score of −4.5 is safe, durable, with low rate of reintervention. Patients with a proximal arch z score <−4.5 should undergo aortic arch reconstruction via sternotomy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101516"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412576","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}
The study evaluated whether no-touch saphenous vein harvesting (NTH) improves graft patency compared with conventional harvesting (CH) and whether this translates into clinical benefit in coronary artery bypass grafting.
Methods
A systematic literature review was performed during May 2025 to retrieve randomized controlled trials comparing NTH and CH in coronary artery bypass grafting. Primary outcomes included graft occlusion per graft and per patient, and graft failure per patient. Secondary outcomes included all-cause death, myocardial infarction, repeat revascularization, recurrent angina, and leg wound complications. Data were extracted and pooled analyses were performed using a random-effects model.
Results
Ten randomized controlled trials with 4251 patients (NTH: 2143, CH: 2108) and 4848 grafts (NTH: 2415, CH: 2433) were included. Weighted mean follow-up was 39.0 months (range, 0.2-192 months). NTH was associated with a lower risk of graft occlusion per graft (risk ratio [RR], 0.70; 95% CI, 0.61-0.81), per patient (RR, 0.71; 95% CI, 0.60-0.84), and graft failure per patient (RR, 0.74; 95% CI, 0.64-0.87). Secondary outcomes showed no significant differences in all-cause death (hazard ratio [HR], 0.87; 95% CI, 0.43-1.79), myocardial infarction (HR, 0.79; 95% CI, 0.34-1.87), repeat revascularization (HR, 0.80; 95% CI, 0.32-1.95), and recurrent angina (HR, 0.59; 95% CI, 0.11-3.33), except for leg wound complications, which were significantly higher with NTH (RR, 1.78; 95% CI, 1.30-2.43).
Conclusions
NTH significantly improves graft patency compared with CH but confers no midterm advantage in major clinical outcomes, with increased leg wound complications. Large-scale studies with extended follow-up are needed to define its clinical influence.
{"title":"No-touch versus conventional vein harvesting in coronary bypass surgery: A meta-analysis of randomized controlled trials","authors":"Taizo Yoshida MD , Tomonari M. Shimoda MD , Yosuke Sakurai MD , Yujiro Yokoyama MD , Shinichi Fukuhara MD , Junichi Shimamura MD , Makoto Hibino MD , Tsuyoshi Kaneko MD , Hiroo Takayama MD , Michel Pompeu Sa MD, PhD , Hisato Takagi MD, PhD , Toshiki Kuno MD, PhD","doi":"10.1016/j.xjon.2025.11.003","DOIUrl":"10.1016/j.xjon.2025.11.003","url":null,"abstract":"<div><h3>Objectives</h3><div>The study evaluated whether no-touch saphenous vein harvesting (NTH) improves graft patency compared with conventional harvesting (CH) and whether this translates into clinical benefit in coronary artery bypass grafting.</div></div><div><h3>Methods</h3><div>A systematic literature review was performed during May 2025 to retrieve randomized controlled trials comparing NTH and CH in coronary artery bypass grafting. Primary outcomes included graft occlusion per graft and per patient, and graft failure per patient. Secondary outcomes included all-cause death, myocardial infarction, repeat revascularization, recurrent angina, and leg wound complications. Data were extracted and pooled analyses were performed using a random-effects model.