Pub Date : 2024-04-01DOI: 10.1016/j.xjon.2024.01.006
Soichiro Henmi MD, PhD , Alyssia Venna MBS , Mitchell C. Haverty MS , Rittal Mehta MS, BDS , Manan Desai MD , Aybala Tongut MD , Can Yerebakan MD , Mary T. Donofrio MD , Ricardo A. Munoz MD , Yves d’Udekem MD
Objective
The best approach to minimize the observed higher mortality of newborn infants with low birth weight who require congenital heart surgery is unclear. This retrospective study was designed to review outcomes of newborn infants weighing <2000 g who have undergone cardiovascular surgery to identify patient parameters and clinical strategies for care associated with higher survival.
Methods
A retrospective chart review of 103 patients who underwent cardiovascular surgery from 2010 to 2021 who were identified as having low birth weight (≤2000 g). Patients who underwent only patent ductus arteriosus ligation or weighing >3500 g at surgery were excluded.
Results
Median age was 24 days and weight at the time of surgery was 1920 g. Twenty-six (25%) operative mortalities were recorded. Median follow-up period was 2.7 years. The 1- and 3-year overall Kaplan-Meier survival estimate was 72.4% ± 4.5% and 69.1% ± 4.6%. The 1-year survival of patients who had a weight increase >300 g from birth to surgery was far superior to the survival of those who did not achieve such a weight gain (81.4% ± 5.6% vs 64.0% ± 6.7%; log-rank P = .04). By multivariable Cox-hazard regression analysis, the independent predictor of 1-year mortality was genetic syndrome (hazard ratio, 3.54; 95% CI, 1.67-7.82; P < .001), whereas following a strategy of increasing weight from birth to surgery resulted in lower mortality (hazard ratio, 0.49; 95% CI, 0.24-0.90; P = .02).
Conclusions
A strategy of wait and grow for newborn infants with very low birth weight requiring heart surgery results in better survival than immediate surgery provided that the patient's condition allows for this waiting period.
{"title":"Survival benefits of the wait-and-grow approach in small babies (≤2000 g) requiring heart surgery","authors":"Soichiro Henmi MD, PhD , Alyssia Venna MBS , Mitchell C. Haverty MS , Rittal Mehta MS, BDS , Manan Desai MD , Aybala Tongut MD , Can Yerebakan MD , Mary T. Donofrio MD , Ricardo A. Munoz MD , Yves d’Udekem MD","doi":"10.1016/j.xjon.2024.01.006","DOIUrl":"10.1016/j.xjon.2024.01.006","url":null,"abstract":"<div><h3>Objective</h3><p>The best approach to minimize the observed higher mortality of newborn infants with low birth weight who require congenital heart surgery is unclear. This retrospective study was designed to review outcomes of newborn infants weighing <2000 g who have undergone cardiovascular surgery to identify patient parameters and clinical strategies for care associated with higher survival.</p></div><div><h3>Methods</h3><p>A retrospective chart review of 103 patients who underwent cardiovascular surgery from 2010 to 2021 who were identified as having low birth weight (≤2000 g). Patients who underwent only patent ductus arteriosus ligation or weighing >3500 g at surgery were excluded.</p></div><div><h3>Results</h3><p>Median age was 24 days and weight at the time of surgery was 1920 g. Twenty-six (25%) operative mortalities were recorded. Median follow-up period was 2.7 years. The 1- and 3-year overall Kaplan-Meier survival estimate was 72.4% ± 4.5% and 69.1% ± 4.6%. The 1-year survival of patients who had a weight increase >300 g from birth to surgery was far superior to the survival of those who did not achieve such a weight gain (81.4% ± 5.6% vs 64.0% ± 6.7%; log-rank <em>P</em> = .04). By multivariable Cox-hazard regression analysis, the independent predictor of 1-year mortality was genetic syndrome (hazard ratio, 3.54; 95% CI, 1.67-7.82; <em>P</em> < .001), whereas following a strategy of increasing weight from birth to surgery resulted in lower mortality (hazard ratio, 0.49; 95% CI, 0.24-0.90; <em>P</em> = .02).</p></div><div><h3>Conclusions</h3><p>A strategy of wait and grow for newborn infants with very low birth weight requiring heart surgery results in better survival than immediate surgery provided that the patient's condition allows for this waiting period.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266627362400007X/pdfft?md5=1c987ed8bb2c61c224dba779b32ace50&pid=1-s2.0-S266627362400007X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139639483","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 : 2024-04-01DOI: 10.1016/j.xjon.2024.02.003
Thomas F. O'Shea MD , Lynze R. Franko MD , Dane C. Paneitz MD, MPH , Kenneth T. Shelton MD , Asishana A. Osho MD, MPH , Hugh G. Auchincloss MD, MPH
Objective
We sought to quantify the influence that tracheostomy placement has on the hemodynamic stability of postoperative cardiac surgery patients with persistent ventilatory requirements.
