Pub Date : 2024-06-01DOI: 10.1016/j.xjon.2024.04.016
James A. Brown MD, MS , Ibrahim Sultan MD
{"title":"Reply: Suit yourself: Tailoring treatment to malperfusion in acute type A aortic dissection","authors":"James A. Brown MD, MS , Ibrahim Sultan MD","doi":"10.1016/j.xjon.2024.04.016","DOIUrl":"10.1016/j.xjon.2024.04.016","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001190/pdfft?md5=c30cccc7fcfbf9937b002df2371c1d5b&pid=1-s2.0-S2666273624001190-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140760275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.xjon.2024.04.001
Yuichiro Kitada MD , Homare Okamura MD, PhD
{"title":"Reply: How to define oversizing or undersizing of frozen elephant trunk","authors":"Yuichiro Kitada MD , Homare Okamura MD, PhD","doi":"10.1016/j.xjon.2024.04.001","DOIUrl":"10.1016/j.xjon.2024.04.001","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000962/pdfft?md5=d26a9d1cfe6491cae8a9c3f35e20f058&pid=1-s2.0-S2666273624000962-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.xjon.2024.02.022
Mariusz Kowalewski MD, PhD , Michał Święczkowski MD , Łukasz Kuźma MD, PhD , Bart Maesen MD, PhD , Emil Julian Dąbrowski MD , Matteo Matteucci MD , Jakub Batko MD, PhD , Radosław Litwinowicz MD, PhD , Adam Kowalówka MD, PhD , Wojciech Wańha MD, PhD , Federica Jiritano MD, PhD , Giuseppe Maria Raffa MD, PhD , Pietro Giorgio Malvindi MD, PhD , Luigi Pannone MD , Paolo Meani MD, PhD , Roberto Lorusso MD, PhD , Richard Whitlock MD, PhD , Mark La Meir MD, PhD , Carlo de Asmundis MD, PhD , James Cox MD, PhD , Piotr Suwalski MD, PhD
Objective
Left atrial appendage closure (LAAC) concomitant to heart surgery in patients with underlying atrial fibrillation (AF) has gained attention because of long-term reduction of thromboembolic complications. As of mortality benefits in the setting of non-AF, data from both observational studies and randomized controlled trials are conflicting.
Methods
On-line databases were screened for studies comparing LAAC versus no LAAC concomitant to other heart surgery. End points assessed were all-cause mortality and stroke at early and longest-available follow-up. Subgroup analyses stratified on preoperative AF were performed. Risk ratios (RR) with 95% CIs served as primary statistics.
Results
Electronic search yielded 25 studies (N = 660 [158 patients]). There was no difference between LAAC and no LAAC in terms of early mortality. In the overall population analysis, LAAC reduced long-term mortality (RR, 0.86; 95% CI, 0.74-1.00; P = .05; I2 = 88%), reduced early stroke risk by 19% (RR, 0.81; 95% CI, 0.72-0.93; P = .002; I2 = 57%), and reduced late stroke risk by 13% (RR, 0.87; 95% CI, 0.84-0.90; P < .001; I2 = 58%). Subgroup analysis showed lower mortality (RR, 0.85; 95% CI, 0.72-1.01; P = .06; I2 = 91%), short-, and long-term stroke risk reduction only in patients with preoperative AF (RR, 0.81; 95% CI, 0.71-0.93; P = .003; I2 = 71% and RR, 0.87; 95% CI, 0.84-0.91; P < .001; I2 = 70%, respectively). No benefit of LAAC in patients without AF was found.
Conclusions
Concomitant LAAC was associated with reduced stroke rates at early and long-term and possibly reduced all-cause mortality at the long-term follow-up but the benefits were limited to patients with preoperative AF. There is not enough evidence to support routine concomitant LAAC in non-AF settings.
