JTCVS open最新文献_第9页

Nationwide analysis of case volume and outcomes in cardiac surgery during the COVID-19 pandemic COVID-19 大流行期间全国心脏外科病例量和结果分析

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.02.024

Jean-Luc A. Maigrot BS , Guangjin Zhou PhD , Siran M. Koroukian PhD , Aaron J. Weiss MD, PhD , A. Marc Gillinov MD , Faisal Bakaeen MD , Lars G. Svensson MD, PhD , Edward G. Soltesz MD, MPH

引用次数: 0

Timeliness of surgery for early-stage lung cancer: Patient factors and predictors 早期肺癌手术的及时性：患者因素和预测因素

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.02.019

Jeffrey Zhu MSPH , Sydney Kantor MBA , Jiafang Zhang MS , Rowena Yip PhD, MPH , Raja M. Flores MD , Claudia I. Henschke PhD, MD , David F. Yankelevitz MD

Objectives

Time-to-treatment initiation is an important consideration for patients undergoing thoracic surgery for early-stage lung cancer because delays have the potential to adversely affect outcomes. This study seeks to quantify time-to-treatment initiation for patients with clinical stage I lung cancer, explore patient factors and predictors that lead to an increased time-to-treatment initiation, and compare surgeon perception of appropriate time-to-treatment initiation to the results.

Methods

Time-to-treatment initiation was determined for patients enrolled in the Mount Sinai Initiative for Early Lung Cancer Research on Treatment study who underwent surgical resection for clinical stage I lung cancer between March 2016 and December 2021. The following dates were determined: (1) date of first suspicious radiologic imaging, (2) date of first biopsy, and (3) date of surgery. A total of 15 thoracic surgeons who participated in the Mount Sinai Initiative for Early Lung Cancer Research on Treatment were assessed on their perception on time-to-treatment initiation.

Results

For 638 patients, median time from first suspicious imaging findings to biopsy was 40 days, biopsy to surgery was 37 days, and suspicious imaging to surgery was 84 days. Significant factors that resulted in longer time-to-treatment initiation in the multivariate analysis were African American or Black race (P = .005), vascular disease (P = .01), and median household income less than $75,000 (P = .04). Although the surgeon's perception was that the average time from biopsy to surgery was 28 days, it was longer for 63.5% of participants; surgeon perception of maximum time between diagnosis and surgery was 84 days and longer for 28.7% of participants.

Conclusions

Patient factors such as race, income, and comorbidities were found to have differences in time-to-treatment initiation. Delays to surgery exceeded the expectations of thoracic surgeons.

目的对于接受胸腔镜手术治疗的早期肺癌患者来说，开始治疗的时间是一个重要的考虑因素，因为延误治疗可能会对预后产生不利影响。本研究旨在量化临床 I 期肺癌患者开始治疗的时间，探索导致开始治疗时间延长的患者因素和预测因素，并比较外科医生对适当开始治疗时间的认知和结果。方法对 2016 年 3 月至 2021 年 12 月期间参加西奈山早期肺癌治疗研究倡议（Mount Sinai Initiative for Early Lung Cancer Research on Treatment）研究并接受临床 I 期肺癌手术切除的患者确定开始治疗的时间。确定了以下日期：（1）首次可疑放射成像日期；（2）首次活检日期；（3）手术日期。共有 15 名胸外科医生参与了西奈山肺癌早期治疗研究计划，他们对开始治疗时间的看法接受了评估。结果在 638 名患者中，从首次可疑影像学检查结果到活检的中位时间为 40 天，活检到手术的中位时间为 37 天，可疑影像学检查结果到手术的中位时间为 84 天。在多变量分析中，非裔美国人或黑人种族（P = .005）、血管疾病（P = .01）和家庭收入中位数低于 75,000 美元（P = .04）是导致开始治疗时间延长的重要因素。虽然外科医生认为从活检到手术的平均时间为 28 天，但 63.5% 的参与者认为时间更长；外科医生认为从诊断到手术的最长时间为 84 天，28.7% 的参与者认为时间更长。手术延迟时间超出了胸外科医生的预期。