Methods
A retrospective, single-center, and observational analysis of postoperative cardiac surgery patients with prolonged mechanical ventilation who underwent tracheostomy placement from 2018 to 2022 was conducted. Patients were excluded if receiving mechanical circulatory support or if they had an unrelated significant complication 3 days surrounding tracheostomy placement. Vasoactive and inotropic requirements were quantified using the Vasoactive-Inotrope Score.
Results
Sixty-one patients were identified, of whom 58 met inclusion criteria. The median vasoactive-inotrope score over the 3 days before tracheostomy compared with 3 days after decreased from 3.35 days (interquartile range, 0-8.79) to 0 days (interquartile range, 0-7.79 days) (P = .027). Graphic representation of this trend demonstrates a clear inflection point at the time of tracheostomy. Also, after tracheostomy placement, fewer patients were on vasoactive/inotropic infusions (67.2% [n = 39] pre vs 24.1% [n = 14] post; P < .001) and sedative infusions (62.1% [n = 36] pre vs 27.6% [n = 16] post; P < .001). The percent of patients on active mechanical ventilation did not differ.
Conclusions
The median vasoactive-inotrope score in cardiac surgery patients with prolonged mechanical ventilation was significantly reduced after tracheostomy placement. There was also a significant reduction in the number of patients on vasoactive/inotropic and sedative infusions 3 days after tracheostomy. These data suggest that tracheostomy has a positive effect on the hemodynamic stability of patients after cardiac surgery and should be considered to facilitate postoperative recovery.
{"title":"Tracheostomy is associated with decreased vasoactive-inotropic score in postoperative cardiac surgery patients on prolonged mechanical ventilation","authors":"Thomas F. O'Shea MD , Lynze R. Franko MD , Dane C. Paneitz MD, MPH , Kenneth T. Shelton MD , Asishana A. Osho MD, MPH , Hugh G. Auchincloss MD, MPH","doi":"10.1016/j.xjon.2024.02.003","DOIUrl":"10.1016/j.xjon.2024.02.003","url":null,"abstract":"<div><h3>Objective</h3><p>We sought to quantify the influence that tracheostomy placement has on the hemodynamic stability of postoperative cardiac surgery patients with persistent ventilatory requirements.</p></div><div><h3>Methods</h3><p>A retrospective, single-center, and observational analysis of postoperative cardiac surgery patients with prolonged mechanical ventilation who underwent tracheostomy placement from 2018 to 2022 was conducted. Patients were excluded if receiving mechanical circulatory support or if they had an unrelated significant complication 3 days surrounding tracheostomy placement. Vasoactive and inotropic requirements were quantified using the Vasoactive-Inotrope Score.</p></div><div><h3>Results</h3><p>Sixty-one patients were identified, of whom 58 met inclusion criteria. The median vasoactive-inotrope score over the 3 days before tracheostomy compared with 3 days after decreased from 3.35 days (interquartile range, 0-8.79) to 0 days (interquartile range, 0-7.79 days) (<em>P</em> = .027). Graphic representation of this trend demonstrates a clear inflection point at the time of tracheostomy. Also, after tracheostomy placement, fewer patients were on vasoactive/inotropic infusions (67.2% [n = 39] pre vs 24.1% [n = 14] post; <em>P</em> < .001) and sedative infusions (62.1% [n = 36] pre vs 27.6% [n = 16] post; <em>P</em> < .001). The percent of patients on active mechanical ventilation did not differ.</p></div><div><h3>Conclusions</h3><p>The median vasoactive-inotrope score in cardiac surgery patients with prolonged mechanical ventilation was significantly reduced after tracheostomy placement. There was also a significant reduction in the number of patients on vasoactive/inotropic and sedative infusions 3 days after tracheostomy. These data suggest that tracheostomy has a positive effect on the hemodynamic stability of patients after cardiac surgery and should be considered to facilitate postoperative recovery.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266627362400038X/pdfft?md5=41cb9fd23ee9d3957627482a837f10e0&pid=1-s2.0-S266627362400038X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139815992","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 : 2024-04-01DOI: 10.1016/j.xjon.2024.02.005
Andrew Kalra BS , Jessica M. Ruck MD , Armaan F. Akbar BS , Alice L. Zhou MS , Albert Leng BA , Alfred J. Casillan MD, PhD , Jinny S. Ha MD, MHS , Christian A. Merlo MD, MPH , Errol L. Bush MD
Objective
The “July Effect” is a theory that the influx of trainees from July to September negatively impacts patient outcomes. We aimed to study this theoretical phenomenon in lung transplant recipients given the highly technical nature of thoracic procedures.