{"title":"Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and stroke","authors":"Mariusz Kowalewski MD, PhD , Michał Święczkowski MD , Łukasz Kuźma MD, PhD , Bart Maesen MD, PhD , Emil Julian Dąbrowski MD , Matteo Matteucci MD , Jakub Batko MD, PhD , Radosław Litwinowicz MD, PhD , Adam Kowalówka MD, PhD , Wojciech Wańha MD, PhD , Federica Jiritano MD, PhD , Giuseppe Maria Raffa MD, PhD , Pietro Giorgio Malvindi MD, PhD , Luigi Pannone MD , Paolo Meani MD, PhD , Roberto Lorusso MD, PhD , Richard Whitlock MD, PhD , Mark La Meir MD, PhD , Carlo de Asmundis MD, PhD , James Cox MD, PhD , Piotr Suwalski MD, PhD","doi":"10.1016/j.xjon.2024.02.022","DOIUrl":"10.1016/j.xjon.2024.02.022","url":null,"abstract":"<div><h3>Objective</h3><p>Left atrial appendage closure (LAAC) concomitant to heart surgery in patients with underlying atrial fibrillation (AF) has gained attention because of long-term reduction of thromboembolic complications. As of mortality benefits in the setting of non-AF, data from both observational studies and randomized controlled trials are conflicting.</p></div><div><h3>Methods</h3><p>On-line databases were screened for studies comparing LAAC versus no LAAC concomitant to other heart surgery. End points assessed were all-cause mortality and stroke at early and longest-available follow-up. Subgroup analyses stratified on preoperative AF were performed. Risk ratios (RR) with 95% CIs served as primary statistics.</p></div><div><h3>Results</h3><p>Electronic search yielded 25 studies (N = 660 [158 patients]). There was no difference between LAAC and no LAAC in terms of early mortality. In the overall population analysis, LAAC reduced long-term mortality (RR, 0.86; 95% CI, 0.74-1.00; <em>P</em> = .05; <em>I</em><sup>2</sup> = 88%), reduced early stroke risk by 19% (RR, 0.81; 95% CI, 0.72-0.93; <em>P</em> = .002; <em>I</em><sup>2</sup> = 57%), and reduced late stroke risk by 13% (RR, 0.87; 95% CI, 0.84-0.90; <em>P</em> < .001; <em>I</em><sup>2</sup> = 58%). Subgroup analysis showed lower mortality (RR, 0.85; 95% CI, 0.72-1.01; <em>P</em> = .06; <em>I</em><sup>2</sup> = 91%), short-, and long-term stroke risk reduction only in patients with preoperative AF (RR, 0.81; 95% CI, 0.71-0.93; <em>P</em> = .003; <em>I</em><sup>2</sup> = 71% and RR, 0.87; 95% CI, 0.84-0.91; <em>P</em> < .001; <em>I</em><sup>2</sup> = 70%, respectively). No benefit of LAAC in patients without AF was found.</p></div><div><h3>Conclusions</h3><p>Concomitant LAAC was associated with reduced stroke rates at early and long-term and possibly reduced all-cause mortality at the long-term follow-up but the benefits were limited to patients with preoperative AF. There is not enough evidence to support routine concomitant LAAC in non-AF settings.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000585/pdfft?md5=c21d11a31c91a61dd45c5196fcb5b057&pid=1-s2.0-S2666273624000585-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140267941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is no consensus regarding the strategies for repairing acute type A aortic dissection (ATAAD) in patients with bicuspid aortic valve (BAV). This meta-analysis aimed to compare the treatment strategies and outcomes of ATAAD repair between patients with BAV and those with tricuspid aortic valve (TAV).
Methods
A systematic review of databases were performed from inception through March 2023. The primary outcome of interest was all-cause mortality, with a minimum follow-up of 1 year. The secondary outcomes of interest included ratios of performed procedures and rate of distal aortic reoperation. Data were extracted, and pooled analysis was performed using a random-effects model.
Results
Eight observational studies including a total of 3701 patients (BAV, n = 349; TAV, n = 3352) were selected for a meta-analysis. Concerning proximal aortic procedures, BAV patients exhibited a higher incidence of necessary root replacement (odds ratio [OR], 6.53; 95% confidence interval [CI], 3.84 to 11.09; P < .01). Regarding distal aortic procedures, extended arch replacement was performed less frequently in BAV patients (OR, 0.69; 95% CI, 0.49 to 0.99; P = .04), whereas hemiarch procedure rates were comparable in the 2 groups. All-cause mortality was lower in the BAV group (hazard ratio, 0.68; 95% CI, 0.50 to 0.92; P = .01). Distal aortic reoperation rates were comparable in the 2 groups.
