JTCVS open最新文献_第9页

Endoscopic hydrodissection for saphenous vein harvesting: Remove no-touch in minimally invasive no touch? 内镜下隐静脉摘除：微创无接触去除无接触？

IF 1.9

JTCVS open

Pub Date : 2026-02-01 Epub Date: 2025-11-22 DOI: 10.1016/j.xjon.2025.11.017

Michael R. Dashwood PhD , Kenji Iino MD, PhD

引用次数: 0

Reducing treatment time and number of nerves treated fails to improve cryoanalgesia outcomes 减少治疗时间和治疗神经数量并不能改善冷冻镇痛效果

IF 1.9

JTCVS open

Pub Date : 2026-02-01 Epub Date: 2026-01-03 DOI: 10.1016/j.xjon.2025.101574

Lauren Drake DO, Kara Specht PA-C, Pamela Kuchta CRNP, Lawrence Crist DO, Hiran C. Fernando MD, Benny Weksler MD

Objective

Cryoanalgesia is an attractive method to improve postoperative pain. However, our randomized trial did not show significant reduction in pain or opioid use in adults undergoing minimally invasive thoracic surgery. We hypothesized that reducing the number of intercostal spaces and treatment time may decrease postoperative pain and narcotic consumption.

Methods

In this quality improvement study, the quality improvement cohort received an intercostal nerve block with bupivacaine and lidocaine, and cryotherapy to 3 levels for 90 seconds. Outcomes from this cohort were compared with outcomes from our randomized trial cohorts: The cryoanalgesia cohort was treated with cryotherapy to 5 to 6 intercostal nerves for 120 seconds and intercostal nerve block, and the standard of care cohort was treated with intercostal nerve block only. Primary outcomes were opioid consumption up to the first postoperative visit measured by morphine milligram equivalents. Secondary outcomes included patient-reported pain and incentive spirometry volumes in the immediate postoperative period.

Results

A total of 161 patients were analyzed (quality improvement N = 58, standard of care N = 52, cryoanalgesia N = 51). There was no difference in baseline characteristics, procedure type, or length of stay. There were no differences in inpatient or total morphine milligram equivalents up to the first postoperative visit. Outpatient morphine milligram equivalents were significantly higher in the quality improvement cohort (P = .029). Patient-reported pain scores were similar among all groups, and there were no significant differences in incentive spirometry volumes.

Conclusions

Modifying the cryoanalgesia protocol to include fewer levels and less time did not improve opioid consumption, incentive spirometry, or pain scores in patients undergoing lung resection.

目的低温镇痛是改善术后疼痛的一种有效方法。然而，我们的随机试验并没有显示在接受微创胸外科手术的成人中疼痛或阿片类药物使用的显著减少。我们假设减少肋间隙的数量和治疗时间可以减少术后疼痛和麻醉消耗。方法在本质量改善研究中，质量改善组接受布比卡因和利多卡因肋间神经阻滞，并进行3级冷冻治疗，持续90秒。将该队列的结果与我们随机试验队列的结果进行比较：低温镇痛队列接受5至6条肋间神经冷冻治疗120秒并进行肋间神经阻滞，而标准护理队列仅接受肋间神经阻滞治疗。主要结果是阿片类药物的消耗，直到第一次术后就诊吗啡毫克当量测量。次要结局包括术后患者报告的疼痛和刺激肺活量。结果共分析161例患者，其中质量改善组58例，标准护理组52例，冷冻镇痛组51例。基线特征、手术类型或住院时间没有差异。到术后第一次就诊时，住院病人或总吗啡毫克当量没有差异。门诊吗啡毫克当量显著高于质量改善组（P = 0.029）。患者报告的疼痛评分在所有组中相似，并且激励性肺活量没有显著差异。结论：改进冷冻镇痛方案以减少剂量和时间并不能改善肺切除术患者的阿片类药物消耗、刺激肺活量测定或疼痛评分。

{"title":"Reducing treatment time and number of nerves treated fails to improve cryoanalgesia outcomes","authors":"Lauren Drake DO, Kara Specht PA-C, Pamela Kuchta CRNP, Lawrence Crist DO, Hiran C. Fernando MD, Benny Weksler MD","doi":"10.1016/j.xjon.2025.101574","DOIUrl":"10.1016/j.xjon.2025.101574","url":null,"abstract":"<div><h3>Objective</h3><div>Cryoanalgesia is an attractive method to improve postoperative pain. However, our randomized trial did not show significant reduction in pain or opioid use in adults undergoing minimally invasive thoracic surgery. We hypothesized that reducing the number of intercostal spaces and treatment time may decrease postoperative pain and narcotic consumption.</div></div><div><h3>Methods</h3><div>In this quality improvement study, the quality improvement cohort received an intercostal nerve block with bupivacaine and lidocaine, and cryotherapy to 3 levels for 90 seconds. Outcomes from this cohort were compared with outcomes from our randomized trial cohorts: The cryoanalgesia cohort was treated with cryotherapy to 5 to 6 intercostal nerves for 120 seconds and intercostal nerve block, and the standard of care cohort was treated with intercostal nerve block only. Primary outcomes were opioid consumption up to the first postoperative visit measured by morphine milligram equivalents. Secondary outcomes included patient-reported pain and incentive spirometry volumes in the immediate postoperative period.</div></div><div><h3>Results</h3><div>A total of 161 patients were analyzed (quality improvement N = 58, standard of care N = 52, cryoanalgesia N = 51). There was no difference in baseline characteristics, procedure type, or length of stay. There were no differences in inpatient or total morphine milligram equivalents up to the first postoperative visit. Outpatient morphine milligram equivalents were significantly higher in the quality improvement cohort (<em>P</em> = .029). Patient-reported pain scores were similar among all groups, and there were no significant differences in incentive spirometry volumes.</div></div><div><h3>Conclusions</h3><div>Modifying the cryoanalgesia protocol to include fewer levels and less time did not improve opioid consumption, incentive spirometry, or pain scores in patients undergoing lung resection.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101574"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412319","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}

