JTCVS open最新文献

{"title":"Experience with Berlin heart support in children with a focus on device removal","authors":"Valerii Iaprintsev MD ,&nbsp;Igor E. Konstantinov MD, PhD, FRACS ,&nbsp;Edward Buratto MD, PhD, FRACS ,&nbsp;Tyson A. Fricke MBBS, PhD, FRACS ,&nbsp;Lucas Eastaugh MBBS, FRACP ,&nbsp;Christian P. Brizard MD, MS ,&nbsp;Stephanie Perrier MD ,&nbsp;Jacob Mathew MBBS, FRACP","doi":"10.1016/j.xjon.2025.09.025","DOIUrl":"10.1016/j.xjon.2025.09.025","url":null,"abstract":"<div><h3>Objective</h3><div>The Berlin Heart EXCOR is the only durable ventricular assist device available for infants and small children. A subset of patients supported by the Berlin Heart EXCOR device experience cardiac recovery. This study aimed to evaluate the outcomes of Berlin Heart EXCOR support at our center and identify the factors associated with successful device explantation.</div></div><div><h3>Methods</h3><div>This retrospective observational study included all consecutive patients who underwent Berlin Heart EXCOR implantation at the Royal Children's Hospital from 2009 to 2024.</div></div><div><h3>Results</h3><div>A total of 72 patients received Berlin Heart EXCOR support during the study period. The median age at implantation was 1.0 year (interquartile range, 0.44-2.92), median body surface area was 0.43 m² (interquartile range, 0.30-0.56), and median support duration was 127 days (interquartile range, 59-219). Heart transplantation was performed in 47 patients (65.3%), and 10 patients (13.9%) achieved device explantation without transplantation—4 with dilated cardiomyopathy and 6 with myocarditis. Fourteen patients (19.4%) died on support, and 1 patient remained supported at analysis. There were no significant differences in age, body surface area at implantation, or duration of support between those who recovered and those who died or underwent transplantation. Of 30 patients aged less than 2 years with body surface area between 0.35 and 0.55 m², 9 achieved recovery. In contrast, none of the 23 patients with body surface area less than 0.35 m² and only 1 of 18 patients with body surface area more than 0.55 m² successfully underwent explantation. In multivariable Cox regression, myocarditis was significantly associated with successful explantation (hazard ratio, 11.6, 95% CI, 0.987-135.1; <em>P =</em> .05). Because of the low number of recovery events and near-complete separation by body surface area category, Firth's penalized Cox regression was applied. Within this model, body surface area between 0.35 and 0.55 m² was strongly associated with recovery (hazard ratio, 27.4, 95% CI, 3.46-3539.5; <em>P =</em> .0003).</div></div><div><h3>Conclusions</h3><div>This study demonstrates that a strategy focused on evaluation of myocardial recovery may increase the rate of device removal. The majority of successful device removals occurred in children younger than 2 years of age with a body surface area of 0.35 to 0.55 m². Patients with myocarditis are more likely to have a successful device removal. We believe that every patient must be evaluated for myocardial recovery and device removal before committing the patient to heart transplantation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 479-494"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697741","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":"Are there different phenotypes of thoracic surgery patients? A latent class analysis of pretreatment patient-reported outcomes","authors":"Eagan J. Peters MD ,&nbsp;Brenden Dufault MSc ,&nbsp;Sadeesh K. Srinathan MD, MSc ,&nbsp;Gordon Buduhan MD, MSc ,&nbsp;Lawrence Tan MD ,&nbsp;Biniam Kidane MD, MSc","doi":"10.1016/j.xjon.2025.10.015","DOIUrl":"10.1016/j.xjon.2025.10.015","url":null,"abstract":"<div><h3>Background</h3><div>Among patients undergoing thoracic surgery, quality of life is associated with multiple perioperative outcomes. Whether patients suffer reduced quality of life in certain areas compared to others is unclear. Knowing this could direct risk mitigation interventions for patients who share common symptoms. The objective of this study was to determine whether patients can be subdivided into groups based on preoperative quality of life.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of a retrospective cohort study of consecutive patients undergoing thoracic surgery between January 2018 and January 2019 at a Canadian tertiary center. Latent class analysis was conducted according to 3-level EuroQol-5 dimension (EQ-5D-3L) scores. The number of latent classes was selected by comparing different models using the Akaike information criterion, Bayesian information criterion, and <em>G</em>² statistic. Class separation was measured using normalized entropy statistics.