</div></div><div><h3>Results</h3><div>Ten randomized controlled trials with 4251 patients (NTH: 2143, CH: 2108) and 4848 grafts (NTH: 2415, CH: 2433) were included. Weighted mean follow-up was 39.0 months (range, 0.2-192 months). NTH was associated with a lower risk of graft occlusion per graft (risk ratio [RR], 0.70; 95% CI, 0.61-0.81), per patient (RR, 0.71; 95% CI, 0.60-0.84), and graft failure per patient (RR, 0.74; 95% CI, 0.64-0.87). Secondary outcomes showed no significant differences in all-cause death (hazard ratio [HR], 0.87; 95% CI, 0.43-1.79), myocardial infarction (HR, 0.79; 95% CI, 0.34-1.87), repeat revascularization (HR, 0.80; 95% CI, 0.32-1.95), and recurrent angina (HR, 0.59; 95% CI, 0.11-3.33), except for leg wound complications, which were significantly higher with NTH (RR, 1.78; 95% CI, 1.30-2.43).</div></div><div><h3>Conclusions</h3><div>NTH significantly improves graft patency compared with CH but confers no midterm advantage in major clinical outcomes, with increased leg wound complications. Large-scale studies with extended follow-up are needed to define its clinical influence.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101509"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412662","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}
Pub Date : 2026-02-01Epub Date: 2025-12-18DOI: 10.1016/j.xjon.2025.101562
Jan Coveliers MD , Paolo Meani MD, PhD , Mariusz Kowalewski MD, PhD , Eliza Huizinga , Karthik Gutta , Giulia Piccirillo MD , Emanuele Gasparotti MEng, PhD , Emanuele Vignali MSc , Marilena Mazzoli MSc , Wouter Huberts MEng, PhD , Hamed Moradi MEng, PhD , Michele Di Mauro MD, PhD , Robert J. Holtackers MSc, PhD , Monique de Jong , Sandro Gelsomino MD, PhD , Domenico Paparella MD , Simona Celi MEng, PhD , Dorela Haxhiademi MD , Erik Körver BSc , Arne Doddema MSc , Roberto Lorusso MD, PhD
Background
Subclavian or axillary artery cannulation for venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides a valuable alternative to femoral access; however, a comprehensive overview of such an approach in this setting is lacking. This review examined types of access, clinical complications, and outcomes of subclavian/axillary cannulation, emphasizing the pros and cons of this VA-ECMO approach as well as areas for further investigation.
Methods
A systematic search was conducted in PubMed, Scopus, and Web of Science for articles published between January 2000 and December 2024. Studies were included that (1) reported on axillary or subclavian artery cannulation in VA-ECMO, (2) involved adult patients, and (3) provided in-hospital outcomes. Exclusion criteria were case reports with fewer than 5 patients and non-English language articles. Data on patient demographics, indications, cannulation techniques, complications, and in-hospital survival were collected.
Results
Seventeen studies with a total of 2030 patients were selected and analyzed. Subclavian or axillary cannulation was predominantly right-sided (99%) and involved graft interposition in 81% of cases. Indications for VA-ECMO with this arterial access included acute myocardial infarction shock (11%-42%), acute decompensation with chronic heart failure (4.9%-52%), postcardiotomy shock (7%-75.2%), acute myocarditis (4%- 7.7%) and refractory respiratory distress (5%-50%). Complications included limb ischemia (1.2%-9.6%), stroke (5.2%-18.8%) and bleeding events (4%-37.5%, often at the graft site). Left ventricular (LV) unloading strategies were used in 5.2% to 15.0% of cases but were not documented in almost 60% of the studies. In-hospital and 1-year survival rates ranged from 82.7% to 55% and from 50.6% to 25.7%, respectively.
Conclusions
VA-ECMO with axillary or subclavian artery access can be a safe and effective configuration, particularly for patients with contraindications or need of change of femoral cannulation. However, conflicting data on stroke risk, hemodynamic effects on LV ejection, the need for LV unloading (particularly with the right-sided approach), and both short- and long-term survival rates warrant further investigation.
