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IF 1.9

JTCVS open

Pub Date : 2026-01-01

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IF 1.9

JTCVS open

Pub Date : 2026-01-01

引用次数: 0

IF 1.9

JTCVS open

Pub Date : 2026-01-01

引用次数: 0

IF 1.9

JTCVS open

Pub Date : 2026-01-01

引用次数: 0

IF 1.9

JTCVS open

Pub Date : 2026-01-01

引用次数: 0

IF 1.9

JTCVS open

Pub Date : 2026-01-01

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 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。

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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 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

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 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。

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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 DOI: 10.1016/j.xjon.2025.09.003

Joshua D. Sparks MD , Bahaaldin Alsoufi MD

引用次数: 0

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