</div></div><div><h3>Results</h3><div>Among 482 patients, models with 2 to 5 classes were constructed. The 3-class model demonstrated the lowest Akaike and Bayesian information criterion values. The <em>G</em>² statistic and entropy showed increased preference for models as the number of classes decreased. Within the 3-class model, class 1 demonstrated a 73% to 100% probability of endorsing low impairment across all EQ-5D-3L dimensions, class 2 demonstrated a 93% probability of at least some impairment in mobility, and class 3 showed an 81% probability of moderate pain.</div></div><div><h3>Conclusions</h3><div>There is evidence that patients undergoing thoracic surgery can be divided into 3 latent classes based on EQ-5D-3L score: low symptom burden, mobility-pain complex, and pain predominant. By identifying patients using these latent classes, targeted supportive interventions may be offered in the pretreatment period to improve perioperative outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 715-727"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697868","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":"A structured, competency-based framework for aspiring cardiothoracic surgeons","authors":"Adham Ahmed MD ,&nbsp;Samantha Colon BS ,&nbsp;Gianna J. Dafflisio BS ,&nbsp;Purab Kothari BS ,&nbsp;Nina Uzoigwe BS ,&nbsp;Alice Zhou MD ,&nbsp;Juli Buchwald BS ,&nbsp;Betemariam Sharew BS ,&nbsp;Carter Glenn MD ,&nbsp;Steven Medvedovsky BS ,&nbsp;Justin Olivera MD ,&nbsp;Ryan Kramer MD ,&nbsp;Gabrielle Colon BS ,&nbsp;Jonathan M. Tomasko MD ,&nbsp;Sara J. Pereira MD ,&nbsp;Mara Antonoff MD ,&nbsp;Marc Pelletier MD ,&nbsp;Irbaz Hameed MD, PhD","doi":"10.1016/j.xjon.2025.10.005","DOIUrl":"10.1016/j.xjon.2025.10.005","url":null,"abstract":"<div><h3>Objective</h3><div>Cardiothoracic surgery requires mastery of a broad knowledge base and advanced skillset to manage critically ill patients. Although competency-based assessment frameworks have been developed in several specialties, there remains a paucity of resources to guide practical progression for early cardiothoracic surgical trainees.</div></div><div><h3>Methods</h3><div>Members of the Thoracic Surgery Residents Association, Thoracic Surgery Medical Student Association, and attending cardiothoracic surgeons with a strong track record of surgical education were invited to share their insights and experiences. A structured, milestone-driven roadmap was developed on the basis of their contributions.</div></div><div><h3>Results</h3><div>We developed a structured, competency-based framework for early surgical trainees, with an emphasis on progressive development of clinical knowledge, technical skills, and academic proficiency. Key milestones and applicable resources were curated to help guide independent learning and skill acquisition.</div></div><div><h3>Conclusions</h3><div>This structured roadmap offers early-stage cardiothoracic surgery trainees a competency-guided path toward proficiency. By providing clear guidance and granular action points, this guide may help facilitate independent learning and prepare residents for advanced cardiothoracic surgical training.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 736-752"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697870","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":"Internal thoracic artery grafting confers a survival benefit even in the most elderly population undergoing coronary artery bypass grafting","authors":"Paul Kurlansky MD ,&nbsp;Ernest A. Traad MD ,&nbsp;Sameer Singh MD ,&nbsp;David L. Galbut MD ,&nbsp;George Ebra EdD, PhD","doi":"10.1016/j.xjon.2025.09.030","DOIUrl":"10.1016/j.xjon.2025.09.030","url":null,"abstract":"<div><h3>Objective</h3><div>Although the use of the left thoracic artery (LITA) is well accepted as the optimal conduit in coronary artery bypass graft surgery to improve survival, the survival benefit for the most elderly population is less well defined. Herein, we explore the lifetime benefit for use of the LITA versus saphenous vein grafting (SVG) only in a matched population of patients aged 80 years and older.