引用次数: 0

Impact of age at Norwood surgery on pre–stage II outcomes in neonates with hypoplastic left heart syndrome 诺伍德手术年龄对左心发育不全综合征新生儿II期前结局的影响

IF 1.9

JTCVS open

Pub Date : 2026-02-01 Epub Date: 2025-12-06 DOI: 10.1016/j.xjon.2025.101550

Halil Beqaj MD, MS , V. Reed LaSala MD , Sophia Jackman MD , Paul Kurlansky MD , Edward Buratto MD, PhD , Priyanka Asrani MD , Michael Fremed MD , Andrew Goldstone MD, PhD , Oliver Barry MD , Sabrina Law MD , Diana Vargas Chaves MD , Tarif Choudhury MD , Stephanie Levasseur MD , Ganga Krishnamurthy MD , Christopher Petit MD , Emile Bacha MD , David Kalfa MD, PhD

Objective

The timing of Norwood surgery, a potentially modifiable component of hypoplastic left heart syndrome management, lacks expert consensus, and its relationship to longer-term outcomes remains unclear.

Methods

We performed a retrospective cohort study of neonates with hypoplastic left heart syndrome who underwent Norwood surgery between 2006 and 2023. The primary outcome was a composite of pre–stage II mortality or transplant and prolonged intensive care unit length of stay. The relationship between age at Norwood surgery and the composite outcome was assessed primarily through Cox proportional hazards analysis, modeling age as a restricted cubic spline, as a binary factor, and as a linear variable. Log-rank tests were used to compare subgroups based on age cutoffs determined from regression analysis.

Results

In multivariable analysis with age modeled as restricted cubic spline, age at surgery (chi-square = 8.31, P = .0400), moderate or worse preoperative tricuspid regurgitation (chi-square = 3.94, P = .0472), and use of the valved Sano shunt compared with the Blalock–Taussig shunt (β = −1.1642, P = .0431) were independently associated with the composite outcome. When age at surgery was modeled as a binary variable, surgery on days 3 to 5 conferred a reduced risk compared with other days (hazard ratio, 0.53; 95% CI, 0.31-0.89; P = .0173). After day 4, a linear relationship is observed with a 34% increase in hazard per each additional day of age.

Conclusions

Age at Norwood surgery is independently associated with pre–stage II outcomes. Surgery between days 3 and 5 may represent an optimal window for intervention, with delays in surgery beyond this period being associated with increased risk of adverse outcomes.

诺伍德手术是左心发育不全综合征治疗中一个可能改变的组成部分，其时机缺乏专家共识，其与长期预后的关系尚不清楚。方法对2006年至2023年间接受诺伍德手术的左心发育不全综合征新生儿进行回顾性队列研究。主要结局是II期前死亡率或移植和延长重症监护病房的住院时间的综合结果。主要通过Cox比例风险分析评估诺伍德手术年龄与复合结局之间的关系，将年龄建模为受限三次样条、二元因素和线性变量。使用Log-rank检验根据回归分析确定的年龄截止值来比较亚组。结果在年龄为受限三次样条模型的多变量分析中，手术年龄（卡方= 8.31,P = 0.0400）、术前三尖瓣返流中度或更严重（卡方= 3.94,P = 0.0472）、有瓣Sano分流器与Blalock-Taussig分流器的使用（β = - 1.1642, P = 0.0431）与综合结果独立相关。当手术年龄作为二元变量建模时，与其他天数相比，手术第3至5天的风险降低（风险比，0.53;95% CI, 0.31-0.89; P = 0.0173）。在第4天之后，观察到的线性关系为每增加一天的年龄危险性增加34%。结论诺伍德手术的sage与II期前预后独立相关。手术在第3天至第5天之间可能是最佳的干预窗口，超过这一时期的手术延误与不良后果的风险增加有关。

