Previous studies reported worse outcomes for radiographically central tumors, but the impact of pathologically confirmed tumor origin remains unclear. This study investigated whether pathologically determined inner lesions are associated with nodal upstaging and poorer prognosis than outer lesions, and examined segmentectomy feasibility versus lobectomy.
Methods
We retrospectively analyzed participants with clinical stage IA (Union for International Cancer Control version 8) non−small cell lung cancer who underwent segmentectomy and lobectomy between November 2007 and December 2022 at 2 Japanese centers. The location of the tumor origin was confirmed pathologically via the Walter classification. Tumors classified as central and intermediate were allocated to the inner group, whereas those classified as peripheral type were allocated to the outer group. The oncologic outcomes were compared between the 2 groups. After propensity score matching analysis on the basis of sex, age, pulmonary function, serum carcinoembryonic antigen level, and radiographic findings, we compared oncologic outcomes in patients who underwent segmentectomy (n = 99) and lobectomy (n = 99) in the inner group.
Results
The cohort comprised inner (n = 654) and outer (n = 1275) groups. Nodal upstaging was greater in the inner group (13.1% [86/654] vs 9.5% [121/1275], P = .015). Five-year recurrence-free survival (RFS) was lower in the inner group (73.1%; 95% CI, 69.4%-77.3% vs 79.4%; 95% CI, 76.7%-81.8%, P = .002). Multivariable analysis did not identify segmentectomy as significant for RFS (hazard ratio, 0.81; 95% CI, 0.58-1.13; P = .20). In matched inner lesions, segmentectomy and lobectomy showed similar RFS (83.6%; 95% CI, 76.3-93.1% vs 76.4%; 95% CI, 66.8-87.4%; P = .80).
Conclusions
Although worse prognosis and increased nodal upstaging should be considered in inner primary tumors, segmentectomy is an acceptable treatment option compared with lobectomy for pathologically confirmed inner-located early-stage NSCLC.
先前的研究报道了影像学上的中枢性肿瘤的预后较差，但病理证实的肿瘤起源的影响尚不清楚。本研究调查了病理确定的内部病变是否与淋巴结分期和预后较差的外部病变相关，并检查了节段切除术与肺叶切除术的可行性。方法回顾性分析2007年11月至2022年12月在日本2个中心接受节段切除术和肺叶切除术的临床期IA（国际癌症控制联盟版本8）非小细胞肺癌患者。肿瘤起源的位置经Walter分类病理证实。中心型和中间型的肿瘤归内组，外周型的归外组。比较两组患者的肿瘤预后。在基于性别、年龄、肺功能、血清癌胚抗原水平和影像学表现的倾向评分匹配分析后，我们比较了内组中接受节段切除术（n = 99）和肺叶切除术（n = 99）的患者的肿瘤预后。结果该队列分为内组（n = 654）和外组（n = 1275）。内组淋巴结占优率更高（13.1% [86/654]vs 9.5% [121/1275], P = 0.015）。内组5年无复发生存率（RFS）较低（73.1%;95% CI, 69.4%-77.3% vs 79.4%; 95% CI, 76.7%-81.8%, P = 0.002）。多变量分析未发现节段切除术对RFS有显著影响（风险比，0.81;95% CI, 0.58-1.13; P = 0.20）。在匹配的内病变中，节段切除术和肺叶切除术的RFS相似（83.6%;95% CI, 76.3-93.1% vs 76.4%; 95% CI, 66.8-87.4%; P = 0.80）。结论虽然内部原发肿瘤的预后较差，淋巴结分期增高，但对于病理证实的内部早期非小细胞肺癌，与肺叶切除术相比，节段切除术是一种可接受的治疗选择。
{"title":"Impact of pathologically confirmed inner lung tumors on nodal upstaging and feasibility of segmentectomy versus lobectomy","authors":"Shinya Tane MD, PhD , Nahoko Shimizu MD, PhD , Naoe Jimbo MD, PhD , Midori Takanashi MD , Takefumi Doi MD, PhD , Hiroyuki Ogawa MD, PhD , Daisuke Hokka MD, PhD , Yoshitaka Kitamura MD , Yuki Shimomura PhD , Wataru Nishio MD, PhD , Yoshimasa Maniwa MD, PhD","doi":"10.1016/j.xjon.2025.101575","DOIUrl":"10.1016/j.xjon.2025.101575","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous studies reported worse outcomes for radiographically central tumors, but the impact of pathologically confirmed tumor origin remains unclear. This study investigated whether pathologically determined inner lesions are associated with nodal upstaging and poorer prognosis than outer lesions, and examined segmentectomy feasibility versus lobectomy.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed participants with clinical stage IA (Union for International Cancer Control version 8) non−small cell lung cancer who underwent segmentectomy and lobectomy between November 2007 and December 2022 at 2 Japanese centers. The location of the tumor origin was confirmed pathologically via the Walter classification. Tumors classified as central and intermediate were allocated to the inner group, whereas those classified as peripheral type were allocated to the outer group. The oncologic outcomes were compared between the 2 groups. After propensity score matching analysis on the basis of sex, age, pulmonary function, serum carcinoembryonic antigen level, and radiographic findings, we compared oncologic outcomes in patients who underwent segmentectomy (n = 99) and lobectomy (n = 99) in the inner group.</div></div><div><h3>Results</h3><div>The cohort comprised inner (n = 654) and outer (n = 1275) groups. Nodal upstaging was greater in the inner group (13.1% [86/654] vs 9.5% [121/1275], <em>P</em> = .015). Five-year recurrence-free survival (RFS) was lower in the inner group (73.1%; 95% CI, 69.4%-77.3% vs 79.4%; 95% CI, 76.7%-81.8%, <em>P</em> = .002). Multivariable analysis did not identify segmentectomy as significant for RFS (hazard ratio, 0.81; 95% CI, 0.58-1.13; <em>P</em> = .20). In matched inner lesions, segmentectomy and lobectomy showed similar RFS (83.6%; 95% CI, 76.3-93.1% vs 76.4%; 95% CI, 66.8-87.4%; <em>P</em> = .80).</div></div><div><h3>Conclusions</h3><div>Although worse prognosis and increased nodal upstaging should be considered in inner primary tumors, segmentectomy is an acceptable treatment option compared with lobectomy for pathologically confirmed inner-located early-stage NSCLC.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101575"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-28DOI: 10.1016/j.xjon.2025.11.021
Marcel Lucas Chee MD , Allen Gu MD , Roshan Karri MD, MPhil , Luke Perry MBBS(Hons), BSc , Julian A. Smith MBMS, MSurgEd, FRACS , Jahan Penny-Dimri MBBS, PhD
Objective
Prolonged mechanical ventilation after cardiac surgery contributes significantly to morbidity, mortality, and excessive hospital resource use. Accurate prediction of prolonged mechanical ventilation duration can improve decision-making and patient outcomes. We aimed to develop and validate time-to-event models to predict the duration of ventilation and prolonged mechanical ventilation.