</div></div><div><h3>Methods</h3><div>Retrospective review was conducted of consecutive patients aged 80 years and older who underwent isolated coronary artery bypass graft procedures using either SVG only or ITA + SVG grafting between June 1982 and December 2011. Propensity score matching, logistic regression, Kaplan-Meier survival analysis, and Cox regression were used to examine perioperative and long-term survival outcomes.</div></div><div><h3>Results</h3><div>There were 923 SVG patients and 1217 ITA + SVG patients. After propensity score matching there were 923 in each group. Follow-up ranged from 5 weeks to 25 years and was 99% complete. For matched patients, the operative mortality was 10.9% (101 out of 923) for SVG only and 7.8% (72 out of 923) (<em>P</em> = .021) for ITA + SVG. When examining long-term outcomes for hospital survivors, ITA + SVG was associated with improved survival (hazard ratio of mortality, 0.88; 95% CI, 0.80-0.97; <em>P</em> = .009). When stratifying the patients by age, it appeared that the survival benefit for ITA + SVG persisted well into the eighth decade of life but may be attenuated as patients approach age 90 years.</div></div><div><h3>Conclusions</h3><div>Despite their advanced age and limited life expectancy, our data suggest that after adjusting for factors associated with selection bias, octogenarians enjoy long-term survival benefits from the use of ITA grafting.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 180-190"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698079","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":"Distal anastomotic new-entry tear after type A aortic dissection repair: Incidence patterns and long-term outcomes by extent of aortic replacement","authors":"Go Yamashita MD,&nbsp;Shingo Hirao MD, PhD,&nbsp;Koh Yaegashi MD,&nbsp;Takumi Takauchi MD,&nbsp;Atsushi Sugaya MD,&nbsp;Jiro Sakai MD,&nbsp;Tatsuhiko Komiya MD, PhD","doi":"10.1016/j.xjon.2025.09.018","DOIUrl":"10.1016/j.xjon.2025.09.018","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to investigate the incidence patterns, anatomic distribution, and long-term outcomes of distal anastomotic new-entry tear in acute type A aortic dissection according to the extent of aortic replacement.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 409 patients with acute type A aortic dissection who underwent surgical repair between 2003 and 2023. Patients were categorized by the extent of aortic replacement: hemiarch replacement (n = 173), partial arch replacement (n = 126), and total arch replacement (n = 110). Distal anastomotic new-entry tear was identified using postoperative contrast-enhanced computed tomography. Long-term outcomes were distal anastomotic new-entry tear status (distal anastomotic new-entry tear vs nondistal anastomotic new-entry tear) and the extent of aortic replacement (hemiarch replacement, partial arch replacement, and total arch replacement).</div></div><div><h3>Results</h3><div>Distal anastomotic new-entry tears occurred in 27.4% of the patients, predominantly in the greater curve of aortic arch across all replacement types. Supra-aortic branch dissection was an independent risk factor for distal anastomotic new-entry tear occurrence (odds ratio, 2.80, <em>P &lt; .</em>001). Patients with distal anastomotic new-entry tear were younger and predominantly male. Long-term survival was similar between the distal anastomotic new-entry tear and nondistal anastomotic new-entry tear groups; distal anastomotic new-entry tear significantly increased the cumulative incidence of distal aortic reoperation, particularly in patients with hemiarch replacement and partial arch replacement, but not in those with total arch replacement. Multivariate analysis identified distal anastomotic new-entry tear (hazard ratio, 3.95, <em>P &lt; .</em>001) and Marfan syndrome (hazard ratio, 7.46, <em>P =</em> .005) as independent predictors of distal reoperation.</div></div><div><h3>Conclusions</h3><div>Distal anastomotic new-entry tear commonly develops at the greater curve of the aortic arch after acute type A aortic dissection repair and substantially increases the risk of distal reoperation after hemiarch replacement and partial arch replacement but not total arch replacement, suggesting that total arch replacement may protect against distal anastomotic new-entry tear-related reoperations, particularly in patients with supra-aortic branch dissection. Careful surgical planning and long-term surveillance are crucial for optimizing outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 73-86"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698147","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":"Spinal cord–protective effect of resorcimoline for