{"title":"Timeliness of surgery for early-stage lung cancer: Patient factors and predictors","authors":"Jeffrey Zhu MSPH , Sydney Kantor MBA , Jiafang Zhang MS , Rowena Yip PhD, MPH , Raja M. Flores MD , Claudia I. Henschke PhD, MD , David F. Yankelevitz MD","doi":"10.1016/j.xjon.2024.02.019","DOIUrl":"10.1016/j.xjon.2024.02.019","url":null,"abstract":"<div><h3>Objectives</h3><p>Time-to-treatment initiation is an important consideration for patients undergoing thoracic surgery for early-stage lung cancer because delays have the potential to adversely affect outcomes. This study seeks to quantify time-to-treatment initiation for patients with clinical stage I lung cancer, explore patient factors and predictors that lead to an increased time-to-treatment initiation, and compare surgeon perception of appropriate time-to-treatment initiation to the results.</p></div><div><h3>Methods</h3><p>Time-to-treatment initiation was determined for patients enrolled in the Mount Sinai Initiative for Early Lung Cancer Research on Treatment study who underwent surgical resection for clinical stage I lung cancer between March 2016 and December 2021. The following dates were determined: (1) date of first suspicious radiologic imaging, (2) date of first biopsy, and (3) date of surgery. A total of 15 thoracic surgeons who participated in the Mount Sinai Initiative for Early Lung Cancer Research on Treatment were assessed on their perception on time-to-treatment initiation.</p></div><div><h3>Results</h3><p>For 638 patients, median time from first suspicious imaging findings to biopsy was 40 days, biopsy to surgery was 37 days, and suspicious imaging to surgery was 84 days. Significant factors that resulted in longer time-to-treatment initiation in the multivariate analysis were African American or Black race (<em>P</em> = .005), vascular disease (<em>P</em> = .01), and median household income less than $75,000 (<em>P</em> = .04). Although the surgeon's perception was that the average time from biopsy to surgery was 28 days, it was longer for 63.5% of participants; surgeon perception of maximum time between diagnosis and surgery was 84 days and longer for 28.7% of participants.</p></div><div><h3>Conclusions</h3><p>Patient factors such as race, income, and comorbidities were found to have differences in time-to-treatment initiation. Delays to surgery exceeded the expectations of thoracic surgeons.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 325-337"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000548/pdfft?md5=4c68c26ec0edd07d2c5eb95061f0c580&pid=1-s2.0-S2666273624000548-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279442","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}

引用次数: 0

The effect of treatment timing on repeat revascularization in patients with stable ischemic heart disease 治疗时机对稳定型缺血性心脏病患者重复血管重建的影响

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.04.009

Sean Hardiman PhD, MHA , Guy Fradet MD, MSc , Lisa Kuramoto MSc , Michael Law PhD , Simon Robinson MB, ChB, MD , Boris Sobolev PhD

Objectives

In patients with stable ischemic heart disease, there is no evidence for the effect of revascularization treatment timing on the need for repeat procedures. We aimed to determine if repeat revascularizations differed among patients who received coronary artery bypass graft surgery after the time recommended by physicians compared with those who had timely percutaneous coronary intervention.

Methods

We identified 25,520 British Columbia residents 60 years or older who underwent first-time nonemergency revascularization for angiographically proven, stable left main or multivessel ischemic heart disease between January 1, 2001, and December 31, 2016. We estimated unadjusted and adjusted cumulative incidence functions for repeat revascularization, in the presence of death as a competing risk, after index revascularization or last staged percutaneous coronary intervention for patients undergoing delayed coronary artery bypass grafting compared with timely percutaneous coronary intervention.

Results

After adjustment with inverse probability of treatment weights, at 3 years, patients who underwent delayed coronary artery bypass grafting had a statistically significant lower cumulative incidence of a repeat revascularization compared with patients who received timely percutaneous coronary intervention (4.84% delayed coronary artery bypass grafting, 12.32% timely percutaneous coronary intervention; subdistribution hazard ratio, 0.16, 95% CI, 0.04-0.65).

Conclusions

Patients who undergo delayed coronary artery bypass grafting have a lower cumulative incidence of repeat revascularization than patients who undergo timely percutaneous coronary intervention. Patients who want to wait to receive coronary artery bypass grafting will see the benefit of lower repeat revascularization over percutaneous coronary intervention unaffected by a delay in treatment.

目标在稳定型缺血性心脏病患者中，没有证据表明血管重建治疗时机对重复手术的需求有影响。我们旨在确定在医生建议的时间后接受冠状动脉旁路移植手术的患者与及时接受经皮冠状动脉介入治疗的患者相比，重复血管再通的情况是否有所不同。方法我们确定了 25520 名 60 岁或以上的不列颠哥伦比亚省居民，他们在 2001 年 1 月 1 日至 2016 年 12 月 31 日期间因血管造影证实的稳定型左主干或多支血管缺血性心脏病接受了首次非急诊血管再通治疗。与及时接受经皮冠状动脉介入治疗的患者相比，我们估算了延迟接受冠状动脉旁路移植术的患者在指数血管重建或最后一次分期经皮冠状动脉介入治疗后，在死亡作为竞争风险的情况下，重复血管重建的未调整和调整累积发病率函数。结果经治疗权重逆概率调整后，3 年后，与及时接受经皮冠状动脉介入治疗的患者相比，接受延迟冠状动脉旁路移植术的患者重复血管再通的累积发生率有显著统计学意义（4.结论与及时接受经皮冠状动脉介入治疗的患者相比，接受延迟冠状动脉旁路移植术的患者重复血管再通的累积发生率较低。希望等待接受冠状动脉搭桥术的患者将看到，与经皮冠状动脉介入治疗相比，延迟治疗带来的重复血管再通发生率较低的益处不受影响。

