Pub Date : 2025-10-01DOI: 10.1016/j.xjon.2025.06.020
Joshua G. Crane MD , Gretel Monreal PhD , Steven C. Koenig PhD , Mark S. Slaughter MD
Objective
Patients on venoarterial extracorporeal membrane oxygenation undergoing ipsilateral cannulation may develop distal limb ischemia. We postulate 2 clinical questions: (1) Would contralateral cannulation have a lower distal limb ischemia rate than ipsilateral? (2) Do larger diameter arterial and venous cannulae increase the risk of distal limb ischemia independent of cannulation approach? A dynamic mock loop study investigating the potential hemodynamic benefits and risks of ipsilateral versus contralateral cannulation and cannulae size is presented.
Methods
The hemodynamics of ipsilateral versus contralateral cannulation with arterial (15F, 17F) and venous (23F, 25F) cannulae combinations over pump speeds (0-3000 rpm) delivering 0 to 3.5 L/min extracorporeal membrane oxygenation flow was evaluated in an adult heart failure dynamic mock loop.
Results
In the dynamic mock loop, contralateral cannulation was more effective than ipsilateral at increasing flow and decreasing pressure in both limbs. Increasing arterial cannula size from 15F to 17F enabled higher extracorporeal membrane oxygenation flows but at the expense of greater intravascular obstruction. Venous cannula size (23F, 25F) had no effect on limb hemodynamics.
Conclusions
Our dynamic mock loop findings are consistent with reported Extracorporeal Life Support Organization Registry data and others, while also suggesting added hemodynamic benefits of venoarterial extracorporeal membrane oxygenation using a contralateral approach with the potential for better clinical outcomes.
{"title":"Hemodynamic considerations of ipsilateral versus contralateral cannulation with venoarterial extracorporeal membrane oxygenation","authors":"Joshua G. Crane MD , Gretel Monreal PhD , Steven C. Koenig PhD , Mark S. Slaughter MD","doi":"10.1016/j.xjon.2025.06.020","DOIUrl":"10.1016/j.xjon.2025.06.020","url":null,"abstract":"<div><h3>Objective</h3><div>Patients on venoarterial extracorporeal membrane oxygenation undergoing ipsilateral cannulation may develop distal limb ischemia. We postulate 2 clinical questions: (1) Would contralateral cannulation have a lower distal limb ischemia rate than ipsilateral? (2) Do larger diameter arterial and venous cannulae increase the risk of distal limb ischemia independent of cannulation approach? A dynamic mock loop study investigating the potential hemodynamic benefits and risks of ipsilateral versus contralateral cannulation and cannulae size is presented.</div></div><div><h3>Methods</h3><div>The hemodynamics of ipsilateral versus contralateral cannulation with arterial (15F, 17F) and venous (23F, 25F) cannulae combinations over pump speeds (0-3000 rpm) delivering 0 to 3.5 L/min extracorporeal membrane oxygenation flow was evaluated in an adult heart failure dynamic mock loop.</div></div><div><h3>Results</h3><div>In the dynamic mock loop, contralateral cannulation was more effective than ipsilateral at increasing flow and decreasing pressure in both limbs. Increasing arterial cannula size from 15F to 17F enabled higher extracorporeal membrane oxygenation flows but at the expense of greater intravascular obstruction. Venous cannula size (23F, 25F) had no effect on limb hemodynamics.</div></div><div><h3>Conclusions</h3><div>Our dynamic mock loop findings are consistent with reported Extracorporeal Life Support Organization Registry data and others, while also suggesting added hemodynamic benefits of venoarterial extracorporeal membrane oxygenation using a contralateral approach with the potential for better clinical outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"27 ","pages":"Pages 90-101"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145326927","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 : 2025-10-01DOI: 10.1016/j.xjon.2025.07.016
Siva P. Namachivayam MBios , Johnny Millar PhD , Roberto Chiletti MD , Stephen B. Horton PhD , Christian P. Brizard MD , Warwick Butt MBBS , Igor E. Konstantinov PhD , Yves d’Udekem PhD
Objective
Peritoneal dialysis (PD) commenced early in the postoperative period has the potential to mitigate the postcardiopulmonary bypass inflammatory response. We evaluated the role of early PD on postoperative outcomes after the arterial switch operation (ASO).
Methods
Newborns (≤30 days, n = 318) undergoing ASO were classified into those who did (early PD, n = 90) or did not (control, n = 228) receive PD within 6 hours of admission to intensive care unit after surgery. Using observational data and imitating a preplanned clinical trial (target trial framework), we evaluated the role of early PD on postoperative outcomes.
Results
Infants in the early PD group had greater serum lactate (median [interquartile range]: 2.6 [2.1, 4.1] vs 2.2 [1.8, 2.9]) and lower central venous saturation (median [interquartile range]: 45.2 [39.3, 51.4] vs 51.3 [42.2, 59.9]) at admission. Early PD was associated with a shorter duration of mechanical ventilation, but this effect was restricted to the subgroup receiving extracorporeal membrane oxygenation (ECMO) in the perioperative period (incidence rate ratio [95% confidence interval]: for early PD/control: 0.28 [0.17-0.47] for those requiring ECMO and 1.14 [0.93-1.39] for those not requiring ECMO, P interaction <.001). Similar results were seen for intensive care unit length of stay.
Conclusions
Early PD after ASO was associated with a reduction in duration of mechanical ventilation and intensive care stay for infants who required ECMO in the perioperative period. Future studies of early PD, ideally clinical trials, in high-risk infants (such as those requiring ECMO after cardiac surgery) will be of benefit to either confirm or refute these findings.