Conclusions
This study highlights distinct procedural patterns in ATAAD patients with BAV and TAV. Despite differing baseline characteristics, BAV patients exhibited superior survival compared to TAV patients, with comparable distal aortic reoperation rates. These findings may be useful for decision making regarding limited versus extended aortic arch repair.
{"title":"Treatment strategies and outcomes following acute type A aortic dissection repair in patients with bicuspid and tricuspid aortic valves: A meta-analysis","authors":"Tomonari Shimoda MD , Yujiro Yokoyama MD , Hisato Takagi MD, PhD , Toshiki Kuno MD, PhD , Shinichi Fukuhara MD","doi":"10.1016/j.xjon.2024.02.020","DOIUrl":"10.1016/j.xjon.2024.02.020","url":null,"abstract":"<div><h3>Background</h3><p>There is no consensus regarding the strategies for repairing acute type A aortic dissection (ATAAD) in patients with bicuspid aortic valve (BAV). This meta-analysis aimed to compare the treatment strategies and outcomes of ATAAD repair between patients with BAV and those with tricuspid aortic valve (TAV).</p></div><div><h3>Methods</h3><p>A systematic review of databases were performed from inception through March 2023. The primary outcome of interest was all-cause mortality, with a minimum follow-up of 1 year. The secondary outcomes of interest included ratios of performed procedures and rate of distal aortic reoperation. Data were extracted, and pooled analysis was performed using a random-effects model.</p></div><div><h3>Results</h3><p>Eight observational studies including a total of 3701 patients (BAV, n = 349; TAV, n = 3352) were selected for a meta-analysis. Concerning proximal aortic procedures, BAV patients exhibited a higher incidence of necessary root replacement (odds ratio [OR], 6.53; 95% confidence interval [CI], 3.84 to 11.09; <em>P</em> < .01). Regarding distal aortic procedures, extended arch replacement was performed less frequently in BAV patients (OR, 0.69; 95% CI, 0.49 to 0.99; <em>P</em> = .04), whereas hemiarch procedure rates were comparable in the 2 groups. All-cause mortality was lower in the BAV group (hazard ratio, 0.68; 95% CI, 0.50 to 0.92; <em>P</em> = .01). Distal aortic reoperation rates were comparable in the 2 groups.</p></div><div><h3>Conclusions</h3><p>This study highlights distinct procedural patterns in ATAAD patients with BAV and TAV. Despite differing baseline characteristics, BAV patients exhibited superior survival compared to TAV patients, with comparable distal aortic reoperation rates. These findings may be useful for decision making regarding limited versus extended aortic arch repair.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266627362400055X/pdfft?md5=335b6bf1280c8c974a01e9c4e042a3e4&pid=1-s2.0-S266627362400055X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140275835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.xjon.2024.04.006
Alice V. Vinogradsky BA , Stephanie N. Nguyen MD , Krushang Patel MD , Matthew Regan MS , Kelly M. Axsom MD , Matthew J. Lewis MD , Gabriel Sayer MD , Nir Uriel MD, MSc , Yoshifumi Naka MD, PhD , Andrew B. Goldstone MD, PhD , Koji Takeda MD, PhD
Objective
Congenital heart disease is a risk factor for mortality after orthotopic heart transplantation; however, the impact of preoperative circulation type and primary congenital heart disease diagnosis remains poorly delineated.
Methods
We retrospectively reviewed patients with adult congenital heart disease aged 16 years or more who underwent orthotopic heart transplantation at our institution between 2008 and 2022. Patients were categorized as having single-ventricle or biventricular circulation. The primary end point was 5-year post-transplant survival.