Methods
From the Medical Information Mart for Intensive Care III and IV databases, we extracted postoperative data from all cardiac surgery patients. We benchmarked 3 machine learning time-to-event algorithms (random survival forest, gradient boosted survival model, and survival support vector machine) against traditional Elastic-Net Cox regression. We evaluated model performance using weighted mean area under the curve (), cumulative/dynamic area under the receiver operating characteristic curve (AUCC,D(t)), Concordance Index, and integrated Brier score. Permutation feature importance was reported for the best models. We conducted a sensitivity analysis to evaluate model fairness across different races and sexes.
Results
Models were trained on data from 10,430 cardiac surgery patients ventilated for a median of 7.0 hours (interquartile range, 4.4-16.0). Random survival forest had the highest (0.834, 95% CI, 0.832-0.836) and integrated Brier score (0.041), whereas gradient boosted survival model had the highest Concordance Index (0.721, 95% CI, 0.717-0.724). All machine learning models significantly outperformed Elastic-Net Cox Regression. Ventilatory settings, laboratory results, and Sequential Organ Failure Assessment score within 4 hours of intubation were identified as the most important features. Sensitivity analysis showed equal or improved performance for minority female and non-White cohorts.
Conclusions
Machine learning time-to-event models for prolonged mechanical ventilation and the duration of ventilation, particularly random survival forest and gradient boosted survival model, have significantly improved performance compared with current state-of-the-art tools and may be valuable decision supports in the postoperative management of cardiac surgery patients.
{"title":"Machine learning time-to-event algorithms for predicting the duration of ventilation after cardiac surgery","authors":"Marcel Lucas Chee MD , Allen Gu MD , Roshan Karri MD, MPhil , Luke Perry MBBS(Hons), BSc , Julian A. Smith MBMS, MSurgEd, FRACS , Jahan Penny-Dimri MBBS, PhD","doi":"10.1016/j.xjon.2025.11.021","DOIUrl":"10.1016/j.xjon.2025.11.021","url":null,"abstract":"<div><h3>Objective</h3><div>Prolonged mechanical ventilation after cardiac surgery contributes significantly to morbidity, mortality, and excessive hospital resource use. Accurate prediction of prolonged mechanical ventilation duration can improve decision-making and patient outcomes. We aimed to develop and validate time-to-event models to predict the duration of ventilation and prolonged mechanical ventilation.</div></div><div><h3>Methods</h3><div>From the Medical Information Mart for Intensive Care III and IV databases, we extracted postoperative data from all cardiac surgery patients. We benchmarked 3 machine learning time-to-event algorithms (random survival forest, gradient boosted survival model, and survival support vector machine) against traditional Elastic-Net Cox regression. We evaluated model performance using weighted mean area under the curve (<span><math><mrow><msubsup><mover><mrow><mi>A</mi><mi>U</mi><mi>C</mi></mrow><mo>¯</mo></mover><mi>w</mi><mrow><mi>C</mi><mo>,</mo><mi>D</mi></mrow></msubsup></mrow></math></span>), cumulative/dynamic area under the receiver operating characteristic curve (AUC<sup>C,D</sup>(<em>t</em>)), Concordance Index, and integrated Brier score. Permutation feature importance was reported for the best models. We conducted a sensitivity analysis to evaluate model fairness across different races and sexes.</div></div><div><h3>Results</h3><div>Models were trained on data from 10,430 cardiac surgery patients ventilated for a median of 7.0 hours (interquartile range, 4.4-16.0). Random survival forest had the highest <span><math><mrow><msubsup><mover><mrow><mi>A</mi><mi>U</mi><mi>C</mi></mrow><mo>¯</mo></mover><mi>w</mi><mrow><mi>C</mi><mo>,</mo><mi>D</mi></mrow></msubsup></mrow></math></span> (0.834, 95% CI, 0.832-0.836) and integrated Brier score (0.041), whereas gradient boosted survival model had the highest Concordance Index (0.721, 95% CI, 0.717-0.724). All machine learning models significantly outperformed Elastic-Net Cox Regression. Ventilatory settings, laboratory results, and Sequential Organ Failure Assessment score within 4 hours of intubation were identified as the most important features. Sensitivity analysis showed equal or improved performance for minority female and non-White cohorts.</div></div><div><h3>Conclusions</h3><div>Machine learning time-to-event models for prolonged mechanical ventilation and the duration of ventilation, particularly random survival forest and gradient boosted survival model, have significantly improved performance compared with current state-of-the-art tools and may be valuable decision supports in the postoperative management of cardiac surgery patients.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101537"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-08DOI: 10.1016/j.xjon.2025.101554
Mark Petrovic MS , Awab Ahmad MD , Chen Chia Wang BSc , Aaron M. Williams MD , John Trahanas MD , Swaroop Bommareddi MD , Tarek Absi MD , Eric Quintana MD , Kevin McGann MD , Stephen DeVries DMSc, PA-C , Joshua Lowman PA-C , Aniket S. Rali MD , Hasan Siddiqi MD , Kaushik Amancherla MD, PhD , Stacy Tsai MD , Marshall Brinkley MD , Jonathan N. Menachem MD , Dawn Pedrotty MD, PhD , Lynn Punnoose MD , JoAnn Lindenfeld MD , Brian Lima MD, MBA
Background
Goal-directed perfusion (GDP) during cardiopulmonary bypass (CPB) commonly targets indexed oxygen delivery (DO2i), yet fixed delivery thresholds may ignore patient-specific metabolic demand. The oxygen extraction ratio (O2ER) integrates delivery and consumption and may better reflect supply–demand balance during heart transplantation. We evaluated whether intra-CPB O2ER burden is associated with adverse outcomes after adult heart transplantation and whether O2ER provides incremental prognostic value beyond DO2i.
Methods
We retrospectively analyzed adult heart transplantations performed at a single center between November 2021 and June 2025. Minute-level CPB data were extracted. O2ER was the primary exposure, and the primary outcome was a composite morbidity–mortality (M-M) endpoint (severe primary graft dysfunction [PGD], ventilation for >72 hours, intensive care unit length of stay >15 days, renal replacement therapy, or 90-day mortality). Generalized propensity score–weighted logistic regression modeled associations adjusting for prespecified donor/recipient/procedural covariates. Comparative models assessed O2ER versus DO2i. A post hoc analysis quantified pre- and post-reperfusion O2ER area under the receiver operating characteristic curve (AUC) to localize phase-specific risk.
Results
Among 381 heart transplant recipients, 40 (10.5%) experienced M-M. O2ER trajectories separated between the M-M and non–M-M groups during the mid-procedure window (∼35-100 minutes). Each additional 10 minutes at O2ER > 0.20 was associated with higher odds of M-M (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.00-1.15; P = .043) and 90-day mortality (OR, 1.13; 95% CI, 1.02-1.26; adjusted P = .02). Adding time at O2ER > 0.20 improved a DO2i < 280-only model (P = .04), whereas adding DO2i below-time to an O2ER-only model did not (P = .30). Phase-specific analysis showed that post-reperfusion O2ER AUC was independently associated with M-M (OR, 1.23; 95% CI, 1.08-1.40; P = .002) and severe PGD (OR, 1.22; 95% CI, 1.04-1.43; P = .01), while pre-reperfusion O2ER AUC was related to 90-day mortality (OR, 1.05; 95% CI, 1.004-1.10; P = .03).