{"title":"Impact of age at Norwood surgery on pre–stage II outcomes in neonates with hypoplastic left heart syndrome","authors":"Halil Beqaj MD, MS , V. Reed LaSala MD , Sophia Jackman MD , Paul Kurlansky MD , Edward Buratto MD, PhD , Priyanka Asrani MD , Michael Fremed MD , Andrew Goldstone MD, PhD , Oliver Barry MD , Sabrina Law MD , Diana Vargas Chaves MD , Tarif Choudhury MD , Stephanie Levasseur MD , Ganga Krishnamurthy MD , Christopher Petit MD , Emile Bacha MD , David Kalfa MD, PhD","doi":"10.1016/j.xjon.2025.101550","DOIUrl":"10.1016/j.xjon.2025.101550","url":null,"abstract":"<div><h3>Objective</h3><div>The timing of Norwood surgery, a potentially modifiable component of hypoplastic left heart syndrome management, lacks expert consensus, and its relationship to longer-term outcomes remains unclear.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of neonates with hypoplastic left heart syndrome who underwent Norwood surgery between 2006 and 2023. The primary outcome was a composite of pre–stage II mortality or transplant and prolonged intensive care unit length of stay. The relationship between age at Norwood surgery and the composite outcome was assessed primarily through Cox proportional hazards analysis, modeling age as a restricted cubic spline, as a binary factor, and as a linear variable. Log-rank tests were used to compare subgroups based on age cutoffs determined from regression analysis.</div></div><div><h3>Results</h3><div>In multivariable analysis with age modeled as restricted cubic spline, age at surgery (chi-square = 8.31, <em>P = .</em>0400), moderate or worse preoperative tricuspid regurgitation (chi-square = 3.94, <em>P = .</em>0472), and use of the valved Sano shunt compared with the Blalock–Taussig shunt (β = −1.1642, <em>P = .</em>0431) were independently associated with the composite outcome. When age at surgery was modeled as a binary variable, surgery on days 3 to 5 conferred a reduced risk compared with other days (hazard ratio, 0.53; 95% CI, 0.31-0.89; <em>P = .</em>0173). After day 4, a linear relationship is observed with a 34% increase in hazard per each additional day of age.</div></div><div><h3>Conclusions</h3><div>Age at Norwood surgery is independently associated with pre–stage II outcomes. Surgery between days 3 and 5 may represent an optimal window for intervention, with delays in surgery beyond this period being associated with increased risk of adverse outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101550"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412931","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}

引用次数: 0

The impact of genotype-phenotype on the prognosis of children with hypertrophic cardiomyopathy 基因型-表型对肥厚性心肌病患儿预后的影响

IF 1.9

JTCVS open

Pub Date : 2026-02-01 Epub Date: 2025-12-18 DOI: 10.1016/j.xjon.2025.101563

Yabing Duan MD, Ju Wang MD, Jiachen Li MD, Lizhi Lv MD, Qiang Wang MD, Jun Yan MD

Objective

To investigate the relationship between different genotypes and clinical phenotypes within a pediatric hypertrophic cardiomyopathy (HCM) population and explore the impact of various genotypes on patient outcomes.

Methods

This study involved 82 pediatric HCM patients. A comprehensive review was conducted of echocardiography results, second-generation whole-exome sequencing (WES) findings, and conditions warranting pathologic examination or surgical intervention.

Results

WES was performed in 82 children, of whom 65 (79.3%) and pathogenic or likely pathogenic (P/LP) variants. The median patient age was 6.4 years (interquartile range, 3.8- 11.4 years), 45 (54.9%) were male, and 15 (18.3%) had a definitive family history of HCM. The RASopathy group was diagnosed at a significantly younger age compared to the sarcomeric variant HCM group (P = .0017). Female patients were more common (P = .0001) and the rates of right ventricular outflow tract obstruction (P = .026) and biventricular outflow tract obstruction (P = .026) were higher in the RASopathy group. The freedom from early postoperative reobstruction was 83.3% (95% confidence interval [CI], 64.7%-100%) in the no P/LP variant HCM group and 87% (95% CI, 74.2%-100%) in the RASopathy group. The 7-year freedom from reobstruction was 76.3% (95% CI, 59.8%-97.2%). A statistically significant difference in the incidence of left ventricular outflow tract reobstruction was observed between the sarcomeric HCM group and the RASopathy group (P = .025). Linear regression analysis demonstrated a significant association between age and interventricular septal thickness in the RASopathy group (P = .008; r = 0.48).

Conclusions

Identifying pathogenic genes in children with HCM enables the assessment of genotype–cardiac phenotype relationships and can guide treatment strategy selection and prognosis, particularly for children with RASopathies.

目的探讨小儿肥厚性心肌病（HCM）人群中不同基因型与临床表型的关系，并探讨不同基因型对患者预后的影响。方法本研究纳入82例儿童HCM患者。全面回顾超声心动图结果，第二代全外显子组测序（WES）结果，以及需要病理检查或手术干预的情况。结果82例患儿中65例（79.3%）为致病性或可能致病性（P/LP）变异。患者年龄中位数为6.4岁（四分位数间距为3.8- 11.4岁），男性45例（54.9%），有明确HCM家族史的15例（18.3%）。与肌瘤变HCM组相比，RASopathy组的诊断年龄明显更小（P = 0.0017）。女性患者较多（P = 0.0001）， RASopathy组右室流出道梗阻（P = 0.026）和双室流出道梗阻（P = 0.026）发生率较高。无P/LP变异性HCM组术后早期再阻塞发生率为83.3%(95%可信区间[CI]， 64.7%-100%)， RASopathy组为87% （95% CI, 74.2%-100%）。7年无再梗阻率为76.3% （95% CI, 59.8%-97.2%）。肌瘤性HCM组与RASopathy组左室流出道再阻塞发生率比较，差异有统计学意义（P = 0.025）。线性回归分析显示，RASopathy组年龄与室间隔厚度之间存在显著相关性（P = 0.008; r = 0.48）。结论确定HCM患儿的致病基因有助于评估基因型与心脏表型之间的关系，并可指导治疗策略的选择和预后，特别是对有RASopathies的患儿。

