JTCVS open最新文献

{"title":"Long-term outcomes and evolving trends in thoracic aortic infections: A 25-year, single-center study in Japan","authors":"Katsuhiro Yamanaka MD, PhD ,&nbsp;Kenji Okada MD, PhD ,&nbsp;Daiki Kato MD ,&nbsp;Hironaga Shiraki MD ,&nbsp;Ryo Kawabata MD ,&nbsp;Shunya Chomei MD ,&nbsp;Taishi Inoue MD, PhD ,&nbsp;Shota Hasegawa MD ,&nbsp;Soichiro Henmi MD, PhD ,&nbsp;Hiroaki Takahashi MD, PhD ,&nbsp;Yutaka Okita MD, PhD","doi":"10.1016/j.xjon.2025.10.004","DOIUrl":"10.1016/j.xjon.2025.10.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Thoracic aortic infection (TAI), including infections of the native aorta, prosthetic graft infections, aortoesophageal fistula, and aortobronchial fistula, remains among the most challenging and fatal diseases. This study aimed to review our 25-year experience with surgical management of TAI.</div></div><div><h3>Methods</h3><div>This retrospective study included 106 participants with TAI from January 2000 to September 2024. The primary end point was hospital mortality. Secondary end points included 30-day mortality, trends in TAI management, overall survival, freedom from infection-related death, and freedom from infection-related events. Subgroup analyses were also conducted. The current surgical strategy has been in use since 2008.</div></div><div><h3>Results</h3><div>Among 106 participants, 33 (31.1%) had aortoesophageal fistula, 7 (6.6%) had aortobronchial fistula, and 66 (62.2%) had TAI without fistula. Eighty-four participants underwent surgery after 2008. In situ replacement was performed in 85 (80.1%), thoracic endovascular aortic repair in 15 (14.1%), and extra-anatomical bypass in 6 (6%). The 30-day mortality rate was 3.7% (n = 4), and hospital mortality was 16.0% (n = 17). At 10 years, overall survival was 55.4% ± 5.9%, freedom from infection-related death was 78.7% ± 4.3%, and freedom from infection-related events was 76.1% ± 4.4%. Participants who underwent surgery after 2008 had significantly better outcomes than those treated before 2008.</div></div><div><h3>Conclusions</h3><div>Despite the continued high hospital mortality associated with surgical treatment of TAI, the strategy implemented since 2008 has resulted in improved outcomes. The long-term outcomes were acceptable.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 1-12"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697921","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":"Bilateral internal thoracic artery grafting in isolated coronary artery bypass grafting: A 35-year experience","authors":"Youssef Shahin MD ,&nbsp;Tedy Sawma MD ,&nbsp;Yazan AlJamal MD ,&nbsp;Arman Arghami MD, MPH ,&nbsp;Phillip Rowse MD ,&nbsp;Hartzell Schaff MD ,&nbsp;Richard C. Daly MD ,&nbsp;Lorenzo Knop ,&nbsp;John Stulak MD","doi":"10.1016/j.xjon.2025.09.040","DOIUrl":"10.1016/j.xjon.2025.09.040","url":null,"abstract":"<div><h3>Objectives</h3><div>The study objectives were to analyze trends in bilateral internal thoracic artery grafting during isolated coronary artery bypass grafting over a 35-year interval and compare outcomes between bilateral internal thoracic artery and non–bilateral internal thoracic artery strategies.</div></div><div><h3>Methods</h3><div>A cohort of 15,991 patients underwent isolated multivessel coronary artery bypass grafting at our institution between 1990 and 2024. Trends in bilateral internal thoracic artery, radial artery, and left internal thoracic artery + saphenous vein graft were assessed using chi-square tests with Bonferroni correction. Changes in obesity and diabetes prevalence across intervals were also analyzed. Propensity score matching (1:1) yielded 2013 pairs for outcome comparisons between bilateral internal thoracic artery and non–bilateral internal thoracic artery groups.</div></div><div><h3>Results</h3><div>Between 1990 and 2024, use of bilateral internal thoracic artery and radial artery increased (11.0% and 13.2%, respectively), although bilateral internal thoracic artery declined during 2020 to 2024 as radial artery and left internal thoracic artery + saphenous vein graft use increased. This decline was unrelated to rising obesity or diabetes rates. Matched analysis revealed longer operative times for bilateral internal thoracic artery (+51 minutes, <em>P</em> &lt; .001), whereas cardiopulmonary bypass and crossclamp durations remained similar. Wound-healing complication rates did not increase with bilateral internal thoracic artery grafting. Kaplan–Meier analysis showed superior 30-year survival for bilateral internal thoracic artery compared with other grafting strategies.