Results
Sixty-one patients with adult congenital heart disease (single-ventricle: n = 26 [42.6%], biventricular: n = 35 [57.4%]) underwent orthotopic heart transplantation at 33.7 [interquartile range, 19.1-48.7] years. The most common congenital heart disease diagnosis was hypoplastic left heart syndrome (n = 11, 42.3%) in the single-ventricle group and congenitally corrected transposition of the great arteries (n = 7, 20.0%) in the biventricular group. Twenty-four patients previously underwent Fontan palliation. At transplant, patients in the single-ventricle group were younger (18.5 [interquartile range, 17.6-32.3] years vs 45.0 [interquartile range, 33.0-52.2] years, P < .001) and more likely to have biopsy-proven cirrhosis (46.2% vs 14.3%, P = .01) and protein-losing enteropathy (42.3% vs 2.9%, P < .001). Patients in the single-ventricle group also had longer bypass times (223.4 ± 65.3 minutes vs 187.4 ± 59.5 minutes, P = .03) and longer durations of mechanical ventilatory support (3.5 [interquartile range, 2.0-6.0] days vs 1.0 [interquartile range, 1.0-2.0] days, P < .001). Operative mortality was comparable (11.5% vs 8.6%, P = 1). Median follow-up was 6.0 [interquartile range, 2.4-10.0] years. Five-year survival was worse in the single-ventricle group (66.0% ± 10.0% vs 91.3% ± 4.8%, P = .03), as was freedom from major rejection (58.3% ± 10.2% vs 84.0% ± 6.6%, P = .02). In univariable analysis, hypoplastic left heart syndrome and Fontan circulation were risk factors for post-transplant mortality (hypoplastic left heart syndrome: hazard ratio, 5.0, P < .001; Fontan: hazard ratio, 3.5, P = .03).
Conclusions
Adult patients with congenital heart disease undergoing heart transplant with single-ventricle physiology experienced a more complicated post-transplant course, with worse long-term survival and freedom from rejection. Multicenter studies are required to guide orthotopic heart transplantation decision-making in this complex cohort.
方法我们回顾性研究了2008年至2022年期间在我院接受心脏移植手术的16岁及以上成人先天性心脏病患者。患者被分为单心室或双心室循环。结果61例成人先天性心脏病患者（单心室：26例[42.6%]，双心室：35例[57.4%]）在33.7[四分位间范围，19.1-48.7]岁时接受了正位心脏移植手术。最常见的先天性心脏病诊断是单心室组的左心发育不全综合征（n = 11，42.3%）和双心室组的先天性矫正性大动脉转位（n = 7，20.0%）。24名患者曾接受过丰坦姑息术。移植时，单心室组患者更年轻（18.5 [四分位数间距，17.6-32.3] 岁 vs 45.0 [四分位数间距，33.0-52.2] 岁，P < .001），更有可能患有活检证实的肝硬化（46.2% vs 14.3%，P = .01）和蛋白丢失性肠病（42.3% vs 2.9%，P < .001）。单心室组患者的旁路时间更长（223.4 ± 65.3 分钟 vs 187.4 ± 59.5 分钟，P = .03），机械通气支持时间更长（3.5 [四分位间范围，2.0-6.0] 天 vs 1.0 [四分位间范围，1.0-2.0] 天，P < .001）。手术死亡率相当（11.5% vs 8.6%，P = 1）。中位随访时间为 6.0 [四分位间范围，2.4-10.0] 年。单心室组的五年存活率较低（66.0% ± 10.0% vs 91.3% ± 4.8%，P = .03），无严重排斥反应的存活率也较低（58.3% ± 10.2% vs 84.0% ± 6.6%，P = .02）。在单变量分析中，左心发育不全综合征和Fontan循环是导致移植后死亡的危险因素（左心发育不全综合征：危险比，5.0，P = .001；Fontan：危险比，3.5，P = .03）。需要进行多中心研究，以指导这一复杂群体的正位心脏移植决策。
{"title":"Long-term outcomes of heart transplantation in adults with congenital heart disease: The impact of single-ventricle versus biventricular physiology","authors":"Alice V. Vinogradsky BA , Stephanie N. Nguyen MD , Krushang Patel MD , Matthew Regan MS , Kelly M. Axsom MD , Matthew J. Lewis MD , Gabriel Sayer MD , Nir Uriel MD, MSc , Yoshifumi Naka MD, PhD , Andrew B. Goldstone MD, PhD , Koji Takeda MD, PhD","doi":"10.1016/j.xjon.2024.04.006","DOIUrl":"10.1016/j.xjon.2024.04.006","url":null,"abstract":"<div><h3>Objective</h3><p>Congenital heart disease is a risk factor for mortality after orthotopic heart transplantation; however, the impact of preoperative circulation type and primary congenital heart disease diagnosis remains poorly delineated.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed patients with adult congenital heart disease aged 16 years or more who underwent orthotopic heart transplantation at our institution between 2008 and 2022. Patients were categorized as having single-ventricle or biventricular circulation. The primary end point was 5-year post-transplant survival.