JTCVS open最新文献

{"title":"Longitudinal quality of life assessment following robotic mitral valve repair versus conventional sternotomy","authors":"Nadia H. Bakir MD ,&nbsp;Fachreza Aryo Damara MD ,&nbsp;Daniel J.P. Burns MD, MPhil ,&nbsp;Penny L. Houghtaling MS ,&nbsp;Linda M. DiPaola BA ,&nbsp;Lars G. Svensson MD, PhD ,&nbsp;Eugene H. Blackstone MD ,&nbsp;Tarek Malas MD ,&nbsp;Marc Gillinov MD","doi":"10.1016/j.xjon.2025.11.001","DOIUrl":"10.1016/j.xjon.2025.11.001","url":null,"abstract":"<div><h3>Objective</h3><div>Robotic-assisted mitral repair has demonstrated excellent late outcomes without increased morbidity and mortality in experienced centers. Robust analysis of postoperative quality of life in large cohorts has been limited.</div></div><div><h3>Methods</h3><div>Between January 1, 2020, and April 1, 2024, 563 adult patients who underwent mitral repair for degenerative mitral regurgitation at our institution were retrospectively reviewed. Patient-Reported Outcomes Information System Global Health 10-question survey (PROMIS-10) physical and mental scores, as well as MacNew social scores were evaluated at baseline and serial follow-up at 1 month, 3 months, 6 months, and 1 year. Quality of life (QoL) metrics were evaluated longitudinally using a nonlinear multiphase mixed-effects regression model.</div></div><div><h3>Results</h3><div>A total of 1493 postoperative QoL measurements were available in 563 patients (247 robotic vs 316 sternotomy). Patients who received a robotic approach were younger than those who underwent sternotomy (age 58 ± 10 years vs age 66 ± 10 years; <em>P</em> &lt; .001) with fewer comorbidities and higher baseline PROMIS-10 physical (55 robotic vs 51 sternotomy; <em>P</em> &lt; .001) and mental (57 vs 53; <em>P</em> &lt; .001) scores. There was no significant difference in temporal outcomes between groups (physical: <em>P</em> = .11; mental: <em>P</em> = .84; social: <em>P</em> = .55). Each metric in both groups surpassed the population norm and returned to preoperative baseline within 6 months (graphical abstract).</div></div><div><h3>Conclusions</h3><div>Postoperative QoL following mitral valve repair was excellent, regardless of approach. Patients who were selected for a robotic approach demonstrated higher baseline QoL metrics than those who received a sternotomy, but this did not translate to a comparative improvement on adjusted analyses and QoL for most patients returned to baseline by 6 months. The operative approach for mitral valve repair in patients who are candidates for a minimally invasive procedure should be tailored to surgeon experience in offering a safe, durable repair.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101503"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412642","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":"Cardiac valve prosthesis choice for left-sided infective endocarditis in Medicare patients","authors":"Waseem Lutfi MD ,&nbsp;Ziwei Pan MS ,&nbsp;Madison A. Grasty MD ,&nbsp;Nicolas J. Goel MD ,&nbsp;Michael A. Catalano MD ,&nbsp;Alexandra E. Sperry MD ,&nbsp;Jonathan Szeto BA ,&nbsp;Pablo Kurzan BS ,&nbsp;Kendall M. Lawrence MD ,&nbsp;Nimesh D. Desai MD, PhD ,&nbsp;Wilson Y. Szeto MD ,&nbsp;John H. Holmes PhD ,&nbsp;Chase R. Brown MD, MPH","doi":"10.1016/j.xjon.2025.09.050","DOIUrl":"10.1016/j.xjon.2025.09.050","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the outcomes between bioprosthetic and mechanical prosthesis choice for aortic valve and mitral valve infective endocarditis (IE) in patients &gt;65 years old.