Methods
Adult lung transplant hospitalizations were identified within the National Inpatient Sample (2005-2020). Recipients were categorized as academic Q1 (July to September) or Q2-Q4 (October to June). In-hospital mortality, operator-driven complications (pneumothorax, dehiscence including wound dehiscence, bronchial anastomosis, and others, and vocal cord/diaphragm paralysis, all 3 treated as a composite outcome), length of stay, and inflation-adjusted hospitalization charges were compared between both groups. Multivariable logistic regression was performed to assess the association between academic quarter and in-hospital mortality and operator-driven complications. The models were adjusted for recipient demographics and transplant characteristics. Subgroup analysis was performed between academic and nonacademic hospitals.
Results
Of 30,788 lung transplants, 7838 occurred in Q1 and 22,950 occurred in Q2-Q4. Recipient demographic and clinical characteristics were similar between groups. Dehiscence (n = 922, 4% vs n = 236, 3%), post-transplant cardiac arrest (n = 532, 2% vs n = 113, 1%), and pulmonary embolism (n = 712, 3% vs n = 164, 2%) were more common in Q2-Q4 versus Q1 recipients (all P < .05). Other operator-driven complications, in-hospital mortality, and resource use were similar between groups (P > .05). These inferences remained unchanged in adjusted analyses and on subgroup analyses of academic versus nonacademic hospitals.
Conclusions
The “July Effect” is not evident in US lung transplantation recipient outcomes during the transplant hospitalization. This suggests that current institutional monitoring systems for trainees across multiple specialties, including surgery, anesthesia, critical care, nursing, and others, are robust.
目的 "七月效应 "是一种理论，认为从七月到九月大量学员的涌入会对患者的治疗效果产生负面影响。鉴于胸腔手术的高技术性，我们旨在对肺移植受者的这一理论现象进行研究。方法在全国住院患者样本（2005-2020 年）中确定了成人肺移植住院患者。受者被分为学术 Q1（7 月至 9 月）或 Q2-Q4（10 月至 6 月）。对两组患者的院内死亡率、术者驱动的并发症（气胸、伤口裂开、支气管吻合等裂开以及声带/膈肌麻痹，所有三项均作为综合结果处理）、住院时间和通货膨胀调整后的住院费用进行了比较。进行了多变量逻辑回归，以评估学术季度与院内死亡率和手术并发症之间的关系。模型根据受者人口统计学和移植特征进行了调整。结果 在30788例肺部移植中，7838例发生在第一季度，22950例发生在第二至第四季度。两组受者的人口统计学特征和临床特征相似。第2-4季度与第1季度相比，开裂（n = 922，4% vs n = 236，3%）、移植后心脏骤停（n = 532，2% vs n = 113，1%）和肺栓塞（n = 712，3% vs n = 164，2%）在第2-4季度受者中更为常见（所有P均为0.05）。其他由手术者引起的并发症、院内死亡率和资源使用情况在各组之间相似（P >.05）。结论 "七月效应 "在美国肺移植受者住院期间的结果中并不明显。这表明，目前针对包括外科、麻醉、重症监护、护理等多个专业的受训人员的机构监测系统是健全的。
{"title":"Debunking the July Effect in lung transplantation recipients","authors":"Andrew Kalra BS , Jessica M. Ruck MD , Armaan F. Akbar BS , Alice L. Zhou MS , Albert Leng BA , Alfred J. Casillan MD, PhD , Jinny S. Ha MD, MHS , Christian A. Merlo MD, MPH , Errol L. Bush MD","doi":"10.1016/j.xjon.2024.02.005","DOIUrl":"10.1016/j.xjon.2024.02.005","url":null,"abstract":"<div><h3>Objective</h3><p>The “July Effect” is a theory that the influx of trainees from July to September negatively impacts patient outcomes. We aimed to study this theoretical phenomenon in lung transplant recipients given the highly technical nature of thoracic procedures.</p></div><div><h3>Methods</h3><p>Adult lung transplant hospitalizations were identified within the National Inpatient Sample (2005-2020). Recipients were categorized as academic Q1 (July to September) or Q2-Q4 (October to June). In-hospital mortality, operator-driven complications (pneumothorax, dehiscence including wound dehiscence, bronchial anastomosis, and others, and vocal cord/diaphragm paralysis, all 3 treated as a composite outcome), length of stay, and inflation-adjusted hospitalization charges were compared between both groups. Multivariable logistic regression was performed to assess the association between academic quarter and in-hospital mortality and operator-driven complications. The models were adjusted for recipient demographics and transplant characteristics. Subgroup analysis was performed between academic and nonacademic hospitals.</p></div><div><h3>Results</h3><p>Of 30,788 lung transplants, 7838 occurred in Q1 and 22,950 occurred in Q2-Q4. Recipient demographic and clinical characteristics were similar between groups. Dehiscence (n = 922, 4% vs n = 236, 3%), post-transplant cardiac arrest (n = 532, 2% vs n = 113, 1%), and pulmonary embolism (n = 712, 3% vs n = 164, 2%) were more common in Q2-Q4 versus Q1 recipients (all <em>P</em> < .05). Other operator-driven complications, in-hospital mortality, and resource use were similar between groups (<em>P</em> > .05). These inferences remained unchanged in adjusted analyses and on subgroup analyses of academic versus nonacademic hospitals.</p></div><div><h3>Conclusions</h3><p>The “July Effect” is not evident in US lung transplantation recipient outcomes during the transplant hospitalization. This suggests that current institutional monitoring systems for trainees across multiple specialties, including surgery, anesthesia, critical care, nursing, and others, are robust.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000408/pdfft?md5=86b414584beb4d6cea2c9cf2775073eb&pid=1-s2.0-S2666273624000408-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139823556","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 : 2024-04-01DOI: 10.1016/j.xjon.2024.01.017
J.W. Awori Hayanga MD, MPH, Elwin Tham MD, Manuel Gomez-Tschrnko MD, J. Hunter Mehaffey MD, Jason Lamb MD, Paul Rothenberg MD, Vinay Badhwar MD, Alper Toker MD
Background
Surgical volume is known to influence failure to rescue (FTR), defined as death following a complication. Robotic lung surgery continues to expand and there is variability in outcomes among hospitals. We sought to estimate the contribution of hospital-based factors on outcomes and FTR following robotic right upper lobectomy (RRUL).
