Pub Date : 2024-08-01DOI: 10.1016/j.xjon.2024.06.011
Tedy Sawma MD , Hartzell V. Schaff MD , Jeffrey B. Geske MD , Joseph A. Dearani MD , Steve R. Ommen MD
Background
Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of developing cardiac arrhythmias and have a high prevalence of cardiac implantable electronic device (CIED) use. Tricuspid regurgitation (TR) is a potential complication of device leads and can be severe enough to prompt surgical intervention.
Methods
We identified 21 consecutive patients who underwent tricuspid valve (TV) surgery for device lead-induced TR late following septal myectomy (SM) for obstructive HCM. The primary endpoint was long-term all-cause mortality.
Results
The median patient age was 63 years (range, 55-71 years), 19 patients (91%) had New York Heart Association class III or IV limitation, and all patients were receiving diuretics for right heart failure. The median interval between device implantation and TV surgery was 4 years (range, 1.5-8.5 years). Eight patients (38%) underwent pacemaker implantation due to complete heart block following SM. Preoperatively, TR was severe in 81% of the patients. The primary mechanism of lead-induced TR was leaflet impingement without adherence (n = 15; 75%). Nine patients (43%) underwent TV replacement, and 12 patients (57%) underwent repair. Only 1 patient died early postoperatively. Patients with lead-induced TR had markedly reduced long-term survival compared to the overall population of patients undergoing SM; 5-year survival was 58%, compared to 96% for the contemporary SM group.
Conclusions
Late lead-induced TR is a potential complication of CIEDs in patients with HCM who have undergone SM. Although TV repair and replacement can be done with acceptable early mortality, late patient survival is poor.
背景肥厚型心肌病（HCM）患者发生心律失常的风险增加，使用心脏植入式电子设备（CIED）的比例也很高。三尖瓣反流（TR）是装置导联的一种潜在并发症，其严重程度可导致手术干预。方法我们确定了 21 名连续患者，他们因阻塞性 HCM 而接受房间隔肌肉切除术（SM）后，因装置导联诱发的 TR 而接受了三尖瓣（TV）手术。主要终点是长期全因死亡率。结果患者的中位年龄为 63 岁（55-71 岁），19 名患者（91%）为纽约心脏协会 III 级或 IV 级受限，所有患者均因右心衰接受利尿剂治疗。设备植入与电视手术之间的中位间隔为 4 年（1.5-8.5 年）。八名患者（38%）因 SM 术后出现完全性心脏传导阻滞而接受了起搏器植入手术。术前，81%的患者TR严重。导联诱发 TR 的主要机制是无粘连的小叶撞击（n = 15；75%）。9 名患者（43%）接受了电视置换术，12 名患者（57%）接受了修复术。只有一名患者在术后早期死亡。铅诱导 TR 患者的长期存活率明显低于接受 SM 的所有患者；5 年存活率为 58%，而同期 SM 组的存活率为 96%。虽然 TV 修复和置换术的早期死亡率可以接受，但患者的晚期存活率却很低。
{"title":"Tricuspid valve surgery following septal myectomy in patients with a cardiac implantable electronic device","authors":"Tedy Sawma MD , Hartzell V. Schaff MD , Jeffrey B. Geske MD , Joseph A. Dearani MD , Steve R. Ommen MD","doi":"10.1016/j.xjon.2024.06.011","DOIUrl":"10.1016/j.xjon.2024.06.011","url":null,"abstract":"<div><h3>Background</h3><p>Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of developing cardiac arrhythmias and have a high prevalence of cardiac implantable electronic device (CIED) use. Tricuspid regurgitation (TR) is a potential complication of device leads and can be severe enough to prompt surgical intervention.</p></div><div><h3>Methods</h3><p>We identified 21 consecutive patients who underwent tricuspid valve (TV) surgery for device lead-induced TR late following septal myectomy (SM) for obstructive HCM. The primary endpoint was long-term all-cause mortality.</p></div><div><h3>Results</h3><p>The median patient age was 63 years (range, 55-71 years), 19 patients (91%) had New York Heart Association class III or IV limitation, and all patients were receiving diuretics for right heart failure. The median interval between device implantation and TV surgery was 4 years (range, 1.5-8.5 years). Eight patients (38%) underwent pacemaker implantation due to complete heart block following SM. Preoperatively, TR was severe in 81% of the patients. The primary mechanism of lead-induced TR was leaflet impingement without adherence (n = 15; 75%). Nine patients (43%) underwent TV replacement, and 12 patients (57%) underwent repair. Only 1 patient died early postoperatively. Patients with lead-induced TR had markedly reduced long-term survival compared to the overall population of patients undergoing SM; 5-year survival was 58%, compared to 96% for the contemporary SM group.