</div></div><div><h3>Conclusions</h3><div>Bilateral internal thoracic artery grafting remains underused, particularly in recent years, despite demonstrated survival benefits and comparable wound-healing risks. The decline is not explained by patient risk factors, highlighting the need for broader adoption of bilateral internal thoracic artery grafting and further randomized trials to optimize coronary artery bypass grafting strategies.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 191-204"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698080","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":"Impact of hepatic dysfunction on outcomes following adult cardiac surgery","authors":"Brian E. Woolley BS ,&nbsp;Nidhi Iyanna MPH ,&nbsp;Yeahwa Hong MD, PhD ,&nbsp;Umar Nasim BS ,&nbsp;Ander Dorken-Gallastegi MD ,&nbsp;Danny Chu MD ,&nbsp;Johannes O. Bonatti MD ,&nbsp;Derek R. Serna-Gallegos MD ,&nbsp;Ibrahim Sultan MD ,&nbsp;David J. Kaczorowski MD","doi":"10.1016/j.xjon.2025.09.024","DOIUrl":"10.1016/j.xjon.2025.09.024","url":null,"abstract":"<div><h3>Objective</h3><div>Laboratory abnormalities related to hepatic function are common after cardiac surgery and may reflect transient physiologic stress or early organ dysfunction. This study aimed to evaluate how postoperative liver-related laboratory abnormalities inform prognosis for 30-day mortality after adult cardiac surgery.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 16,236 adults undergoing coronary artery bypass grafting or left-sided valve surgery between 2010 and 2022 at a single institution. Receiver operating characteristic analysis was conducted to assess discriminatory performance of laboratory values for 30-day mortality. Peak postoperative aspartate aminotransferase, total bilirubin, and lactate were analyzed as markers of hepatic dysfunction. Patients were stratified by combinations of laboratory abnormalities and timing of peak elevation. Unadjusted logistic regression was used to generate probability plots illustrating the relationship between peak laboratory values and mortality. Multivariable logistic regression adjusted for postoperative complications.</div></div><div><h3>Results</h3><div>Aspartate aminotransferase and lactate (area under the curve = 0.85) demonstrated the highest discrimination for 30-day mortality. Aspartate aminotransferase remained independently associated with mortality after multivariable adjustment (odds ratio, 1.03 per 100 U/L, <em>P &lt;</em> .001). Isolated laboratory elevations were not associated with substantial mortality risk. However, patients with concurrent elevations in aspartate aminotransferase, total bilirubin, and lactate experienced significantly greater (25.5% vs 1.2%, <em>P &lt;</em> .001) 30-day mortality compared with those with no abnormalities. Mortality was significantly higher when laboratory abnormalities persisted more than 48 hours postoperatively.</div></div><div><h3>Conclusions</h3><div>Postoperative elevations in liver-related laboratory values—particularly when occurring in combination or peaking beyond 48 hours after surgery—identify patients at markedly increased risk of 30-day mortality. These markers provide valuable insight into physiologic stress and should be carefully managed after cardiac surgery.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 369-386"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698203","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":"Comment on single anesthesia robotic bronchoscopy","authors":"Frederic W. Grannis Jr MD ,&nbsp;Raja Flores MD","doi":"10.1016/j.xjon.2025.09.026","DOIUrl":"10.1016/j.xjon.2025.09.026","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 603-604"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697871","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":"The impact of Kommerell diverticulum resection on patient outcomes: A 21-year comparative analysis of surgical techniques for vascular rings","authors":"Julian C. Marsh BS ,&nbsp;Ashok Muralidaran MD ,&nbsp;Irving Shen MD ,&nbsp;John P. Iguidbashian MD ,&nbsp;Yoshio Ootaki MD, PhD","doi":"10.1016/j.xjon.2025.10.001","DOIUrl":"10.1016/j.xjon.2025.10.001","url":null,"abstract":"<div><h3>Objective</h3><div>Kommerell diverticulum is an embryologic remnant of the dorsal fourth aortic arch. It often presents as part of vascular rings with a right dominant arch. Historically, these have been treated by dividing the ligamentum arteriosum. In recent years, some centers have adopted Kommerell diverticulum resection with subclavian translocation as a primary approach. However, no long-term studies have directly compared outcomes with simple ligamentum division. To address this, we conducted a 21-year dual-institution review comparing short- and long-term outcomes across surgical strategies.