{"title":"The effect of treatment timing on repeat revascularization in patients with stable ischemic heart disease","authors":"Sean Hardiman PhD, MHA , Guy Fradet MD, MSc , Lisa Kuramoto MSc , Michael Law PhD , Simon Robinson MB, ChB, MD , Boris Sobolev PhD","doi":"10.1016/j.xjon.2024.04.009","DOIUrl":"10.1016/j.xjon.2024.04.009","url":null,"abstract":"<div><h3>Objectives</h3><p>In patients with stable ischemic heart disease, there is no evidence for the effect of revascularization treatment timing on the need for repeat procedures. We aimed to determine if repeat revascularizations differed among patients who received coronary artery bypass graft surgery after the time recommended by physicians compared with those who had timely percutaneous coronary intervention.</p></div><div><h3>Methods</h3><p>We identified 25,520 British Columbia residents 60 years or older who underwent first-time nonemergency revascularization for angiographically proven, stable left main or multivessel ischemic heart disease between January 1, 2001, and December 31, 2016. We estimated unadjusted and adjusted cumulative incidence functions for repeat revascularization, in the presence of death as a competing risk, after index revascularization or last staged percutaneous coronary intervention for patients undergoing delayed coronary artery bypass grafting compared with timely percutaneous coronary intervention.</p></div><div><h3>Results</h3><p>After adjustment with inverse probability of treatment weights, at 3 years, patients who underwent delayed coronary artery bypass grafting had a statistically significant lower cumulative incidence of a repeat revascularization compared with patients who received timely percutaneous coronary intervention (4.84% delayed coronary artery bypass grafting, 12.32% timely percutaneous coronary intervention; subdistribution hazard ratio, 0.16, 95% CI, 0.04-0.65).</p></div><div><h3>Conclusions</h3><p>Patients who undergo delayed coronary artery bypass grafting have a lower cumulative incidence of repeat revascularization than patients who undergo timely percutaneous coronary intervention. Patients who want to wait to receive coronary artery bypass grafting will see the benefit of lower repeat revascularization over percutaneous coronary intervention unaffected by a delay in treatment.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 164-174"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001116/pdfft?md5=c41fdb3883983137ac32d3c05190baf8&pid=1-s2.0-S2666273624001116-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140779381","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}

引用次数: 0

Effects of implantation height on the performance of a redo transcatheter aortic valve replacement using a balloon-expandable valve 植入高度对使用球囊扩张瓣膜的重做经导管主动脉瓣置换术性能的影响

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.02.021

Huang Chen PhD , Milad Samaee PhD , Pradeep Yadav MD , Vinod Thourani MD , Lakshmi Prasad Dasi PhD

Objective

The use of the transcatheter aortic valve in low-risk patients might lead to a second intervention due to the deterioration of the first 1. Understanding the implantation height is key to an effective redo transcatheter aortic valve replacement treatment.

Methods

The effects of implantation height on the performance of a balloon-expandable valve within a self-expandable valve were assessed using hemodynamic testing and particle image velocimetry. The hemodynamic performances, leaflet kinematics, and turbulent shear stresses were measured and compared.

Results

When a second balloon-expandable valve was positioned at varying heights relative to the first self-expandable valve, the leaflet motion of the first valve transitioned from free opening and closing to overhanging, and eventually to being entirely pinned to the stent, forming a neo-skirt. When the leaflets of the self-expandable valve could move freely, a decrease in regurgitation fraction was observed, but with an increased pressure gradient across the valve. Flow visualization indicated that the overhanging leaflets disrupted the flow, generating a higher level of turbulence.

Conclusions

This study suggests that the overhanging leaflets should be avoided, whereas the other 2 scenarios should be carefully evaluated based on an individual patient's anatomy and the cause of failure of the first valve.

方法采用血流动力学测试和粒子图像测速仪评估了植入高度对自扩张瓣内球囊扩张瓣性能的影响。结果当第二个球囊扩张瓣膜相对于第一个自体扩张瓣膜以不同高度定位时，第一个瓣膜的瓣叶运动从自由开闭过渡到悬垂，最终完全固定在支架上，形成一个新裙边。当自扩张瓣膜的瓣叶可以自由运动时，反流率下降，但瓣膜上的压力梯度增加。本研究表明，应避免使用悬垂瓣叶，而其他两种情况则应根据患者的解剖结构和第一个瓣膜失效的原因进行仔细评估。

{"title":"Effects of implantation height on the performance of a redo transcatheter aortic valve replacement using a balloon-expandable valve","authors":"Huang Chen PhD , Milad Samaee PhD , Pradeep Yadav MD , Vinod Thourani MD , Lakshmi Prasad Dasi PhD","doi":"10.1016/j.xjon.2024.02.021","DOIUrl":"https://doi.org/10.1016/j.xjon.2024.02.021","url":null,"abstract":"<div><h3>Objective</h3><p>The use of the transcatheter aortic valve in low-risk patients might lead to a second intervention due to the deterioration of the first 1. Understanding the implantation height is key to an effective redo transcatheter aortic valve replacement treatment.</p></div><div><h3>Methods</h3><p>The effects of implantation height on the performance of a balloon-expandable valve within a self-expandable valve were assessed using hemodynamic testing and particle image velocimetry. The hemodynamic performances, leaflet kinematics, and turbulent shear stresses were measured and compared.</p></div><div><h3>Results</h3><p>When a second balloon-expandable valve was positioned at varying heights relative to the first self-expandable valve, the leaflet motion of the first valve transitioned from free opening and closing to overhanging, and eventually to being entirely pinned to the stent, forming a neo-skirt. When the leaflets of the self-expandable valve could move freely, a decrease in regurgitation fraction was observed, but with an increased pressure gradient across the valve. Flow visualization indicated that the overhanging leaflets disrupted the flow, generating a higher level of turbulence.</p></div><div><h3>Conclusions</h3><p>This study suggests that the overhanging leaflets should be avoided, whereas the other 2 scenarios should be carefully evaluated based on an individual patient's anatomy and the cause of failure of the first valve.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 61-67"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000561/pdfft?md5=af9497c1ab8208ff97c409c0e9b792b3&pid=1-s2.0-S2666273624000561-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141325205","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}