</p></div><div><h3>Conclusions</h3><p>Late lead-induced TR is a potential complication of CIEDs in patients with HCM who have undergone SM. Although TV repair and replacement can be done with acceptable early mortality, late patient survival is poor.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 29-36"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001712/pdfft?md5=641af9c689d2d204d387914ed0975b63&pid=1-s2.0-S2666273624001712-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961061","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 : 2024-08-01DOI: 10.1016/j.xjon.2024.04.012
{"title":"Discussion to: Salvage lung resection after immunotherapy is feasible and safe","authors":"","doi":"10.1016/j.xjon.2024.04.012","DOIUrl":"10.1016/j.xjon.2024.04.012","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 151-152"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001153/pdfft?md5=0724d0347417e8f1197b53d3b0a2e350&pid=1-s2.0-S2666273624001153-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756826","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 : 2024-08-01DOI: 10.1016/j.xjon.2024.06.007
Christina L. Greene MD , Antonia Schulz MD , Mariana Chávez MD , Steven J. Staffa MS , David Zurakowski MS, PhD , Kevin G. Friedman MD , Sitaram M. Emani MD , Christopher W. Baird MD
Objective
To evaluate the short- and long-term outcomes of cardiac repair versus nonoperative management in patients with trisomy 13 and trisomy 18 with congenital heart disease.
Methods
An institutional review board-approved, retrospective review was undertaken to identify all patients admitted with trisomy 13/18 and congenital heart disease. Patients were divided into 2 cohorts (operated vs nonoperated) and compared.
Results
Between 1985 and 2023, 62 patients (34 operated and 28 nonoperated) with trisomy 13 (n = 9) and trisomy 18 (n = 53) were identified. The operated cohort was 74% girls, underwent mainly The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category 1 procedures (n = 24 [71%]) at a median age of 2.5 months (interquartile range [IQR], 1.3-4.5 months). This compares with the nonoperative cohort where 64% (n = 18) would have undergone The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category 1 procedures if surgery would have been elected. The most common diagnosis was ventricular septal defect. Postoperative median intensive care unit stay was 6.5 days (IQR, 3.7-15 days) with a total hospital length of stay of 15 days (IQR, 11-49 days). Thirty-day postoperative survival was 94%. There were 5 in-hospital deaths in the operated and 7 in the nonoperated cohort. Median follow-up was 15.4 months (IQR, 4.3-48.7 months) for the operated and 11.2 months (IQR, 1.2-48.3 months) for the nonoperated cohorts. One-year survival was 79% operated versus 51.5% nonoperated (P < .003). Nonoperative treatment had an increased risk of mortality (hazard ratio, 3.28; 95% CI, 1.46-7.4; P = .004).
Conclusions
Controversy exists regarding the role of primary cardiac repair in patients with trisomy 13/18 and congenital heart disease. Cardiac repair can be performed safely with low early mortality and operated patients had higher long-term survival compared with nonoperated in our cohort.