{"title":"Role of early peritoneal dialysis after neonatal arterial switch operation","authors":"Siva P. Namachivayam MBios , Johnny Millar PhD , Roberto Chiletti MD , Stephen B. Horton PhD , Christian P. Brizard MD , Warwick Butt MBBS , Igor E. Konstantinov PhD , Yves d’Udekem PhD","doi":"10.1016/j.xjon.2025.07.016","DOIUrl":"10.1016/j.xjon.2025.07.016","url":null,"abstract":"<div><h3>Objective</h3><div>Peritoneal dialysis (PD) commenced early in the postoperative period has the potential to mitigate the postcardiopulmonary bypass inflammatory response. We evaluated the role of early PD on postoperative outcomes after the arterial switch operation (ASO).</div></div><div><h3>Methods</h3><div>Newborns (≤30 days, n = 318) undergoing ASO were classified into those who did (early PD, n = 90) or did not (control, n = 228) receive PD within 6 hours of admission to intensive care unit after surgery. Using observational data and imitating a preplanned clinical trial (target trial framework), we evaluated the role of early PD on postoperative outcomes.</div></div><div><h3>Results</h3><div>Infants in the early PD group had greater serum lactate (median [interquartile range]: 2.6 [2.1, 4.1] vs 2.2 [1.8, 2.9]) and lower central venous saturation (median [interquartile range]: 45.2 [39.3, 51.4] vs 51.3 [42.2, 59.9]) at admission. Early PD was associated with a shorter duration of mechanical ventilation, but this effect was restricted to the subgroup receiving extracorporeal membrane oxygenation (ECMO) in the perioperative period (incidence rate ratio [95% confidence interval]: for early PD/control: 0.28 [0.17-0.47] for those requiring ECMO and 1.14 [0.93-1.39] for those not requiring ECMO, <em>P</em> interaction <.001). Similar results were seen for intensive care unit length of stay.</div></div><div><h3>Conclusions</h3><div>Early PD after ASO was associated with a reduction in duration of mechanical ventilation and intensive care stay for infants who required ECMO in the perioperative period. Future studies of early PD, ideally clinical trials, in high-risk infants (such as those requiring ECMO after cardiac surgery) will be of benefit to either confirm or refute these findings.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"27 ","pages":"Pages 144-156"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327202","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 : 2025-10-01DOI: 10.1016/j.xjon.2025.06.021
Harmik J. Soukiasian MD, Claire Perez MD, Lucas Weiser MD, Kellie Knabe MSN, Woosik Yu MD, Allen Razavi MD, Philicia Moonsamy MD, Raffaele Rocco MD, Andrew R. Brownlee MD
Objective
To evaluate intraoperative pathologic assessment of robotic bronchoscopic biopsies and its role in altering the operative plan.
Methods
We included patients consented for robotic bronchoscopy with biopsy followed by possible pulmonary resection between April 2021 and May 2024. Cohen's kappa test was used to assess agreement between frozen section and final pathology. Diagnostic yield was calculated for strict and intermediate yields, separated into tertiles. Potentially avoidable benign resections were defined as cases in which a benign biopsy result would have excluded surgery.
Results
A total of 107 patients consented for the procedure, with 78 patients meeting the inclusion criteria. The mean age was 67.9 ± 12.1. Patients with a final benign diagnosis were more likely to be younger (61.5 ± 15.3 years vs 69.5 ± 10.7 years; P = .018) and have a solid nodule versus a subsolid nodule (93.8% vs 59.7%; P = .023). Patients with a final malignant diagnosis were more likely to have interval growth on serial computed tomography scans (56.5% vs 6.2%; P < .001). Both strict and intermediate diagnostic yields improved from the early phase to late phase (P = .008 and .283, respectively), with a final yield of 80.8% for both. The potentially avoidable benign resection rate improved over time with each tertile (23.1% vs 15.4% vs 0%; P = .04), while there was no statistical change in the rate of benign diagnosis (26.9% vs 23.1% vs 11.5%; P = .360). Twelve cases were stopped at bronchoscopy, and all intraoperative pathology findings were confirmed by final pathology.
Conclusions
Intraoperative robotic bronchoscopic biopsy provides reliable pathologic information. Combining robotic bronchoscopy with possible surgical resection results in a low benign resection rate.