</p></div><div><h3>Results</h3><p>Sixty-one patients with adult congenital heart disease (single-ventricle: n = 26 [42.6%], biventricular: n = 35 [57.4%]) underwent orthotopic heart transplantation at 33.7 [interquartile range, 19.1-48.7] years. The most common congenital heart disease diagnosis was hypoplastic left heart syndrome (n = 11, 42.3%) in the single-ventricle group and congenitally corrected transposition of the great arteries (n = 7, 20.0%) in the biventricular group. Twenty-four patients previously underwent Fontan palliation. At transplant, patients in the single-ventricle group were younger (18.5 [interquartile range, 17.6-32.3] years vs 45.0 [interquartile range, 33.0-52.2] years, <em>P < .</em>001) and more likely to have biopsy-proven cirrhosis (46.2% vs 14.3%<em>, P = .</em>01) and protein-losing enteropathy (42.3% vs 2.9%<em>, P < .</em>001). Patients in the single-ventricle group also had longer bypass times (223.4 ± 65.3 minutes vs 187.4 ± 59.5 minutes<em>, P = .</em>03) and longer durations of mechanical ventilatory support (3.5 [interquartile range, 2.0-6.0] days vs 1.0 [interquartile range, 1.0-2.0] days<em>, P < .</em>001). Operative mortality was comparable (11.5% vs 8.6%, <em>P</em> = 1). Median follow-up was 6.0 [interquartile range, 2.4-10.0] years. Five-year survival was worse in the single-ventricle group (66.0% ± 10.0% vs 91.3% ± 4.8%<em>, P = .</em>03), as was freedom from major rejection (58.3% ± 10.2% vs 84.0% ± 6.6%<em>, P = .</em>02). In univariable analysis, hypoplastic left heart syndrome and Fontan circulation were risk factors for post-transplant mortality (hypoplastic left heart syndrome: hazard ratio, 5.0<em>, P < .</em>001; Fontan: hazard ratio, 3.5, <em>P = .</em>03).</p></div><div><h3>Conclusions</h3><p>Adult patients with congenital heart disease undergoing heart transplant with single-ventricle physiology experienced a more complicated post-transplant course, with worse long-term survival and freedom from rejection. Multicenter studies are required to guide orthotopic heart transplantation decision-making in this complex cohort.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001086/pdfft?md5=c1ab72bdf11563cf3c7b3eda601d2e4d&pid=1-s2.0-S2666273624001086-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140785907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.xjon.2024.02.025
Eric Lim MD , Rosie A. Harris MSc , Tim Batchelor Bsc (Hons), MBChB, FRCS , Gianluca Casali MEDGB , Rakesh Krishnadas MD , Sofina Begum MD , Simon Jordan MD , Joel Dunning MD , Ian Paul MD , Michael Shackcloth MD , Sarah Feeney RN , Vladimir Anikin MD , Niall Mcgonigle MD , Hazem Fallouh MD , Luis Hernandez MD , Franscesco Di Chiara MD , Dionisios Stavroulias MD , Mahmoud Loubani MD , Syed Qadri MD , Vipin Zamvar MD , Chris A. Rogers PhD
Objectives
Surgery through a single port may be less painful because access is supplied by 1 intercostal nerve or more painful because multiple instruments are used in 1 port. We analyzed data collected from the video-assisted thoracoscopic surgery group of a randomized controlled trial to compare differences in pain up to 1 year.
Methods
Groups were compared in a prespecified exploratory analysis using direct (regression) and indirect comparison (difference with respect to thoracotomy). In-hospital visual analogue scale pain scores were used, and analgesic ratios were calculated. After discharge, pain was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaires-Core 30 scores up to 1 year.
Results
From July 2015 to February 2019, we randomized 503 participants. After excluding 50 participants who did not receive lobectomy, surgery was performed using a single port in 42 participants (predominately by a single surgeon), multiple ports in 166 participants, and thoracotomy in 245 participants. No differences were observed in-hospital between single- and multiple-port video-assisted thoracoscopic surgery when modeled using a direct comparison, mean difference of −0.24 (95% CI, −1.06 to 0.58) or indirect comparison, mean difference of −0.33 (−1.16 to 0.51). Mean analgesic ratio (single/multiple port) was 0.75 (0.64 to 0.87) for direct comparison and 0.90 (0.64 to 1.25) for indirect comparison. After discharge, pain for single-port video-assisted thoracoscopic surgery was lower than for multiple-port video-assisted thoracoscopic surgery (first 3 months), and corresponding physical function was higher up to 12 months.