{"title":"The impact of genotype-phenotype on the prognosis of children with hypertrophic cardiomyopathy","authors":"Yabing Duan MD, Ju Wang MD, Jiachen Li MD, Lizhi Lv MD, Qiang Wang MD, Jun Yan MD","doi":"10.1016/j.xjon.2025.101563","DOIUrl":"10.1016/j.xjon.2025.101563","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the relationship between different genotypes and clinical phenotypes within a pediatric hypertrophic cardiomyopathy (HCM) population and explore the impact of various genotypes on patient outcomes.</div></div><div><h3>Methods</h3><div>This study involved 82 pediatric HCM patients. A comprehensive review was conducted of echocardiography results, second-generation whole-exome sequencing (WES) findings, and conditions warranting pathologic examination or surgical intervention.</div></div><div><h3>Results</h3><div>WES was performed in 82 children, of whom 65 (79.3%) and pathogenic or likely pathogenic (P/LP) variants. The median patient age was 6.4 years (interquartile range, 3.8- 11.4 years), 45 (54.9%) were male, and 15 (18.3%) had a definitive family history of HCM. The RASopathy group was diagnosed at a significantly younger age compared to the sarcomeric variant HCM group (<em>P</em> = .0017). Female patients were more common (<em>P</em> = .0001) and the rates of right ventricular outflow tract obstruction (<em>P</em> = .026) and biventricular outflow tract obstruction (<em>P</em> = .026) were higher in the RASopathy group. The freedom from early postoperative reobstruction was 83.3% (95% confidence interval [CI], 64.7%-100%) in the no P/LP variant HCM group and 87% (95% CI, 74.2%-100%) in the RASopathy group. The 7-year freedom from reobstruction was 76.3% (95% CI, 59.8%-97.2%). A statistically significant difference in the incidence of left ventricular outflow tract reobstruction was observed between the sarcomeric HCM group and the RASopathy group (<em>P</em> = .025). Linear regression analysis demonstrated a significant association between age and interventricular septal thickness in the RASopathy group (<em>P</em> = .008; r = 0.48).</div></div><div><h3>Conclusions</h3><div>Identifying pathogenic genes in children with HCM enables the assessment of genotype–cardiac phenotype relationships and can guide treatment strategy selection and prognosis, particularly for children with RASopathies.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101563"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412932","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}

引用次数: 0

Advancing the early detection of lung cancer: Outcomes of a surgeon-led lung nodule clinic in a distressed patient population 推进肺癌的早期发现：一个外科主导的肺结节门诊在一个痛苦的病人群体的结果

IF 1.9

JTCVS open

Pub Date : 2026-02-01 Epub Date: 2025-11-08 DOI: 10.1016/j.xjon.2025.10.025

Albert Dweck BS , Lamisha Shah BS, MS , Saba Saidi BS , Sophia Yanis BA , Grace Ha MD , Rajika Jindani MD, MPH, MS , Tamar Nobel MD, MPH , Marc Vimolratana MD , Daniel Da Costa MD , Brendon M. Stiles MD , Neel P. Chudgar MD

Objective

Lung cancer screening and support for guideline-concordant follow-up of incidental pulmonary nodules are critical to identifying lung cancers at an earlier stage. A surgeon-led lung nodule clinic was developed at our institution, which serves a majority-minority population. We describe outcomes of this initiative.

Methods

A referral for screen-detected and incidental pulmonary nodules was created within our health system during February 2022. Sociodemographic and clinical data, follow-up rates and outcomes of nodule evaluation were collected from February 1, 2022, to December 31, 2024.

Results

During the study period, a total of 1056 referrals were placed for the lung nodule clinic. Of all referrals, 440 were for screen-detected lesions, whereas 616 were for incidental pulmonary nodules. Underrepresented patients accounted for 69.7% (n = 736) of patients, and 342 were Black, whereas 394 were Hispanic. The Distressed Communities Index was also investigated and most patients were categorized as at-risk (n = 478) or distressed (n = 493). In evaluating incidental lesions, 45.9% (n = 283) of patients had nodules >6 mm. In the overall group, positron-emission tomography-computed tomography was recommended for 218 patients, and 143 patients underwent biopsy. Primary lung cancer was diagnosed in 94, of which 59 (62.7%) had stage I disease. Of patients with primary lung cancer, 61 underwent resection with therapeutic intent. A critical stage shift has been identified with stage I diagnoses increasing from 20.2% in 2020 to 35.3% in 2024.

Conclusions

Centralized referral for pulmonary nodules has been embraced within our institution. This referral provides a means for efficient work-up, and continued expansion will likely provide aid in early detection.