锁骨下动脉或腋窝动脉插管用于静脉动脉体外膜氧合（VA-ECMO）提供了一种有价值的替代股动脉通道；然而，在这种情况下，缺乏对这种方法的全面概述。本文综述了锁骨下/腋窝插管的通路类型、临床并发症和结果，强调了VA-ECMO入路的优缺点以及需要进一步研究的领域。方法系统检索2000年1月至2024年12月在PubMed、Scopus和Web of Science中发表的论文。研究包括：(1)报道VA-ECMO中腋窝或锁骨下动脉插管，(2)涉及成年患者，(3)提供住院结果。排除标准为少于5例患者的病例报告和非英语文章。收集了患者人口统计学、适应症、插管技术、并发症和住院生存率的数据。结果选取17项研究共2030例患者进行分析。锁骨下或腋窝插管主要位于右侧（99%），81%的病例涉及移植物插入。经此动脉通路的VA-ECMO适应症包括急性心肌梗死休克（11%-42%）、急性代偿丧失伴慢性心力衰竭（4.9%-52%）、开心术后休克（7%-75.2%）、急性心肌炎（4%- 7.7%）和难治性呼吸窘迫（5%-50%）。并发症包括肢体缺血（1.2%-9.6%）、中风（5.2%-18.8%）和出血（4%-37.5%，常发生在移植物部位）。5.2%至15.0%的病例使用左心室卸荷策略，但在近60%的研究中没有记录。住院和1年生存率分别为82.7% ~ 55%和50.6% ~ 25.7%。结论经腋窝或锁骨下动脉通路的sva - ecmo是一种安全有效的配置，尤其适用于有禁忌症或需要改变股动脉插管的患者。然而，关于卒中风险、血流动力学对左室射血的影响、左室卸荷的必要性（特别是右侧入路）以及短期和长期生存率等相互矛盾的数据值得进一步研究。
{"title":"Subclavian or axillary artery cannulation for extracorporeal membrane oxygenation: A systematic review","authors":"Jan Coveliers MD , Paolo Meani MD, PhD , Mariusz Kowalewski MD, PhD , Eliza Huizinga , Karthik Gutta , Giulia Piccirillo MD , Emanuele Gasparotti MEng, PhD , Emanuele Vignali MSc , Marilena Mazzoli MSc , Wouter Huberts MEng, PhD , Hamed Moradi MEng, PhD , Michele Di Mauro MD, PhD , Robert J. Holtackers MSc, PhD , Monique de Jong , Sandro Gelsomino MD, PhD , Domenico Paparella MD , Simona Celi MEng, PhD , Dorela Haxhiademi MD , Erik Körver BSc , Arne Doddema MSc , Roberto Lorusso MD, PhD","doi":"10.1016/j.xjon.2025.101562","DOIUrl":"10.1016/j.xjon.2025.101562","url":null,"abstract":"<div><h3>Background</h3><div>Subclavian or axillary artery cannulation for venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides a valuable alternative to femoral access; however, a comprehensive overview of such an approach in this setting is lacking. This review examined types of access, clinical complications, and outcomes of subclavian/axillary cannulation, emphasizing the pros and cons of this VA-ECMO approach as well as areas for further investigation.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in PubMed, Scopus, and Web of Science for articles published between January 2000 and December 2024. Studies were included that (1) reported on axillary or subclavian artery cannulation in VA-ECMO, (2) involved adult patients, and (3) provided in-hospital outcomes. Exclusion criteria were case reports with fewer than 5 patients and non-English language articles. Data on patient demographics, indications, cannulation techniques, complications, and in-hospital survival were collected.</div></div><div><h3>Results</h3><div>Seventeen studies with a total of 2030 patients were selected and analyzed. Subclavian or axillary cannulation was predominantly right-sided (99%) and involved graft interposition in 81% of cases. Indications for VA-ECMO with this arterial access included acute myocardial infarction shock (11%-42%), acute decompensation with chronic heart failure (4.9%-52%), postcardiotomy shock (7%-75.2%), acute myocarditis (4%- 7.7%) and refractory respiratory distress (5%-50%). Complications included limb ischemia (1.2%-9.6%), stroke (5.2%-18.8%) and bleeding events (4%-37.5%, often at the graft site). Left ventricular (LV) unloading strategies were used in 5.2% to 15.0% of cases but were not documented in almost 60% of the studies. In-hospital and 1-year survival rates ranged from 82.7% to 55% and from 50.6% to 25.7%, respectively.</div></div><div><h3>Conclusions</h3><div>VA-ECMO with axillary or subclavian artery access can be a safe and effective configuration, particularly for patients with contraindications or need of change of femoral cannulation. However, conflicting data on stroke risk, hemodynamic effects on LV ejection, the need for LV unloading (particularly with the right-sided approach), and both short- and long-term survival rates warrant further investigation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101562"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411921","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}