Conclusions
There were no consistent differences for in-hospital pain when lobectomy was undertaken using 1 or multiple ports. However, better pain scores and physical function were observed for single-port surgery after discharge.
{"title":"Outcomes of single- versus multi-port video-assisted thoracoscopic surgery: Data from a multicenter randomized controlled trial of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer","authors":"Eric Lim MD , Rosie A. Harris MSc , Tim Batchelor Bsc (Hons), MBChB, FRCS , Gianluca Casali MEDGB , Rakesh Krishnadas MD , Sofina Begum MD , Simon Jordan MD , Joel Dunning MD , Ian Paul MD , Michael Shackcloth MD , Sarah Feeney RN , Vladimir Anikin MD , Niall Mcgonigle MD , Hazem Fallouh MD , Luis Hernandez MD , Franscesco Di Chiara MD , Dionisios Stavroulias MD , Mahmoud Loubani MD , Syed Qadri MD , Vipin Zamvar MD , Chris A. Rogers PhD","doi":"10.1016/j.xjon.2024.02.025","DOIUrl":"https://doi.org/10.1016/j.xjon.2024.02.025","url":null,"abstract":"<div><h3>Objectives</h3><p>Surgery through a single port may be less painful because access is supplied by 1 intercostal nerve or more painful because multiple instruments are used in 1 port. We analyzed data collected from the video-assisted thoracoscopic surgery group of a randomized controlled trial to compare differences in pain up to 1 year.</p></div><div><h3>Methods</h3><p>Groups were compared in a prespecified exploratory analysis using direct (regression) and indirect comparison (difference with respect to thoracotomy). In-hospital visual analogue scale pain scores were used, and analgesic ratios were calculated. After discharge, pain was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaires-Core 30 scores up to 1 year.</p></div><div><h3>Results</h3><p>From July 2015 to February 2019, we randomized 503 participants. After excluding 50 participants who did not receive lobectomy, surgery was performed using a single port in 42 participants (predominately by a single surgeon), multiple ports in 166 participants, and thoracotomy in 245 participants. No differences were observed in-hospital between single- and multiple-port video-assisted thoracoscopic surgery when modeled using a direct comparison, mean difference of −0.24 (95% CI, −1.06 to 0.58) or indirect comparison, mean difference of −0.33 (−1.16 to 0.51). Mean analgesic ratio (single/multiple port) was 0.75 (0.64 to 0.87) for direct comparison and 0.90 (0.64 to 1.25) for indirect comparison. After discharge, pain for single-port video-assisted thoracoscopic surgery was lower than for multiple-port video-assisted thoracoscopic surgery (first 3 months), and corresponding physical function was higher up to 12 months.</p></div><div><h3>Conclusions</h3><p>There were no consistent differences for in-hospital pain when lobectomy was undertaken using 1 or multiple ports. However, better pain scores and physical function were observed for single-port surgery after discharge.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000949/pdfft?md5=a26bc67800c5e8425b43fb22f19f6484&pid=1-s2.0-S2666273624000949-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141325252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.xjon.2024.03.001
Mathias Lilja MS , Richard Leaback MD , Jonas Banefelt MSc , Tae Jin Park PharmD, MS , Darshini Shah BPharm, MS , William G. Ferguson PhD , Örjan Friberg MD, PhD
Objectives
Postoperative atrial fibrillation (POAF) is the most common perioperative arrhythmia. The association of POAF with negative short-term outcomes after cardiac surgery is well understood; however, the association of POAF with long-term morbidity and mortality is not well described. We compared the risk of long-term clinical outcomes (up to 9 years postdischarge) in patients with and without POAF following open-chest cardiac surgery.
Methods
This observational, retrospective cohort study used data from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) Swedish Cardiac Surgery Registry and National Board of Health and Welfare. Patients aged 55 to 90 years who underwent open-chest coronary artery bypass and/or valvular surgery between 2010 and 2019 were included. Clinical outcomes were adjusted for differences in baseline demographics and clinical history using multivariable Cox regression.