目的探讨机器人支气管镜活检术中病理评价及其在改变手术方案中的作用。方法：我们纳入了同意在2021年4月至2024年5月期间进行机器人支气管镜活检并可能进行肺切除术的患者。采用Cohen’s kappa试验评估冷冻切片与最终病理的一致性。对严格产量和中间产量进行诊断产量计算，并按三分位数进行划分。潜在可避免的良性切除被定义为良性活检结果排除手术的病例。结果107例患者同意手术，其中78例符合纳入标准。平均年龄67.9±12.1岁。最终诊断为良性的患者更年轻（61.5±15.3岁vs 69.5±10.7岁；P = 0.018），实性结节vs亚实性结节（93.8% vs 59.7%; P = 0.023）。在连续计算机断层扫描中，最终诊断为恶性的患者更有可能出现间隔生长（56.5% vs 6.2%; P < 0.001）。从早期到晚期，严格诊断率和中期诊断率均有所提高（P = 0.008和P = 0.008）。两者的最终收益率均为80.8%。潜在可避免的良性切除率随时间的推移而提高（23.1% vs 15.4% vs 0%, P = 0.04），而良性诊断率无统计学变化（26.9% vs 23.1% vs 11.5%, P = 0.360）。12例经支气管镜检查停诊，术中病理结果均经最终病理证实。结论术中机器人支气管镜活检提供了可靠的病理信息。结合机器人支气管镜检查和可能的手术切除导致良性切除率低。
{"title":"Can we rely on intraoperative bronchoscopic biopsies for surgical decision making? 78 single anesthetic robotic bronchoscopy to anatomic resections","authors":"Harmik J. Soukiasian MD, Claire Perez MD, Lucas Weiser MD, Kellie Knabe MSN, Woosik Yu MD, Allen Razavi MD, Philicia Moonsamy MD, Raffaele Rocco MD, Andrew R. Brownlee MD","doi":"10.1016/j.xjon.2025.06.021","DOIUrl":"10.1016/j.xjon.2025.06.021","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate intraoperative pathologic assessment of robotic bronchoscopic biopsies and its role in altering the operative plan.</div></div><div><h3>Methods</h3><div>We included patients consented for robotic bronchoscopy with biopsy followed by possible pulmonary resection between April 2021 and May 2024. Cohen's kappa test was used to assess agreement between frozen section and final pathology. Diagnostic yield was calculated for strict and intermediate yields, separated into tertiles. Potentially avoidable benign resections were defined as cases in which a benign biopsy result would have excluded surgery.</div></div><div><h3>Results</h3><div>A total of 107 patients consented for the procedure, with 78 patients meeting the inclusion criteria. The mean age was 67.9 ± 12.1. Patients with a final benign diagnosis were more likely to be younger (61.5 ± 15.3 years vs 69.5 ± 10.7 years; <em>P</em> = .018) and have a solid nodule versus a subsolid nodule (93.8% vs 59.7%; <em>P</em> = .023). Patients with a final malignant diagnosis were more likely to have interval growth on serial computed tomography scans (56.5% vs 6.2%; <em>P</em> < .001). Both strict and intermediate diagnostic yields improved from the early phase to late phase (<em>P</em> = .008 and .283, respectively), with a final yield of 80.8% for both. The potentially avoidable benign resection rate improved over time with each tertile (23.1% vs 15.4% vs 0%; <em>P</em> = .04), while there was no statistical change in the rate of benign diagnosis (26.9% vs 23.1% vs 11.5%; <em>P</em> = .360). Twelve cases were stopped at bronchoscopy, and all intraoperative pathology findings were confirmed by final pathology.</div></div><div><h3>Conclusions</h3><div>Intraoperative robotic bronchoscopic biopsy provides reliable pathologic information. Combining robotic bronchoscopy with possible surgical resection results in a low benign resection rate.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"27 ","pages":"Pages 164-172"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327199","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}
To compare the outcomes of classical elephant trunk (CET) + total arch replacement (TAR) and frozen elephant trunk (FET) + TAR using propensity score matching analysis.
Methods
Between 2012 and 2023, 370 patients who underwent TAR were divided into 2 groups based on their elephant trunk type: the CET group (153 patients; 92 men; mean age, 66 ± 13 years) and FET group (217 patients; 116 men; mean age, 64 ± 12 years). Among these patients, 124 from each group were matched using propensity scores to account for differences in patient characteristics.
Results
Early outcomes, such as mortality and morbidity, were similar between the unmatched and matched cohorts. Circulatory arrest time was significantly shorter in the CET group, even after propensity score matching. In matched cohorts, the FET group had significantly higher rates of freedom from dissection-related distal aortic reoperation at 3 years and 5 years (87% and 85%, respectively, in the CET group and 96% and 96%, respectively, in the FET group; P = .008). Cox regression analysis identified the FET procedure (hazard ratio, 0.20; P = .008) is an independent positive inhibitory factor of distal aortic reoperation. Serial sizing analysis revealed that the aortic diameter at the level of the celiac artery was significantly smaller in the FET group even 5 years after the initial surgery.
Conclusions
FET + TAR has potential as the first option for improved mid-term outcomes after surgery for type A acute aortic dissection.
{"title":"Efficacy of total arch replacement with frozen elephant trunk in patients with acute type A aortic dissection","authors":"Yosuke Inoue MD, PhD, Kazufumi Yoshida MD, Yojiro Koda MD, PhD, Takayuki Shijo MD, PhD, Yoshimasa Seike MD, PhD, Hitoshi Matsuda MD, PhD","doi":"10.1016/j.xjon.2025.07.002","DOIUrl":"10.1016/j.xjon.2025.07.002","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the outcomes of classical elephant trunk (CET) + total arch replacement (TAR) and frozen elephant trunk (FET) + TAR using propensity score matching analysis.</div></div><div><h3>Methods</h3><div>Between 2012 and 2023, 370 patients who underwent TAR were divided into 2 groups based on their elephant trunk type: the CET group (153 patients; 92 men; mean age, 66 ± 13 years) and FET group (217 patients; 116 men; mean age, 64 ± 12 years). Among these patients, 124 from each group were matched using propensity scores to account for differences in patient characteristics.</div></div><div><h3>Results</h3><div>Early outcomes, such as mortality and morbidity, were similar between the unmatched and matched cohorts. Circulatory arrest time was significantly shorter in the CET group, even after propensity score matching. In matched cohorts, the FET group had significantly higher rates of freedom from dissection-related distal aortic reoperation at 3 years and 5 years (87% and 85%, respectively, in the CET group and 96% and 96%, respectively, in the FET group; <em>P</em> = .008). Cox regression analysis identified the FET procedure (hazard ratio, 0.20; <em>P</em> = .008) is an independent positive inhibitory factor of distal aortic reoperation. Serial sizing analysis revealed that the aortic diameter at the level of the celiac artery was significantly smaller in the FET group even 5 years after the initial surgery.</div></div><div><h3>Conclusions</h3><div>FET + TAR has potential as the first option for improved mid-term outcomes after surgery for type A acute aortic dissection.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"27 ","pages":"Pages 8-16"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145326929","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 : 2025-10-01DOI: 10.1016/j.xjon.2025.08.001
Claire Woods BA , Mark Shacker BA , Artur Rybachok BS , Parth Patel BS , Noor Jahanshashi BS , Stephanie Gerardin RN, BSN , Cindy Stotts , Enise Yoo-Liu MD , Michael A. Smith MD , Ross M. Bremner MD , Jasmine Huang MD
Objective
Lung cancer screening reduces mortality, but the role of socioeconomic factors in screening rates is unclear. We used the Distressed Communities Index to evaluate how socioeconomic distress impacts lung cancer screening.