ischemia-reperfusion injury in a rabbit model","authors":"Yu Kawahara MD ,&nbsp;Takayuki Kawashima MD, PhD ,&nbsp;Kenshi Yoshimura MD, PhD ,&nbsp;Kazuki Mori MD ,&nbsp;Ryotaro Nagashima MD ,&nbsp;Tadashi Umeno MD, PhD ,&nbsp;Haruto Nishida MD, PhD ,&nbsp;Hiroki Sato MD, PhD ,&nbsp;Akihiro Higuchi PhD ,&nbsp;Osamu Tokumaru MD, PhD ,&nbsp;Shinji Miyamoto MD, PhD","doi":"10.1016/j.xjon.2025.10.017","DOIUrl":"10.1016/j.xjon.2025.10.017","url":null,"abstract":"<div><h3>Objectives</h3><div>Spinal cord injury can occur after aortic surgery as a result of reactive oxygen species (ROS) generated during ischemia-reperfusion. Resorcimoline is a novel and potent antioxidant that has demonstrated ROS-scavenging activity in vitro. We evaluated the spinal cord–protective effects of resorcimoline and compared its efficacy with that of edaravone, a free-radical scavenger currently used clinically in Japan.</div></div><div><h3>Methods</h3><div>A spinal cord injury model was established via infrarenal aortic occlusion for 20 minutes in 30 Japanese white rabbits. The animals received saline (control), resorcimoline (6 mg/kg), or edaravone (6 mg/kg) immediately after reperfusion. Neurologic function was assessed using the modified Tarlov score, and a linear mixed model was used to analyze the modified Tarlov score data. Logistic regression analysis was used to compare the risk of paraplegia between groups. After 5 days, spinal cord segments (L3-L5) were harvested. The number of residual normal neurons was evaluated histologically, and oxidative DNA damage was assessed via immunostaining for 8-hydroxy-2-deoxyguanosine.</div></div><div><h3>Results</h3><div>Compared with the control group, resorcimoline treatment resulted in significantly greater modified Tarlov score improvement (regression coefficient; 2.025; 95% confidence interval, 0.267-3.782; <em>P</em> = .025), lower incidence of paraplegia (odds ratio, 0.04; 95% confidence interval, 0.002-0.4; <em>P</em> = .004), greater number of residual normal neurons (<em>P</em> = .018), and greater percentage of 8-hydroxy-2-deoxyguanosine−negative neurons (<em>P</em> &lt; .001). Conversely, these parameters did not differ significantly between the edaravone and control groups.</div></div><div><h3>Conclusions</h3><div>Resorcimoline demonstrated spinal cord–protective effects, likely associated with its antioxidant ability to eliminate ROS generated during ischemia-reperfusion.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 397-403"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698205","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":"A real-time rapid cycle process improvement tool for accelerated quality improvement in coronary artery bypass grafting surgery","authors":"John G. Byrne MD ,&nbsp;Farhaan Chaugle BS ,&nbsp;Waheed Asger BS ,&nbsp;Aaliyah Willis MD ,&nbsp;Shelby DeRose MHA ,&nbsp;Rachel Jones RN ,&nbsp;Hannan Chaugle MD","doi":"10.1016/j.xjon.2025.08.010","DOIUrl":"10.1016/j.xjon.2025.08.010","url":null,"abstract":"<div><h3>Background</h3><div>We report a custom-designed visual feedback tool integrated into a comprehensive quality improvement (QI) program to drive accelerated, real-time advances in coronary artery bypass grafting (CABG) surgery.</div></div><div><h3>Methods</h3><div>The Society of Thoracic Surgeons (STS) risk profiles of 977 consecutive patients who underwent CABG between January 1, 2021, and December 31, 2024 risk profiles were analyzed. For 2021-2022, the mortality observed-to-expected ratio (O/E) was 2.5. In 2023, we started a real-time, rapid cycle process improvement program. We designed a QI tool to calculate in real time the O/Es for death, stroke, renal failure, prolonged ventilation, reoperation, deep sternal wound infection, prolonged length of stay, and failure of left internal mammary artery (LIMA) use or medication compliance. We developed a final composite score in which we assigned 80% to mortality, 7% to LIMA use, 3% to medications, and 10% to nonfatal STS adverse outcomes as a rough estimate of the STS 3-star CABG construct. For a final composite grade, we assigned “good” (O/E &lt; 0.65), “fair” (O/E = 0.65-1.0), or “poor” (O/E &gt; 1.0) for each adverse outcome.</div></div><div><h3>Results</h3><div>The CABG mortality O/E improved from 1.5 in 2021-2022 to 0.25 in 2023-2024 (<em>P</em> &lt; .0001; z = 327,991). The final composite O/E for 2023-2024 was 0.55 (“good”). This resulted in a final composite grade of “good,” coinciding with our 3-star STS status for isolated CABG.