Pub Date : 2026-02-01Epub Date: 2025-12-19DOI: 10.1016/j.xjon.2025.101567
John F. Gallagher MD , Victor Garcia PhD , Steven Escaravage MHS, PA-C , Pamela Gallagher MD , Paul J. Gallagher MSc , Danielle Diegisser MSc , William Davalan MD, MSc Candidate , Walid Ben Ali MD, PhD , Maximilian Y. Emmert MD, PhD , Daniel Fusco MD , Louis P. Perrault MD, PhD
{"title":"Reply: Hydrodissection for conduit harvesting: Catch the wave!","authors":"John F. Gallagher MD , Victor Garcia PhD , Steven Escaravage MHS, PA-C , Pamela Gallagher MD , Paul J. Gallagher MSc , Danielle Diegisser MSc , William Davalan MD, MSc Candidate , Walid Ben Ali MD, PhD , Maximilian Y. Emmert MD, PhD , Daniel Fusco MD , Louis P. Perrault MD, PhD","doi":"10.1016/j.xjon.2025.101567","DOIUrl":"10.1016/j.xjon.2025.101567","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101567"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411925","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}
Pub Date : 2026-02-01Epub Date: 2025-12-09DOI: 10.1016/j.xjon.2025.101553
Ali Fatehi Hassanabad MD, MSc, PhD , Mortaza Fatehi Hassanabad MSc , Melissa A. King MD, MSc , Madeleine P. McKenzie BSc , Alexandre Bergeron MSc , Adwaiy Manerikar MD , Anna Huskin RN, BSN , Jane Kruse BSN , Abigail S. Baldridge DrPH , Justyna Fercho MD , Mateusz Janeczek MD , Muhammad Israr-Ul-Haq MD , Mathieu Rheault-Henry MD , Abdullatif Abo Dan MD , Michael W.A. Chu MD, MSc , Muhammad R. Ahsan MBBS , Holly N. Smith MD, MBA , Andrew Maitland MD , Daniel D. Holloway MD, MSc , Wojtek Karolak MD , William D.T. Kent MD, MSc
Background
Right anterior mini thoracotomy (RAMT) is a sternum-sparing approach for aortic valve replacement (AVR). Single-center studies have found RAMT AVR to be safe; however, there is a paucity of large, multicenter, all-comer, and real-world data for this surgical strategy.
Methods
This retrospective study investigated the outcomes of isolated RAMT AVR at 6 centers in the United States, Canada, and Europe. Primary outcomes were death and disabling stroke within 30 days of surgery. Secondary outcomes included rate of conversion to sternotomy, prosthetic used, operative times, residual paravalvular leak, rate of permanent pacemaker (PPM) implantation, incidence of new onset postoperative atrial fibrillation (POAF), rate of blood transfusion, and intensive care unit and hospital length of stay.
Results
Seven hundred and sixteen patients underwent isolated RAMT AVR between January 2012 and December 2024 across 6 centers. Four hundred and twenty-eight were male, and the mean age of the cohort was 68.1 ± 10.7 years. Six patients (0.8%) died and 3 (0.4%) experienced a disabling stroke. Thirteen patients (1.8%) required emergent reoperation to control bleeding, while 45 (6.3%) received transfused blood products. One hundred and thirty patients (18.2%) experienced POAF. The incidence of permanent pacemaker implantation after a sutured valve replacement was 2.51% (n = 18 patients). The median intensive care unit and hospital length of stay was 1 day and 5 days, respectively.