目的肺癌筛查和支持偶发肺结节的指导随访是早期发现肺癌的关键。在我们的机构发展了一个外科医生主导的肺结节诊所，服务于多数少数民族人群。我们描述了这一倡议的成果。方法于2022年2月在我们的卫生系统中创建了筛查发现和偶发肺结节的转诊。从2022年2月1日至2024年12月31日收集社会人口学和临床数据、随访率和结节评估结果。结果在研究期间，共有1056例转诊至肺结节门诊。在所有转诊病例中，440例为筛查发现的病变，616例为偶发肺结节。未被充分代表的患者占69.7% (n = 736)，其中黑人342人，西班牙裔394人。还调查了痛苦社区指数，大多数患者被归类为有风险（n = 478）或痛苦（n = 493）。在评估偶发病变时，45.9% （n = 283）的患者有结节（直径6毫米）。在整个组中，218例患者推荐正电子发射断层扫描-计算机断层扫描，143例患者接受活检。94例确诊为原发性肺癌，其中59例（62.7%）为I期肺癌。在原发肺癌患者中，61例接受了有治疗目的的切除术。一个关键的阶段转移已经被确定，第一阶段的诊断率从2020年的20.2%增加到2024年的35.3%。结论我院已接受肺结节集中转诊。这种转诊提供了有效的检查手段，继续扩大可能有助于早期发现。

{"title":"Advancing the early detection of lung cancer: Outcomes of a surgeon-led lung nodule clinic in a distressed patient population","authors":"Albert Dweck BS , Lamisha Shah BS, MS , Saba Saidi BS , Sophia Yanis BA , Grace Ha MD , Rajika Jindani MD, MPH, MS , Tamar Nobel MD, MPH , Marc Vimolratana MD , Daniel Da Costa MD , Brendon M. Stiles MD , Neel P. Chudgar MD","doi":"10.1016/j.xjon.2025.10.025","DOIUrl":"10.1016/j.xjon.2025.10.025","url":null,"abstract":"<div><h3>Objective</h3><div>Lung cancer screening and support for guideline-concordant follow-up of incidental pulmonary nodules are critical to identifying lung cancers at an earlier stage. A surgeon-led lung nodule clinic was developed at our institution, which serves a majority-minority population. We describe outcomes of this initiative.</div></div><div><h3>Methods</h3><div>A referral for screen-detected and incidental pulmonary nodules was created within our health system during February 2022. Sociodemographic and clinical data, follow-up rates and outcomes of nodule evaluation were collected from February 1, 2022, to December 31, 2024.</div></div><div><h3>Results</h3><div>During the study period, a total of 1056 referrals were placed for the lung nodule clinic. Of all referrals, 440 were for screen-detected lesions, whereas 616 were for incidental pulmonary nodules. Underrepresented patients accounted for 69.7% (n = 736) of patients, and 342 were Black, whereas 394 were Hispanic. The Distressed Communities Index was also investigated and most patients were categorized as at-risk (n = 478) or distressed (n = 493). In evaluating incidental lesions, 45.9% (n = 283) of patients had nodules >6 mm. In the overall group, positron-emission tomography-computed tomography was recommended for 218 patients, and 143 patients underwent biopsy. Primary lung cancer was diagnosed in 94, of which 59 (62.7%) had stage I disease. Of patients with primary lung cancer, 61 underwent resection with therapeutic intent. A critical stage shift has been identified with stage I diagnoses increasing from 20.2% in 2020 to 35.3% in 2024.</div></div><div><h3>Conclusions</h3><div>Centralized referral for pulmonary nodules has been embraced within our institution. This referral provides a means for efficient work-up, and continued expansion will likely provide aid in early detection.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101504"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412522","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}

引用次数: 0

Social media in surgery: Navigating evidence, sensationalism, and stewardship 外科手术中的社交媒体：导航证据、哗众取宠和管理

IF 1.9

JTCVS open

Pub Date : 2026-02-01 Epub Date: 2025-11-24 DOI: 10.1016/j.xjon.2025.11.015

Dena G. Shehata MD , Hee-Jung J. Kim BS , Zhuxuan Pan BS , Ammara A. Watkins MD, MPH , Elliot L. Servais MD

引用次数: 0

Reply: Clarifying the role of severe obesity in pediatric heart transplant outcomes 回答：明确严重肥胖在儿童心脏移植结果中的作用

IF 1.9

JTCVS open

Pub Date : 2025-12-01 Epub Date: 2025-09-10 DOI: 10.1016/j.xjon.2025.09.003

Joshua D. Sparks MD , Bahaaldin Alsoufi MD

引用次数: 0

Safety of parenteral anticoagulation as a bridge to warfarin in patients undergoing mechanical aortic valve replacement 机械主动脉瓣置换术患者肠外抗凝作为华法林过渡的安全性

IF 1.9

JTCVS open

Pub Date : 2025-12-01 Epub Date: 2025-09-22 DOI: 10.1016/j.xjon.2025.09.020

Liz Mann PharmD , Bryan A. Whitson MD, PhD , Eric McLaughlin MS , Laura Andino PharmD, MPH , Alan Rozycki PharmD

Objective

To evaluate bleeding rates among patients who received a mechanical aortic valve replacement (mAVR) treated with warfarin monotherapy versus warfarin with a therapeutic parenteral anticoagulant bridge.

Methods

This retrospective, single-center, observational study included patients at least 18 years old who received an mAVR and had anticoagulation ordered by the end of postoperative day 2. Exclusion criteria included an INR goal other than 2-3, a hypercoagulable state, postoperative mechanical circulatory support, delayed sternal closure, pregnancy or incarceration. The primary outcome was International Society of Thrombosis and Hemostasis major bleeding until hospital discharge or 30 days after valve replacement, whichever came first. Secondary outcomes included thromboembolic events, hospital length of stay, and mortality.