</div></div><div><h3>Methods</h3><div>Medicare Provider Analysis and Review files from 2011 to 2019 were queried for adult patients &gt;65 years old with de novo IE who underwent isolated bioprosthetic aortic valve replacement (bAVR), mechanical aortic valve replacement (mAVR), bioprosthetic mitral valve replacement (bMVR), or mechanical mitral valve replacement (mMVR). Patients with preoperative ischemic or hemorrhagic stroke were excluded. Analyses were conducted separately for the aortic and mitral position: bAVR versus mAVR, and bMVR versus mMVR. Propensity score matching was used to account for measured confounders. The primary outcome was 5-year overall survival analyzed using restricted mean survival time; secondary outcomes were the 5-year cumulative incidences of valve reoperation, heart failure readmission, recurrent IE, bleeding, and ischemic stroke analyzed using Fine-Gray regression with death as a competing risk.</div></div><div><h3>Results</h3><div>Matching yielded 330 patients in each AVR group and 250 patients in each MVR group. Five-year survival favored bAVR over mAVR (66.1% vs 56.7%, RMST: 3.96 years vs 3.46 years, <em>P</em> = .001), whereas 5-year survival was similar for bMVR versus mMVR (53.1% vs 53.1%, RMST: 3.50 years vs 3.35 years, <em>P</em> = .451). There were no significant differences in the cumulative incidences of secondary outcomes.</div></div><div><h3>Conclusions</h3><div>This analysis of patients &gt;65 years old with left-sided IE demonstrated that mechanical valves were associated with worse early mortality, no 5-year survival advantage over bioprosthetic valves, and provide no benefit in this population.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101490"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412661","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":"Modified Del Nido “microplegia” reduces intraoperative, postoperative, and total blood products","authors":"Abigayle B. Simon BS ,&nbsp;Tyler Coffey BS, CCP, LP ,&nbsp;Philip Coffey MD ,&nbsp;Bhargav Doddala MD, MPH ,&nbsp;Nikki Jones RN, BSN ,&nbsp;Neal L. Weintraub MD ,&nbsp;Dominic M. Gallo MD ,&nbsp;Robert D. Rice MD ,&nbsp;Vijay S. Patel MD ,&nbsp;Richard Lee MD, JD, MBA","doi":"10.1016/j.xjon.2025.11.002","DOIUrl":"10.1016/j.xjon.2025.11.002","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous studies have shown that Buckberg microplegia reduces the need for intraoperative blood transfusion by minimizing hemodilution. However, this approach has been largely understudied in the context of Del Nido cardioplegia. We hypothesized that applying microplegia principles to Del Nido cardioplegia would similarly reduce transfusion requirements.</div></div><div><h3>Methods</h3><div>A total of 192 consecutive patients undergoing isolated coronary artery bypass grafting with a single crossclamp and 1 dose of cardioplegia at a single institution between October 2023 and January 2025 were divided into 2 groups: standard Del Nido cardioplegia and modified micro Del Nido cardioplegia. All patients underwent retrograde autologous priming before initiation of bypass. Demographic factors, hematocrit levels, lactate levels, bypass time, crossclamp time, and transfusion of blood products including red blood cells, fresh-frozen plasma, platelets, and cryoprecipitate were compared. Additional outcomes of postoperative complications were measured.</div></div><div><h3>Results</h3><div>Patients receiving modified micro Del Nido cardioplegia received significantly fewer units of intraoperative packed red blood cells (<em>P = .</em>0010), platelets (<em>P = .</em>0429), cryoprecipitate (<em>P = .</em>0149), and total intraoperative blood products (<em>P = .</em>0079) compared with patients receiving Del Nido cardioplegia. Postoperatively, patients receiving modified micro Del Nido cardioplegia also required significantly fewer units of platelets (<em>P = .</em>0387) and cryoprecipitate (<em>P = .</em>0099). Overall, patients receiving modified micro Del Nido cardioplegia received significantly lower total blood products (<em>P = .</em>0001), total platelets (<em>P = .</em>0136), and total cryoprecipitate (<em>P = .</em>0005) throughout hospitalization. They also experienced a smaller decrease in hematocrit (<em>P = .