Conclusions
The findings of this study, the largest multicenter study on RAMT AVR reported to date, suggest that this is a safe operation associated with excellent outcomes.
{"title":"Right anterior mini-thoracotomy for isolated aortic valve replacement: An international and multicenter study","authors":"Ali Fatehi Hassanabad MD, MSc, PhD , Mortaza Fatehi Hassanabad MSc , Melissa A. King MD, MSc , Madeleine P. McKenzie BSc , Alexandre Bergeron MSc , Adwaiy Manerikar MD , Anna Huskin RN, BSN , Jane Kruse BSN , Abigail S. Baldridge DrPH , Justyna Fercho MD , Mateusz Janeczek MD , Muhammad Israr-Ul-Haq MD , Mathieu Rheault-Henry MD , Abdullatif Abo Dan MD , Michael W.A. Chu MD, MSc , Muhammad R. Ahsan MBBS , Holly N. Smith MD, MBA , Andrew Maitland MD , Daniel D. Holloway MD, MSc , Wojtek Karolak MD , William D.T. Kent MD, MSc","doi":"10.1016/j.xjon.2025.101553","DOIUrl":"10.1016/j.xjon.2025.101553","url":null,"abstract":"<div><h3>Background</h3><div>Right anterior mini thoracotomy (RAMT) is a sternum-sparing approach for aortic valve replacement (AVR). Single-center studies have found RAMT AVR to be safe; however, there is a paucity of large, multicenter, all-comer, and real-world data for this surgical strategy.</div></div><div><h3>Methods</h3><div>This retrospective study investigated the outcomes of isolated RAMT AVR at 6 centers in the United States, Canada, and Europe. Primary outcomes were death and disabling stroke within 30 days of surgery. Secondary outcomes included rate of conversion to sternotomy, prosthetic used, operative times, residual paravalvular leak, rate of permanent pacemaker (PPM) implantation, incidence of new onset postoperative atrial fibrillation (POAF), rate of blood transfusion, and intensive care unit and hospital length of stay.</div></div><div><h3>Results</h3><div>Seven hundred and sixteen patients underwent isolated RAMT AVR between January 2012 and December 2024 across 6 centers. Four hundred and twenty-eight were male, and the mean age of the cohort was 68.1 ± 10.7 years. Six patients (0.8%) died and 3 (0.4%) experienced a disabling stroke. Thirteen patients (1.8%) required emergent reoperation to control bleeding, while 45 (6.3%) received transfused blood products. One hundred and thirty patients (18.2%) experienced POAF. The incidence of permanent pacemaker implantation after a sutured valve replacement was 2.51% (n = 18 patients). The median intensive care unit and hospital length of stay was 1 day and 5 days, respectively.</div></div><div><h3>Conclusions</h3><div>The findings of this study, the largest multicenter study on RAMT AVR reported to date, suggest that this is a safe operation associated with excellent outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101553"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412065","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}
Pub Date : 2026-02-01Epub Date: 2025-09-11DOI: 10.1016/j.xjon.2025.08.014
Elizabeth M. Cordoves BA , Gerardo Ramos-Lemos BS , Vincent R. LaSala MD , Halil Beqaj MD , Paul Trackey BS , Chunhui Wang MD, MPH , Andrew B. Goldstone MD, PhD , Paul A. Kurlansky MD , Stephanie Levasseur MD , Amee Shah MD , Ganga Krishnamurthy MD , Emile Bacha MD , David Kalfa MD, PhD
Objective
The aortic atresia/mitral stenosis (AA/MS) subtype in hypoplastic left heart syndrome (HLHS) has been associated with poor single-ventricle palliation outcomes. We evaluated whether HLHS anatomic subtype influences transplant and Fontan-takedown−free survival and right ventricular (RV) and tricuspid valve (TV) function in the current era.