Conclusions
During heart transplantation, a higher O2ER burden on CPB is linearly associated with increased post-transplant morbidity and early mortality and contributes prognostic information beyond DO2i. These data support an O2ER-guided GDP strategy that minimizes time (or AUC) above O2ER thresholds, with heightened vigilance regarding reperfusion. Prospective validation is warranted.
{"title":"Elevated oxygen extraction during heart transplantation is associated with increased morbidity and mortality: Implications for goal-directed perfusion","authors":"Mark Petrovic MS , Awab Ahmad MD , Chen Chia Wang BSc , Aaron M. Williams MD , John Trahanas MD , Swaroop Bommareddi MD , Tarek Absi MD , Eric Quintana MD , Kevin McGann MD , Stephen DeVries DMSc, PA-C , Joshua Lowman PA-C , Aniket S. Rali MD , Hasan Siddiqi MD , Kaushik Amancherla MD, PhD , Stacy Tsai MD , Marshall Brinkley MD , Jonathan N. Menachem MD , Dawn Pedrotty MD, PhD , Lynn Punnoose MD , JoAnn Lindenfeld MD , Brian Lima MD, MBA","doi":"10.1016/j.xjon.2025.101554","DOIUrl":"10.1016/j.xjon.2025.101554","url":null,"abstract":"<div><h3>Background</h3><div>Goal-directed perfusion (GDP) during cardiopulmonary bypass (CPB) commonly targets indexed oxygen delivery (DO<sub>2</sub>i), yet fixed delivery thresholds may ignore patient-specific metabolic demand. The oxygen extraction ratio (O<sub>2</sub>ER) integrates delivery and consumption and may better reflect supply–demand balance during heart transplantation. We evaluated whether intra-CPB O<sub>2</sub>ER burden is associated with adverse outcomes after adult heart transplantation and whether O<sub>2</sub>ER provides incremental prognostic value beyond DO<sub>2</sub>i.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed adult heart transplantations performed at a single center between November 2021 and June 2025. Minute-level CPB data were extracted. O<sub>2</sub>ER was the primary exposure, and the primary outcome was a composite morbidity–mortality (M-M) endpoint (severe primary graft dysfunction [PGD], ventilation for >72 hours, intensive care unit length of stay >15 days, renal replacement therapy, or 90-day mortality). Generalized propensity score–weighted logistic regression modeled associations adjusting for prespecified donor/recipient/procedural covariates. Comparative models assessed O<sub>2</sub>ER versus DO<sub>2</sub>i. A post hoc analysis quantified pre- and post-reperfusion O<sub>2</sub>ER area under the receiver operating characteristic curve (AUC) to localize phase-specific risk.</div></div><div><h3>Results</h3><div>Among 381 heart transplant recipients, 40 (10.5%) experienced M-M. O<sub>2</sub>ER trajectories separated between the M-M and non–M-M groups during the mid-procedure window (∼35-100 minutes). Each additional 10 minutes at O<sub>2</sub>ER > 0.20 was associated with higher odds of M-M (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.00-1.15; <em>P</em> = .043) and 90-day mortality (OR, 1.13; 95% CI, 1.02-1.26; adjusted <em>P</em> = .02). Adding time at O<sub>2</sub>ER > 0.20 improved a DO<sub>2</sub>i < 280-only model (<em>P</em> = .04), whereas adding DO<sub>2</sub>i below-time to an O<sub>2</sub>ER-only model did not (<em>P</em> = .30). Phase-specific analysis showed that post-reperfusion O<sub>2</sub>ER AUC was independently associated with M-M (OR, 1.23; 95% CI, 1.08-1.40; <em>P</em> = .002) and severe PGD (OR, 1.22; 95% CI, 1.04-1.43; <em>P</em> = .01), while pre-reperfusion O<sub>2</sub>ER AUC was related to 90-day mortality (OR, 1.05; 95% CI, 1.004-1.10; <em>P</em> = .03).</div></div><div><h3>Conclusions</h3><div>During heart transplantation, a higher O<sub>2</sub>ER burden on CPB is linearly associated with increased post-transplant morbidity and early mortality and contributes prognostic information beyond DO<sub>2</sub>i. These data support an O<sub>2</sub>ER-guided GDP strategy that minimizes time (or AUC) above O<sub>2</sub>ER thresholds, with heightened vigilance regarding reperfusion. Prospective validation is warranted.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101554"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-19DOI: 10.1016/j.xjon.2025.101566
Aditya Sengupta MD, MPH, Robin Varghese MD, MS, Parth Patel MD, Paul Stelzer MD
Objective
We sought to investigate the midterm outcomes of combined aortic and mitral valve replacement with aortomitral curtain patch reconstruction (the Commando operation).
Methods
A single-center, retrospective review of all patients who underwent the Commando operation from January 2007 to July 2024 was performed. Outcomes included operative death or major postoperative morbidity, postdischarge (late) death, and late reintervention. Explanatory variables included primary indication for the Commando approach and patch material, among others. Associations were evaluated using logistic, Cox, or competing risk regression, adjusting for baseline patient risk and operative complexity.
Results
Of 71 patients meeting entry criteria, 41 (57.8%) received glutaraldehyde-preserved bovine pericardium (GPBP) or autologous pericardium (AP); the remainder received decellularized bovine pericardium (DBP). There were 4 (5.6%) operative deaths and 15 (21.1%) cases of operative death or major postoperative morbidity. Of the 67 operative survivors, there were 18 (26.9%) deaths and 14 (20.9%) reinterventions at a median follow-up of 2.2 years (range, 0.1-12.7 years). Patch material was not associated with late death. On multivariable analysis, DBP conferred an increased risk of reintervention (subdistribution hazard ratio, 9.5; 95% confidence interval, 1.2-75.8, P = .03) versus GPBP/AP. Of the 14 reinterventions, 12 (85.7%) were performed for aorto-left atrial fistula (aortomitral curtain re-repair in 3 [25.0%] patients, redo-Commando operation in 4 [33.3%] patients, and transcatheter fistula occlusion in 5 [41.7%] patients). Use of DBP was independently associated with a greater risk of reintervention for aorto-left atrial fistula (subdistribution hazard ratio, 11.8; 95% confidence interval, 1.6-87.7, P = .02), compared to use of GPBP/AP.
Conclusions
Patch material influences reintervention risk following the Commando operation.