Results

A total of 143 patients were included in the final analysis, 112 patients in the therapeutic anticoagulation bridge group and 31 patients in the warfarin monotherapy (no-bridge) group. Eighty-seven percent of the patients were white and 69.2% were male, and the median age was 49 years (interquartile range [IQR], 41-58 years). Sixteen patients (14.3%) in the bridge group experienced a major bleed, compared to 0 patients in the no-bridge group (P = .02). Thromboembolic events occurred in 6.5% of patients in the no-bridge group versus 2.7% in the bridge group (P = .30). There was no difference in mortality between the 2 groups (P = .99).

Conclusions

The use of therapeutic parenteral anticoagulation with warfarin after mAVR significantly increased the rate of major bleeding compared to warfarin monotherapy. Larger prospective studies are needed to confirm these findings.

目的评价在机械主动脉瓣置换术（mAVR）中接受华法林单药治疗与华法林联合静脉外抗凝桥治疗的出血发生率。方法：这项回顾性、单中心、观察性研究纳入了至少18岁、接受mAVR治疗并在术后第2天嘱行抗凝治疗的患者。排除标准包括非2-3的INR指标、高凝状态、术后机械循环支持、延迟胸骨闭合、妊娠或嵌顿。主要终点是国际血栓和止血学会的大出血，直到出院或瓣膜置换术后30天，以先到者为准。次要结局包括血栓栓塞事件、住院时间和死亡率。结果共纳入143例患者，其中治疗性抗凝桥组112例，华法林单药（无桥）组31例。87%的患者为白人，69.2%为男性，中位年龄为49岁（四分位间距[IQR]， 41-58岁）。搭桥组16例（14.3%）发生大出血，无搭桥组0例（P = 0.02）。无桥组6.5%的患者发生血栓栓塞事件，而桥组2.7% （P = 0.30）。两组患者死亡率差异无统计学意义（P = 0.99）。结论与华法林单药治疗相比，mAVR术后静脉外抗凝联合华法林明显增加了大出血发生率。需要更大规模的前瞻性研究来证实这些发现。

{"title":"Safety of parenteral anticoagulation as a bridge to warfarin in patients undergoing mechanical aortic valve replacement","authors":"Liz Mann PharmD , Bryan A. Whitson MD, PhD , Eric McLaughlin MS , Laura Andino PharmD, MPH , Alan Rozycki PharmD","doi":"10.1016/j.xjon.2025.09.020","DOIUrl":"10.1016/j.xjon.2025.09.020","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate bleeding rates among patients who received a mechanical aortic valve replacement (mAVR) treated with warfarin monotherapy versus warfarin with a therapeutic parenteral anticoagulant bridge.</div></div><div><h3>Methods</h3><div>This retrospective, single-center, observational study included patients at least 18 years old who received an mAVR and had anticoagulation ordered by the end of postoperative day 2. Exclusion criteria included an INR goal other than 2-3, a hypercoagulable state, postoperative mechanical circulatory support, delayed sternal closure, pregnancy or incarceration. The primary outcome was International Society of Thrombosis and Hemostasis major bleeding until hospital discharge or 30 days after valve replacement, whichever came first. Secondary outcomes included thromboembolic events, hospital length of stay, and mortality.</div></div><div><h3>Results</h3><div>A total of 143 patients were included in the final analysis, 112 patients in the therapeutic anticoagulation bridge group and 31 patients in the warfarin monotherapy (no-bridge) group. Eighty-seven percent of the patients were white and 69.2% were male, and the median age was 49 years (interquartile range [IQR], 41-58 years). Sixteen patients (14.3%) in the bridge group experienced a major bleed, compared to 0 patients in the no-bridge group (<em>P</em> = .02). Thromboembolic events occurred in 6.5% of patients in the no-bridge group versus 2.7% in the bridge group (<em>P</em> = .30). There was no difference in mortality between the 2 groups (<em>P</em> = .99).</div></div><div><h3>Conclusions</h3><div>The use of therapeutic parenteral anticoagulation with warfarin after mAVR significantly increased the rate of major bleeding compared to warfarin monotherapy. Larger prospective studies are needed to confirm these findings.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 131-137"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698075","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}

引用次数: 0

Predictors of intraoperative donor heart turndown after initial acceptance for transplantation 初次接受移植后术中供体心脏骤停的预测因素

IF 1.9

JTCVS open

Pub Date : 2025-12-01 Epub Date: 2025-10-24 DOI: 10.1016/j.xjon.2025.09.049

Armaan F. Akbar MD, Alice L. Zhou MD, Jessica M. Ruck MD, PhD, Sorush Rokui MD, Dane Paneitz MD, Ahmet Kilic MD

Objective

Because of the low use of potential heart donors, it is important to maximize transplantation and minimize discard of accepted offers. We analyzed national registry data to investigate risk factors for intraoperative turndown of donor hearts that were initially accepted for transplantation.

Methods

All adult deceased donors who donated ≥1 organs during the period from January 2005 to March 2023 in the United Network for Organ Sharing database and received an acceptance or provisional acceptance by a heart team were categorized by heart allograft use versus intraoperative turndown (ITD). We investigated risk factors for ITD using multivariable logistic regression adjusted for covariates with P < .2 on univariate analysis.

