Pub Date : 2026-08-01Epub Date: 2026-05-20DOI: 10.1016/j.xjon.2026.101865
Maeve M. Sargeant MA, Samantha McCrary MS, Ekin C. Uzunoglu MD, Elizabeth Jordan MA, Phoebe Jollay-Castelblanco BS, Erica Barwick FNP-C, Benjamin C. Degner MD, Samuel F. Sears PhD
{"title":"Disease-specific emotional burden persists after surgical repair for thoracic aortic aneurysm","authors":"Maeve M. Sargeant MA, Samantha McCrary MS, Ekin C. Uzunoglu MD, Elizabeth Jordan MA, Phoebe Jollay-Castelblanco BS, Erica Barwick FNP-C, Benjamin C. Degner MD, Samuel F. Sears PhD","doi":"10.1016/j.xjon.2026.101865","DOIUrl":"10.1016/j.xjon.2026.101865","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"32 ","pages":"Article 101865"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-01Epub Date: 2026-06-05DOI: 10.1016/j.xjon.2026.101887
Rafael Maniés Pereira MSc, Beatriz Draiblate MD, Francisca Montenegro MD, Margarida Rocha MD, Nuno Guerra MD, Ricardo Ferreira MD, PhD, Ângelo Nobre MD, Luís Ferreira Moita MD, PhD, Tiago R. Velho MD, PhD
<div><h3>Objective</h3><div>The use of a minimally invasive approach in mitral valve surgery is increasing; however, its impact on early organ dysfunction and hemodynamic support remains debated. This study compared postoperative organ dysfunction, assessed by the Sequential Organ Failure Assessment score and the maximum vasoactive-inotropic score at 24 hours, between the minimally invasive approach in mitral valve surgery and sternotomy.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed of all consecutive patients undergoing mitral valve surgery at a single center. Patients were stratified according to surgical approach (minimally invasive approach in mitral valve surgery vs sternotomy). Primary outcomes were Sequential Organ Failure Assessment and maximum vasoactive-inotropic score at 24 hours. Group comparisons were performed using nonparametric tests, and multivariable regression models were adjusted for demographics and clinical covariates. A propensity score–matched sensitivity analysis was also performed.</div></div><div><h3>Results</h3><div>A total of 710 patients were included, 275 undergoing the minimally invasive approach in mitral valve surgery and 435 undergoing sternotomy. Median Sequential Organ Failure Assessment at 24 hours was lower after the minimally invasive approach in mitral valve surgery (4 [interquartile range, 2-6] vs 5 [interquartile range, 3-9], <em>P</em> < .001), and fewer patients undergoing the minimally invasive approach in mitral valve surgery had Sequential Organ Failure Assessment of 5 or more (43.6% vs 58.6%). On multivariable analysis, the minimally invasive approach in mitral valve surgery was independently associated with lower odds of elevated Sequential Organ Failure Assessment (odds ratio, 0.24, 95% CI, 0.15-0.37, <em>P</em> < .001). Maximum vasoactive-inotropic score at 24 hours was also lower after the minimally invasive approach in mitral valve surgery, with fewer patients presenting a maximum vasoactive-inotropic score at 24 hours of 13 or more (44.7% vs 56.1%); the minimally invasive approach in mitral valve surgery remained associated with lower odds of an elevated maximum vasoactive-inotropic score at 24 hours (odds ratio, 0.34, 95% CI, 0.22-0.51, <em>P</em> < .001). In the propensity score–matched cohort, the minimally invasive approach in mitral valve surgery remained associated with lower Sequential Organ Failure Assessment at 24 hours (mean difference, −2.64; 95% CI, −3.81 to −1.47; <em>P</em> < .0001), lower maximum vasoactive-inotropic score at 24 hours (mean difference, −23.82; 95% CI, −39.44 to −8.2; <em>P</em> = .003), lower odds of Sequential Organ Failure Assessment of 5 or more (odds ratio, 0.35; 95% CI, 0.2-0.63; <em>P</em> < .001), and lower odds of maximum vasoactive-inotropic score at 24 hours of 13 or more (odds ratio, 0.56; 95% CI, 0.33-0.97; <em>P</em> = .039). Differences were also observed across individual Sequential Organ Failure Asse