Methods
Using the Centers for Medicare and Medicaid Services inpatient claims database, we evaluated all patients age ≥65 years with a diagnosis of lung cancer who underwent RRUL between January 2018 and December 2020. We excluded patients who had undergone segmentectomy, sublobar, wedge, or bronchoplastic resection; had metastatic or nonmalignant disease; or had a history of neoadjuvant chemotherapy. Primary outcomes included FTR rate, length of stay (LOS), readmissions, conversion to open surgery, complications, and costs. We analyzed hospitals by tertiles of volume and Medicare Mortality Index (MMI). Defined as the institutional number of deaths per number of survivors, MMI is a marker of overall hospital performance and quality. Propensity score models were adjusted for confounding using goodness of fit.
Results
Data for 4317 patients who underwent robotic right upper lobectomy were analyzed. Hospitals were categorized by volume of cases (low, <9; medium, 9-20; high, >20) and MMI (low, <0.04; medium, 0.04-0.13; high, >0.13). After propensity score balancing, patients from tertiles of lowest volume and highest MMI had higher costs ($34,222 vs $30,316; P = .006), as well as higher mortality (odds ratio, 7.46; 95% confidence interval, 2.67-28.2; P < .001). Compared to high-volume centers, low-volume centers had higher rates of conversion to open surgery, respiratory failure, hemorrhagic anemia, and death; longer LOS; and greater cost (P < .001 for all). The C-statistic for volume as a predictor of overall mortality was 0.6, and the FTR was 0.8. Hospitals in the highest tertile of MMI had the highest rates of conversion to open surgery (P = .01), pneumothorax (P = .02), and respiratory failure (P < .001). They also had the highest mortality and rate of readmission, longest LOS, and greatest costs (P < .001 for all) and the shortest survival (P < .001). The C-statistic for MMI as a predictor of overall mortality was 0.8, and FTR was 0.9.
Conclusions
The MMI incorporates hospital-based factors in the adjudication of outcomes and is a more sensitive predictor of FTR rates than volume alone. Combining MMI and volume may provide a metric that can guide quality improvement and cost-effectiveness measures in hospitals seeking to implement robotic lung surgery programs.