{"title":"Operative and nonoperative outcomes in patients with trisomy 13 and 18 with congenital heart disease","authors":"Christina L. Greene MD , Antonia Schulz MD , Mariana Chávez MD , Steven J. Staffa MS , David Zurakowski MS, PhD , Kevin G. Friedman MD , Sitaram M. Emani MD , Christopher W. Baird MD","doi":"10.1016/j.xjon.2024.06.007","DOIUrl":"10.1016/j.xjon.2024.06.007","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the short- and long-term outcomes of cardiac repair versus nonoperative management in patients with trisomy 13 and trisomy 18 with congenital heart disease.</p></div><div><h3>Methods</h3><p>An institutional review board-approved, retrospective review was undertaken to identify all patients admitted with trisomy 13/18 and congenital heart disease. Patients were divided into 2 cohorts (operated vs nonoperated) and compared.</p></div><div><h3>Results</h3><p>Between 1985 and 2023, 62 patients (34 operated and 28 nonoperated) with trisomy 13 (n = 9) and trisomy 18 (n = 53) were identified. The operated cohort was 74% girls, underwent mainly The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category 1 procedures (n = 24 [71%]) at a median age of 2.5 months (interquartile range [IQR], 1.3-4.5 months). This compares with the nonoperative cohort where 64% (n = 18) would have undergone The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category 1 procedures if surgery would have been elected. The most common diagnosis was ventricular septal defect. Postoperative median intensive care unit stay was 6.5 days (IQR, 3.7-15 days) with a total hospital length of stay of 15 days (IQR, 11-49 days). Thirty-day postoperative survival was 94%. There were 5 in-hospital deaths in the operated and 7 in the nonoperated cohort. Median follow-up was 15.4 months (IQR, 4.3-48.7 months) for the operated and 11.2 months (IQR, 1.2-48.3 months) for the nonoperated cohorts. One-year survival was 79% operated versus 51.5% nonoperated (<em>P</em> < .003). Nonoperative treatment had an increased risk of mortality (hazard ratio, 3.28; 95% CI, 1.46-7.4; <em>P</em> = .004).</p></div><div><h3>Conclusions</h3><p>Controversy exists regarding the role of primary cardiac repair in patients with trisomy 13/18 and congenital heart disease. Cardiac repair can be performed safely with low early mortality and operated patients had higher long-term survival compared with nonoperated in our cohort.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 123-131"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001669/pdfft?md5=7f5c6941eee514d471dc97a60d6160e8&pid=1-s2.0-S2666273624001669-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141960995","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 : 2024-08-01DOI: 10.1016/j.xjon.2024.05.001
{"title":"Discussion to: Identifying lung cancer disparities among Asian Americans: A novel analytic approach","authors":"","doi":"10.1016/j.xjon.2024.05.001","DOIUrl":"10.1016/j.xjon.2024.05.001","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 165-166"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001219/pdfft?md5=1602ca512303ca2f2f94ba095b471d2e&pid=1-s2.0-S2666273624001219-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141055694","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 : 2024-08-01DOI: 10.1016/j.xjon.2024.06.003
Objective
Coronary artery disease remains a leading cause of morbidity and mortality worldwide. Patients with advanced coronary artery disease who are not eligible for endovascular or surgical revascularization have limited options. Extracellular vesicles have shown potential to improve myocardial function in preclinical models. Extracellular vesicles can be conditioned to modify their components. Hypoxia-conditioned extracellular vesicles have demonstrated the ability to reduce infarct size and apoptosis in small animals. Our objective is to assess the potential benefits of hypoxia-conditioned extracellular vesicles in a large animal model of coronary artery disease.
Methods
Coronary artery disease was induced in 14 Yorkshire swine by ameroid constriction of the left circumflex coronary artery. Two weeks postsurgery, swine underwent a repeat left thoracotomy for injections of hypoxia-conditioned extracellular vesicles (n = 7) or saline (control, n = 7). Five weeks later, all animals underwent terminal harvest for perfusion measurements and myocardial sectioning.
Results
Myocardial perfusion analysis demonstrated a trend toward increase at rest and a significant increase during rapid pacing (P = .09, P < .001). There were significant increases in activated phosphorylated endothelial nitric oxide synthase, endothelial nitric oxide synthase, phosphatidylinositol 3-kinase, phosphorylated protein kinase B, and the phosphorylated protein kinase B/protein kinase B ratio in the hypoxia-conditioned extracellular vesicles group compared with the control group (all P < .05). Additionally, there was a significant decrease in the antiangiogenic proteins collagen 18 and angiostatin (P = .01, P = .01) in the hypoxia-conditioned extracellular vesicles group.