</em>004). No differences were observed in other clinical outcomes or in total red blood cell transfusions (<em>P = .</em>165).</div></div><div><h3>Conclusions</h3><div>Modified micro Del Nido cardioplegia reduces intraoperative and total blood product use and may further improve outcomes in larger studies.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101506"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412664","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":"Trogocytosis-derived regulatory cluster of differentiation 8−positive T cells facilitate induction of immune tolerance after lung transplantation","authors":"Jing Wang PhD ,&nbsp;Song-ping Cui PhD ,&nbsp;Qing Zhao MD ,&nbsp;Yi Liu PhD ,&nbsp;Jin-bai Miao PhD ,&nbsp;Yi-li Fu MD ,&nbsp;Lin Zhou PhD ,&nbsp;Bin Hu MD","doi":"10.1016/j.xjon.2025.09.047","DOIUrl":"10.1016/j.xjon.2025.09.047","url":null,"abstract":"<div><h3>Objective</h3><div>Donor-specific regulatory T cells are crucial for establishing immune tolerance in lung transplantation. We sought to elucidate the specific mechanisms by which major histocompatibility complex class II (MHC-II⁺) trogocytosis Tregs induce transient immune tolerance in lung transplantation.</div></div><div><h3>Methods</h3><div>A rat lung transplantation model with spontaneous tolerance was established. CD8⁺CD45RCl^ow Tregs and plasmacytoid dendritic cells (pDCs) were isolated by magnetic separation and characterized by flow cytometry, cytokine profiling, and confocal microscopy. Mixed lymphocyte reactions and targeted interventions were used to dissect the mechanisms governing MHC-II acquisition and the involvement of the interferon-gamma (IFN-γ)/indoleamine 2,3-dioxygenase (IDO) signaling axis. Adoptive transfer experiments were performed to evaluate the therapeutic potential of these cells.</div></div><div><h3>Results</h3><div>Lung grafts from spontaneously tolerant rats exhibited significantly increased frequencies of MHC-II compared with acutely rejected grafts (13.9 ± 0.9% vs 3.5 ± 0.5%, <em>P</em> &lt; .001). Confocal microscopy assay enhanced presence of MHC-II⁺CD8⁺CD45RC^lowTregs may be attributed to a specialized trogocytosis interaction between CD8⁺CD45RC^lowTregs and pDCs, which facilitated the transfer and chimerism of MHC-II molecules on the surfaces of both CD8⁺CD45RC^lowTregs and pDCs as well. Intervention with IFN-γ resulted in an increased production of MHC-II⁺CD8⁺CD45RC^lowTregs during mixed lymphocyte reactions (<em>P</em> &lt; .01). Conversely, blockade of IDO with anti−IFN-γ antibody or 1-MT significantly decreased the expression (<em>P</em> &lt; .001). MHC-II⁺CD8⁺CD45RC^lowTregs secreted high levels of IL-10, and the adoptive transfer of MHC-II⁺ trogocytosis Tregs notably prolonged the survival of lung-transplanted rats (40.2 ± 8.1 days vs 9.05 ± 2.3 days).</div></div><div><h3>Conclusions</h3><div>MHC-II⁺CD8⁺CD45RC^lowTregs mediate lung transplantation transient immune tolerance through the IFN-γ/IDO signaling pathway, providing theoretical support for the development of donor-specific immune tolerance clinical strategies.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101484"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412317","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":"Bronchial sleeve lobectomy with pulmonary artery reconstruction following neoadjuvant chemoimmunotherapy: A propensity score–weighted comparison","authors":"Yuzhou Wang MD ,&nbsp;Yichen Dong MD ,&nbsp;Tao Chen MD ,&nbsp;Jialiang Wen MD ,&nbsp;Long Xu MD ,&nbsp;Jiajun Deng MD ,&nbsp;Yunlang She MD ,&nbsp;Junqi Wu MD ,&nbsp;Qiankun Chen MD ,&nbsp;Lei Jiang MD ,&nbsp;Xuefei Hu MD, PhD ,&nbsp;Diego Gonzalez-Rivas MD, PhD ,&nbsp;Deping Zhao MD, PhD ,&nbsp;Dong Xie MD, PhD ,&nbsp;Chang Chen MD, PhD","doi":"10.1016/j.xjon.2025.11.008","DOIUrl":"10.1016/j.xjon.2025.11.008","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the feasibility and safety of bronchial sleeve lobectomy (BSL) with pulmonary artery reconstruction (PAR) following neoadjuvant chemoimmunotherapy.