引用次数: 0

Discussion to: Noncomplex ventricular arrhythmia associated with higher freedom from recurrent ectopy at 1 year after mitral repair surgery 讨论到：非复杂性室性心律失常与二尖瓣修复手术后 1 年内复发性异位发生率较高有关。

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.04.015

引用次数: 0

National trends, safety, and effectiveness of minimally invasive concomitant chest wall resection for locally advanced lung cancer 局部晚期肺癌微创同期胸壁切除术的全国趋势、安全性和有效性

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.016

Shawn Purnell MD , Ayham Odeh MD , Richard Freeman MD, MBA , Wissam Raad MD, FACS , Elliot Servais MD, FACS , Zaid Abdelsattar MD, MS, FACS

Objective

Concomitant chest wall resection for locally advanced lung cancer is traditionally performed via an open approach. The safety and effectiveness of minimally invasive approaches for chest wall resections are unknown.

Methods

We used the National Cancer Database to identify patients undergoing lobectomy/bi-lobectomy with concomitant chest wall resection from 2010 to 2020. We stratified patients into those undergoing a minimally invasive resection (video-assisted thoracoscopic surgery [VATS]/robotic) or open, while accounting for conversions. We also compared VATS with robotic approaches. The main outcomes were length of stay, mortality, readmissions, and overall survival. We used multivariable, Kaplan-Meier and Cox proportional models to identify associations.

Results

Of 2837 patients, 756 procedures (26.6%) were started minimally invasive, of which 23.1% were robotic. There were 237 (31.3%) conversions. Patients undergoing a minimally invasive operation were similar in terms of age (65.2 ± 9.8 years vs 66.0 ± 9.9 years), sex, race, tumor histology, and location (all P > .05) but had smaller cancers (5.4 ± 2.6 cm vs 6.2 ± 4.3 cm; P < .001) compared with those undergoing open. They also had shorter length of stay (8.6 ± 7.6 days vs 9.7 ± 9.3 days; P < .001) but similar unadjusted 90-day mortality (8.2% vs 8.0%; P = .999). Neoadjuvant therapy was associated with less minimally invasive approaches (adjusted odds ratio, 0.69; P ≤ .001). Larger cancers were associated with less minimally invasive operations and greater rates of conversions. However, the robotic approach was associated with lower conversion rates than VATS across all tumor sizes. Overall survival was equivalent.

Conclusions

The use of minimally invasive approaches to concomitant chest wall resection is increasing. Although conversions to open are common, this approach is safe and is associated with shorter hospital stays. Overall survival is equivalent to the open approach.

目的局部晚期肺癌的胸壁同期切除术传统上是通过开放式方法进行的。方法我们利用国家癌症数据库识别了 2010 年至 2020 年期间接受肺叶切除术/双叶切除术并同时接受胸壁切除术的患者。我们将患者分为接受微创切除术（视频辅助胸腔镜手术 [VATS]/机器人手术）或开放手术的患者，同时考虑了转换手术。我们还比较了视频辅助胸腔镜手术和机器人手术。主要结果包括住院时间、死亡率、再入院率和总生存率。我们使用了多变量、Kaplan-Meier 和 Cox 比例模型来确定两者之间的关联。有 237 例（31.3%）患者转为微创手术。接受微创手术的患者在年龄（65.2 ± 9.8 岁 vs 66.0 ± 9.9 岁）、性别、种族、肿瘤组织学和位置（均为 P >.05）方面相似，但与接受开放手术的患者相比，他们的癌细胞更小（5.4 ± 2.6 cm vs 6.2 ± 4.3 cm; P <.001）。他们的住院时间也较短（8.6 ± 7.6 天 vs 9.7 ± 9.3 天；P < .001），但未经调整的 90 天死亡率相似（8.2% vs 8.0%；P = .999）。新辅助治疗与较少的微创方法有关（调整后的几率比为0.69；P≤.001）。较大的癌症与较少的微创手术和较高的转换率有关。然而，在所有大小的肿瘤中，机器人方法的转换率均低于VATS方法。结论同时进行胸壁切除术的微创方法越来越多。虽然转为开胸手术的情况很常见，但这种方法很安全，而且住院时间较短。总生存率与开放式方法相当。