Conclusions
Intramyocardial injection of hypoxia-conditioned extracellular vesicles results in increased myocardial perfusion without a corresponding change in vessel density. Therefore, this improvement in perfusion is possibly due to changes in nitric oxide signaling. Hypoxia-conditioned extracellular vesicles represent a potential therapeutic strategy to increase myocardial perfusion in patients with advanced coronary artery disease.
目的冠状动脉疾病仍然是全球发病率和死亡率的主要原因。晚期冠状动脉疾病患者如果不符合血管内或外科血管再通手术的条件，则选择有限。细胞外囊泡在临床前模型中显示出改善心肌功能的潜力。细胞外囊泡可以通过调节来改变其成分。缺氧条件下的细胞外囊泡已证明能够缩小小动物的心肌梗死面积并减少细胞凋亡。我们的目的是评估低氧调节细胞外囊泡在冠状动脉疾病大型动物模型中的潜在益处。方法通过对左侧环状冠状动脉进行羊膜样收缩，诱导 14 头约克夏猪患冠状动脉疾病。术后两周，猪再次接受左胸廓切开术，注射缺氧调节细胞外囊泡（n = 7）或生理盐水（对照组，n = 7）。结果心肌灌注分析表明，静息时心肌灌注有增加趋势，快速起搏时心肌灌注显著增加（P = .09，P < .001）。与对照组相比，缺氧条件细胞外囊泡组的活化磷酸化内皮一氧化氮合酶、内皮一氧化氮合酶、磷脂酰肌醇 3-激酶、磷酸化蛋白激酶 B 和磷酸化蛋白激酶 B/ 蛋白激酶 B 比率均有明显增加（均为 P <.05）。此外，低氧条件细胞外囊泡组的抗血管生成蛋白胶原 18 和血管抑素显著下降（P = .01, P = .01）。因此，灌注的改善可能是由于一氧化氮信号的改变。低氧调节细胞外囊泡是增加晚期冠心病患者心肌灌注的一种潜在治疗策略。
{"title":"Intramyocardial injection of hypoxia-conditioned extracellular vesicles increases myocardial perfusion in a swine model of chronic coronary disease","authors":"","doi":"10.1016/j.xjon.2024.06.003","DOIUrl":"10.1016/j.xjon.2024.06.003","url":null,"abstract":"<div><h3>Objective</h3><p>Coronary artery disease remains a leading cause of morbidity and mortality worldwide. Patients with advanced coronary artery disease who are not eligible for endovascular or surgical revascularization have limited options. Extracellular vesicles have shown potential to improve myocardial function in preclinical models. Extracellular vesicles can be conditioned to modify their components. Hypoxia-conditioned extracellular vesicles have demonstrated the ability to reduce infarct size and apoptosis in small animals. Our objective is to assess the potential benefits of hypoxia-conditioned extracellular vesicles in a large animal model of coronary artery disease.</p></div><div><h3>Methods</h3><p>Coronary artery disease was induced in 14 Yorkshire swine by ameroid constriction of the left circumflex coronary artery. Two weeks postsurgery, swine underwent a repeat left thoracotomy for injections of hypoxia-conditioned extracellular vesicles (n = 7) or saline (control, n = 7). Five weeks later, all animals underwent terminal harvest for perfusion measurements and myocardial sectioning.</p></div><div><h3>Results</h3><p>Myocardial perfusion analysis demonstrated a trend toward increase at rest and a significant increase during rapid pacing (<em>P =</em> .09, <em>P <</em> .001). There were significant increases in activated phosphorylated endothelial nitric oxide synthase, endothelial nitric oxide synthase, phosphatidylinositol 3-kinase, phosphorylated protein kinase B, and the phosphorylated protein kinase B/protein kinase B ratio in the hypoxia-conditioned extracellular vesicles group compared with the control group (all <em>P</em> < .05). Additionally, there was a significant decrease in the antiangiogenic proteins collagen 18 and angiostatin (<em>P =</em> .01, <em>P</em> = .01) in the hypoxia-conditioned extracellular vesicles group.</p></div><div><h3>Conclusions</h3><p>Intramyocardial injection of hypoxia-conditioned extracellular vesicles results in increased myocardial perfusion without a corresponding change in vessel density. Therefore, this improvement in perfusion is possibly due to changes in nitric oxide signaling. Hypoxia-conditioned extracellular vesicles represent a potential therapeutic strategy to increase myocardial perfusion in patients with advanced coronary artery disease.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 49-63"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266627362400161X/pdfft?md5=3c49ce287b9addf97d357dc18a02db15&pid=1-s2.0-S266627362400161X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413368","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.2024.03.009
David M. Kwiatkowski MD, MS , Jeffrey A. Alten MD , Kenneth E. Mah MD , David T. Selewski MD , Tia T. Raymond MD, MBA , Natasha S. Afonso MD, MPH , Joshua J. Blinder MD , Matthew T. Coghill MD , David S. Cooper MD, MPH , Joshua D. Koch MD , Catherine D. Krawczeski MD , David L.S. Morales MD , Tara M. Neumayr MD , A.K.M. Fazlur Rahman PhD , Garrett Reichle MS , Sarah Tabbutt MD, PhD , Tennille N. Webb MD , Santiago Borasino MD
Objective
The study objective was to determine if intraoperative peritoneal catheter placement is associated with improved outcomes in neonates undergoing high-risk cardiac surgery with cardiopulmonary bypass.