</div></div><div><h3>Methods</h3><div>Patients undergoing sleeve lobectomy or pneumonectomy after neoadjuvant chemoimmunotherapy between 2019 and 2023 were enrolled in the analysis retrospectively. Perioperative outcomes, overall survival, and event-free survival were compared among the BSL, BSL with PAR, and pneumonectomy (PN) groups before and after propensity score matching weights (MW).</div></div><div><h3>Results</h3><div>In the overall cohort, 143 patients received simple BSL, 49 received BSL with PAR, and 48 underwent PN. There were marked differences in the distribution of age, clinical N stage, and tumor location among the 3 groups. After MW, BSL with PAR was associated with a higher thoracotomy rate (<em>P</em> = .011), longer operative time (<em>P</em> = .007), and more intraoperative blood loss (<em>P</em> &lt; .001) compared with BSL and PN. The incidences of surgery-related complications (33.1% vs 49.3%) and severe complications (28.1% vs 45.8%) was lower and the hospital stay was shorter (median, 6 days vs 9 days) in the BSL with PAR group compared to the PN group. There was no significant discrepancy in postoperative complication rates between BSL with PAR and BSL after MW. Multivariable logistic regression analysis revealed that compared to PN, BSL with PAR served as a protective factor for both postoperative complications (<em>P</em> = .042) and severe complications (<em>P</em> = .014). Kaplan-Meier analysis further suggested that BSL with PAR was associated with favorable overall survival compared to PN after MW (<em>P</em> = .027).</div></div><div><h3>Conclusions</h3><div>BSL with PAR can be recognized as a safe and feasible surgical procedure even after neoadjuvant chemoimmunotherapy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101519"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412523","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":"Biogenic polymer-based heart valve for congenital cardiac surgery","authors":"Julian Hubrich ,&nbsp;Christopher Herz MS ,&nbsp;Dario Arcuti MS ,&nbsp;Alexandra Zorin BS ,&nbsp;Emma Richert MD ,&nbsp;Stefan Simon ,&nbsp;Dominik Obrist PhD ,&nbsp;Christian Hagl MD, PhD ,&nbsp;Petra Mela PhD ,&nbsp;Jürgen Hörer MD, PhD ,&nbsp;Thierry Carrel MD, PhD ,&nbsp;Jacobus Theron PhD ,&nbsp;Linda Grefen MD ,&nbsp;Maximilian Grab MS ,&nbsp;Paul Philipp Heinisch MD, PhD","doi":"10.1016/j.xjon.2025.11.013","DOIUrl":"10.1016/j.xjon.2025.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Current heart valve prostheses in congenital cardiac surgery (CCS) are unable to grow, remodel, or adapt to a child's evolving physiology, resulting in increased mortality rates due to material-related limitations. The excellent biocompatibility and hemocompatibility of bacterial cellulose (BC) make it a promising alternative. This study aimed to use BC to develop a biogenic polymer-based heart valve and then to assess its hemodynamic performance and long-term durability.</div></div><div><h3>Methods</h3><div>Heart valve leaflets were produced via a standard BC protocol and compressed to a minimal thickness, and their biomechanical properties were evaluated. Using a customized template, BC leaflets were sutured into a 23-mm stent scaffold. Two prototype series with different leaflet designs were tested in a mock circulatory flow loop model with a flow rate of 5 L/minute at 120/80 mm Hg. Long-term durability was assessed for 10 ± 0.5 million cycles at 120/80 mm Hg, followed by retesting.