</div></div><div><h3>Conclusions</h3><div>Our custom-designed QI tool enabled rapid improvement of our CABG outcomes (<em>P</em> &lt; .0001). This report is unique because it uses the publicly available STS risk calculator for real-time rapid cycle process improvement, integrated into a comprehensive QI program.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 242-249"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698238","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":"Long-term survival for preoperative versus postoperative treatment of N2 lung cancer: The importance of complete adjuvant therapy for occult N2 disease","authors":"Fatemehsadat Pezeshkian MD ,&nbsp;Chandana Adhikarla MD, MPH ,&nbsp;Emanuele Mazzola PhD ,&nbsp;Hao Li MD ,&nbsp;Carla Vega MD ,&nbsp;Anupama Singh MD ,&nbsp;Fatemeh Hooshmand MSc ,&nbsp;Miles McAllister BA ,&nbsp;Rafael Ribeiro Barcelos MD ,&nbsp;Elias Bou Farhat MD ,&nbsp;Abby A. White DO ,&nbsp;Matthew M. Rochefort MD ,&nbsp;Raphael Bueno MD ,&nbsp;Desiree Steimer MD ,&nbsp;Matthew J. Pommerening MD ,&nbsp;Paula A. Ugalde Figueroa MD ,&nbsp;Michael T. Jaklitsch MD ,&nbsp;Scott J. Swanson MD","doi":"10.1016/j.xjon.2025.09.008","DOIUrl":"10.1016/j.xjon.2025.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Unsuspected (defined here as occult) N2-positive lung cancer impacts overall survival (OS), and treatment patterns likely influence outcomes. We aimed to evaluate factors that could improve the long-term outcomes of patients with occult N2 disease compared to biopsy-proven, pre-resectional N2 disease.</div></div><div><h3>Methods</h3><div>Our institutional prospective database was queried for N2 non–small cell lung cancer (NSCLC) at presentation (biopsy-proven) prior to surgical resection or postoperatively diagnosed N2 (occult N2), excluding stage IV disease or patients with insufficient follow-up. In occult N2 group, postoperative therapy was stratified into complete (≥3 cycles), incomplete (1-2 cycles), or no adjuvant treatment. Propensity score weighting adjusted for age, comorbidities, tumor size, and N2 involvement. Kaplan-Meier analysis assessed 5-year overalls survival (OS).</div></div><div><h3>Results</h3><div>Between 2006-2023, 483 patients met inclusion criteria, stratified into 325 patients (67.2%) with biopsy-proven N2 and 158 (32.8%) with occult N2. The biopsy-proven N2 group primarily received neoadjuvant therapy (chemo/chemoimmunotherapy ± radiation). In the occult N2 group, 86 patients (54.4%) received full-dose adjuvant therapy, 31 (19.6%) received incomplete adjuvant therapy, and 41 (26%) received no adjuvant therapy. After propensity score weighting, the occult N2 group had significantly lower OS (<em>P</em> = .03); however, when the cohort was stratified by completeness of adjuvant treatment, those who received full adjuvant therapy had OS comparable to that of the biopsy-proven group (hazard ratio [HR], 0.98; 95% confidence interval [CI], 0.65-1.48; <em>P</em> = .9). Incomplete therapy provided some survival benefits but was associated with worse OS compared to complete therapy (HR, 1.54; 95% CI, 0.9-2.6; <em>P</em> = .1). The no-therapy group had the lowest OS.</div></div><div><h3>Conclusions</h3><div>Patients with occult N2 treated with adjuvant treatment may achieve improved survival rates compared to those not fully treated. Neoadjuvant treatment is optimal to ensure delivery of therapy as prescribed, and thus every effort should be made to identify N2 disease prior to resection.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 541-553"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697717","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":"Long-term survival after superior vena cava resection and reconstruction for locally advanced epithelial thymic tumors invading superior vena cava","authors":"Jiahao Jiang MD,&nbsp;Jian Gao MD,&nbsp;Yongqiang Ao MD,&nbsp;Shuai Wang MD,&nbsp;Xifei Jiang MD,&nbsp;Lijie Tan MD,&nbsp;Jianyong Ding MD","doi":"10.1016/j.xjon.2025.10.012","DOIUrl":"10.1016/j.xjon.2025.10.012","url":null,"abstract":"<div><h3>Objectives</h3><div>Thymic epithelial tumors (TETs) invading superior vena cava have traditionally posed significant surgical challenges. However, advances in surgical techniques have expanded treatment options. This study aimed to evaluate the long-term survival outcomes following superior vena cava resection and reconstruction in patients with locally advanced TETs.