Methods
We retrospectively reviewed patients screened for lung cancer at a single institution from July 25, 2016, to January 18, 2024. Distressed Communities Index scores ranged from 0 (no distress) to 100 (severe distress) and were grouped into quintiles. County-level US Census data were used for comparison.
Results
Of 864 patients who underwent screening, 39%, 18%, 16%, 11%, and 16% were in the first, second, third, fourth, and fifth quintiles, respectively. Patients in distressed quintiles had increased rates of active cigarette use (P = .016), minority race (P = .002), and Medicaid health insurance (P < .001). Patients from the highest distress communities were overrepresented in screenings (screened: 16.2% vs county: 10.0%, P < .001), whereas those in mid-tier (screened: 16.4% vs county: 19.7%, P = .015) and at-risk (screened: 11.1% vs county: 13.7%, P = .026) communities were marginally underrepresented. The screened population was predominantly of non-Hispanic White race (screened: 85.0% vs county: 53.3%, P < .001). Hispanic (screened: 5.9% vs county: 30.6%, P < .001) and Asian (screened: 1.6% vs county: 4.5%, P < .001) populations, but not Black populations (screened: 5.3% vs county: 5.5%, P = .882), were underrepresented. Time to biopsy and malignancy rates were similar across Distressed Communities Index quintiles and racial groups.
Conclusions
Minorities face disparities in lung cancer screening access, but when screened, they have outcomes similar to those of nonminorities. The Distressed Communities Index effectively identified communities that could benefit from targeted interventions to improve screening access.
{"title":"Disparities in lung cancer screening among patients in socioeconomically distressed communities","authors":"Claire Woods BA , Mark Shacker BA , Artur Rybachok BS , Parth Patel BS , Noor Jahanshashi BS , Stephanie Gerardin RN, BSN , Cindy Stotts , Enise Yoo-Liu MD , Michael A. Smith MD , Ross M. Bremner MD , Jasmine Huang MD","doi":"10.1016/j.xjon.2025.08.001","DOIUrl":"10.1016/j.xjon.2025.08.001","url":null,"abstract":"<div><h3>Objective</h3><div>Lung cancer screening reduces mortality, but the role of socioeconomic factors in screening rates is unclear. We used the Distressed Communities Index to evaluate how socioeconomic distress impacts lung cancer screening.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients screened for lung cancer at a single institution from July 25, 2016, to January 18, 2024. Distressed Communities Index scores ranged from 0 (no distress) to 100 (severe distress) and were grouped into quintiles. County-level US Census data were used for comparison.</div></div><div><h3>Results</h3><div>Of 864 patients who underwent screening, 39%, 18%, 16%, 11%, and 16% were in the first, second, third, fourth, and fifth quintiles, respectively. Patients in distressed quintiles had increased rates of active cigarette use (<em>P</em> = .016), minority race (<em>P</em> = .002), and Medicaid health insurance (<em>P</em> < .001). Patients from the highest distress communities were overrepresented in screenings (screened: 16.2% vs county: 10.0%, <em>P</em> < .001), whereas those in mid-tier (screened: 16.4% vs county: 19.7%, <em>P</em> = .015) and at-risk (screened: 11.1% vs county: 13.7%, <em>P</em> = .026) communities were marginally underrepresented. The screened population was predominantly of non-Hispanic White race (screened: 85.0% vs county: 53.3%, <em>P</em> < .001). Hispanic (screened: 5.9% vs county: 30.6%, <em>P</em> < .001) and Asian (screened: 1.6% vs county: 4.5%, <em>P</em> < .001) populations, but not Black populations (screened: 5.3% vs county: 5.5%, <em>P</em> = .882), were underrepresented. Time to biopsy and malignancy rates were similar across Distressed Communities Index quintiles and racial groups.</div></div><div><h3>Conclusions</h3><div>Minorities face disparities in lung cancer screening access, but when screened, they have outcomes similar to those of nonminorities. The Distressed Communities Index effectively identified communities that could benefit from targeted interventions to improve screening access.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"27 ","pages":"Pages 231-241"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327252","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 : 2025-10-01DOI: 10.1016/j.xjon.2025.03.024
Mohamad S. Alabdaljabar MBBS , Tedy Sawma MD , S. Allen Luis MBBS, PhD , Juan A. Crestanello MD , Sorin V. Pislaru MD, PhD , Patricia A. Pellikka MD , Heidi M. Connolly MD
{"title":"Overall survival based on risk prediction scores after cardiac surgery in carcinoid heart disease","authors":"Mohamad S. Alabdaljabar MBBS , Tedy Sawma MD , S. Allen Luis MBBS, PhD , Juan A. Crestanello MD , Sorin V. Pislaru MD, PhD , Patricia A. Pellikka MD , Heidi M. Connolly MD","doi":"10.1016/j.xjon.2025.03.024","DOIUrl":"10.1016/j.xjon.2025.03.024","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"27 ","pages":"Pages 55-57"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327255","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 : 2025-10-01DOI: 10.1016/j.xjon.2025.06.022
G. Chad Hughes MD , Michael D. Dake MD , Himanshu J. Patel MD , Jon S. Matsumura MD , Jean M. Panneton MD , Ali Azizzadeh MD , Jason T. Lee MD , William T. Brinkman MD , Alan B. Lumsden MD , Chandler A. Long MD
Background
Thoracic endovascular aortic repair (TEVAR) has become the preferred management strategy for most pathologies involving the descending aorta. When left subclavian artery (LSA) coverage is required during TEVAR to achieve an adequate proximal landing zone (PLZ), revascularization is recommended. Branched endografts represent an alternative to surgical revascularization.