{"title":"Mortality index is more accurate than volume in predicting outcome and failure to rescue in Medicare beneficiaries undergoing robotic right upper lobectomy","authors":"J.W. Awori Hayanga MD, MPH, Elwin Tham MD, Manuel Gomez-Tschrnko MD, J. Hunter Mehaffey MD, Jason Lamb MD, Paul Rothenberg MD, Vinay Badhwar MD, Alper Toker MD","doi":"10.1016/j.xjon.2024.01.017","DOIUrl":"10.1016/j.xjon.2024.01.017","url":null,"abstract":"<div><h3>Background</h3><p>Surgical volume is known to influence failure to rescue (FTR), defined as death following a complication. Robotic lung surgery continues to expand and there is variability in outcomes among hospitals. We sought to estimate the contribution of hospital-based factors on outcomes and FTR following robotic right upper lobectomy (RRUL).</p></div><div><h3>Methods</h3><p>Using the Centers for Medicare and Medicaid Services inpatient claims database, we evaluated all patients age ≥65 years with a diagnosis of lung cancer who underwent RRUL between January 2018 and December 2020. We excluded patients who had undergone segmentectomy, sublobar, wedge, or bronchoplastic resection; had metastatic or nonmalignant disease; or had a history of neoadjuvant chemotherapy. Primary outcomes included FTR rate, length of stay (LOS), readmissions, conversion to open surgery, complications, and costs. We analyzed hospitals by tertiles of volume and Medicare Mortality Index (MMI). Defined as the institutional number of deaths per number of survivors, MMI is a marker of overall hospital performance and quality. Propensity score models were adjusted for confounding using goodness of fit.</p></div><div><h3>Results</h3><p>Data for 4317 patients who underwent robotic right upper lobectomy were analyzed. Hospitals were categorized by volume of cases (low, <9; medium, 9-20; high, >20) and MMI (low, <0.04; medium, 0.04-0.13; high, >0.13). After propensity score balancing, patients from tertiles of lowest volume and highest MMI had higher costs ($34,222 vs $30,316; <em>P</em> = .006), as well as higher mortality (odds ratio, 7.46; 95% confidence interval, 2.67-28.2; <em>P</em> < .001). Compared to high-volume centers, low-volume centers had higher rates of conversion to open surgery, respiratory failure, hemorrhagic anemia, and death; longer LOS; and greater cost (<em>P</em> < .001 for all). The C-statistic for volume as a predictor of overall mortality was 0.6, and the FTR was 0.8. Hospitals in the highest tertile of MMI had the highest rates of conversion to open surgery (<em>P</em> = .01), pneumothorax (<em>P</em> = .02), and respiratory failure (<em>P</em> < .001). They also had the highest mortality and rate of readmission, longest LOS, and greatest costs (<em>P</em> < .001 for all) and the shortest survival (<em>P</em> < .001). The C-statistic for MMI as a predictor of overall mortality was 0.8, and FTR was 0.9.</p></div><div><h3>Conclusions</h3><p>The MMI incorporates hospital-based factors in the adjudication of outcomes and is a more sensitive predictor of FTR rates than volume alone. Combining MMI and volume may provide a metric that can guide quality improvement and cost-effectiveness measures in hospitals seeking to implement robotic lung surgery programs.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000342/pdfft?md5=8d8919d84ca8ba52576f17e794378b97&pid=1-s2.0-S2666273624000342-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139879893","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 : 2024-04-01DOI: 10.1016/j.xjon.2024.02.001
{"title":"Discussion to: An angiotensin system inhibitor (losartan) potentiates antitumor efficacy of cisplatin in a murine model of non–small cell lung cancer","authors":"","doi":"10.1016/j.xjon.2024.02.001","DOIUrl":"10.1016/j.xjon.2024.02.001","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000366/pdfft?md5=c7e2fb2586836a6c497a58b190c6ac30&pid=1-s2.0-S2666273624000366-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139890932","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 : 2024-04-01DOI: 10.1016/j.xjon.2024.01.002
Ali Vaeli Zadeh MD , Alexander Justicz MD , Juan Plate MD , Michael Cortelli MD , I-wen Wang MD, PhD , John Nicholas Melvan MD, PhD
Objective
Human immunodeficiency virus infection (HIV+) is associated with a 2-fold increased risk of cardiovascular disease. Increasingly, patients who are HIV + are being evaluated to undergo cardiac surgery. Current risk-adjusted scoring systems, including the Society of Thoracic Surgeons Predicted Risk of Mortality score, fail to stratify HIV + risk. Unfortunately, there exists a paucity of cardiac surgery outcomes data in modern patients who are HIV+.
Methods
We conducted a retrospective review of PearlDiver, an all-payer claims administrative database. In total, 14,714,743 patients were captured between 2010 and 2020. Of these, 59,695 (0.4%) of patients had a history of HIV+, and 1759 (2.95%) of these patients underwent cardiac surgery. Patients who were HIV+ were younger, more often male, and had greater comorbidity, history of hypertension, chronic obstructive pulmonary disease, chronic liver disease, chronic kidney disease, chronic lung disease, and heart failure.
Results
Postoperatively, patients who were HIV + had significantly greater rates of pneumonia (relative risk, 1.70; P = .0003) and 30-day all-cause readmission (relative risk, 1.28, P < .0001). After linear regression analysis, these results remained significant. Data also show that a lesser proportion of patients with HIV + underwent coronary artery bypass grafting, aortic valve replacement, and any cardiac surgery compared with controls.
Conclusions
Patients who are HIV + undergoing cardiac surgery are at greater risk of pneumonia and readmission. Moreover, we discovered lower rates of cardiac surgery in patients who are HIV+, which may reflect limited access to surgery when indicated. Today's risk-adjusted scoring systems in cardiac surgery need to better account for the modern patient who is HIV+.