</div></div><div><h3>Methods</h3><div>A retrospective review of 131 patients who underwent vascular ring repair at 2 institutions was performed. Of these, 93 underwent simple ligamentum division and 38 underwent Kommerell diverticulum resection with subclavian artery translocation. Anatomic subtypes, symptoms, perioperative outcomes, and follow-up data were compared.</div></div><div><h3>Results</h3><div>There were no significant differences in intraoperative or postoperative complication rates between groups. Short-term symptoms such as dyspnea (<em>P =</em> .56), cough (<em>P =</em> .72), and dysphagia (<em>P =</em> .55) were comparable. Rates of recurrent laryngeal nerve injury (<em>P =</em> .67), chylothorax (<em>P =</em> .18), infection (<em>P =</em> .62), hospital stay (<em>P =</em> .49), and 30-day readmission (<em>P =</em> .63) were also similar. Four patients in the simple division group required reoperation; none did in the Kommerell diverticulum group (<em>P =</em> .32). Symptom recurrence at long-term follow-up did not differ significantly (<em>P =</em> .30).</div></div><div><h3>Conclusions</h3><div>Kommerell diverticulum resection with arterial translocation is safe and effective, with favorable outcomes comparable to simple ligamentum division.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 428-433"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697789","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":"Safety, efficacy, and patient satisfaction after esophagectomy for esophageal neuromotor disease: A single-institution experience","authors":"Samantha L. Savitch MD,&nbsp;Jonathan E. Williams MD,&nbsp;Andrew C. Chang MD,&nbsp;Rishindra Reddy MD, MBA,&nbsp;Jules Lin MD,&nbsp;Mark B. Orringer MD,&nbsp;Kiran H. Lagisetty MD","doi":"10.1016/j.xjon.2025.10.007","DOIUrl":"10.1016/j.xjon.2025.10.007","url":null,"abstract":"<div><h3>Objective</h3><div>Esophagectomy remains the mainstay of treatment for patients with end-stage esophageal neuromotor diseases, yet there are limited data on outcomes after esophagectomy in this population. We sought to characterize the safety and efficacy of esophagectomy for esophageal neuromotor disease.</div></div><div><h3>Methods</h3><div>We retrospectively queried a prospectively collected database of all esophagectomies performed at our institution from 1975 to 2023 for patients without cancer diagnosed with end-stage esophageal neuromotor disease. Operative characteristics, perioperative and functional outcomes, and mortality were evaluated. Patients with and without a previous esophageal operation were compared using χ² for categorical variables and <em>t</em> test for continuous variables.</div></div><div><h3>Results</h3><div>We identified 237 patients for analysis. The majority were female (57.0%), White (82.7%), and nonsmokers (83.7%). Mean age was 52.4 years. In total, 185 (78.1%) patients had a diagnosis of achalasia, and 72.2% of patients underwent a previous esophageal operation. The majority of esophagectomies (91.6%) were transhiatal, and a gastric conduit was used in 228 patients (96.2%). Anastomotic leak rate was 9.7% (23/237). One-year mortality was 2.5% (6/237). There were no differences in outcomes between patients who had and had not had a previous esophageal operation. Postoperative functional symptoms were reported in 69.7% of patients at first follow-up, and 97 (40.9%) patients required postoperative dilation for symptom management. The majority of patients reported that they felt better (72%) and would undergo esophagectomy again (72%).</div></div><div><h3>Conclusions</h3><div>Esophagectomy for esophageal neuromotor disease is safe and feasible with a gastric conduit, regardless of prior esophageal operations. Despite persistent postoperative functional symptoms, patients have high satisfaction after the procedure.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 657-664"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697797","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":"Evaluating failure to rescue after esophagectomy: The esophagectomy failure to rescue assessment, trends, and Evaluation (E-FATE) study","authors":"Christina S. Boutros DO,&nbsp;Philip A. Linden MD,&nbsp;Omkar Pawar MS,&nbsp;Boxiang Jiang MD,&nbsp;Jillian Sinopoli DO,&nbsp;Leonidas Tapias MD,&nbsp;Christopher W. Towe MD","doi":"10.1016/j.xjon.2025.09.001","DOIUrl":"10.1016/j.xjon.2025.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>Failure to rescue, defined as death after a postoperative complication, is a key metric for evaluating hospital performance and surgical quality. We hypothesized that both patient characteristics and hospital performance are associated with failure to rescue risk after esophagectomy.