Methods
Across 34 investigative sites, 13 adult patients with isolated lesions (nonaneurysm, nondissection, nontrauma) of the descending thoracic aorta requiring a zone 2 PLZ were enrolled in a prospective, nonrandomized study of a single-branched thoracic aortic endograft (GORE TAG Thoracic Branch Endoprosthesis [TBE]; WL Gore and Associates). The TBE incorporates a single side branch for LSA perfusion in zone 2.
Results
The mean patient age was 65 ± 13 years, and 54% were female. Pathologies included intramural hematoma in 23% (n = 3), penetrating aortic ulcer in 39% (n = 5), and other isolated lesions in 39% (n = 5). The technical success rate of the procedure was 100%; 31% (n = 4) of the patients required distal TEVAR in addition to the TBE device for complete exclusion of their aortic pathology. The median procedure time was 142 minutes (range, 66-357 minutes). No 30-day/in-hospital mortality, stroke, paraparesis/paraplegia, or new dialysis occurred. Through 24-month core laboratory adjudicated imaging follow-up, there have been no type I/III endoleaks, LSA branch patency loss, reinterventions, or aortic enlargement (>5 mm).
Conclusions
Two-year results from this multicenter, prospective, nonrandomized cohort study using an investigational single-branched thoracic endograft for maintaining LSA perfusion in patients with isolated lesions of the descending thoracic aorta demonstrate excellent perioperative and early mid-term outcomes in patients with suitable anatomy.
背景：胸主动脉血管内修复术（TEVAR）已成为大多数降主动脉病变的首选治疗策略。当TEVAR期间需要左锁骨下动脉（LSA）覆盖以获得足够的近端着陆区（PLZ）时，建议进行血运重建术。分支内移植物是外科血管重建术的另一种选择。方法：在34个研究地点，13例需要2区PLZ的胸降主动脉孤立病变（非动脉瘤、非夹层、非创伤）的成年患者被纳入一项前瞻性、非随机的单支胸主动脉内移植术研究（GORE TAG胸椎分支内移植术[TBE]； WL GORE and Associates）。TBE在2区合并了一个用于LSA灌注的单侧分支。结果患者平均年龄65±13岁，女性占54%。病理包括壁内血肿23% (n = 3)，穿透性主动脉溃疡39% (n = 5)，其他孤立性病变39% （n = 5）。手术技术成功率100%；31% （n = 4）的患者需要远端TEVAR和TBE装置来完全排除其主动脉病变。手术时间中位数为142分钟（范围66-357分钟）。未发生30天/住院死亡率、中风、截瘫/截瘫或新的透析。通过24个月的核心实验室确定的影像学随访，没有I/III型内漏，LSA分支通畅丧失，再干预或主动脉扩大（5毫米）。结论：这项为期两年的多中心、前瞻性、非随机队列研究的结果表明，在解剖结构合适的胸降主动脉病变患者中，单支胸腔内移植物用于维持LSA灌注的研究性研究表明，患者围手术期和中期预后良好。
{"title":"Two-year outcomes of endovascular repair of isolated thoracic aortic lesions using a single-branch thoracic endograft with left subclavian artery preservation","authors":"G. Chad Hughes MD , Michael D. Dake MD , Himanshu J. Patel MD , Jon S. Matsumura MD , Jean M. Panneton MD , Ali Azizzadeh MD , Jason T. Lee MD , William T. Brinkman MD , Alan B. Lumsden MD , Chandler A. Long MD","doi":"10.1016/j.xjon.2025.06.022","DOIUrl":"10.1016/j.xjon.2025.06.022","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic endovascular aortic repair (TEVAR) has become the preferred management strategy for most pathologies involving the descending aorta. When left subclavian artery (LSA) coverage is required during TEVAR to achieve an adequate proximal landing zone (PLZ), revascularization is recommended. Branched endografts represent an alternative to surgical revascularization.</div></div><div><h3>Methods</h3><div>Across 34 investigative sites, 13 adult patients with isolated lesions (nonaneurysm, nondissection, nontrauma) of the descending thoracic aorta requiring a zone 2 PLZ were enrolled in a prospective, nonrandomized study of a single-branched thoracic aortic endograft (GORE TAG Thoracic Branch Endoprosthesis [TBE]; WL Gore and Associates). The TBE incorporates a single side branch for LSA perfusion in zone 2.</div></div><div><h3>Results</h3><div>The mean patient age was 65 ± 13 years, and 54% were female. Pathologies included intramural hematoma in 23% (n = 3), penetrating aortic ulcer in 39% (n = 5), and other isolated lesions in 39% (n = 5). The technical success rate of the procedure was 100%; 31% (n = 4) of the patients required distal TEVAR in addition to the TBE device for complete exclusion of their aortic pathology. The median procedure time was 142 minutes (range, 66-357 minutes). No 30-day/in-hospital mortality, stroke, paraparesis/paraplegia, or new dialysis occurred. Through 24-month core laboratory adjudicated imaging follow-up, there have been no type I/III endoleaks, LSA branch patency loss, reinterventions, or aortic enlargement (>5 mm).</div></div><div><h3>Conclusions</h3><div>Two-year results from this multicenter, prospective, nonrandomized cohort study using an investigational single-branched thoracic endograft for maintaining LSA perfusion in patients with isolated lesions of the descending thoracic aorta demonstrate excellent perioperative and early mid-term outcomes in patients with suitable anatomy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"27 ","pages":"Pages 17-24"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145326928","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 : 2025-10-01DOI: 10.1016/j.xjon.2025.07.010
Emily C. Scheffel MPH , Matthew P. Weber MD , Lauryn A. Ridley BS , Sean W.W. Noona MD , Steven D. Young MD , Mohamad El Moheb MD , Raymond Strobel MD, MS , Andrew Young MD , Ramesh Singh MD , Mark Joesph MD , Kenan Yount MD, MBA , Mohammed Quader MD , Nicholas Teman MD , Jared P. Beller MD
Objective
Medical management after multiarterial grafting (MAG) versus single arterial grafting (SAG) in coronary artery bypass grafting (CABG) is less characterized. We sought to identify discharge prescription patterns after CABG on the basis of conduit selection.