{"title":"Type of patch material affects midterm outcomes of combined aortic and mitral valve replacement and aortomitral curtain reconstruction","authors":"Aditya Sengupta MD, MPH, Robin Varghese MD, MS, Parth Patel MD, Paul Stelzer MD","doi":"10.1016/j.xjon.2025.101566","DOIUrl":"10.1016/j.xjon.2025.101566","url":null,"abstract":"<div><h3>Objective</h3><div>We sought to investigate the midterm outcomes of combined aortic and mitral valve replacement with aortomitral curtain patch reconstruction (the Commando operation).</div></div><div><h3>Methods</h3><div>A single-center, retrospective review of all patients who underwent the Commando operation from January 2007 to July 2024 was performed. Outcomes included operative death or major postoperative morbidity, postdischarge (late) death, and late reintervention. Explanatory variables included primary indication for the Commando approach and patch material, among others. Associations were evaluated using logistic, Cox, or competing risk regression, adjusting for baseline patient risk and operative complexity.</div></div><div><h3>Results</h3><div>Of 71 patients meeting entry criteria, 41 (57.8%) received glutaraldehyde-preserved bovine pericardium (GPBP) or autologous pericardium (AP); the remainder received decellularized bovine pericardium (DBP). There were 4 (5.6%) operative deaths and 15 (21.1%) cases of operative death or major postoperative morbidity. Of the 67 operative survivors, there were 18 (26.9%) deaths and 14 (20.9%) reinterventions at a median follow-up of 2.2 years (range, 0.1-12.7 years). Patch material was not associated with late death. On multivariable analysis, DBP conferred an increased risk of reintervention (subdistribution hazard ratio, 9.5; 95% confidence interval, 1.2-75.8, <em>P</em> = .03) versus GPBP/AP. Of the 14 reinterventions, 12 (85.7%) were performed for aorto-left atrial fistula (aortomitral curtain re-repair in 3 [25.0%] patients, redo-Commando operation in 4 [33.3%] patients, and transcatheter fistula occlusion in 5 [41.7%] patients). Use of DBP was independently associated with a greater risk of reintervention for aorto-left atrial fistula (subdistribution hazard ratio, 11.8; 95% confidence interval, 1.6-87.7, <em>P</em> = .02), compared to use of GPBP/AP.</div></div><div><h3>Conclusions</h3><div>Patch material influences reintervention risk following the Commando operation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101566"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-04DOI: 10.1016/j.xjon.2025.101545
Yun Zhu Bai MD , Charles R. Liu MD , Yan Yan MD, PhD , Anjana Delhi MBBS, MPH , Su-Hsin Chang PhD, SM , Chad A. Witt MD , Rodrigo Vazquez Guillamet MD , Derek E. Byers MD, PhD , Gary F. Marklin MD , Matthew G. Hartwig MD , Whitney S. Brandt MD , Ruben G. Nava MD , Bryan F. Meyers MD, MPH , Benjamin D. Kozower MD, MPH , G. Alexander Patterson MD , Daniel Kreisel MD, PhD , Varun Puri MD, MSCI
Objective
Organ transplantation is associated with significant physiologic, metabolic, and medication-related changes that impact recipient weight. This study investigates the association of post-transplant body mass index trajectory with survival in lung transplant recipients.
Methods
This is a retrospective study of all adult lung transplants performed in the United States between 2005 and 2013. Recipients were stratified by body mass index change at 1 year post-transplant relative to pretransplant into quartiles: decreased: <–1.16, stable: -1.16-0.98, and increased: >0.98 kg/m2. All-cause mortality was analyzed with Kaplan–Meier and Cox proportional hazards models adjusted for relevant donor and recipient variables. Subgroup analysis was performed in patients with body mass index with and without pretransplant obesity (body mass index ≥30 kg/m2).
Results
Among 9709 lung recipients, median body mass index at 1 year post-transplant was 25.5 kg/m2, and median 1-year body mass index change was +0.98 kg/m2. Survival was highest in the increased body mass index group, followed by stable then decreased groups (P < .001). On multivariable analysis, decreased body mass index was associated with increased risk of all-cause mortality (adjusted hazard ratio, 1.19, 95% CI, 1.11-1.27), whereas increased body mass index was associated with decreased risk of all-cause mortality (adjusted hazard ratio, 0.84, 95% CI, 0.79-0.89) compared with the stable group. Among those with pretransplant obesity, both increased and decreased groups had similar adjusted risk of mortality as the stable group.
Conclusions
Weight gain in the first year after lung transplantation is associated with a survival benefit, except in patients with pretransplant obesity, whereas weight loss is associated with long-term recipient mortality. Close attention should be directed toward weight trajectory in the postoperative period.
{"title":"Early post–lung transplant weight gain is associated with increased long-term recipient survival","authors":"Yun Zhu Bai MD , Charles R. Liu MD , Yan Yan MD, PhD , Anjana Delhi MBBS, MPH , Su-Hsin Chang PhD, SM , Chad A. Witt MD , Rodrigo Vazquez Guillamet MD , Derek E. Byers MD, PhD , Gary F. Marklin MD , Matthew G. Hartwig MD , Whitney S. Brandt MD , Ruben G. Nava MD , Bryan F. Meyers MD, MPH , Benjamin D. Kozower MD, MPH , G. Alexander Patterson MD , Daniel Kreisel MD, PhD , Varun Puri MD, MSCI","doi":"10.1016/j.xjon.2025.101545","DOIUrl":"10.1016/j.xjon.2025.101545","url":null,"abstract":"<div><h3>Objective</h3><div>Organ transplantation is associated with significant physiologic, metabolic, and medication-related changes that impact recipient weight. This study investigates the association of post-transplant body mass index trajectory with survival in lung transplant recipients.</div></div><div><h3>Methods</h3><div>This is a retrospective study of all adult lung transplants performed in the United States between 2005 and 2013. Recipients were stratified by body mass index change at 1 year post-transplant relative to pretransplant into quartiles: decreased: <–1.16, stable: -1.16-0.98, and increased: >0.98 kg/m<sup>2</sup>. All-cause mortality was analyzed with Kaplan–Meier and Cox proportional hazards models adjusted for relevant donor and recipient variables. Subgroup analysis was performed in patients with body mass index with and without pretransplant obesity (body mass index ≥30 kg/m<sup>2</sup>).</div></div><div><h3>Results</h3><div>Among 9709 lung recipients, median body mass index at 1 year post-transplant was 25.5 kg/m<sup>2</sup>, and median 1-year body mass index change was +0.98 kg/m<sup>2</sup>. Survival was highest in the increased body mass index group, followed by stable then decreased groups (<em>P <</em> .001). On multivariable analysis, decreased body mass index was associated with increased risk of all-cause mortality (adjusted hazard ratio, 1.19, 95% CI, 1.11-1.27), whereas increased body mass index was associated with decreased risk of all-cause mortality (adjusted hazard ratio, 0.84, 95% CI, 0.79-0.89) compared with the stable group. Among those with pretransplant obesity, both increased and decreased groups had similar adjusted risk of mortality as the stable group.</div></div><div><h3>Conclusions</h3><div>Weight gain in the first year after lung transplantation is associated with a survival benefit, except in patients with pretransplant obesity, whereas weight loss is associated with long-term recipient mortality. Close attention should be directed toward weight trajectory in the postoperative period.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101545"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-24DOI: 10.1016/j.xjon.2025.11.018
Addison Gearhart MD , Gianna Dafflisio BS , Yuanyuan Fu MA , Stuart Lipsitz ScD , Sitaram Emani MD , Tajinder P. Singh MD, MSc
Objective
Management of immunosuppression after human valve transplant remains unclear and may be aided by understanding valve function during rejection and with chronic graft failure after heart transplant. We assessed valve function during biopsy-diagnosed rejection and before death/retransplantation in pediatric heart transplant recipients.
Methods
This was a single-center, retrospective study. Patients in cohort 1 had 2 serial biopsies showing nonrejection followed by rejection and concurrent echocardiograms. Cohort 2 had graft loss (death or retransplant) with a pre-event echocardiogram.