{"title":"Human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgery","authors":"Ali Vaeli Zadeh MD , Alexander Justicz MD , Juan Plate MD , Michael Cortelli MD , I-wen Wang MD, PhD , John Nicholas Melvan MD, PhD","doi":"10.1016/j.xjon.2024.01.002","DOIUrl":"https://doi.org/10.1016/j.xjon.2024.01.002","url":null,"abstract":"<div><h3>Objective</h3><p>Human immunodeficiency virus infection (HIV+) is associated with a 2-fold increased risk of cardiovascular disease. Increasingly, patients who are HIV + are being evaluated to undergo cardiac surgery. Current risk-adjusted scoring systems, including the Society of Thoracic Surgeons Predicted Risk of Mortality score, fail to stratify HIV + risk. Unfortunately, there exists a paucity of cardiac surgery outcomes data in modern patients who are HIV+.</p></div><div><h3>Methods</h3><p>We conducted a retrospective review of PearlDiver, an all-payer claims administrative database. In total, 14,714,743 patients were captured between 2010 and 2020. Of these, 59,695 (0.4%) of patients had a history of HIV+, and 1759 (2.95%) of these patients underwent cardiac surgery. Patients who were HIV+ were younger, more often male, and had greater comorbidity, history of hypertension, chronic obstructive pulmonary disease, chronic liver disease, chronic kidney disease, chronic lung disease, and heart failure.</p></div><div><h3>Results</h3><p>Postoperatively, patients who were HIV + had significantly greater rates of pneumonia (relative risk, 1.70; <em>P</em> = .0003) and 30-day all-cause readmission (relative risk, 1.28, <em>P</em> < .0001). After linear regression analysis, these results remained significant. Data also show that a lesser proportion of patients with HIV + underwent coronary artery bypass grafting, aortic valve replacement, and any cardiac surgery compared with controls.</p></div><div><h3>Conclusions</h3><p>Patients who are HIV + undergoing cardiac surgery are at greater risk of pneumonia and readmission. Moreover, we discovered lower rates of cardiac surgery in patients who are HIV+, which may reflect limited access to surgery when indicated. Today's risk-adjusted scoring systems in cardiac surgery need to better account for the modern patient who is HIV+.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000032/pdfft?md5=18110c64d8e64db383c6c78fd359475a&pid=1-s2.0-S2666273624000032-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140554682","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 : 2024-04-01DOI: 10.1016/j.xjon.2023.10.038
Mona Kakavand MD , Filip Stembal MD , Lin Chen BA , Rashed Mahboubi MD , Habib Layoun MD , Serge C. Harb MD , Fei Xiang MD , Haytham Elgharably MD , Edward G. Soltesz MD , Faisal G. Bakaeen MD , Kevin Hodges MD , Patrick R. Vargo MD , Jeevanantham Rajeswaran PhD , Austin Firth MS , Eugene H. Blackstone MD , Marc Gillinov MD , Eric E. Roselli MD , Lars G. Svensson MD, PhD , Gösta B. Pettersson MD, PhD , Shinya Unai MD , Douglas R. Johnston MD
Objective
Anterior mitral anular calcification, particularly in radiation heart disease, and previous valve replacement with destroyed intervalvular fibrosa are challenging for prosthesis sizing and placement. The Commando procedure with intervalvular fibrosa reconstruction permits double-valve replacement in these challenging conditions. We referenced outcomes after Commando procedures to standard double-valve replacements.
Methods
From January 2011 to January 2022, 129 Commando procedures and 1191 aortic and mitral double-valve replacements were performed at the Cleveland Clinic, excluding endocarditis. Reasons for the Commando were severe calcification after radiation (n = 67), without radiation (n = 43), and others (n = 19). Commando procedures were referenced to a subset of double-valve replacements using balancing-score methods (109 pairs).
Results
Between balanced groups, Commando versus double-valve replacement had higher total calcium scores (median 6140 vs 2680 HU, P = .03). Hospital outcomes were similar, including operative mortality (12/11% vs 8/7.3%, P = .35) and reoperation for bleeding (9/8.3% vs 5/4.6%, P = .28). Survival and freedom from reoperation at 5 years were 54% versus 67% (P = .33) and 87% versus 100% (P = .04), respectively. Higher calcium score was associated with lower survival after double-valve replacement but not after the Commando. The Commando procedure had lower aortic valve mean gradients at 4 years (9.4 vs 11 mm Hg, P = .04). After Commando procedures for calcification, 5-year survival was 60% and 59% with and without radiation, respectively (P = .47).
Conclusions
The Commando procedure with reconstruction of the intervalvular fibrosa destroyed by mitral anular calcification, radiation, or previous surgery demonstrates acceptable outcomes similar to standard double-valve replacement. More experience and long-term outcomes are required to refine patient selection for and application of the Commando approach.