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 50 consecutive patients with TETs invading superior vena cava who underwent surgical resection and vascular reconstruction at our center between March 2015 and September 2023. Survival outcomes were assessed by Kaplan-Meier methods, and prognostic factors were analyzed using Cox regression.</div></div><div><h3>Results</h3><div>All patients achieved complete resection. The mean patient age was 53.0 years, with 68.0% male predominance. Thymomas accounted for 50% of cases. The median follow-up time was 41 months. The 5-year disease-free survival and overall survival rates were 32.2% and 71.4%, respectively. There were no statistical differences between thymomas and thymic carcinomas in disease-free survival (mean, 40.1 ± 5.2 vs 35.5 ± 6.4 months; <em>P</em> = .502) or overall survival (mean, 72.3 ± 6.7 vs 59.0 ± 5.9 months; <em>P</em> = .363). Patients with Masaoka stage IV demonstrated a trend toward poorer disease-free survival compared with those with stage IIIB disease (mean, 26.8 ± 7.3 vs 42.3 ± 5.3 months; <em>P</em> = .086), yet their long-term overall survival rates were similar (mean, 69.3 ± 9.7 vs 63.6 ± 4.8 months; <em>P</em> = .968). Univariate analysis showed nonsignificant trends for poorer disease-free survival in higher Masaoka stages (hazard ratio, 1.971; <em>P</em> = .094) and reduced overall survival associated with older age (hazard ratio, 4.739; <em>P</em> = .053). No independent predictors were confirmed on multivariate analysis.</div></div><div><h3>Conclusions</h3><div>Aggressive surgical resection with superior vena cava reconstruction is feasible and offers favorable long-term survival in selected patients with locally advanced TETs.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 665-671"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697858","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":"Regadenoson in the rehabilitation of marginal donor lungs on ex vivo lung perfusion: A blinded multicenter randomized controlled clinical trial","authors":"Emily Fleischmann BS ,&nbsp;Mark Conaway PhD ,&nbsp;Joseph Rabin MD ,&nbsp;Kaitlyn Vecere MBA, RN, CCRC ,&nbsp;Kaitlyn Masih BSN ,&nbsp;Yunge Zhao PhD ,&nbsp;Ashling Zhang MD ,&nbsp;Mohammad Khan PhD ,&nbsp;Valeria Mas MS, PhD ,&nbsp;Alexander Krupnick MD ,&nbsp;Joel Linden PhD ,&nbsp;Toshihiro Okamoto MD, PhD ,&nbsp;Kamal Ayyat MD, PhD ,&nbsp;Kenneth McCurry MD ,&nbsp;Christine Lau MD, MBA","doi":"10.1016/j.xjon.2025.09.017","DOIUrl":"10.1016/j.xjon.2025.09.017","url":null,"abstract":"<div><h3>Objective</h3><div>We hypothesized that regadenoson, an adenosine A2A receptor agonist, will increase the use rate after ex vivo lung perfusion and reduce ischemic reperfusion injury.</div></div><div><h3>Methods</h3><div>This randomized (2:1), multicenter, blinded, placebo-controlled trial (NCT04521569) treated donor lungs with a regadenoson infusion (1.44 μg/kg/h, n = 26) or placebo (n = 8) during ex vivo lung perfusion. Eligibility criteria were adapted from the NOVEL trial. The rate of use of donor lungs was the primary end point. Secondary end points were primary graft dysfunction scores and 30-day safety.</div></div><div><h3>Results</h3><div>Comparing regadenoson with placebo, 10 of 26 (38%) versus 0 of 8 (0%) donor lungs had a PaO₂/F<span>io</span>₂ less than 300 (<em>P =</em> .04), the use rates were not significantly different with 17 of 26 (65%) and 6 of 8 (75%) lungs accepted after study treatment protocol (95% CI, −35 to 26; <em>P =</em> .62), and there was no significant difference in the proportion of recipients with at least 1 adverse event (12/17 [71%] vs 6/7 [86%], 95% CI, −25 to 42, <em>P =</em> .45), serious adverse event (11/17 [65%] vs 4/7 [57%], 95% CI, −36 to 51, <em>P =</em> .73), major lung event (10/17 [59%] vs 4/7 [57%], 95% CI, −34 to 59, <em>P =</em> .94), or grade 3 primary graft dysfunction (5/17 [29%] vs 2/7 [29%], 95% CI, −43 to 28, <em>P =</em> .87). No adverse events were related to the study treatment.</div></div><div><h3>Conclusions</h3><div>There was no significant increase in the use of marginal donor lungs or a decrease in ischemic reperfusion injury in lungs undergoing ex vivo lung perfusion with regadenoson compared with placebo. Regadenoson is a safe ex vivo lung perfusion adjunct. The use rate of the placebo group was greater than the expectation set in the NOVEL trial of 51%, making it difficult for the regadenoson group to have a significant increase in use.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 681-689"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697861","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}