Results

Of 48,240 potential adult donors who received an acceptance from a heart transplant center, 43,401 (90.0%) of donors resulted in heart use, 1262 (2.6%) resulted in heart ITD, and 3577 (7.4%) resulted in heart nonuse for other reasons. ITD increased from 0.75% in 2005 to 2.2% in 2023 as a proportion of potential heart recoveries annually (P-trend = .02). On adjusted analysis, the strongest independent risk factor for ITD was donation after circulatory death (adjusted odds ratio, 2.60; 95% confidence interval, 1.86-3.62; P < .001), followed by older donor age (age ≥50 [vs <30] years [adjusted odds ratio, 2.02; 95% confidence interval, 1.59-2.56], P < .001). Additional independent risk factors included left ventricular ejection fraction ≤50%, >10 transfusions during terminal hospitalization, Hispanic and Other (vs White) race/ethnicity, death attributable to stroke, and hypertension.

Conclusions

We identified several factors associated with intraoperative turndown that can inform anticipatory intraoperative evaluation and team coordination while preserving access to donor hearts.

目的由于潜在心脏供体的使用率较低，最大限度地扩大移植和减少已接受供体的丢弃是很重要的。我们分析了国家登记数据，以调查最初接受移植的供体心脏术中降血压的危险因素。方法对2005年1月至2023年3月在美国器官共享网络（United Network for Organ Sharing）数据库中捐献≥1个器官并获得心脏小组接受或临时接受的成年死亡供体按同种异体心脏移植使用与术中拒绝（ITD）进行分类。在单因素分析中，我们使用P <； 2校正协变量的多变量逻辑回归来调查ITD的危险因素。结果48240名接受心脏移植中心的潜在成年捐赠者中，43401名（90.0%）捐赠者使用了心脏，1262名（2.6%）捐赠者发生了心脏过渡段，3577名（7.4%）捐赠者因其他原因没有使用心脏。作为每年潜在心脏恢复的比例，ITD从2005年的0.75%增加到2023年的2.2% （p趋势= 0.02）。经校正分析，ITD的最大独立危险因素是循环死亡后捐献（校正优势比为2.60；95%可信区间为1.86-3.62;P < 0.001），其次是年龄较大的捐献者（年龄≥50 [vs <；30]岁[校正优势比为2.02；95%可信区间为1.59-2.56],P < 001）。其他独立危险因素包括左室射血分数≤50%、住院末期输注次数≤10次、西班牙裔和其他（相对于白人）种族/民族、脑卒中死亡和高血压。结论：我们确定了与术中拒接率相关的几个因素，这些因素可以在保留供体心脏通道的同时，为预期的术中评估和团队协调提供信息。

{"title":"Predictors of intraoperative donor heart turndown after initial acceptance for transplantation","authors":"Armaan F. Akbar MD, Alice L. Zhou MD, Jessica M. Ruck MD, PhD, Sorush Rokui MD, Dane Paneitz MD, Ahmet Kilic MD","doi":"10.1016/j.xjon.2025.09.049","DOIUrl":"10.1016/j.xjon.2025.09.049","url":null,"abstract":"<div><h3>Objective</h3><div>Because of the low use of potential heart donors, it is important to maximize transplantation and minimize discard of accepted offers. We analyzed national registry data to investigate risk factors for intraoperative turndown of donor hearts that were initially accepted for transplantation.</div></div><div><h3>Methods</h3><div>All adult deceased donors who donated ≥1 organs during the period from January 2005 to March 2023 in the United Network for Organ Sharing database and received an acceptance or provisional acceptance by a heart team were categorized by heart allograft use versus intraoperative turndown (ITD). We investigated risk factors for ITD using multivariable logistic regression adjusted for covariates with <em>P</em> < .2 on univariate analysis.</div></div><div><h3>Results</h3><div>Of 48,240 potential adult donors who received an acceptance from a heart transplant center, 43,401 (90.0%) of donors resulted in heart use, 1262 (2.6%) resulted in heart ITD, and 3577 (7.4%) resulted in heart nonuse for other reasons. ITD increased from 0.75% in 2005 to 2.2% in 2023 as a proportion of potential heart recoveries annually (<em>P</em>-trend = .02). On adjusted analysis, the strongest independent risk factor for ITD was donation after circulatory death (adjusted odds ratio, 2.60; 95% confidence interval, 1.86-3.62; <em>P</em> < .001), followed by older donor age (age ≥50 [vs <30] years [adjusted odds ratio, 2.02; 95% confidence interval, 1.59-2.56], <em>P</em> < .001). Additional independent risk factors included left ventricular ejection fraction ≤50%, >10 transfusions during terminal hospitalization, Hispanic and Other (vs White) race/ethnicity, death attributable to stroke, and hypertension.</div></div><div><h3>Conclusions</h3><div>We identified several factors associated with intraoperative turndown that can inform anticipatory intraoperative evaluation and team coordination while preserving access to donor hearts.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 320-330"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698173","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}

引用次数: 0

Surgical experience and long-term outcomes of retrograde type A aortic dissection after thoracic endovascular aortic repair 胸血管内主动脉修复术后逆行A型主动脉夹层的手术经验及远期疗效

IF 1.9

JTCVS open

Pub Date : 2025-12-01 Epub Date: 2025-09-10 DOI: 10.1016/j.xjon.2025.09.006

Yumeng Ji MD , Kai Zhang MD , Chenyu Zhou MD , Wei Gao MD , Bin Hou MD , Ji Wang MD , Kai Xu MD , Shiqi Gao MD , Juntao Qiu MD , Cuntao Yu MD

Objective

To evaluate and summarize the long-term outcomes of surgical treatment in patients who developed retrograde type A aortic dissection (RTAD) following thoracic endovascular aortic repair (TEVAR).