Methods
This propensity score–matched retrospective study used data from 22 academic pediatric cardiac intensive care units. Consecutive neonates undergoing Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery category 3 to 5 cardiac surgery with cardiopulmonary bypass at centers participating in the NEonatal and Pediatric Heart Renal Outcomes Network collaborative were studied to determine the association of the use of an intraoperative placed peritoneal catheter for dialysis or passive drainage with clinical outcomes, including the duration of mechanical ventilation.
Results
Among 1490 eligible neonates in the NEonatal and Pediatric Heart Renal Outcomes Network dataset, a propensity-matched analysis was used to compare 395 patients with peritoneal catheter placement with 628 patients without peritoneal catheter placement. Time to extubation and most clinical outcomes were similar. Postoperative length of stay was 5 days longer in the peritoneal catheter placement cohort (17 vs 22 days, P = .001). There was a 50% higher incidence of moderate to severe acute kidney injury in the no-peritoneal catheter cohort (12% vs 18%, P = .02). Subgroup analyses between specific treatments and in highest risk patients yielded similar associations.
Conclusions
This study does not demonstrate improved outcomes among neonates with placement of a peritoneal catheter during cardiac surgery. Outcomes were similar apart from longer hospital stay in the peritoneal catheter cohort. The no-peritoneal catheter cohort had a 50% higher incidence of moderate to severe acute kidney injury (12% vs 18%). This analysis does not support indiscriminate peritoneal catheter use, although it may support the utility for postoperative fluid removal among neonates at risk for acute kidney injury. A multicenter controlled trial may better elucidate peritoneal catheter effects.
{"title":"An evaluation of the outcomes associated with peritoneal catheter use in neonates undergoing cardiac surgery: A multicenter study","authors":"David M. Kwiatkowski MD, MS , Jeffrey A. Alten MD , Kenneth E. Mah MD , David T. Selewski MD , Tia T. Raymond MD, MBA , Natasha S. Afonso MD, MPH , Joshua J. Blinder MD , Matthew T. Coghill MD , David S. Cooper MD, MPH , Joshua D. Koch MD , Catherine D. Krawczeski MD , David L.S. Morales MD , Tara M. Neumayr MD , A.K.M. Fazlur Rahman PhD , Garrett Reichle MS , Sarah Tabbutt MD, PhD , Tennille N. Webb MD , Santiago Borasino MD","doi":"10.1016/j.xjon.2024.03.009","DOIUrl":"10.1016/j.xjon.2024.03.009","url":null,"abstract":"<div><h3>Objective</h3><p>The study objective was to determine if intraoperative peritoneal catheter placement is associated with improved outcomes in neonates undergoing high-risk cardiac surgery with cardiopulmonary bypass.</p></div><div><h3>Methods</h3><p>This propensity score–matched retrospective study used data from 22 academic pediatric cardiac intensive care units. Consecutive neonates undergoing Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery category 3 to 5 cardiac surgery with cardiopulmonary bypass at centers participating in the NEonatal and Pediatric Heart Renal Outcomes Network collaborative were studied to determine the association of the use of an intraoperative placed peritoneal catheter for dialysis or passive drainage with clinical outcomes, including the duration of mechanical ventilation.