Results
A total of 30,870 patients with a mean age of 69.2 years were included in the study (no POAF, n = 20,734; POAF, n = 10,136). The median follow-up was 4.6 years. After adjustment, POAF was associated with a significantly higher risk of recurrent atrial fibrillation (hazard ratio [HR], 2.30; 95% CI, 2.21-2.41), heart failure (HR, 1.17; 95% CI, 1.10-1.25), chronic kidney disease (HR, 1.15; 95% CI, 1.07-1.24), all-cause mortality (HR, 1.11; 95% CI, 1.04-1.18), and cardiovascular mortality (HR, 1.16; 95% CI, 1.06-1.26). POAF was also associated with a numerically higher risk of ischemic stroke and major bleed, but these findings were not statistically significant after adjustment.
Conclusions
These data provide further insight into the long-term clinical outcomes associated with POAF in patients undergoing cardiac surgery.
{"title":"Postoperative atrial fibrillation is associated with long-term morbidity and mortality in older adults: Analysis from the SWEDEHEART Registry","authors":"Mathias Lilja MS , Richard Leaback MD , Jonas Banefelt MSc , Tae Jin Park PharmD, MS , Darshini Shah BPharm, MS , William G. Ferguson PhD , Örjan Friberg MD, PhD","doi":"10.1016/j.xjon.2024.03.001","DOIUrl":"10.1016/j.xjon.2024.03.001","url":null,"abstract":"<div><h3>Objectives</h3><p>Postoperative atrial fibrillation (POAF) is the most common perioperative arrhythmia. The association of POAF with negative short-term outcomes after cardiac surgery is well understood; however, the association of POAF with long-term morbidity and mortality is not well described. We compared the risk of long-term clinical outcomes (up to 9 years postdischarge) in patients with and without POAF following open-chest cardiac surgery.</p></div><div><h3>Methods</h3><p>This observational, retrospective cohort study used data from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) Swedish Cardiac Surgery Registry and National Board of Health and Welfare. Patients aged 55 to 90 years who underwent open-chest coronary artery bypass and/or valvular surgery between 2010 and 2019 were included. Clinical outcomes were adjusted for differences in baseline demographics and clinical history using multivariable Cox regression.</p></div><div><h3>Results</h3><p>A total of 30,870 patients with a mean age of 69.2 years were included in the study (no POAF, n = 20,734; POAF, n = 10,136). The median follow-up was 4.6 years. After adjustment, POAF was associated with a significantly higher risk of recurrent atrial fibrillation (hazard ratio [HR], 2.30; 95% CI, 2.21-2.41), heart failure (HR, 1.17; 95% CI, 1.10-1.25), chronic kidney disease (HR, 1.15; 95% CI, 1.07-1.24), all-cause mortality (HR, 1.11; 95% CI, 1.04-1.18), and cardiovascular mortality (HR, 1.16; 95% CI, 1.06-1.26). POAF was also associated with a numerically higher risk of ischemic stroke and major bleed, but these findings were not statistically significant after adjustment.</p></div><div><h3>Conclusions</h3><p>These data provide further insight into the long-term clinical outcomes associated with POAF in patients undergoing cardiac surgery.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000573/pdfft?md5=1e67f9f7c829d8bca7d9d5d8c77de23e&pid=1-s2.0-S2666273624000573-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140282018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.xjon.2024.03.005
Victory B. Effiom MD , Anayo J. Michael MD , Fatma K. Ahmed MD , Achanga B.S. Anyinkeng MD , Jonas L. Ibekwe MD , Abdullah K. Alassiri MD , Victor O. Femi-Lawal MD , Eric E. Vinck MD
Objective
Cardiovascular disease is the leading cause of death globally, responsible for 17.5 million deaths each year, 80% of which occur in low- and middle-income countries, including countries in Africa. Cardiothoracic surgery, with its heavy financial outlay, is unavailable in many African countries. Many African healthcare givers are under the erroneous impression that the cardiovascular surgical landscape of Africa is blank. This review aims at describing the cardiothoracic surgery practice in Africa, the different training programs in the region, and its future prospects.
Method
Through a literature review, the authors elaborate on key points, such as healthcare and cardiothoracic surgery in Africa, African cardiothoracic practice and training, and the future of cardiothoracic surgery in Africa.