</div></div><div><h3>Methods</h3><div>We analyzed esophagectomy cases from the Society of Thoracic Surgeons General Thoracic Surgery Database (2012-2023), excluding emergency surgeries and colonic interpositions. The primary outcome was failure to rescue, defined as death within 30 days or during the index hospitalization after a complication. Hospitals were grouped into quintiles based on their risk-adjusted standardized mortality ratio using hierarchical logistic regression. We compared failure to rescue rates between hospitals in the top (very low standardized mortality ratio) and bottom (very high standardized mortality ratio) quintiles using generalized estimating equations to account for clustering. Failure to rescue rates were further stratified across patient risk categories using established Society of Thoracic Surgeons risk metrics.</div></div><div><h3>Results</h3><div>A total of 28,626 patients from 318 hospitals were included. Top-tier hospitals performed more procedures than bottom-tier hospitals (10,431 vs 3527, <em>P</em> &lt; .001) and had significantly lower unadjusted mortality (1.2% vs 6.6%, <em>P</em> &lt; .001). Adjusted odds of failure to rescue were 4.4 times higher in bottom-tier hospitals (95% CI, 3.6-5.3), with similar trends after major complications (odds ratio, 3.83) and esophagectomy-specific complications (odds ratio, 7.27). Across all patient risk strata, bottom-tier hospitals had higher failure to rescue rates; high-risk patients had an odds ratio of 5.94 (95% CI, 3.6-9.6).</div></div><div><h3>Conclusions</h3><div>Hospital performance is strongly associated with failure to rescue after esophagectomy, even after adjusting for patient risk. System-level interventions are needed to reduce variation in rescue capacity.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 606-614"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697873","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":"Extracorporeal cardiopulmonary resuscitation in Medicare recipients","authors":"Jeremiah W. Awori Hayanga MD, MPH,&nbsp;Hakam Rajjoub BSc,&nbsp;J. Hunter Mehaffey MD,&nbsp;Vinay Badhwar MD","doi":"10.1016/j.xjon.2025.09.029","DOIUrl":"10.1016/j.xjon.2025.09.029","url":null,"abstract":"<div><h3>Objective</h3><div>The use of extracorporeal cardiopulmonary resuscitation (ECPR) in older patients is a controversial practice. The historically high mortality associated with elderly patients who require extracorporeal support frequently dampens the enthusiasm for expending limited, cost-intensive resources on patients of advanced age. We evaluated outcomes in Medicare patients who had suffered sudden acute cardiac arrest and received extracorporeal support.</div></div><div><h3>Methods</h3><div>We used the United States Medicare Inpatient Analytical Files (2018-2023) to evaluate beneficiaries with cardiac arrest who were placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO). International Classification of Diseases, Tenth Revision codes were used to define comorbidities and frailty using validated metrics.</div></div><div><h3>Results</h3><div>Of the 5810 Medicare beneficiaries who were placed on VA-ECMO, 1174 experienced cardiac arrest during the same admission and were categorized as the “ECPR cohort.” Their mean Charlson Comorbidity Index score was 2.66 ± 1.36. Approximately one-third had a history of diabetes, liver disease, and chronic renal failure; 52.9% had coronary artery disease, and 65.4% had heart failure. Mortality during hospitalization was 63.8%. Age-stratified 5-year mortality was 69.8% in patients age &lt;70, 78.0% in those age 71% to 80%, and 86.8% in those age &gt;80 years. Conditional on surviving to discharge, mortality was ∼10% at both 1 year and 5 years.</div></div><div><h3>Conclusions</h3><div>The use of ECPR in Medicare recipients is characterized by high mortality, which further increases with age. This real-world report may help guide the complex clinical decision making in the resuscitation of elderly patients who suffer cardiac arrest.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 296-303"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698153","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":"Association of mild-to-moderate Model for End-Stage Liver Disease scores on short-term cardiac surgery postoperative outcomes","authors":"Tom Liu MD, MS ,&nbsp;Zhanlin Chen BS, MS ,&nbsp;Ryan C. Jacobs MD, MS ,&nbsp;Charles D. Logan MD, MS ,&nbsp;Beth Whippo MSN, RN ,&nbsp;Seokyung An PhD ,&nbsp;Patrick M. McCarthy MD ,&nbsp;Christopher K. Mehta MD","doi":"10.1016/j.xjon.2025.09.034","DOIUrl":"10.1016/j.xjon.2025.09.034","url":null,"abstract":"<div><h3>Objective</h3><div>We assessed the Model for End-Stage Liver Disease score in patients with mild-moderate scores to predict perioperative outcomes in patients undergoing cardiac surgery.