</p></div><div><h3>Results</h3><p>Among 1490 eligible neonates in the NEonatal and Pediatric Heart Renal Outcomes Network dataset, a propensity-matched analysis was used to compare 395 patients with peritoneal catheter placement with 628 patients without peritoneal catheter placement. Time to extubation and most clinical outcomes were similar. Postoperative length of stay was 5 days longer in the peritoneal catheter placement cohort (17 vs 22 days, <em>P</em> = .001). There was a 50% higher incidence of moderate to severe acute kidney injury in the no-peritoneal catheter cohort (12% vs 18%, <em>P</em> = .02). Subgroup analyses between specific treatments and in highest risk patients yielded similar associations.</p></div><div><h3>Conclusions</h3><p>This study does not demonstrate improved outcomes among neonates with placement of a peritoneal catheter during cardiac surgery. Outcomes were similar apart from longer hospital stay in the peritoneal catheter cohort. The no-peritoneal catheter cohort had a 50% higher incidence of moderate to severe acute kidney injury (12% vs 18%). This analysis does not support indiscriminate peritoneal catheter use, although it may support the utility for postoperative fluid removal among neonates at risk for acute kidney injury. A multicenter controlled trial may better elucidate peritoneal catheter effects.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 275-295"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000688/pdfft?md5=c36f936319a101fe5d6c4b4f8d96cfa9&pid=1-s2.0-S2666273624000688-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399684","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.2024.03.011
Hao Liu MD, PhD , Tianyue Pan MD, PhD , Bin Chen MD, PhD , Junhao Jiang MD, PhD , Weiguo Fu MD, PhD , Zhihui Dong MD, PhD
Objective
Midaortic syndrome is a rare clinical condition that has been mainly studied in juveniles through case reports and series. This study aims to report the anatomic characteristics and long-term outcomes of 41 adult patients with midaortic syndrome who received open surgical treatment or endovascular treatment over a 14-year period.
Methods
A consecutive cohort of 41 adult patients diagnosed with midaortic syndrome at our center between January 2008 and November 2021 were enrolled in the study. Patients’ baseline and anatomic characteristics were collected and analyzed. Primary follow-up outcomes included death and reintervention. Other follow-up outcomes included hypertension and complications.
Results
The study enrolled 41 adult patients with midaortic syndrome with a mean age of 37.5 ± 13.4 years. Twenty-five patients received open surgical treatment, and 16 patients received endovascular treatment. Isolated infrarenal lesions were more likely to be found in the endovascular treatment group (P = .005), whereas patients with multiple (P = .002) or intravisceral involvement (P = .001) were more likely to be found in the open surgical treatment group. The open surgical treatment group was more likely to have a lower postoperative peak systolic pressure gradient (P = .020). The 5- and 10-year reintervention-free survivals were 87.7% and 71.7% in the open surgical treatment group and 92.3% and 79.1% in the endovascular treatment group, respectively.
Conclusions
Both open surgical treatment and endovascular treatment showed satisfactory long-term efficacy outcomes for adult patients with midaortic syndrome. Given the patients’ relatively young age and long life expectancy, strict and regular lifelong follow-up is necessary.