Methods

Between January 2010 and June 2023, patients who underwent surgical treatment for RTAD following TEVAR at Fuwai Hospital were selected for clinical data collection and long-term follow-up. Both early postoperative outcomes and long-term follow-up results were evaluated.

Results

Among 67 patients who underwent surgical treatment for RTAD following TEVAR (33 acute dissections, 34 chronic dissections), 57 (85.1%) received total arch replacement (TAR) combined with frozen elephant trunk (FET). Entry tears were located predominantly in the aortic arch (73.1%). Early mortality was 6.0% (n = 4). The 1-year and 5-year survival rates were 95.1% and 90.5%, respectively. Cardiovascular reintervention rates were 16.4% at 1 year and 23.8% at 5 years. During follow-up, 5-year survival rates were similar in the acute and chronic dissection groups (90.9% vs 85.5%; P = .9). The TAR with FET group was associated with a significantly lower incidence of composite endpoint events compared to other surgical approaches (28.1% vs 70%; P = .034), with Cox analysis showing a 66% risk reduction for endpoint events in the TAR with FET group.

Conclusions

Surgical management of RTAD after TEVAR shows comparable outcomes between acute and chronic cases. TAR with FET was associated with favorable long-term results in our cohort, suggesting that it may be a reasonable approach to consider for these patients. Vigilant follow-up remains essential as RTAD risk persists well beyond the conventional 1-month post-TEVAR period.

目的评价和总结胸血管内主动脉修复术（TEVAR）后发生逆行性A型主动脉夹层（RTAD）手术治疗的远期疗效。方法选择2010年1月至2023年6月阜外医院TEVAR术后行RTAD手术治疗的患者进行临床资料收集和长期随访。对术后早期结果和长期随访结果进行评估。结果在67例TEVAR术后RTAD患者中（急性夹层33例，慢性夹层34例），57例（85.1%）采用全足弓置换术联合冷冻象鼻（FET）。进入性撕裂主要位于主动脉弓（73.1%）。早期死亡率为6.0% （n = 4）。1年和5年生存率分别为95.1%和90.5%。1年心血管再干预率为16.4%，5年为23.8%。随访期间，急慢性夹层组5年生存率相近（90.9% vs 85.5%, P = 0.9）。与其他手术入路相比，TAR + FET组的复合终点事件发生率显著降低（28.1% vs 70%; P = 0.034）， Cox分析显示TAR + FET组的终点事件风险降低66%。结论TEVAR术后RTAD的手术治疗在急性和慢性病例之间具有可比性。在我们的队列中，TAR联合FET与良好的长期结果相关，这表明对于这些患者来说，这可能是一种合理的治疗方法。由于RTAD风险在tevar后的常规1个月之后仍然存在，因此保持警惕的随访至关重要。

{"title":"Surgical experience and long-term outcomes of retrograde type A aortic dissection after thoracic endovascular aortic repair","authors":"Yumeng Ji MD , Kai Zhang MD , Chenyu Zhou MD , Wei Gao MD , Bin Hou MD , Ji Wang MD , Kai Xu MD , Shiqi Gao MD , Juntao Qiu MD , Cuntao Yu MD","doi":"10.1016/j.xjon.2025.09.006","DOIUrl":"10.1016/j.xjon.2025.09.006","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate and summarize the long-term outcomes of surgical treatment in patients who developed retrograde type A aortic dissection (RTAD) following thoracic endovascular aortic repair (TEVAR).</div></div><div><h3>Methods</h3><div>Between January 2010 and June 2023, patients who underwent surgical treatment for RTAD following TEVAR at Fuwai Hospital were selected for clinical data collection and long-term follow-up. Both early postoperative outcomes and long-term follow-up results were evaluated.</div></div><div><h3>Results</h3><div>Among 67 patients who underwent surgical treatment for RTAD following TEVAR (33 acute dissections, 34 chronic dissections), 57 (85.1%) received total arch replacement (TAR) combined with frozen elephant trunk (FET). Entry tears were located predominantly in the aortic arch (73.1%). Early mortality was 6.0% (n = 4). The 1-year and 5-year survival rates were 95.1% and 90.5%, respectively. Cardiovascular reintervention rates were 16.4% at 1 year and 23.8% at 5 years. During follow-up, 5-year survival rates were similar in the acute and chronic dissection groups (90.9% vs 85.5%; <em>P</em> = .9). The TAR with FET group was associated with a significantly lower incidence of composite endpoint events compared to other surgical approaches (28.1% vs 70%; <em>P</em> = .034), with Cox analysis showing a 66% risk reduction for endpoint events in the TAR with FET group.</div></div><div><h3>Conclusions</h3><div>Surgical management of RTAD after TEVAR shows comparable outcomes between acute and chronic cases. TAR with FET was associated with favorable long-term results in our cohort, suggesting that it may be a reasonable approach to consider for these patients. Vigilant follow-up remains essential as RTAD risk persists well beyond the conventional 1-month post-TEVAR period.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 87-96"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698148","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}

引用次数: 0