{"title":"National trends, safety, and effectiveness of minimally invasive concomitant chest wall resection for locally advanced lung cancer","authors":"Shawn Purnell MD , Ayham Odeh MD , Richard Freeman MD, MBA , Wissam Raad MD, FACS , Elliot Servais MD, FACS , Zaid Abdelsattar MD, MS, FACS","doi":"10.1016/j.xjon.2024.03.016","DOIUrl":"10.1016/j.xjon.2024.03.016","url":null,"abstract":"<div><h3>Objective</h3><p>Concomitant chest wall resection for locally advanced lung cancer is traditionally performed via an open approach. The safety and effectiveness of minimally invasive approaches for chest wall resections are unknown.</p></div><div><h3>Methods</h3><p>We used the National Cancer Database to identify patients undergoing lobectomy/bi-lobectomy with concomitant chest wall resection from 2010 to 2020. We stratified patients into those undergoing a minimally invasive resection (video-assisted thoracoscopic surgery [VATS]/robotic) or open, while accounting for conversions. We also compared VATS with robotic approaches. The main outcomes were length of stay, mortality, readmissions, and overall survival. We used multivariable, Kaplan-Meier and Cox proportional models to identify associations.</p></div><div><h3>Results</h3><p>Of 2837 patients, 756 procedures (26.6%) were started minimally invasive, of which 23.1% were robotic. There were 237 (31.3%) conversions. Patients undergoing a minimally invasive operation were similar in terms of age (65.2 ± 9.8 years vs 66.0 ± 9.9 years), sex, race, tumor histology, and location (all <em>P</em> > .05) but had smaller cancers (5.4 ± 2.6 cm vs 6.2 ± 4.3 cm; <em>P</em> < .001) compared with those undergoing open. They also had shorter length of stay (8.6 ± 7.6 days vs 9.7 ± 9.3 days; <em>P</em> < .001) but similar unadjusted 90-day mortality (8.2% vs 8.0%; <em>P</em> = .999). Neoadjuvant therapy was associated with less minimally invasive approaches (adjusted odds ratio, 0.69; <em>P</em> ≤ .001). Larger cancers were associated with less minimally invasive operations and greater rates of conversions. However, the robotic approach was associated with lower conversion rates than VATS across all tumor sizes. Overall survival was equivalent.</p></div><div><h3>Conclusions</h3><p>The use of minimally invasive approaches to concomitant chest wall resection is increasing. Although conversions to open are common, this approach is safe and is associated with shorter hospital stays. Overall survival is equivalent to the open approach.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 311-324"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000974/pdfft?md5=23e283284243639c052996ec280658de&pid=1-s2.0-S2666273624000974-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775997","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}

引用次数: 0

Quality of life, psychological states, and personality traits in patients with pectus excavatum 乳突患者的生活质量、心理状态和个性特征

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.013

Kohei Matsuda MD , Daisuke Fujisawa MD , Kyohei Masai MD , Naoki Miyazaki , Shigeki Suzuki MD , Yu Okubo MD , Kaoru Kaseda MD , Keisuke Asakura MD , Tomoyuki Hishida MD , Hisao Asamura MD

Objective

The quality of life (QOL) and psychological states of patients with pectus excavatum (PE) have yet to be well understood. This study aimed to evaluate the health-related QOL (HRQOL), psychological states, and personality traits of patients with PE, alongside the associations of these factors with the severity of PE.

Methods

A cross-sectional evaluation was prospectively performed in patients scheduled to undergo PE repair surgery between July 2019 and April 2021. The primary outcome was the patients’ HRQOL, and the secondary outcomes were depression, social anxiety, self-efficacy, and personality traits.

Results

In total, 129 patients were subjected to analyses. Patients' HRQOL had a lower role component summary score (mean ± standard deviation: 41.8 ± 12.8, P < .001) than the general population controls. Patients' HRQOL had a significantly better physical component summary (54.0 ± 10.4, P < .001) and mental component summary (53.3 ± 8.8, P < .001) than that of the general population. Fourteen patients' (10.9%) and 56 patients' (43.4%) scores indicated the presence of depression and social anxiety disorder, respectively. Patients’ self-efficacy (46.1 ± 11.4, P, .001) and level of extraversion (46.5 ± 11.8, P < .001) were lower than those of the general population. No significant correlation was found between the severity of PE and these scores.

Conclusions

Our study revealed that patients with PE had decreased social-role QOL, depressive tendencies, increased social anxiety, lower self-efficacy, and introversion. No correlation between the severity of PE and the patients’ psychological outcomes leads us to conclude that surgical implications of PE should not be decided solely by a physical index.

目的：人们尚未充分了解乳房下垂（PE）患者的生活质量（QOL）和心理状态。本研究旨在评估PE患者的健康相关QOL（HRQOL）、心理状态和人格特质，以及这些因素与PE严重程度的关系。方法对2019年7月至2021年4月期间计划接受PE修复手术的患者进行前瞻性横断面评估。主要结果是患者的 HRQOL，次要结果是抑郁、社交焦虑、自我效能感和人格特质。与普通对照组相比，患者的 HRQOL 的角色成分总分较低（平均值 ± 标准差：41.8 ± 12.8，P < .001）。与普通人群相比，患者的 HRQOL 的身体部分总分（54.0 ± 10.4，P < .001）和精神部分总分（53.3 ± 8.8，P < .001）明显更高。14名患者（10.9%）和56名患者（43.4%）的得分分别表明他们患有抑郁症和社交焦虑症。患者的自我效能感（46.1 ± 11.4，P，.001）和外向程度（46.5 ± 11.8，P < .001）均低于普通人群。结论我们的研究显示，PE 患者的社会角色 QOL 下降、抑郁倾向、社交焦虑增加、自我效能感降低、性格内向。PE 的严重程度与患者的心理结果之间没有相关性，因此我们得出结论，PE 的手术影响不应仅由生理指标来决定。