Methods
This retrospective study included patients from a 17-institution regional collaborative undergoing isolated CABG from 2020 to 2023. Patients were stratified into MAG and SAG cohorts. Primary analysis included dual antiplatelet therapy (DAPT), anticoagulation, beta-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker discharge prescription rates. Multivariable logistic regression was executed to assess independent associations.
Results
The cohort included 10,966 patients (8904 SAG, 2062 MAG). Patients in the SAG group were significantly older with a median age of 67 years [61, 74] versus 61 years [55, 68] in the MAG cohort. Patients in the SAG group were more likely to present with non−ST-segment elevation myocardial infarction (34.1% vs 31.0%, P < .01) and greater Society of Thoracic Surgeons predicted risk of mortality (1.1% vs 0.7%, P < .01). Patients in the MAG group were more likely to be prescribed DAPT (51.2% vs 70.6%, P < .01), amiodarone (54.2% vs 66.7%, P < .01) and less likely to be prescribed any anticoagulants (12.7% vs 9.1%, P < .01), warfarin (3.2% vs 1.5%, P < .01) or angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (24.6% vs 19.8%, P < .01). After risk adjustment, MAG was independently associated with DAPT (odds ratio, 1.69 [1.4-2.0], P < .01).
Conclusions
Patients undergoing MAG are more likely to be prescribed DAPT at discharge, independent of clinical presentation and baseline comorbidities. Differences in postrevascularization medications between patients who receive MAG and SAG differ and should be considered when comparing groups and outcomes.
目的冠状动脉旁路移植术（CABG）中多动脉移植（MAG）与单动脉移植（SAG）术后的医疗管理差异较小。我们试图在导管选择的基础上确定冠脉搭桥后的出院处方模式。方法本回顾性研究纳入了来自17家区域合作机构的患者，于2020年至2023年接受了孤立的CABG。患者被分为MAG组和SAG组。主要分析包括双重抗血小板治疗（DAPT）、抗凝、受体阻滞剂和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的出院处方率。采用多变量逻辑回归来评估独立关联。结果纳入10966例患者（8904例SAG， 2062例MAG）。SAG组患者的中位年龄为67岁[61,74]，而MAG组的中位年龄为61岁[55,68]。SAG组患者更容易出现非st段抬高型心肌梗死（34.1%比31.0%,P < 01），胸外科学会预测的死亡风险更高（1.1%比0.7%,P < 01）。MAG组患者更有可能使用DAPT （51.2% vs 70.6%, P < 01）、胺碘酮（54.2% vs 66.7%, P < 01），而更少可能使用抗凝剂（12.7% vs 9.1%, P < 01）、华法林（3.2% vs 1.5%, P < 01）或血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（24.6% vs 19.8%, P < 01）。风险调整后，MAG与DAPT独立相关（优势比为1.69 [1.4-2.0],P < 0.01）。结论接受MAG治疗的患者出院时更有可能使用DAPT，与临床表现和基线合并症无关。接受MAG和SAG治疗的患者在血管化后用药方面存在差异，在比较组和结果时应考虑到这一点。
{"title":"Discharge prescription patterns in multiarterial versus single-arterial coronary artery bypass grafting: A regional multicenter cohort analysis","authors":"Emily C. Scheffel MPH , Matthew P. Weber MD , Lauryn A. Ridley BS , Sean W.W. Noona MD , Steven D. Young MD , Mohamad El Moheb MD , Raymond Strobel MD, MS , Andrew Young MD , Ramesh Singh MD , Mark Joesph MD , Kenan Yount MD, MBA , Mohammed Quader MD , Nicholas Teman MD , Jared P. Beller MD","doi":"10.1016/j.xjon.2025.07.010","DOIUrl":"10.1016/j.xjon.2025.07.010","url":null,"abstract":"<div><h3>Objective</h3><div>Medical management after multiarterial grafting (MAG) versus single arterial grafting (SAG) in coronary artery bypass grafting (CABG) is less characterized. We sought to identify discharge prescription patterns after CABG on the basis of conduit selection.</div></div><div><h3>Methods</h3><div>This retrospective study included patients from a 17-institution regional collaborative undergoing isolated CABG from 2020 to 2023. Patients were stratified into MAG and SAG cohorts. Primary analysis included dual antiplatelet therapy (DAPT), anticoagulation, beta-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker discharge prescription rates. Multivariable logistic regression was executed to assess independent associations.</div></div><div><h3>Results</h3><div>The cohort included 10,966 patients (8904 SAG, 2062 MAG). Patients in the SAG group were significantly older with a median age of 67 years [61, 74] versus 61 years [55, 68] in the MAG cohort. Patients in the SAG group were more likely to present with non−ST-segment elevation myocardial infarction (34.1% vs 31.0%, <em>P</em> < .01) and greater Society of Thoracic Surgeons predicted risk of mortality (1.1% vs 0.7%, <em>P</em> < .01). Patients in the MAG group were more likely to be prescribed DAPT (51.2% vs 70.6%, <em>P</em> < .01), amiodarone (54.2% vs 66.7%, <em>P</em> < .01) and less likely to be prescribed any anticoagulants (12.7% vs 9.1%, <em>P</em> < .01), warfarin (3.2% vs 1.5%, <em>P</em> < .01) or angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (24.6% vs 19.8%, <em>P</em> < .01). After risk adjustment, MAG was independently associated with DAPT (odds ratio, 1.69 [1.4-2.0], <em>P</em> < .01).</div></div><div><h3>Conclusions</h3><div>Patients undergoing MAG are more likely to be prescribed DAPT at discharge, independent of clinical presentation and baseline comorbidities. Differences in postrevascularization medications between patients who receive MAG and SAG differ and should be considered when comparing groups and outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"27 ","pages":"Pages 110-119"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327210","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 : 2025-10-01DOI: 10.1016/j.xjon.2025.07.019
Duc M. Giao MD , Dominic P. Recco MD , Matthew Schildmeier BS , Kimberlee Gauvreau ScD , Pakaparn Kittichokechai MD , Gerald R. Marx MD , Christopher W. Baird MD , Pedro J. del Nido MD , Sitaram M. Emani MD
Objective
Valve-sparing root replacement effectively treats aortic root pathology in adults, but data in pediatric patients are limited. We analyzed the midterm outcomes of valve-sparing root replacement in children and adolescents to define the risk factors for reintervention.