Results
In cohort 1 (n = 86), the median age at heart transplant was 12.0 years, and the median time between heart transplant and rejection was 2.6 years. No patient had more than trivial aortic regurgitation at baseline or during rejection. Mild pulmonary regurgitation was present in 2 patients (2.3%) at baseline and 4 patients (4.8%) during rejection (P = .10). Patients with mild or greater mitral regurgitation increased from 13 patients (15.1%) at baseline to 29 patients (33.7%) during rejection (P < .001). Worse mitral regurgitation during rejection was more likely in conjunction with moderate or greater left ventricular dysfunction (64.8% vs 8.7%, P < .001). In cohort 2 (n = 51), the median duration between heart transplant and graft loss was 8.4 years. Mild or greater aortic regurgitation was present in 1 patient (2.0%), pulmonary regurgitation mild or greater was present in 4 patients (7.8%), and mitral regurgitation mild or greater was present in 20 patients (39.2%). No patient developed valve stenosis.
Conclusions
In a series of more than 100 pediatric heart transplant recipients, semilunar valve dysfunction was rare, suggesting that contemporary immunosuppression is sufficient to preserve the longevity of semilunar valve transplants. Mitral valve dysfunction was more common, often associated with left ventricular dysfunction, and warrants further study.
目的人类瓣膜移植后免疫抑制的处理尚不清楚，可能有助于了解心脏移植后排斥反应和慢性移植物衰竭期间的瓣膜功能。我们评估了儿童心脏移植受者在活检诊断为排斥反应期间和死亡/再移植前的瓣膜功能。方法本研究为单中心回顾性研究。队列1的患者进行了两次连续活检，显示无排斥反应，随后出现排斥反应，同时进行超声心动图检查。队列2有移植物丢失（死亡或再移植），事件前超声心动图显示。结果在队列1 （n = 86）中，接受心脏移植的中位年龄为12.0岁，从心脏移植到排异反应的中位时间为2.6年。在基线或排斥反应期间，没有患者有轻微的主动脉反流。2例患者（2.3%）在基线时出现轻度肺反流，4例患者（4.8%）在排斥反应期间（P = 0.10）。轻度或重度二尖瓣反流患者从基线时的13例（15.1%）增加到排斥反应时的29例（33.7%）（P < .001）。排斥反应期间二尖瓣反流加重更可能伴有中度或更严重的左心室功能不全（64.8% vs 8.7%, P < .001）。在队列2 （n = 51）中，心脏移植和移植物损失之间的中位持续时间为8.4年。1例（2.0%）出现轻度或更严重的主动脉反流，4例（7.8%）出现轻度或更严重的肺反流，20例（39.2%）出现轻度或更严重的二尖瓣反流。无患者发生瓣膜狭窄。结论在100多例儿童心脏移植受者中，半月瓣功能障碍罕见，提示当代免疫抑制足以维持半月瓣移植的寿命。二尖瓣功能障碍更为常见，常与左心室功能障碍相关，值得进一步研究。
{"title":"Valve function during graft rejection and before graft failure in pediatric heart transplant recipients","authors":"Addison Gearhart MD , Gianna Dafflisio BS , Yuanyuan Fu MA , Stuart Lipsitz ScD , Sitaram Emani MD , Tajinder P. Singh MD, MSc","doi":"10.1016/j.xjon.2025.11.018","DOIUrl":"10.1016/j.xjon.2025.11.018","url":null,"abstract":"<div><h3>Objective</h3><div>Management of immunosuppression after human valve transplant remains unclear and may be aided by understanding valve function during rejection and with chronic graft failure after heart transplant. We assessed valve function during biopsy-diagnosed rejection and before death/retransplantation in pediatric heart transplant recipients.</div></div><div><h3>Methods</h3><div>This was a single-center, retrospective study. Patients in cohort 1 had 2 serial biopsies showing nonrejection followed by rejection and concurrent echocardiograms. Cohort 2 had graft loss (death or retransplant) with a pre-event echocardiogram.</div></div><div><h3>Results</h3><div>In cohort 1 (n = 86), the median age at heart transplant was 12.0 years, and the median time between heart transplant and rejection was 2.6 years. No patient had more than trivial aortic regurgitation at baseline or during rejection. Mild pulmonary regurgitation was present in 2 patients (2.3%) at baseline and 4 patients (4.8%) during rejection (<em>P =</em> .10). Patients with mild or greater mitral regurgitation increased from 13 patients (15.1%) at baseline to 29 patients (33.7%) during rejection (<em>P <</em> .001). Worse mitral regurgitation during rejection was more likely in conjunction with moderate or greater left ventricular dysfunction (64.8% vs 8.7%, <em>P <</em> .001). In cohort 2 (n = 51), the median duration between heart transplant and graft loss was 8.4 years. Mild or greater aortic regurgitation was present in 1 patient (2.0%), pulmonary regurgitation mild or greater was present in 4 patients (7.8%), and mitral regurgitation mild or greater was present in 20 patients (39.2%). No patient developed valve stenosis.</div></div><div><h3>Conclusions</h3><div>In a series of more than 100 pediatric heart transplant recipients, semilunar valve dysfunction was rare, suggesting that contemporary immunosuppression is sufficient to preserve the longevity of semilunar valve transplants. Mitral valve dysfunction was more common, often associated with left ventricular dysfunction, and warrants further study.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101533"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-11DOI: 10.1016/j.xjon.2025.10.028
Shivam Patel BS , Nimesh D. Desai MD, PhD , Derek R. Brinster MD , Qing-Guo Li MD, PhD , Edward P. Chen MD , Ibrahim Sultan MD , Anthony L. Estrera MD , Marc Schermerhorn MD , Mark D. Peterson MD, PhD , Amit Korach MD , Davide Pacini MD , Chih-Wen Pai PhD , Elise Woznicki BS , Payam Salehi MD, PhD , Ourania Preventza MD , Christoph A. Nienaber MD , Kim A. Eagle MD , George Arnaoutakis MD
Objectives
Type A acute aortic dissection can cause preoperative myocardial infarction due to coronary malperfusion or hemodynamic collapse. This study aims to characterize the presentation, management, and outcomes of patients with concomitant dissection and myocardial infarction.
Methods
A total of 5762 patients with type A dissection were evaluated from the International Registry of Acute Aortic Dissection from 1996 to 2024. Patients with endovascular management, iatrogenic dissection, or insufficient data were excluded. Patients with preoperative myocardial infarction (n = 662, 10.8%) were compared with those without preoperative myocardial infarction (n = 5140, 89.2%).
Results
Age and time to diagnosis and treatment were similar between groups. Patients with preoperative myocardial infarction more frequently presented with chest pain (88.6% vs 82.0%, P < .0001) and hemodynamic shock (9.5% vs 6.4%, P = .009). Diagnostic imaging revealed more coronary involvement (39.4% vs 14.3%, P < .0001). Surgery more often involved coronary artery bypass grafting (25.4% vs 8.3%, P < .0001) and root replacement (43.9% vs 35%, P = .0003) in the preoperative myocardial infarction group. Patients with preoperative myocardial infarction had higher rates of low output syndrome (9.5% vs 2.2%, P < .0001), renal failure (31.2% vs 21.1%, P < .0001), coma (5.4% vs 2.8%, P = .006), and in-hospital mortality (33.3% vs 15.6%, P < .0001). However, 4-year survival was similar (P = .810). Preoperative myocardial infarction remained an independent predictor of in-hospital mortality on multivariable analysis (odds ratio, 2.27, P < .0001).