目的二尖瓣前瓣膜钙化，尤其是放射性心脏病患者，以及既往瓣膜置换术中瓣间纤维被破坏，都对假体的尺寸和置放提出了挑战。通过重建瓣间纤维的Commando手术可以在这些困难情况下进行双瓣膜置换。方法从 2011 年 1 月到 2022 年 1 月，克利夫兰诊所共进行了 129 例 Commando 手术和 1191 例主动脉和二尖瓣双瓣膜置换术，其中不包括心内膜炎。进行Commando手术的原因包括放射治疗后严重钙化（67例）、无放射治疗（43例）和其他（19例）。结果在平衡组之间，Commando手术与双瓣膜置换术相比，钙化总分更高（中位数6140 HU vs 2680 HU，P = .03）。住院结果相似，包括手术死亡率（12/11% vs 8/7.3%，P = .35）和因出血再次手术率（9/8.3% vs 5/4.6%，P = .28）。5年的存活率和免再手术率分别为54%对67%（P = .33）和87%对100%（P = .04）。钙化评分越高，双瓣膜置换术后的存活率越低，但Commando术后则不然。Commando手术4年后的主动脉瓣平均梯度较低（9.4 vs 11 mm Hg，P = .04）。结论Commando手术重建了被二尖瓣瓣口钙化、辐射或既往手术破坏的瓣间纤维，其结果与标准双瓣置换术相似，可以接受。需要更多的经验和长期疗效来完善Commando方法的患者选择和应用。
{"title":"Contemporary experience with the Commando procedure for anterior mitral anular calcification","authors":"Mona Kakavand MD , Filip Stembal MD , Lin Chen BA , Rashed Mahboubi MD , Habib Layoun MD , Serge C. Harb MD , Fei Xiang MD , Haytham Elgharably MD , Edward G. Soltesz MD , Faisal G. Bakaeen MD , Kevin Hodges MD , Patrick R. Vargo MD , Jeevanantham Rajeswaran PhD , Austin Firth MS , Eugene H. Blackstone MD , Marc Gillinov MD , Eric E. Roselli MD , Lars G. Svensson MD, PhD , Gösta B. Pettersson MD, PhD , Shinya Unai MD , Douglas R. Johnston MD","doi":"10.1016/j.xjon.2023.10.038","DOIUrl":"10.1016/j.xjon.2023.10.038","url":null,"abstract":"<div><h3>Objective</h3><p>Anterior mitral anular calcification, particularly in radiation heart disease, and previous valve replacement with destroyed intervalvular fibrosa are challenging for prosthesis sizing and placement. The Commando procedure with intervalvular fibrosa reconstruction permits double-valve replacement in these challenging conditions. We referenced outcomes after Commando procedures to standard double-valve replacements.</p></div><div><h3>Methods</h3><p>From January 2011 to January 2022, 129 Commando procedures and 1191 aortic and mitral double-valve replacements were performed at the Cleveland Clinic, excluding endocarditis. Reasons for the Commando were severe calcification after radiation (n = 67), without radiation (n = 43), and others (n = 19). Commando procedures were referenced to a subset of double-valve replacements using balancing-score methods (109 pairs).</p></div><div><h3>Results</h3><p>Between balanced groups, Commando versus double-valve replacement had higher total calcium scores (median 6140 vs 2680 HU, <em>P</em> = .03). Hospital outcomes were similar, including operative mortality (12/11% vs 8/7.3%, <em>P</em> = .35) and reoperation for bleeding (9/8.3% vs 5/4.6%, <em>P</em> = .28). Survival and freedom from reoperation at 5 years were 54% versus 67% (<em>P</em> = .33) and 87% versus 100% (<em>P</em> = .04), respectively. Higher calcium score was associated with lower survival after double-valve replacement but not after the Commando. The Commando procedure had lower aortic valve mean gradients at 4 years (9.4 vs 11 mm Hg, <em>P</em> = .04). After Commando procedures for calcification, 5-year survival was 60% and 59% with and without radiation, respectively (<em>P</em> = .47).</p></div><div><h3>Conclusions</h3><p>The Commando procedure with reconstruction of the intervalvular fibrosa destroyed by mitral anular calcification, radiation, or previous surgery demonstrates acceptable outcomes similar to standard double-valve replacement. More experience and long-term outcomes are required to refine patient selection for and application of the Commando approach.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273623003698/pdfft?md5=44a615e4dd813ed1d87a45b7bec54611&pid=1-s2.0-S2666273623003698-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139291950","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 : 2024-04-01DOI: 10.1016/j.xjon.2023.11.012
{"title":"Discussion to: Contemporary experience with the Commando procedure for anterior mitral anular calcification","authors":"","doi":"10.1016/j.xjon.2023.11.012","DOIUrl":"10.1016/j.xjon.2023.11.012","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273623003674/pdfft?md5=f9300f0486ffa8b725ffb3fc84115ce4&pid=1-s2.0-S2666273623003674-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139296161","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 : 2024-04-01DOI: 10.1016/j.xjon.2023.12.011
Bastien Poitier MD , Pierre Dahdah MD , Margaux Bernardini MD , Lucas Coroyer MD , Mohamed Nouar MD , Ramzi Abi Akar MD , Alain Bel MD , David M. Smadja MD, PhD , Leonora Du Puy-Montbrun MD , Paul Achouh MD, PhD
{"title":"Incidence and impact of hypoattenuated leaflet thickening following aortic valve replacement using a glycerol-preserved bioprosthesis","authors":"Bastien Poitier MD , Pierre Dahdah MD , Margaux Bernardini MD , Lucas Coroyer MD , Mohamed Nouar MD , Ramzi Abi Akar MD , Alain Bel MD , David M. Smadja MD, PhD , Leonora Du Puy-Montbrun MD , Paul Achouh MD, PhD","doi":"10.1016/j.xjon.2023.12.011","DOIUrl":"10.1016/j.xjon.2023.12.011","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000020/pdfft?md5=963f8fb3c0ec6fb53e8946369cbcec50&pid=1-s2.0-S2666273624000020-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139392033","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 : 2024-04-01DOI: 10.1016/j.xjon.2024.01.015
Amit Iyengar MD, MSE , Noah Weingarten MD , David Rekhtman BS , Cindy Song BA , Max Shin BS , Mark R. Helmers MD , John Kelly MD , Pavan Atluri MD
Objectives
We sought to characterize the demographics, outcomes, and quality of life of asymptomatic patients undergoing mitral valve surgery at our center over a 10-year period.