Methods
From 2006 to 2023, 80 patients underwent valve-sparing root replacement at 15 [11-19] years; 31 had connective tissue disorders, and 34 had concomitant greater than mild regurgitation. The primary end points were postoperative aortic valve dysfunction and reintervention with secondary outcome of mortality. Root and graft diameters were compared using Cox regression to determine the effect of intraoperative sizing.
Results
The reimplantation technique with straight-tube (n = 38) or Valsalva (n = 40) grafts was used in all patients (except n = 2 remodeling with straight-tube). Thirty-seven patients underwent concurrent valvuloplasty, and 62 patients underwent ascending aortic replacement. Two patients had more than mild regurgitation at discharge with no perioperative mortality. The most common complication was arrhythmia requiring medication (11%). At 3.6 [0.6-8.2] years follow-up, 4 patients died, 20 patients required reoperation (4 re-repairs, 16 replacements), and 13 patients developed more than mild regurgitation. At 12 years, freedom from death, reintervention, and recurrent regurgitation were 92.0% (80.0%-96.9%), 54.3% (36.1%-69.4%), and 48.7% (25.1%-68.7%). For every 0.1 decrease in ratio of graft size to preoperative annulus diameter, reintervention risk increased by 40% (hazard ratio, 1.40 [1.04-1.90], P = .028). A ratio of less than 1.05 maximized model discrimination (hazard ratio, 3.30 [1.15-9.50], C-index 0.68).
Conclusions
Valve-sparing root replacement is safe and effective for aortic root aneurysms in children and young adults. Early arrhythmias, recurrent regurgitation, and midterm reoperation remain concerns. Graft upsizing or leaflet modification should be considered if ratio of intended graft to preoperative diameter is less than 1.05. Preoperative imaging can guide appropriate graft selection and plication extent to mitigate reintervention risk associated with excessive downsizing.
{"title":"Annulus downsizing in valve-sparing aortic root replacement predicts aortic valve reoperation in children and young adults","authors":"Duc M. Giao MD , Dominic P. Recco MD , Matthew Schildmeier BS , Kimberlee Gauvreau ScD , Pakaparn Kittichokechai MD , Gerald R. Marx MD , Christopher W. Baird MD , Pedro J. del Nido MD , Sitaram M. Emani MD","doi":"10.1016/j.xjon.2025.07.019","DOIUrl":"10.1016/j.xjon.2025.07.019","url":null,"abstract":"<div><h3>Objective</h3><div>Valve-sparing root replacement effectively treats aortic root pathology in adults, but data in pediatric patients are limited. We analyzed the midterm outcomes of valve-sparing root replacement in children and adolescents to define the risk factors for reintervention.</div></div><div><h3>Methods</h3><div>From 2006 to 2023, 80 patients underwent valve-sparing root replacement at 15 [11-19] years; 31 had connective tissue disorders, and 34 had concomitant greater than mild regurgitation. The primary end points were postoperative aortic valve dysfunction and reintervention with secondary outcome of mortality. Root and graft diameters were compared using Cox regression to determine the effect of intraoperative sizing.</div></div><div><h3>Results</h3><div>The reimplantation technique with straight-tube (n = 38) or Valsalva (n = 40) grafts was used in all patients (except n = 2 remodeling with straight-tube). Thirty-seven patients underwent concurrent valvuloplasty, and 62 patients underwent ascending aortic replacement. Two patients had more than mild regurgitation at discharge with no perioperative mortality. The most common complication was arrhythmia requiring medication (11%). At 3.6 [0.6-8.2] years follow-up, 4 patients died, 20 patients required reoperation (4 re-repairs, 16 replacements), and 13 patients developed more than mild regurgitation. At 12 years, freedom from death, reintervention, and recurrent regurgitation were 92.0% (80.0%-96.9%), 54.3% (36.1%-69.4%), and 48.7% (25.1%-68.7%). For every 0.1 decrease in ratio of graft size to preoperative annulus diameter, reintervention risk increased by 40% (hazard ratio, 1.40 [1.04-1.90], <em>P</em> = .028). A ratio of less than 1.05 maximized model discrimination (hazard ratio, 3.30 [1.15-9.50], C-index 0.68).</div></div><div><h3>Conclusions</h3><div>Valve-sparing root replacement is safe and effective for aortic root aneurysms in children and young adults. Early arrhythmias, recurrent regurgitation, and midterm reoperation remain concerns. Graft upsizing or leaflet modification should be considered if ratio of intended graft to preoperative diameter is less than 1.05. Preoperative imaging can guide appropriate graft selection and plication extent to mitigate reintervention risk associated with excessive downsizing.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"27 ","pages":"Pages 120-131"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327211","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 : 2025-10-01DOI: 10.1016/j.xjon.2025.05.011
Maroun Yammine MD, Sophia Hsien MD, Patricia Moscicki MD, Yun Zhang PhD, Marlon Rosenbaum MD, Andrew J. Einstein MD, PhD, Jonathan Kochav MD, Alexandra Channing MD, Edward Buratto MD, PhD, Andrew Goldstone MD, PhD, David Kalfa MD, PhD, Emile Bacha MD, Kanwal M. Farooqi MD
Background
Considerations in the management of anomalous aortic origin of a coronary artery (AAOCA) in adults differ from those in the pediatric population owing to the difference in risk profile. In adults for whom surgery is indicated, data on surgical outcomes can help guide decision making.