Conclusions
Patients with type A acute aortic dissection and preoperative myocardial infarction experienced higher complication and in-hospital mortality rates. Earlier recognition and targeted surgical strategies may improve outcomes.
目的A型急性主动脉夹层可因冠状动脉灌注不良或血流动力学塌陷引起术前心肌梗死。本研究旨在描述合并夹层和心肌梗死患者的表现、处理和预后。方法对1996年至2024年国际急性主动脉夹层登记的5762例A型夹层患者进行评价。排除有血管内管理、医源性夹层或资料不充分的患者。术前心肌梗死患者（n = 662, 10.8%）与术前无心肌梗死患者（n = 5140, 89.2%）进行比较。结果两组患者的年龄、诊治时间相近。术前心肌梗死患者更常出现胸痛（88.6% vs 82.0%, P < 0.0001）和血流动力学休克（9.5% vs 6.4%, P = 0.009）。诊断影像显示更多的冠状动脉受累（39.4% vs 14.3%, P < 0.0001）。术前心肌梗死组手术更多涉及冠状动脉搭桥术（25.4% vs 8.3%, P < 0.0001）和牙根置换术（43.9% vs 35%, P = 0.0003）。术前心肌梗死患者有较高的低输出综合征发生率（9.5% vs 2.2%, P < .0001）、肾功能衰竭发生率（31.2% vs 21.1%, P < .0001）、昏迷发生率（5.4% vs 2.8%, P = 0.006）和住院死亡率（33.3% vs 15.6%, P < .0001）。然而，4年生存率相似（P = .810）。多变量分析显示，术前心肌梗死仍然是院内死亡率的独立预测因子（优势比为2.27,P < 0.0001）。结论A型急性主动脉夹层合并术前心肌梗死患者有较高的并发症和住院死亡率。早期识别和有针对性的手术策略可以改善预后。
{"title":"Type A acute aortic dissection complicated by preoperative myocardial infarction: Insights from the International Registry of Acute Aortic Dissection","authors":"Shivam Patel BS , Nimesh D. Desai MD, PhD , Derek R. Brinster MD , Qing-Guo Li MD, PhD , Edward P. Chen MD , Ibrahim Sultan MD , Anthony L. Estrera MD , Marc Schermerhorn MD , Mark D. Peterson MD, PhD , Amit Korach MD , Davide Pacini MD , Chih-Wen Pai PhD , Elise Woznicki BS , Payam Salehi MD, PhD , Ourania Preventza MD , Christoph A. Nienaber MD , Kim A. Eagle MD , George Arnaoutakis MD","doi":"10.1016/j.xjon.2025.10.028","DOIUrl":"10.1016/j.xjon.2025.10.028","url":null,"abstract":"<div><h3>Objectives</h3><div>Type A acute aortic dissection can cause preoperative myocardial infarction due to coronary malperfusion or hemodynamic collapse. This study aims to characterize the presentation, management, and outcomes of patients with concomitant dissection and myocardial infarction.</div></div><div><h3>Methods</h3><div>A total of 5762 patients with type A dissection were evaluated from the International Registry of Acute Aortic Dissection from 1996 to 2024. Patients with endovascular management, iatrogenic dissection, or insufficient data were excluded. Patients with preoperative myocardial infarction (n = 662, 10.8%) were compared with those without preoperative myocardial infarction (n = 5140, 89.2%).</div></div><div><h3>Results</h3><div>Age and time to diagnosis and treatment were similar between groups. Patients with preoperative myocardial infarction more frequently presented with chest pain (88.6% vs 82.0%, <em>P <</em> .0001) and hemodynamic shock (9.5% vs 6.4%, <em>P =</em> .009). Diagnostic imaging revealed more coronary involvement (39.4% vs 14.3%, <em>P <</em> .0001). Surgery more often involved coronary artery bypass grafting (25.4% vs 8.3%, <em>P <</em> .0001) and root replacement (43.9% vs 35%, <em>P =</em> .0003) in the preoperative myocardial infarction group. Patients with preoperative myocardial infarction had higher rates of low output syndrome (9.5% vs 2.2%, <em>P <</em> .0001), renal failure (31.2% vs 21.1%, <em>P <</em> .0001), coma (5.4% vs 2.8%, <em>P =</em> .006), and in-hospital mortality (33.3% vs 15.6%, <em>P <</em> .0001). However, 4-year survival was similar (<em>P =</em> .810). Preoperative myocardial infarction remained an independent predictor of in-hospital mortality on multivariable analysis (odds ratio, 2.27, <em>P <</em> .0001).</div></div><div><h3>Conclusions</h3><div>Patients with type A acute aortic dissection and preoperative myocardial infarction experienced higher complication and in-hospital mortality rates. Earlier recognition and targeted surgical strategies may improve outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101508"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-24DOI: 10.1016/j.xjon.2025.11.016
Erin Yu BS , Li Ding MD, MPH , Hannah Sidhu BS , Graeme Rosenberg MD , Takashi Harano MD , Sean C. Wightman MD , Scott M. Atay MD , Anthony W. Kim MD , Brooks V. Udelsman MD, MHS
Background
Thymectomy is an uncommon procedure, and operative experience may influence outcomes. We examined the association between center-level operative volume using the National Readmissions Database (NRD) and the National Cancer Database (NCDB). These databases provide complementary insights into short- and long-term outcomes. We hypothesized that perioperative morbidity would be similar in high-volume (HV) centers and low-volume (LV) centers, but long-term survival and R0 resection—especially for minimally invasive (MI) thymectomy—would be superior in HV centers.
Methods
Patients from the NRD (2017-2020) and NCDB (2010-2015 and 2018-2021) diagnosed with thymoma or thymic carcinoma who underwent thymectomy were included. (NCDB 2016-2017 was excluded for missing stage data.) The top quartile defined HV centers from LV centers. The Pearson χ2 test was used to calculate odds ratios (OR) and 95% confidence intervals (CIs). Logistic regression assessed factors associated with in-hospital mortality, postoperative complications, and R0 resection. Kaplan-Meier analysis evaluated long-term survival.
Results
In NRD analysis (n = 3127 patients), MI thymectomy was more frequent in HV centers (57.4% vs 40.9%: P < .001). No differences were found in adjusted 30-day mortality (OR, 2.00; 95% CI, 0.69-5.77; P = .20) or postoperative complications (OR, 0.95; 95% CI, 0.76-1.19; P = .65). In NCDB analysis (n = 3798 patients) HV centers were associated with improved 10-year survival (hazard ratio [HR], 0.77; 95% CI, 0.61-0.97; P = .02) and decreased R1/R2 resection (HR, 0.77; 95% CI, 0.64-0.92; P = .004). MI thymectomies at HV centers were associated with a higher rate of R0 resection for stage I and stage II disease (HR, 0.47 [95% CI, 0.31-0.73; P = .001] and HR, 0.77 [95% CI, 0.64-0.97; P = .004], respectively).
Conclusions
Perioperative outcomes were similar irrespective of center volume, but HV centers demonstrated improved rates of R0 resection and long-term survival even with an MI approach to thymectomy.