Methods
Retrospective chart review was done for 219 consecutive neonates with HLHS who received a Norwood at our center (2006-2023). Primary outcomes were freedom from mortality/transplant/Fontan takedown post-Norwood (n = 219) and Fontan (n = 133). Moderate or greater RV dysfunction and TV failure were secondary outcomes. Log-rank and Cox regression evaluated primary outcomes; Fine-Gray model assessed secondary outcomes.
Results
Post-Norwood (n = 219), we found that AA/MS was not associated with mortality/transplant/Fontan takedown (log-rank and Cox P = .72), RV dysfunction (Fine-Gray HR, 0.79; P = .33), or TV failure (Fine-Gray hazard ratio [HR], 1.27, P = .34). On multivariable regression, RV dysfunction pre-Norwood (HR, 4.45; P = .008) and genetic syndrome (HR, 2.21; P = .031) were associated with mortality/transplant/Fontan takedown. Post-Fontan, AA/MS was not associated with Fontan failure (log-rank and Cox P = .35), RV dysfunction (Fine-Gray HR, 1; P = .99) or TV failure (Fine-Gray HR, 1.15; P = .74). Aortic stenosis was associated with RV dysfunction (Fine-Gray HR, 2.35; P = .02). On univariate regression, extracardiac anomaly was associated with Fontan failure (HR, 7.25; P = .003). On multivariable regression, TV insufficiency pre-Glenn (HR, 5.4; P = .002) and genetic syndrome (HR, 4.15; P = .036) correlated with Fontan failure.
Conclusions
No association was observed between AA/MS and reduced transplant/takedown-free survival, RV function, or TV failure. Aortic stenosis was associated with increased risk of moderate or greater RV dysfunction post-Fontan. We found that preoperative RV and TV dysfunction, genetic syndrome, and extracardiac anomalies remain risk factors.
目的左心发育不全综合征（HLHS）的主动脉闭锁/二尖瓣狭窄（AA/MS）亚型与单心室缓解效果差相关。我们评估了HLHS解剖亚型在当前时代是否影响移植和Fontan-takedown存活以及右心室（RV）和三尖瓣（TV）功能。方法对2006-2023年在我中心连续219例接受诺伍德治疗的HLHS新生儿进行回顾性分析。主要结局为norwood术后（n = 219）和Fontan术后（n = 133）无死亡/移植/Fontan切除。中度或更严重的右心室功能障碍和电视失败是次要结局。Log-rank和Cox回归评估主要结局；Fine-Gray模型评估次要结果。结果在post - norwood （n = 219）中，我们发现AA/MS与死亡率/移植/Fontan取下（log-rank和Cox P = .72）、RV功能障碍（Fine-Gray HR, 0.79; P = .33）或TV失败（Fine-Gray风险比[HR]， 1.27, P = .34）无关。在多变量回归中，左心室功能障碍（HR, 4.45; P = 0.008）和遗传综合征（HR, 2.21; P = 0.031）与死亡率/移植/Fontan取下相关。Fontan后，AA/MS与Fontan失败（log-rank和Cox P = 0.35）、RV功能障碍（Fine-Gray HR, 1; P = 0.99）或TV失败（Fine-Gray HR, 1.15; P = 0.74）无关。主动脉瓣狭窄与右心室功能障碍相关（Fine-Gray HR, 2.35; P = 0.02）。单因素回归显示，心外异常与Fontan衰竭相关（HR, 7.25; P = 0.003）。在多变量回归分析中，TV功能不全（HR, 5.4; P = .002）和遗传综合征（HR, 4.15; P = .036）与Fontan衰竭相关。结论：AA/MS与移植/无摘取生存期降低、RV功能或TV衰竭无相关性。主动脉瓣狭窄与fontan术后中度或更严重的右心室功能障碍风险增加相关。我们发现术前左心室和心室功能障碍、遗传综合征和心外异常仍然是危险因素。
{"title":"Impact of hypoplastic left heart syndrome anatomic subtype on mortality, ventricular function, and atrioventricular valve function in the current era","authors":"Elizabeth M. Cordoves BA , Gerardo Ramos-Lemos BS , Vincent R. LaSala MD , Halil Beqaj MD , Paul Trackey BS , Chunhui Wang MD, MPH , Andrew B. Goldstone MD, PhD , Paul A. Kurlansky MD , Stephanie Levasseur MD , Amee Shah MD , Ganga Krishnamurthy MD , Emile Bacha MD , David Kalfa MD, PhD","doi":"10.1016/j.xjon.2025.08.014","DOIUrl":"10.1016/j.xjon.2025.08.014","url":null,"abstract":"<div><h3>Objective</h3><div>The aortic atresia/mitral stenosis (AA/MS) subtype in hypoplastic left heart syndrome (HLHS) has been associated with poor single-ventricle palliation outcomes. We evaluated whether HLHS anatomic subtype influences transplant and Fontan-takedown−free survival and right ventricular (RV) and tricuspid valve (TV) function in the current era.