{"title":"Long-term outcomes of surgical or endovascular treatment of adult with midaortic syndrome: A single-center retrospective study over a 14-year period","authors":"Hao Liu MD, PhD , Tianyue Pan MD, PhD , Bin Chen MD, PhD , Junhao Jiang MD, PhD , Weiguo Fu MD, PhD , Zhihui Dong MD, PhD","doi":"10.1016/j.xjon.2024.03.011","DOIUrl":"10.1016/j.xjon.2024.03.011","url":null,"abstract":"<div><h3>Objective</h3><p>Midaortic syndrome is a rare clinical condition that has been mainly studied in juveniles through case reports and series. This study aims to report the anatomic characteristics and long-term outcomes of 41 adult patients with midaortic syndrome who received open surgical treatment or endovascular treatment over a 14-year period.</p></div><div><h3>Methods</h3><p>A consecutive cohort of 41 adult patients diagnosed with midaortic syndrome at our center between January 2008 and November 2021 were enrolled in the study. Patients’ baseline and anatomic characteristics were collected and analyzed. Primary follow-up outcomes included death and reintervention. Other follow-up outcomes included hypertension and complications.</p></div><div><h3>Results</h3><p>The study enrolled 41 adult patients with midaortic syndrome with a mean age of 37.5 ± 13.4 years. Twenty-five patients received open surgical treatment, and 16 patients received endovascular treatment. Isolated infrarenal lesions were more likely to be found in the endovascular treatment group (<em>P = .</em>005), whereas patients with multiple (<em>P = .</em>002) or intravisceral involvement (<em>P = .</em>001) were more likely to be found in the open surgical treatment group. The open surgical treatment group was more likely to have a lower postoperative peak systolic pressure gradient (<em>P = .</em>020). The 5- and 10-year reintervention-free survivals were 87.7% and 71.7% in the open surgical treatment group and 92.3% and 79.1% in the endovascular treatment group, respectively.</p></div><div><h3>Conclusions</h3><p>Both open surgical treatment and endovascular treatment showed satisfactory long-term efficacy outcomes for adult patients with midaortic syndrome. Given the patients’ relatively young age and long life expectancy, strict and regular lifelong follow-up is necessary.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 1-8"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000901/pdfft?md5=c66160fa35c72c9abeb3ef82a7d4063b&pid=1-s2.0-S2666273624000901-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140401330","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.2024.03.006
Jonathan D. Kochav MD , Hiroo Takayama MD, PhD , Andrew Goldstone MD, PhD , David Kalfa MD, PhD , Emile Bacha MD , Marlon Rosenbaum MD , Matthew J. Lewis MD, MPH
Objective
Bicuspid aortic valve (AV) patients with aortic regurgitation (AR) differ from tricuspid AV patients given younger age, greater left ventricle (LV) compliance, and more prevalent aortic stenosis (AS). Bicuspid AV-specific data to guide timing of AV replacement or repair are lacking.
Methods
Adults with bicuspid AV and moderate or greater AR who underwent aortic valve replacement or repair at our center were studied. The presurgical echocardiogram, and echocardiograms within 3 years postoperatively were evaluated for LV geometry/function, and AV function. Semiquantitative AS/AR assessment was performed in all patients with adequate imaging.
Results
One hundred thirty-five patients (85% men, aged 44.5 ± 15.9 years) were studied (63% pure AR, 37% mixed AS/AR). Following aortic valve replacement or repair, change in LV end-diastolic dimension and change in LV end-diastolic volume were associated with preoperative LV end-diastolic dimension (β = 0.62 Δcm/cm; 95% CI, 0.43-0.73 Δcm/cm; P < .001), and LV end-diastolic volume (β = 0.6 ΔmL/mL; 95% CI, 0.4-0.7 ΔmL/mL; P < .001), respectively, each independent of AR/AS severity (P = not significant). Baseline LV size predicted postoperative normalization (LV end-diastolic dimension: odds ratio, 3.75/cm; 95% CI, 1.61-8.75/cm, LV end-diastolic volume: odds ratio, 1.01/mL; 95% CI, 1.004-1.019/mL, both P values < .01) whereas AR/AS severity did not (P = not significant). Indexed LV end diastolic volume outperformed LV end-diastolic dimension in predicting postoperative LV normalization (area under the curve = 0.74 vs 0.61) with optimal diagnostic cutoffs of 99 mL/m2 and 6.1 cm, respectively. Postoperative indexed LV end diastolic volume dilatation was associated with increased risk of death, transplant/ventricular assist device, ventricular arrhythmia, and reoperation (hazard ratio, 6.1; 95% CI, 1.7-21.5; P < .01).
Conclusions
Remodeling extent following surgery in patients with bicuspid AV and AR relates to preoperative LV size independent of valve disease phenotype or severity. Many patients with LV end-diastolic dimension below current surgical thresholds did not normalize LV size. LV volumetric assessment offered superior diagnostic performance for predicting residual LV dilatation, and postoperative indexed LV end diastolic volume dilatation was associated with adverse prognosis.