Methods
Adults undergoing mitral surgery were retrospectively reviewed between 2010 and 2019. Patients were included if deemed asymptomatic by review of referring cardiologist and surgeon consultation. Patients were administered a telephone survey consisting of the Kansas City Cardiomyopathy Questionnaire as well as free-response regarding satisfaction surrounding their operation. Outcomes included survival, Kansas City Cardiomyopathy Questionnaire metrics, and thematic analysis of free response questions.
Results
A total of 145 patients were identified who were deemed asymptomatic. Their average age was 60.3 ± 12.1 years, and 71% were male. No patients had endocarditis, and 34% had decreased ejection fraction (<60%). Repair was achieved in 95% of patients. Median length of stay was 6 (5-8) days. Ten-year survival was 91%, with no differences noted by ejection fraction. Composite Kansas City Cardiomyopathy Questionnaire score was 100 (96-100). The lowest component score was “Quality of Life,” with 22% of patients reporting being “mostly satisfied” with present cardiac status. Most common themes expressed were gratitude with surgery results (58%), satisfaction with being able to stay active (23%), and happiness with early disease treatment (21%). Only 1 patient (0.7%) expressed regret with surgery choice.
Conclusions
Mitral surgery for asymptomatic disease can be performed with good long-term outcomes in select patients, and the majority experience excellent quality of life and satisfaction with current health. Continued assessments of quality of life are important in evaluating outcomes of mitral surgery as indications grow.
{"title":"Outcomes and quality of life in patients receiving mitral surgery for asymptomatic disease","authors":"Amit Iyengar MD, MSE , Noah Weingarten MD , David Rekhtman BS , Cindy Song BA , Max Shin BS , Mark R. Helmers MD , John Kelly MD , Pavan Atluri MD","doi":"10.1016/j.xjon.2024.01.015","DOIUrl":"10.1016/j.xjon.2024.01.015","url":null,"abstract":"<div><h3>Objectives</h3><p>We sought to characterize the demographics, outcomes, and quality of life of asymptomatic patients undergoing mitral valve surgery at our center over a 10-year period.</p></div><div><h3>Methods</h3><p>Adults undergoing mitral surgery were retrospectively reviewed between 2010 and 2019. Patients were included if deemed asymptomatic by review of referring cardiologist and surgeon consultation. Patients were administered a telephone survey consisting of the Kansas City Cardiomyopathy Questionnaire as well as free-response regarding satisfaction surrounding their operation. Outcomes included survival, Kansas City Cardiomyopathy Questionnaire metrics, and thematic analysis of free response questions.</p></div><div><h3>Results</h3><p>A total of 145 patients were identified who were deemed asymptomatic. Their average age was 60.3 ± 12.1 years, and 71% were male. No patients had endocarditis, and 34% had decreased ejection fraction (<60%). Repair was achieved in 95% of patients. Median length of stay was 6 (5-8) days. Ten-year survival was 91%, with no differences noted by ejection fraction. Composite Kansas City Cardiomyopathy Questionnaire score was 100 (96-100). The lowest component score was “Quality of Life,” with 22% of patients reporting being “mostly satisfied” with present cardiac status. Most common themes expressed were gratitude with surgery results (58%), satisfaction with being able to stay active (23%), and happiness with early disease treatment (21%). Only 1 patient (0.7%) expressed regret with surgery choice.</p></div><div><h3>Conclusions</h3><p>Mitral surgery for asymptomatic disease can be performed with good long-term outcomes in select patients, and the majority experience excellent quality of life and satisfaction with current health. Continued assessments of quality of life are important in evaluating outcomes of mitral surgery as indications grow.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000329/pdfft?md5=b9462ea11cf35a8c3f791af46c39ec54&pid=1-s2.0-S2666273624000329-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139815131","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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