</div></div><div><h3>Methods</h3><div>Retrospective chart review was done for 219 consecutive neonates with HLHS who received a Norwood at our center (2006-2023). Primary outcomes were freedom from mortality/transplant/Fontan takedown post-Norwood (n = 219) and Fontan (n = 133). Moderate or greater RV dysfunction and TV failure were secondary outcomes. Log-rank and Cox regression evaluated primary outcomes; Fine-Gray model assessed secondary outcomes.</div></div><div><h3>Results</h3><div>Post-Norwood (n = 219), we found that AA/MS was not associated with mortality/transplant/Fontan takedown (log-rank and Cox <em>P</em> = .72), RV dysfunction (Fine-Gray HR, 0.79; <em>P</em> = .33), or TV failure (Fine-Gray hazard ratio [HR], 1.27, <em>P</em> = .34). On multivariable regression, RV dysfunction pre-Norwood (HR, 4.45; <em>P</em> = .008) and genetic syndrome (HR, 2.21; <em>P</em> = .031) were associated with mortality/transplant/Fontan takedown. Post-Fontan, AA/MS was not associated with Fontan failure (log-rank and Cox <em>P</em> = .35), RV dysfunction (Fine-Gray HR, 1; <em>P</em> = .99) or TV failure (Fine-Gray HR, 1.15; <em>P</em> = .74). Aortic stenosis was associated with RV dysfunction (Fine-Gray HR, 2.35; <em>P</em> = .02). On univariate regression, extracardiac anomaly was associated with Fontan failure (HR, 7.25; <em>P</em> = .003). On multivariable regression, TV insufficiency pre-Glenn (HR, 5.4; <em>P</em> = .002) and genetic syndrome (HR, 4.15; <em>P</em> = .036) correlated with Fontan failure.</div></div><div><h3>Conclusions</h3><div>No association was observed between AA/MS and reduced transplant/takedown-free survival, RV function, or TV failure. Aortic stenosis was associated with increased risk of moderate or greater RV dysfunction post-Fontan. We found that preoperative RV and TV dysfunction, genetic syndrome, and extracardiac anomalies remain risk factors.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101420"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412640","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}
Pub Date : 2026-02-01Epub Date: 2025-10-24DOI: 10.1016/j.xjon.2025.10.008
Christian Pizarro MD
{"title":"Commentary: Associations are not enough the explain causality: Multifactorial interactions are the key","authors":"Christian Pizarro MD","doi":"10.1016/j.xjon.2025.10.008","DOIUrl":"10.1016/j.xjon.2025.10.008","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101481"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412641","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}
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