{"title":"Quality of life, psychological states, and personality traits in patients with pectus excavatum","authors":"Kohei Matsuda MD , Daisuke Fujisawa MD , Kyohei Masai MD , Naoki Miyazaki , Shigeki Suzuki MD , Yu Okubo MD , Kaoru Kaseda MD , Keisuke Asakura MD , Tomoyuki Hishida MD , Hisao Asamura MD","doi":"10.1016/j.xjon.2024.03.013","DOIUrl":"10.1016/j.xjon.2024.03.013","url":null,"abstract":"<div><h3>Objective</h3><p>The quality of life (QOL) and psychological states of patients with pectus excavatum (PE) have yet to be well understood. This study aimed to evaluate the health-related QOL (HRQOL), psychological states, and personality traits of patients with PE, alongside the associations of these factors with the severity of PE.</p></div><div><h3>Methods</h3><p>A cross-sectional evaluation was prospectively performed in patients scheduled to undergo PE repair surgery between July 2019 and April 2021. The primary outcome was the patients’ HRQOL, and the secondary outcomes were depression, social anxiety, self-efficacy, and personality traits.</p></div><div><h3>Results</h3><p>In total, 129 patients were subjected to analyses. Patients' HRQOL had a lower role component summary score (mean ± standard deviation: 41.8 ± 12.8, <em>P</em> < .001) than the general population controls. Patients' HRQOL had a significantly better physical component summary (54.0 ± 10.4, <em>P</em> < .001) and mental component summary (53.3 ± 8.8, <em>P</em> < .001) than that of the general population. Fourteen patients' (10.9%) and 56 patients' (43.4%) scores indicated the presence of depression and social anxiety disorder, respectively. Patients’ self-efficacy (46.1 ± 11.4, <em>P</em>, .001) and level of extraversion (46.5 ± 11.8, <em>P</em> < .001) were lower than those of the general population. No significant correlation was found between the severity of PE and these scores.</p></div><div><h3>Conclusions</h3><p>Our study revealed that patients with PE had decreased social-role QOL, depressive tendencies, increased social anxiety, lower self-efficacy, and introversion. No correlation between the severity of PE and the patients’ psychological outcomes leads us to conclude that surgical implications of PE should not be decided solely by a physical index.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 355-369"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000925/pdfft?md5=d95808db0e22014c8f8cedb86d5a8ff4&pid=1-s2.0-S2666273624000925-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140791091","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}

引用次数: 0

Young infants with symptomatic tetralogy of Fallot: Shunt or primary repair? 患有症状性法洛氏四联症的幼儿：分流术还是初次修复术？

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.04.003

Xin Tao Ye MD , Soichiro Henmi MD, PhD , Edward Buratto MBBS, PhD , Mitchell C. Haverty MS , Can Yerebakan MD , Tyson Fricke MBBS, PhD , Christian P. Brizard MD, MS , Yves d’Udekem MD, PhD , Igor E. Konstantinov MD, PhD

Objectives

The optimal treatment strategy for symptomatic young infants with tetralogy of Fallot (TOF) is unclear. We sought to compare the outcomes of staged repair (SR) (shunt palliation followed by second-stage complete repair) versus primary repair (PR) at 2 institutions that have exclusively adopted each strategy.

Methods

We performed propensity score-matched comparison of 143 infants under 4 months of age who underwent shunt palliation at one institution between 1993 and 2021 with 122 infants who underwent PR between 2004 and 2018 at another institution. The primary outcome was mortality. Secondary outcomes were postoperative complications, durations of perioperative support and hospital stays, and reinterventions. Median follow-up was 8.3 years (interquartile range, 8.1-13.4 years).

Results

After the initial procedure, hospital mortality (shunt, 2.8% vs PR, 2.5%; P = .86) and 10-year survival (shunt, 95%; 95% confidence interval [CI], 90%-98% vs PR, 90%; 95% CI, 81%-95%; P = .65) were similar. The SR group had a greater risk of early reinterventions but similar rates of late reinterventions. Propensity score matching yielded 57 well-balanced pairs. In the matched cohort, the SR group had similar freedom from reintervention (55%; 95% CI, 39%-68% vs 59%; 95% CI, 43%-71%; P = .85) and greater survival (98%; 95% CI, 88%-99.8% vs 85%; 95% CI, 69%-93%; P = .02) at 10 years, as the result of more noncardiac-related mortalities in the PR group.

Conclusions

In symptomatic young infants with TOF operated at 2 institutions with exclusive treatment protocols, the SR strategy was associated with similar cardiac-related mortality and reinterventions as the PR strategy at medium-term follow-up.