Methods
Between January 2006 and January 2023, adults who underwent surgery for AAOCA were identified from our retrospective registry that includes medically and surgically managed patients of all ages. We reviewed the preoperative and operative characteristics and in-hospital and 30-day follow-up data for the surgical adult population.
Results
A total of 316 patients with AAOCA were identified, 123 of whom (38.9%) were adults, of whom 54 (43.9%) underwent surgery. The median age of the operative adult cohort was 46 years (interquartile range, 35-52 years), and 51.9% (n = 28) were female. Presentation was because of symptoms in 85% (n = 46), including exertional chest pain in 51.9% (n = 28). Preoperative workup included cardiac computed tomography angiography in 94% (n = 51) and stress testing in 66.7% (n = 36), which was positive in 47% of these 36 patients. Anomalous left coronary was diagnosed in 35.2% of the 54 patients (n = 19), anomalous right in 63.0% (n = 34), and left coronary from noncoronary sinus in 1.9% (n = 1). Surgical approaches included unroofing in 92.6% (n = 50) with commissure resuspension in 7.4% (n = 4), and CABG in 9.2% (n = 5), as a salvage operation in 3.7% (n = 2). There was no operative mortality or stroke. New left ventricular dysfunction was severe in 1 patient (1.9%), and new aortic regurgitation was mild in 2 patients (3.7%).
Conclusions
Knowledge of the various surgical approaches is essential to providing safe treatment for adult patients with AAOCA. While unroofing should remain the mainstay approach, there remains a role for CABG when proximal surgery is not sufficient, possible, or successful.
{"title":"Surgical approach and outcomes in adults with anomalous aortic origin of coronary arteries at a reference center: Outcomes of proximal coronary surgery","authors":"Maroun Yammine MD, Sophia Hsien MD, Patricia Moscicki MD, Yun Zhang PhD, Marlon Rosenbaum MD, Andrew J. Einstein MD, PhD, Jonathan Kochav MD, Alexandra Channing MD, Edward Buratto MD, PhD, Andrew Goldstone MD, PhD, David Kalfa MD, PhD, Emile Bacha MD, Kanwal M. Farooqi MD","doi":"10.1016/j.xjon.2025.05.011","DOIUrl":"10.1016/j.xjon.2025.05.011","url":null,"abstract":"<div><h3>Background</h3><div>Considerations in the management of anomalous aortic origin of a coronary artery (AAOCA) in adults differ from those in the pediatric population owing to the difference in risk profile. In adults for whom surgery is indicated, data on surgical outcomes can help guide decision making.</div></div><div><h3>Methods</h3><div>Between January 2006 and January 2023, adults who underwent surgery for AAOCA were identified from our retrospective registry that includes medically and surgically managed patients of all ages. We reviewed the preoperative and operative characteristics and in-hospital and 30-day follow-up data for the surgical adult population.</div></div><div><h3>Results</h3><div>A total of 316 patients with AAOCA were identified, 123 of whom (38.9%) were adults, of whom 54 (43.9%) underwent surgery. The median age of the operative adult cohort was 46 years (interquartile range, 35-52 years), and 51.9% (n = 28) were female. Presentation was because of symptoms in 85% (n = 46), including exertional chest pain in 51.9% (n = 28). Preoperative workup included cardiac computed tomography angiography in 94% (n = 51) and stress testing in 66.7% (n = 36), which was positive in 47% of these 36 patients. Anomalous left coronary was diagnosed in 35.2% of the 54 patients (n = 19), anomalous right in 63.0% (n = 34), and left coronary from noncoronary sinus in 1.9% (n = 1). Surgical approaches included unroofing in 92.6% (n = 50) with commissure resuspension in 7.4% (n = 4), and CABG in 9.2% (n = 5), as a salvage operation in 3.7% (n = 2). There was no operative mortality or stroke. New left ventricular dysfunction was severe in 1 patient (1.9%), and new aortic regurgitation was mild in 2 patients (3.7%).</div></div><div><h3>Conclusions</h3><div>Knowledge of the various surgical approaches is essential to providing safe treatment for adult patients with AAOCA. While unroofing should remain the mainstay approach, there remains a role for CABG when proximal surgery is not sufficient, possible, or successful.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"27 ","pages":"Pages 62-68"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327249","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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