Results
African countries with established cardiothoracic surgery capacity and training programs still face several challenges across multiple levels, including a persistent low enrollment rate in residency programs, insufficient local expertise, a lack of financial resources, an inadequate health infrastructure, and a skewed health insurance reimbursement system. Thus, there is still a growing burden of surgically correctable cardiovascular disease in these countries.
Conclusions
Cardiothoracic surgery in Africa has faced great challenges due to resource constraints, but it has demonstrated resilience and growth through diverse models and initiatives. The burden of cardiovascular diseases in Africa remains high, yet the capacity to provide cardiothoracic surgery is limited. With investment, support, and the implementation of comprehensive healthcare policies, cardiothoracic surgery practice can improve in this region and this can make a significant impact on the health and well-being of its population.
{"title":"Cardiothoracic surgery training in Africa: History and developments","authors":"Victory B. Effiom MD , Anayo J. Michael MD , Fatma K. Ahmed MD , Achanga B.S. Anyinkeng MD , Jonas L. Ibekwe MD , Abdullah K. Alassiri MD , Victor O. Femi-Lawal MD , Eric E. Vinck MD","doi":"10.1016/j.xjon.2024.03.005","DOIUrl":"https://doi.org/10.1016/j.xjon.2024.03.005","url":null,"abstract":"<div><h3>Objective</h3><p>Cardiovascular disease is the leading cause of death globally, responsible for 17.5 million deaths each year, 80% of which occur in low- and middle-income countries, including countries in Africa. Cardiothoracic surgery, with its heavy financial outlay, is unavailable in many African countries. Many African healthcare givers are under the erroneous impression that the cardiovascular surgical landscape of Africa is blank. This review aims at describing the cardiothoracic surgery practice in Africa, the different training programs in the region, and its future prospects.</p></div><div><h3>Method</h3><p>Through a literature review, the authors elaborate on key points, such as healthcare and cardiothoracic surgery in Africa, African cardiothoracic practice and training, and the future of cardiothoracic surgery in Africa.</p></div><div><h3>Results</h3><p>African countries with established cardiothoracic surgery capacity and training programs still face several challenges across multiple levels, including a persistent low enrollment rate in residency programs, insufficient local expertise, a lack of financial resources, an inadequate health infrastructure, and a skewed health insurance reimbursement system. Thus, there is still a growing burden of surgically correctable cardiovascular disease in these countries.</p></div><div><h3>Conclusions</h3><p>Cardiothoracic surgery in Africa has faced great challenges due to resource constraints, but it has demonstrated resilience and growth through diverse models and initiatives. The burden of cardiovascular diseases in Africa remains high, yet the capacity to provide cardiothoracic surgery is limited. With investment, support, and the implementation of comprehensive healthcare policies, cardiothoracic surgery practice can improve in this region and this can make a significant impact on the health and well-being of its population.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000639/pdfft?md5=baa14500ea3fb2903a97fbdb133adf5e&pid=1-s2.0-S2666273624000639-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141325240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.xjon.2024.05.005
Hannah Rando, M. Acton, Ifeanyi Chinedozi, Zachary Darby, J. K. Kang, G. Whitman
{"title":"Accounting for Concomitant Disease in Hypoglycemic Cardiac Surgery Patients: An Adjusted Analysis of Postoperative Outcomes","authors":"Hannah Rando, M. Acton, Ifeanyi Chinedozi, Zachary Darby, J. K. Kang, G. Whitman","doi":"10.1016/j.xjon.2024.05.005","DOIUrl":"https://doi.org/10.1016/j.xjon.2024.05.005","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141140079","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 : 2024-05-01DOI: 10.1016/j.xjon.2024.04.017
Farshad Tajeddini, David A. Romero, Yu Xuan Huang, Tirone E. David, M. Ouzounian, Cristina H. Amon, J. Chung
{"title":"Type B Aortic Dissection in Marfan Patients after the David Procedure: Insights from Patient-Specific Simulation","authors":"Farshad Tajeddini, David A. Romero, Yu Xuan Huang, Tirone E. David, M. Ouzounian, Cristina H. Amon, J. Chung","doi":"10.1016/j.xjon.2024.04.017","DOIUrl":"https://doi.org/10.1016/j.xjon.2024.04.017","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141041481","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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