目标法洛氏四联症（TOF）无症状幼婴的最佳治疗策略尚不明确。我们试图在两家完全采用分期修复（SR）（分流姑息后进行第二阶段完全修复）与初次修复（PR）策略的机构中比较两者的治疗效果。方法我们对 1993 年至 2021 年期间在一家机构接受分流姑息治疗的 143 名 4 个月以下婴儿与 2004 年至 2018 年期间在另一家机构接受 PR 治疗的 122 名婴儿进行了倾向评分匹配比较。主要结果是死亡率。次要结果是术后并发症、围手术期支持和住院时间以及再干预。中位随访时间为 8.3 年（四分位间范围为 8.1-13.4 年）。结果首次手术后，住院死亡率（分流，2.8% vs PR，2.5%；P = .86）和 10 年生存率（分流，95%；95% 置信区间 [CI]，90%-98% vs PR，90%；95% CI，81%-95%；P = .65）相似。SR 组早期再干预的风险更大，但晚期再干预的比例相似。倾向评分匹配产生了 57 对平衡良好的配对。在匹配队列中，SR 组的再干预率相似（55%；95% CI，39%-68% vs 59%；95% CI，43%-71%；P = .85），10 年后的存活率更高（98%；95% CI，88%-99.8% vs 85%；95% CI，69%-93%；P = .02），这是因为 PR 组的非心脏相关死亡率更高。结论对于在两家机构接受手术并采用独家治疗方案的有症状的年幼 TOF 婴儿，在中期随访时，SR 策略与 PR 策略具有相似的心脏相关死亡率和再干预率。

{"title":"Young infants with symptomatic tetralogy of Fallot: Shunt or primary repair?","authors":"Xin Tao Ye MD , Soichiro Henmi MD, PhD , Edward Buratto MBBS, PhD , Mitchell C. Haverty MS , Can Yerebakan MD , Tyson Fricke MBBS, PhD , Christian P. Brizard MD, MS , Yves d’Udekem MD, PhD , Igor E. Konstantinov MD, PhD","doi":"10.1016/j.xjon.2024.04.003","DOIUrl":"https://doi.org/10.1016/j.xjon.2024.04.003","url":null,"abstract":"<div><h3>Objectives</h3><p>The optimal treatment strategy for symptomatic young infants with tetralogy of Fallot (TOF) is unclear. We sought to compare the outcomes of staged repair (SR) (shunt palliation followed by second-stage complete repair) versus primary repair (PR) at 2 institutions that have exclusively adopted each strategy.</p></div><div><h3>Methods</h3><p>We performed propensity score-matched comparison of 143 infants under 4 months of age who underwent shunt palliation at one institution between 1993 and 2021 with 122 infants who underwent PR between 2004 and 2018 at another institution. The primary outcome was mortality. Secondary outcomes were postoperative complications, durations of perioperative support and hospital stays, and reinterventions. Median follow-up was 8.3 years (interquartile range, 8.1-13.4 years).</p></div><div><h3>Results</h3><p>After the initial procedure, hospital mortality (shunt, 2.8% vs PR, 2.5%; <em>P</em> = .86) and 10-year survival (shunt, 95%; 95% confidence interval [CI], 90%-98% vs PR, 90%; 95% CI, 81%-95%; <em>P</em> = .65) were similar. The SR group had a greater risk of early reinterventions but similar rates of late reinterventions. Propensity score matching yielded 57 well-balanced pairs. In the matched cohort, the SR group had similar freedom from reintervention (55%; 95% CI, 39%-68% vs 59%; 95% CI, 43%-71%; <em>P</em> = .85) and greater survival (98%; 95% CI, 88%-99.8% vs 85%; 95% CI, 69%-93%; <em>P</em> = .02) at 10 years, as the result of more noncardiac-related mortalities in the PR group.</p></div><div><h3>Conclusions</h3><p>In symptomatic young infants with TOF operated at 2 institutions with exclusive treatment protocols, the SR strategy was associated with similar cardiac-related mortality and reinterventions as the PR strategy at medium-term follow-up.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 241-256"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001050/pdfft?md5=634f9db4d1ee51abaafeb9a75e2c24c4&pid=1-s2.0-S2666273624001050-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141323806","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}

引用次数: 0

Multifactorial considerations in frozen elephant trunk selection and treatment strategies for acute type A aortic dissection 急性 A 型主动脉夹层的冰冻象鼻干选择和治疗策略的多因素考虑

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.008

Yang Yu MD, PhD, Lu Liu MD, Enyi Shi MD, PhD, Tianxiang Gu MD, PhD

引用次数: 0

Value of nutritional indices in predicting survival free from pump replacement and driveline infections in centrifugal left ventricular assist devices 营养指标在预测离心式左心室辅助装置免于更换泵和传动系统感染的存活率方面的价值

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.017

Fabian Jimenez Contreras MD , Bret L. Pinsker MD , Jason N. Katz MD, MHS , Stuart D. Russell MD , Jacob Schroder MD , Benjamin Bryner MD , Alexander H. Gunn MD , Krunal Amin MD , Carmelo Milano MD

Objective

There is a paucity of data assessing the impact of nutritional status on outcomes in patients supported with the HeartMate 3 (HM3) left ventricular assist device (LVAD).

Methods

Patients ≥18 years of age who underwent HM3 LVAD implantation between 2015 and 2020 were identified from a single tertiary care center. The primary outcome assessed was death or device replacement. A secondary outcome of driveline infection was also evaluated. Kaplan-Meier survival analysis and a multivariate Cox-proportional hazards model were used to identify predictors of outcome.