{"title":"Left ventricular reverse remodeling after aortic valve replacement or repair in bicuspid aortic valve with moderate or greater aortic regurgitation","authors":"Jonathan D. Kochav MD , Hiroo Takayama MD, PhD , Andrew Goldstone MD, PhD , David Kalfa MD, PhD , Emile Bacha MD , Marlon Rosenbaum MD , Matthew J. Lewis MD, MPH","doi":"10.1016/j.xjon.2024.03.006","DOIUrl":"10.1016/j.xjon.2024.03.006","url":null,"abstract":"<div><h3>Objective</h3><p>Bicuspid aortic valve (AV) patients with aortic regurgitation (AR) differ from tricuspid AV patients given younger age, greater left ventricle (LV) compliance, and more prevalent aortic stenosis (AS). Bicuspid AV-specific data to guide timing of AV replacement or repair are lacking.</p></div><div><h3>Methods</h3><p>Adults with bicuspid AV and moderate or greater AR who underwent aortic valve replacement or repair at our center were studied. The presurgical echocardiogram, and echocardiograms within 3 years postoperatively were evaluated for LV geometry/function, and AV function. Semiquantitative AS/AR assessment was performed in all patients with adequate imaging.</p></div><div><h3>Results</h3><p>One hundred thirty-five patients (85% men, aged 44.5 ± 15.9 years) were studied (63% pure AR, 37% mixed AS/AR). Following aortic valve replacement or repair, change in LV end-diastolic dimension and change in LV end-diastolic volume were associated with preoperative LV end-diastolic dimension (β = 0.62 Δcm/cm; 95% CI, 0.43-0.73 Δcm/cm; <em>P</em> < .001), and LV end-diastolic volume (β = 0.6 ΔmL/mL; 95% CI, 0.4-0.7 ΔmL/mL; <em>P</em> < .001), respectively, each independent of AR/AS severity (<em>P</em> = not significant). Baseline LV size predicted postoperative normalization (LV end-diastolic dimension: odds ratio, 3.75/cm; 95% CI, 1.61-8.75/cm, LV end-diastolic volume: odds ratio, 1.01/mL; 95% CI, 1.004-1.019/mL, both <em>P</em> values < .01) whereas AR/AS severity did not (<em>P</em> = not significant). Indexed LV end diastolic volume outperformed LV end-diastolic dimension in predicting postoperative LV normalization (area under the curve = 0.74 vs 0.61) with optimal diagnostic cutoffs of 99 mL/m<sup>2</sup> and 6.1 cm, respectively. Postoperative indexed LV end diastolic volume dilatation was associated with increased risk of death, transplant/ventricular assist device, ventricular arrhythmia, and reoperation (hazard ratio, 6.1; 95% CI, 1.7-21.5; <em>P</em> < .01).</p></div><div><h3>Conclusions</h3><p>Remodeling extent following surgery in patients with bicuspid AV and AR relates to preoperative LV size independent of valve disease phenotype or severity. Many patients with LV end-diastolic dimension below current surgical thresholds did not normalize LV size. LV volumetric assessment offered superior diagnostic performance for predicting residual LV dilatation, and postoperative indexed LV end diastolic volume dilatation was associated with adverse prognosis.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 47-60"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000652/pdfft?md5=228f2024c58b19ea8c78046c1a5112de&pid=1-s2.0-S2666273624000652-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402467","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.2024.03.002
Dominique Vervoort MD, MPH, MBA , Dimitri Tchienga MD , Maral Ouzounian MD, PhD , Charles Mve Mvondo MD
{"title":"Thoracic aortic surgery in low- and middle-income countries: Time to bridge the gap?","authors":"Dominique Vervoort MD, MPH, MBA , Dimitri Tchienga MD , Maral Ouzounian MD, PhD , Charles Mve Mvondo MD","doi":"10.1016/j.xjon.2024.03.002","DOIUrl":"10.1016/j.xjon.2024.03.002","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 210-214"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000603/pdfft?md5=f5a4957ce040d73404d49e8ccb1e1691&pid=1-s2.0-S2666273624000603-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278045","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}
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