</div></div><div><h3>Results</h3><div>BC valve leaflets exhibited a thickness reduction of 94.01% to 0.3 ± 0.11 mm (<em>P</em> &lt; .001) while retaining a durability of 100% at 500 mm Hg (n = 23), with a maximum tensile strength of 1.64 ± 0.3 MPa (n = 35). All valves combined (n = 21) displayed a mean transvalvular pressure drop (MTP) of 8.32 ± 1.23 mm Hg, a mean regurgitation fraction (REG) of 10.22 ± 4.42%, and a mean effective orifice area (EOA) of 1.85 ± 0.14 cm², with valves of series 2 showing a lower REG (<em>P</em> &lt; .001). Following long-term durability testing, all valves of series 2 (n = 6) remained intact, demonstrating an MTP 9.11 ± 1.13 mm Hg, REG of 9.41 ± 4.25%, and EOA of 1.7 ± 0.1 cm².</div></div><div><h3>Conclusions</h3><div>The potential of BC for use in CCS was demonstrated by developing a new biogenic polymer-based valve with excellent hemodynamic performance. These results warrant further investigation and development of this biomaterial.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101528"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412933","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":"High-volume centers achieve superior outcomes in left ventricular assist device explant-heart transplantation","authors":"Catherine L.B. McGeoch MD, MSc,&nbsp;Clayton J. Rust MD,&nbsp;Reshma Kodimerla MPH,&nbsp;Sally El Sammak MD,&nbsp;Konstantinos S. Mylonas MD, PhD,&nbsp;Humza Naqvi MHS,&nbsp;Supreet S. Randhawa MS,&nbsp;Ailin Tang BS,&nbsp;Michael E. Halkos MD, MSc,&nbsp;Muath M. Bishawi MD, PhD,&nbsp;Mani A. Daneshmand MD,&nbsp;Joshua L. Chan MD","doi":"10.1016/j.xjon.2025.10.036","DOIUrl":"10.1016/j.xjon.2025.10.036","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular assist device <strong>(</strong>LVAD) explantation at the time of orthotopic heart transplantation (OHT) carries increased perioperative risks. This study examined whether institutional operative volume influences outcomes following LVAD explant-OHT in a contemporary national cohort.</div></div><div><h3>Methods</h3><div>Adult patients who underwent LVAD explantation with OHT between 2011 and 2024 were identified in the Organ Procurement and Transportation Network/United Network for Organ Sharing registry. Using a rank-order method based on surgical volume, centers were stratified as either high volume or low volume. The primary outcome was 1-year survival; secondary outcomes included graft failure, ischemic time, dialysis, stroke, and hospital length of stay. Kaplan-Meier and Cox regression analyses were performed to assess survival and predictors of mortality.</div></div><div><h3>Results</h3><div>A total of 2863 patients across 121 centers were analyzed. Eight high-volume centers performed 31.3% (897 cases) of all LVAD explant-OHTs. Baseline characteristics, including heart failure etiology and LVAD device type, were similar in the 2 groups. High-volume centers demonstrated decreased ischemic time (mean, 3.1 ± 1.3 hours vs 3.5 ± 1.4 hours; <em>P</em> &lt; .001), a lower rate of postoperative dialysis (12.7% vs 15.4%; <em>P</em> = .023), and shorter length of stay (mean, 22.8 ± 26.6 days vs 25.9 ± 31.3 days; <em>P</em> = .006) compared to low-volume centers. Graft failure was less common at high-volume centers (24.2% vs 28.8%; <em>P</em> = .011). One-year survival rate (81.6% vs 76.1%; <em>P</em> = .001) and median survival (4.93 years vs 4.00 years; <em>P</em> = .018) were greater at high-volume centers. Multivariable analysis identified low-volume center status as an independent predictor of higher mortality (hazard ratio, 1.28; 95% confidence interval, 1.10-1.50; <em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>High-volume centers were associated with superior survival and improved perioperative outcomes following LVAD explant-OHT.