Results

Of the 289 patients identified, 94 (33%) experienced a primary outcome and 96 (33%) a secondary outcome during a median follow-up time of 2.3 years. Independent predictors of the primary outcome included peripheral vascular disease (hazard ratio [HR], 3.40; 95% confidence interval [CI], 1.66-6.97, P < .01), diabetes mellitus (HR, 0.46; 95% CI, 0.27-0.80, P < .01), body mass index ≥40 kg/m² (HR, 2.63 per 1 kg/m² increase; 95% CI, 1.22-5.70, P < .05), preoperative creatinine level (HR, 1.86 per 1 mg/dL increase; 95% CI, 1.31-2.65, P < .01), and preoperative prognostic nutritional index (PNI) score (HR, 0.88 per 1-point increase; 95% CI, 0.81-0.96, P < .01). Independent predictors of driveline infection included age at the time of implantation (HR, 0.97; 95% CI, 0.96-0.99, P < .01) and diabetes mellitus (HR, 1.79; 95% CI, 1.17-2.73, P < .01).

Conclusions

Preoperative PNI scores may independently predict mortality and the need for device replacement in patients with HM3 LVAD. Routine use of the PNI score during preoperative evaluation and, when possible, supplementation to PNI >33, may be of value in this population.

方法从一家三级医疗中心确定了在 2015 年至 2020 年期间接受 HM3 LVAD 植入术的年龄≥18 岁的患者。评估的主要结果是死亡或设备更换。此外，还评估了传动系感染这一次要结果。结果在中位随访时间为 2.3 年的 289 例患者中，94 例（33%）出现主要结局，96 例（33%）出现次要结局。主要结果的独立预测因素包括外周血管疾病（危险比 [HR]，3.40；95% 置信区间 [CI]，1.66-6.97，P < .01）、糖尿病（HR，0.46；95% CI，0.27-0.80，P < .01）、体重指数≥40 kg/m2（HR，2.63；95% CI，1.22-5.70，P < .05）、术前肌酐水平（HR，每增加 1 mg/dL 增加 1.86；95% CI，1.31-2.65，P < .01）和术前预后营养指数（PNI）评分（HR，每增加 1 分增加 0.88；95% CI，0.81-0.96，P < .01）。结论术前 PNI 评分可独立预测 HM3 LVAD 患者的死亡率和设备更换需求。在术前评估中常规使用 PNI 评分，并在可能的情况下补充 PNI >33，可能对这一人群有价值。

{"title":"Value of nutritional indices in predicting survival free from pump replacement and driveline infections in centrifugal left ventricular assist devices","authors":"Fabian Jimenez Contreras MD , Bret L. Pinsker MD , Jason N. Katz MD, MHS , Stuart D. Russell MD , Jacob Schroder MD , Benjamin Bryner MD , Alexander H. Gunn MD , Krunal Amin MD , Carmelo Milano MD","doi":"10.1016/j.xjon.2024.03.017","DOIUrl":"10.1016/j.xjon.2024.03.017","url":null,"abstract":"<div><h3>Objective</h3><p>There is a paucity of data assessing the impact of nutritional status on outcomes in patients supported with the HeartMate 3 (HM3) left ventricular assist device (LVAD).</p></div><div><h3>Methods</h3><p>Patients ≥18 years of age who underwent HM3 LVAD implantation between 2015 and 2020 were identified from a single tertiary care center. The primary outcome assessed was death or device replacement. A secondary outcome of driveline infection was also evaluated. Kaplan-Meier survival analysis and a multivariate Cox-proportional hazards model were used to identify predictors of outcome.</p></div><div><h3>Results</h3><p>Of the 289 patients identified, 94 (33%) experienced a primary outcome and 96 (33%) a secondary outcome during a median follow-up time of 2.3 years. Independent predictors of the primary outcome included peripheral vascular disease (hazard ratio [HR], 3.40; 95% confidence interval [CI], 1.66-6.97, <em>P</em> < .01), diabetes mellitus (HR, 0.46; 95% CI, 0.27-0.80, <em>P</em> < .01), body mass index ≥40 kg/m<sup>2</sup> (HR, 2.63 per 1 kg/m<sup>2</sup> increase; 95% CI, 1.22-5.70, <em>P</em> < .05), preoperative creatinine level (HR, 1.86 per 1 mg/dL increase; 95% CI, 1.31-2.65, <em>P</em> < .01), and preoperative prognostic nutritional index (PNI) score (HR, 0.88 per 1-point increase; 95% CI, 0.81-0.96, <em>P</em> < .01). Independent predictors of driveline infection included age at the time of implantation (HR, 0.97; 95% CI, 0.96-0.99, <em>P</em> < .01) and diabetes mellitus (HR, 1.79; 95% CI, 1.17-2.73, <em>P</em> < .01).</p></div><div><h3>Conclusions</h3><p>Preoperative PNI scores may independently predict mortality and the need for device replacement in patients with HM3 LVAD. Routine use of the PNI score during preoperative evaluation and, when possible, supplementation to PNI >33, may be of value in this population.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 175-182"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001037/pdfft?md5=f03889c7d804c5b6dc86a6f0101433ca&pid=1-s2.0-S2666273624001037-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140774685","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}

引用次数: 0