背景胸腺切除术是一种不常见的手术，手术经验可能影响手术结果。我们使用国家再入院数据库（NRD）和国家癌症数据库（NCDB）检查了中心级手术量之间的关系。这些数据库提供了对短期和长期结果的补充见解。我们假设高容量（HV）中心和低容量（LV）中心的围手术期发病率相似，但HV中心的长期生存率和R0切除术（尤其是微创胸腺切除术）更优越。方法纳入NRD（2017-2020）和NCDB（2010-2015和2018-2021）诊断为胸腺瘤或胸腺癌并行胸腺切除术的患者。（ndb 2016-2017因缺少阶段数据而被排除在外。）前四分位数从LV中心定义了HV中心。采用Pearson χ2检验计算比值比（OR）和95%置信区间（ci）。Logistic回归评估了与住院死亡率、术后并发症和R0切除相关的因素。Kaplan-Meier分析评估长期生存率。结果在NRD分析中（n = 3127例），心肌梗死胸腺切除术在HV中心更为常见（57.4% vs 40.9%, P < 001）。校正后30天死亡率（OR, 2.00; 95% CI, 0.69-5.77; P = 0.20）和术后并发症（OR, 0.95; 95% CI, 0.76-1.19; P = 0.65）均无差异。在NCDB分析中（n = 3798例患者），HV中心与改善10年生存率（风险比[HR]， 0.77; 95% CI, 0.61-0.97; P = 0.02）和减少R1/R2切除（风险比，0.77;95% CI, 0.64-0.92; P = 0.004）相关。在HV中心进行MI胸腺切除术与I期和II期疾病较高的R0切除率相关（相对危险度分别为0.47 [95% CI, 0.31-0.73; P = 0.001]和0.77 [95% CI, 0.64-0.97; P = 0.004]）。结论：无论胸腺中心体积大小，手术结果相似，但HV中心即使采用心肌梗死入路也能提高R0切除率和长期生存率。
{"title":"Association of hospital volume with perioperative and long-term outcomes of minimally invasive thymectomy","authors":"Erin Yu BS , Li Ding MD, MPH , Hannah Sidhu BS , Graeme Rosenberg MD , Takashi Harano MD , Sean C. Wightman MD , Scott M. Atay MD , Anthony W. Kim MD , Brooks V. Udelsman MD, MHS","doi":"10.1016/j.xjon.2025.11.016","DOIUrl":"10.1016/j.xjon.2025.11.016","url":null,"abstract":"<div><h3>Background</h3><div>Thymectomy is an uncommon procedure, and operative experience may influence outcomes. We examined the association between center-level operative volume using the National Readmissions Database (NRD) and the National Cancer Database (NCDB). These databases provide complementary insights into short- and long-term outcomes. We hypothesized that perioperative morbidity would be similar in high-volume (HV) centers and low-volume (LV) centers, but long-term survival and R0 resection—especially for minimally invasive (MI) thymectomy—would be superior in HV centers.</div></div><div><h3>Methods</h3><div>Patients from the NRD (2017-2020) and NCDB (2010-2015 and 2018-2021) diagnosed with thymoma or thymic carcinoma who underwent thymectomy were included. (NCDB 2016-2017 was excluded for missing stage data.) The top quartile defined HV centers from LV centers. The Pearson χ<sup>2</sup> test was used to calculate odds ratios (OR) and 95% confidence intervals (CIs). Logistic regression assessed factors associated with in-hospital mortality, postoperative complications, and R0 resection. Kaplan-Meier analysis evaluated long-term survival.</div></div><div><h3>Results</h3><div>In NRD analysis (n = 3127 patients), MI thymectomy was more frequent in HV centers (57.4% vs 40.9%: <em>P</em> < .001). No differences were found in adjusted 30-day mortality (OR, 2.00; 95% CI, 0.69-5.77; <em>P</em> = .20) or postoperative complications (OR, 0.95; 95% CI, 0.76-1.19; <em>P</em> = .65). In NCDB analysis (n = 3798 patients) HV centers were associated with improved 10-year survival (hazard ratio [HR], 0.77; 95% CI, 0.61-0.97; <em>P</em> = .02) and decreased R1/R2 resection (HR, 0.77; 95% CI, 0.64-0.92; <em>P</em> = .004). MI thymectomies at HV centers were associated with a higher rate of R0 resection for stage I and stage II disease (HR, 0.47 [95% CI, 0.31-0.73; <em>P</em> = .001] and HR, 0.77 [95% CI, 0.64-0.97; <em>P</em> = .004], respectively).</div></div><div><h3>Conclusions</h3><div>Perioperative outcomes were similar irrespective of center volume, but HV centers demonstrated improved rates of R0 resection and long-term survival even with an MI approach to thymectomy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101531"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-26DOI: 10.1016/j.xjon.2025.11.020
Harrison Higgins BS , Carmel Falek BS , Akshaya Sundaramurthy MS , Eleonore Valencia MD , Juan C. Ibla MD , Aditya K. Kaza MD , Peter Chiu MD, MS
Objective
The study objective was to assess the effect of intraoperative recombinant factor VII administration on postoperative outcomes in neonates.
Methods
Neonates were identified who underwent arterial switch operation, tetralogy of Fallot repair, aortic arch reconstruction, or interrupted aortic arch with ventricular septal defect repair between 2015 and 2022. Patients who received 15 mL/kg or more cryoprecipitate or 24 mL/kg or more platelets intraoperatively were included to create comparable groups. Inverse probability of treatment weighting was used to account for covariate imbalance. Generalized Poisson regression was used to analyze count data for thrombotic events. Linear regression was used for continuous outcomes.
Results
There were 364 neonates who underwent the operations of interest. After exclusions, 33 patients received recombinant factor VII and 122 patients received a large volume of blood product transfusion but did not receive recombinant factor VII. After adjusting for covariates with inverse probability of treatment weighting, no differences in duration of intubation, intensive care unit or hospital length of stay, 30-day mortality, volume of postoperative transfusion, or rate of arterial thrombi were observed with recombinant factor VII administration. The rate of total thrombi (rate ratio: 0.27, 95% CI, 0.08-0.90, P = .03) and deep vein thrombi (rate ratio: 0.12, 95% CI, 0.02-0.70, P = .02) were significantly less with recombinant factor VII administration.
Conclusions
The rates of thrombosis appeared to be less in patients who received recombinant factor VII. This was driven by lower venous thrombotic complications. These findings suggest that factor VII remains a viable option in the setting of severe, uncontrolled bleeding in neonates undergoing congenital cardiac surgery.