</div></div><div><h3>Methods</h3><div>The American College Surgeons National Surgical Quality Improvement Program was used to identify patients (2013-2022) undergoing elective isolated coronary artery bypass grafting, aortic valve surgery, or mitral valve surgery. Patients were stratified by low (&lt;9), moderate (9-15), and high (&gt;15) Model for End-Stage Liver Disease scores. Multivariable logistic regression and observed-to-expected ratios were used to assess Model for End-Stage Liver Disease group association and 30-day outcomes.</div></div><div><h3>Results</h3><div>Of 25,845 patients, 17,743 underwent coronary artery bypass grafting, 5095 underwent aortic valve surgery, and 3007 underwent mitral valve surgery. Increasing Model for End-Stage Liver Disease score (low: n = 18,379; moderate: n = 5922; high: n = 1444) was associated with an increase in mortality for each Model for End-Stage Liver Disease point. The 30-day mortality (low [1.7%], moderate [3.8%], high [8.7%]) and major morbidity (low [25.1%], moderate [33.3%], high [45.7%]) increased with Model for End-Stage Liver Disease severity. Increasing Model for End-Stage Liver Disease category was an independent predictor of 30-day mortality (odds ratio, 1.76; 95% CI, 1.57-1.98) and morbidity (odds ratio, 1.07; 95% CI, 1.02-1.12). The 30-day mortality observed-to-expected ratio was lower in patients with low Model for End-Stage Liver Disease score (observed-to-expected ratio, 0.88; 95% CI, 0.79-0.97) and higher in patients with high Model for End-Stage Liver Disease score (observed-to-expected ratio, 1.15 95% CI, 1.01-1.29). Major morbidity was greater than predicted in all Model for End-Stage Liver Disease categories (all <em>P &lt;</em> .05), driven by increased rates of respiratory complications, renal failure, thromboembolism, and sepsis.</div></div><div><h3>Conclusions</h3><div>Patients with moderate and low Model for End-Stage Liver Disease scores have adequate outcomes with respect to 30-day mortality. However, surgical risk for patients with high Model for End-Stage Liver Disease scores was underpredicted by traditional risk stratification. Patients with mild to moderate liver disease can undergo cardiac surgery with acceptable surgical mortality.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 349-357"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698201","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":"Outcomes after cardiac surgery in patients with epilepsy: A nationwide analysis","authors":"Alexander P. Cabulong MPH ,&nbsp;Guangjin Zhou PhD ,&nbsp;Jean-Luc A. Maigrot MD ,&nbsp;Edward G. Soltesz MD, MPH ,&nbsp;Nicholas Schiltz PhD ,&nbsp;Siran M. Koroukian PhD","doi":"10.1016/j.xjon.2025.09.032","DOIUrl":"10.1016/j.xjon.2025.09.032","url":null,"abstract":"<div><h3>Objective</h3><div>To assess outcomes after cardiac surgery in patients with epilepsy.</div></div><div><h3>Methods</h3><div>We queried the 2016-2019 Nationwide Readmissions Database for adult patients undergoing coronary artery bypass grafting, valve and aortic surgeries, or combination procedures. We compared mortality at index admission, complications, and 90-day readmissions between groups of patients with and without epilepsy before and after propensity-score matching. We used logistic regression analysis to evaluate the risk of adverse postoperative outcomes in the epilepsy group compared with their counterparts without epilepsy.</div></div><div><h3>Results</h3><div>There were 1,104,303 patients identified who underwent cardiac surgery; of those, 15,492 (1.4%) had epilepsy. Patients with epilepsy more often had additional comorbidities, including congestive heart failure, chronic lung disease, and renal failure. Even after propensity-score matching, mortality at index admission (5.2% vs 3.6%), overall complications (44.2% vs 31.4%), and 90-day readmissions (27.3% vs 21.3%) were greater among patients with epilepsy than those without (<em>P</em> &lt; .001 for all comparisons). Patients with epilepsy more frequently experienced specific complications, including stroke, pneumonia and respiratory complications, and infection/sepsis during index admissions. In the adjusted matched analysis, epilepsy was associated with a greater risk of mortality at index admission (adjusted odds ratio [aOR], 1.34; 95% confidence interval, 1.20-1.50), overall complications (aOR, 1.35; 1.28-1.42), and 90-day readmission (aOR, 1.37; 1.29-1.45).</div></div><div><h3>Conclusions</h3><div>Further studies are necessary to identify strategies to improve outcomes after cardiac surgery in patients with epilepsy, as they have greater associated risks of postoperative mortality, complications, and readmission.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 358-368"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698202","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}