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101524"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411919","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":"Pushing the envelope: Routine operating room extubation in aortic surgery","authors":"Michael Salna MD, MBA ,&nbsp;Katherine Phillips MD ,&nbsp;Liliya Pospishil MD ,&nbsp;Elias Zias MD ,&nbsp;Didier Loulmet MD ,&nbsp;Mathew Williams MD ,&nbsp;Eugene Grossi MD ,&nbsp;Ralph Mosca MD ,&nbsp;Aubrey Galloway MD ,&nbsp;Mark D. Peterson MD, PhD","doi":"10.1016/j.xjon.2025.11.011","DOIUrl":"10.1016/j.xjon.2025.11.011","url":null,"abstract":"<div><h3>Objective</h3><div>Prolonged intubation is associated with worse outcomes and longer intensive care unit (ICU) and hospital length of stay (LOS). Extubation in the operating room for patients undergoing isolated coronary artery bypass grafting is feasible, safe, and decreases ICU and hospital LOS. Aortic root and arch procedures are lengthy and often require circulatory arrest. Here, we present our experience with the safety and feasibility of operating room extubation following simple and complex aortic surgery.</div></div><div><h3>Methods</h3><div>All consecutive patients who underwent aortic surgery from August 2023 to April 2025 were included in this descriptive study. We evaluated 30-day postoperative outcomes for patients who were extubated in the operating room and those in the ICU. Outcomes of interest were time to chair, ICU and hospital LOS, as well as reintubation and reoperation rates.</div></div><div><h3>Results</h3><div>Of the 265 patients included, 244 patients (92%) were extubated in the operating room. Cases included 46 Bentall procedures, 74 valve-sparing root replacements, 31 Ross procedures, 21 total arch replacements, and 142 hemiarches either in isolation or as combined procedures. Reoperative aortic surgery and circulatory arrest did not exclude qualifying for operating room extubation. One hundred sixty-five out of the total 265 (67.9%) patients had moderate or deep hypothermic circulatory arrest (22 to 28 °C) during aortic surgery: Of the patients who had circulatory arrest, 91.1% were extubated in the operating room (164 out of 180). Patients extubated in the operating room were out of bed earlier and ambulating quickly compared with ICU extubation: Median time from ICU arrival to sitting in the chair was 3.3 hours and 18.6 hours (<em>P</em> &lt; .001), respectively. The median ICU and hospital LOS were 7.5 hours and 3.1 days compared with 35.6 hours and 5.8 days for operating room versus ICU extubation, respectively (<em>P</em> &lt; .001). Thirty-day outcomes were excellent and comparable in both groups with no deaths or myocardial infarctions for operating room extubation compared with ICU extubation, respectively: atrial fibrillation (n = 49 [21.9%] vs n = 9 [60%]), stroke (n = 1 [0.4%]) vs n = 0), reoperation for bleeding (n = 1 vs n = 0), reintubation for respiratory failure (n = 0 vs n = 1), and 30-day readmission (n = 11 [4.9%] vs n = 2 [11.8%]).</div></div><div><h3>Conclusions</h3><div>Routine extubation in the operating room is safe and feasible for a wide variety of patients undergoing both simple and complex aortic surgery, even when most of them undergo circulatory arrest. Operating room extubation may accelerate recovery and early ICU and hospital discharge, without increasing readmission or morbidity.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101526"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411922","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":"Representativeness in coronary revascularization trials: Beyond demographics","authors":"Dawn S. Hui MD ,&nbsp;Faisal Bakaeen MD","doi":"10.1016/j.xjon.2025.11.004","DOIUrl":"10.1016/j.xjon.2025.11.004","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101513"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412665","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":"","authors":"","doi":"10.1016/S2666-2736(26)00095-1","DOIUrl":"10.1016/S2666-2736(26)00095-1","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101672"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413007","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}