目的探讨术中给药重组因子7对新生儿术后预后的影响。方法选取2015 - 2022年间接受过动脉转换手术、法洛四联症修复、主动脉弓重建或主动脉弓中断合并室间隔缺损修复的患者。术中接受15 mL/kg或更多低温沉淀或24 mL/kg或更多血小板的患者被纳入可比较组。使用处理加权的逆概率来解释协变量不平衡。使用广义泊松回归分析血栓事件的计数数据。连续结果采用线性回归。结果364例新生儿行感兴趣手术。排除后，33例患者接受了重组因子7,122例患者接受了大血制品输血但未接受重组因子7。在调整治疗加权逆概率协变量后，重组因子7在插管时间、重症监护病房或住院时间、30天死亡率、术后输血量或动脉血栓率方面均无差异。重组因子7组总血栓率（比率比：0.27,95% CI: 0.08 ~ 0.90, P = 0.03）和深静脉血栓率（比率比：0.12,95% CI: 0.02 ~ 0.70, P = 0.02）均显著降低。结论重组因子7组患者血栓发生率明显降低。这是由于较低的静脉血栓并发症。这些发现表明，在接受先天性心脏手术的新生儿严重、不受控制的出血的情况下，因子VII仍然是一个可行的选择。
{"title":"Reduced thrombotic risk with recombinant factor VIIa in neonatal cardiac surgery","authors":"Harrison Higgins BS , Carmel Falek BS , Akshaya Sundaramurthy MS , Eleonore Valencia MD , Juan C. Ibla MD , Aditya K. Kaza MD , Peter Chiu MD, MS","doi":"10.1016/j.xjon.2025.11.020","DOIUrl":"10.1016/j.xjon.2025.11.020","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to assess the effect of intraoperative recombinant factor VII administration on postoperative outcomes in neonates.</div></div><div><h3>Methods</h3><div>Neonates were identified who underwent arterial switch operation, tetralogy of Fallot repair, aortic arch reconstruction, or interrupted aortic arch with ventricular septal defect repair between 2015 and 2022. Patients who received 15 mL/kg or more cryoprecipitate or 24 mL/kg or more platelets intraoperatively were included to create comparable groups. Inverse probability of treatment weighting was used to account for covariate imbalance. Generalized Poisson regression was used to analyze count data for thrombotic events. Linear regression was used for continuous outcomes.</div></div><div><h3>Results</h3><div>There were 364 neonates who underwent the operations of interest. After exclusions, 33 patients received recombinant factor VII and 122 patients received a large volume of blood product transfusion but did not receive recombinant factor VII. After adjusting for covariates with inverse probability of treatment weighting, no differences in duration of intubation, intensive care unit or hospital length of stay, 30-day mortality, volume of postoperative transfusion, or rate of arterial thrombi were observed with recombinant factor VII administration. The rate of total thrombi (rate ratio: 0.27, 95% CI, 0.08-0.90, <em>P</em> = .03) and deep vein thrombi (rate ratio: 0.12, 95% CI, 0.02-0.70, <em>P</em> = .02) were significantly less with recombinant factor VII administration.</div></div><div><h3>Conclusions</h3><div>The rates of thrombosis appeared to be less in patients who received recombinant factor VII. This was driven by lower venous thrombotic complications. These findings suggest that factor VII remains a viable option in the setting of severe, uncontrolled bleeding in neonates undergoing congenital cardiac surgery.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101536"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-15DOI: 10.1016/j.xjon.2025.10.032
Aidan Aicher MD , David Rekhtman MD , Ella Eisinger MD , Emma Niemeyer BA , Christiana Davis MD , Andrew Haas MD, PhD , William Garrett Nichols MD , Laura Aguilar MD, PhD , Estuardo Aguilar-Cordova MD, PhD , John Kucharczuk MD , Taine Pechet MD , Doraid Jarrar MD , Sunil Singhal MD , Steven Albelda MD , Jarrod Predina MD, MTR
Objectives
Safety and immunologic priming using neoadjuvant, intratumoral gene-mediated cytotoxic immunotherapy (GMCI) has been established in a phase 1 clinical trial involving patients with resectable non−small cell lung cancer (NSCLC). Here we examine long-term clinical outcomes of this cohort and compare the results with a comparable contemporaneous control group.
Methods
We performed a retrospective review of a prospective database involving our trial cohort. We then identified comparable patients in a ratio of 5:1 considering pathologic stage, histology, resection extent, and age. Kaplan-Meier curves were generated. Differences in disease-free and overall survival were measured by log-rank test.
Results
Intratumoral GMCI was delivered to 12 patients with NSCLC by endobronchial ultrasound (n = 11) or video-assisted thoracic surgery (n = 1). Among patients receiving GMCI and control patients, more than 70% had stage II or stage III disease. Median follow-up for the surviving patients enrolled was 6.0 years (interquartile range, 5.2-6.7 years). Median diseases-free survival was significantly increased among patients receiving GMCI relative to control (2.4 years vs 1.0 year; P = .04). Median OS in the GMCI group was not reached (8 of 12 patients remain alive) versus 3.0 years in controls and was significant by log-rank at 2-7 years (P = .013-.035).
Conclusions
Neoadjuvant immune stimulation induces local and systemic immune activation, is safe when combined with modern systemic therapies, and may confer long-term oncologic advantages. These data provide a foundation for additional trials exploring intratumoral immunotherapy for patients with NSCLC, especially in conjunction with immune checkpoint inhibitors.
{"title":"Neoadjuvant intratumoral immune stimulation using gene-mediated cytotoxic immunotherapy for resectable non−small cell lung cancer: 5-Year outcomes","authors":"Aidan Aicher MD , David Rekhtman MD , Ella Eisinger MD , Emma Niemeyer BA , Christiana Davis MD , Andrew Haas MD, PhD , William Garrett Nichols MD , Laura Aguilar MD, PhD , Estuardo Aguilar-Cordova MD, PhD , John Kucharczuk MD , Taine Pechet MD , Doraid Jarrar MD , Sunil Singhal MD , Steven Albelda MD , Jarrod Predina MD, MTR","doi":"10.1016/j.xjon.2025.10.032","DOIUrl":"10.1016/j.xjon.2025.10.032","url":null,"abstract":"<div><h3>Objectives</h3><div>Safety and immunologic priming using neoadjuvant, intratumoral gene-mediated cytotoxic immunotherapy (GMCI) has been established in a phase 1 clinical trial involving patients with resectable non−small cell lung cancer (NSCLC). Here we examine long-term clinical outcomes of this cohort and compare the results with a comparable contemporaneous control group.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of a prospective database involving our trial cohort. We then identified comparable patients in a ratio of 5:1 considering pathologic stage, histology, resection extent, and age. Kaplan-Meier curves were generated. Differences in disease-free and overall survival were measured by log-rank test.</div></div><div><h3>Results</h3><div>Intratumoral GMCI was delivered to 12 patients with NSCLC by endobronchial ultrasound (n = 11) or video-assisted thoracic surgery (n = 1). Among patients receiving GMCI and control patients, more than 70% had stage II or stage III disease. Median follow-up for the surviving patients enrolled was 6.0 years (interquartile range, 5.2-6.7 years). Median diseases-free survival was significantly increased among patients receiving GMCI relative to control (2.4 years vs 1.0 year; <em>P</em> = .04). Median OS in the GMCI group was not reached (8 of 12 patients remain alive) versus 3.0 years in controls and was significant by log-rank at 2-7 years (<em>P</em> = .013-.035).</div></div><div><h3>Conclusions</h3><div>Neoadjuvant immune stimulation induces local and systemic immune activation, is safe when combined with modern systemic therapies, and may confer long-term oncologic advantages. These data provide a foundation for additional trials exploring intratumoral immunotherapy for patients with NSCLC, especially in conjunction with immune checkpoint inhibitors.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101515"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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