目的微创入路在二尖瓣手术中的应用越来越多；然而，其对早期器官功能障碍和血流动力学支持的影响仍存在争议。本研究比较了微创二尖瓣手术和胸骨切开术的术后器官功能障碍，通过序贯器官衰竭评估评分和24小时最大血管活性-肌力评分来评估。方法对在同一中心连续行二尖瓣手术的患者进行回顾性分析。根据手术入路（微创二尖瓣手术与胸骨切开术）对患者进行分层。主要结果是序贯器官衰竭评估和24小时最大血管活性-肌力评分。采用非参数检验进行组间比较，并根据人口统计学和临床协变量调整多变量回归模型。还进行了倾向评分匹配的敏感性分析。结果共纳入710例患者，其中微创二尖瓣入路275例，胸骨切开术435例。微创入路二尖瓣手术后24小时序贯器官衰竭评估中位数较低（4[四分位数范围，2-6]vs 5[四分位数范围，3-9],P < 001），微创入路二尖瓣手术患者序贯器官衰竭评估5及以上的患者较少（43.6% vs 58.6%）。在多变量分析中，二尖瓣手术的微创入路与序贯器官衰竭评估升高的几率较低独立相关（优势比，0.24,95% CI, 0.15-0.37, P < 0.001）。二尖瓣手术微创入路后24小时最大血管活性-肌力评分也较低，24小时最大血管活性-肌力评分为13或更高的患者较少（44.7% vs 56.1%）；二尖瓣手术微创入路仍与24小时最大血管活性-肌力评分升高的几率较低相关（优势比0.34,95% CI, 0.22-0.51, P < 0.001）。在倾向评分匹配的队列中，二尖瓣手术的微创入路仍然与24小时较低的序贯器官衰竭评估相关（平均差值为- 2.64,95% CI为- 3.81至- 1.47,P < 0.0001）， 24小时较低的血管活性-肌力评分（平均差值为- 23.82,95% CI为- 39.44至- 8.2,P = 0.003），序贯器官衰竭评估的较低几率为5或以上(优势比为0.35,95% CI为0.2-0.63；P < .001)， 13岁或以上24小时血管活性-肌力评分最高的几率较低（优势比0.56;95% CI, 0.33-0.97; P = 0.039）。在各个顺序器官衰竭评估组成部分中也观察到差异，其中心血管、肾脏和神经领域的差异最大。结论在这项大型单中心队列研究中，与胸骨切开术相比，微创二尖瓣手术早期器官功能障碍较低，血管活性-肌力支持减少。在多变量调整和倾向评分匹配后，这些发现是一致的，并支持微创二尖瓣手术早期更有利的术后生理特征。
{"title":"The impact of minimally invasive mitral valve surgery on early postoperative organ dysfunction","authors":"Rafael Maniés Pereira MSc, Beatriz Draiblate MD, Francisca Montenegro MD, Margarida Rocha MD, Nuno Guerra MD, Ricardo Ferreira MD, PhD, Ângelo Nobre MD, Luís Ferreira Moita MD, PhD, Tiago R. Velho MD, PhD","doi":"10.1016/j.xjon.2026.101887","DOIUrl":"10.1016/j.xjon.2026.101887","url":null,"abstract":"<div><h3>Objective</h3><div>The use of a minimally invasive approach in mitral valve surgery is increasing; however, its impact on early organ dysfunction and hemodynamic support remains debated. This study compared postoperative organ dysfunction, assessed by the Sequential Organ Failure Assessment score and the maximum vasoactive-inotropic score at 24 hours, between the minimally invasive approach in mitral valve surgery and sternotomy.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed of all consecutive patients undergoing mitral valve surgery at a single center. Patients were stratified according to surgical approach (minimally invasive approach in mitral valve surgery vs sternotomy). Primary outcomes were Sequential Organ Failure Assessment and maximum vasoactive-inotropic score at 24 hours. Group comparisons were performed using nonparametric tests, and multivariable regression models were adjusted for demographics and clinical covariates. A propensity score–matched sensitivity analysis was also performed.</div></div><div><h3>Results</h3><div>A total of 710 patients were included, 275 undergoing the minimally invasive approach in mitral valve surgery and 435 undergoing sternotomy. Median Sequential Organ Failure Assessment at 24 hours was lower after the minimally invasive approach in mitral valve surgery (4 [interquartile range, 2-6] vs 5 [interquartile range, 3-9], <em>P</em> < .001), and fewer patients undergoing the minimally invasive approach in mitral valve surgery had Sequential Organ Failure Assessment of 5 or more (43.6% vs 58.6%). On multivariable analysis, the minimally invasive approach in mitral valve surgery was independently associated with lower odds of elevated Sequential Organ Failure Assessment (odds ratio, 0.24, 95% CI, 0.15-0.37, <em>P</em> < .001). Maximum vasoactive-inotropic score at 24 hours was also lower after the minimally invasive approach in mitral valve surgery, with fewer patients presenting a maximum vasoactive-inotropic score at 24 hours of 13 or more (44.7% vs 56.1%); the minimally invasive approach in mitral valve surgery remained associated with lower odds of an elevated maximum vasoactive-inotropic score at 24 hours (odds ratio, 0.34, 95% CI, 0.22-0.51, <em>P</em> < .001). In the propensity score–matched cohort, the minimally invasive approach in mitral valve surgery remained associated with lower Sequential Organ Failure Assessment at 24 hours (mean difference, −2.64; 95% CI, −3.81 to −1.47; <em>P</em> < .0001), lower maximum vasoactive-inotropic score at 24 hours (mean difference, −23.82; 95% CI, −39.44 to −8.2; <em>P</em> = .003), lower odds of Sequential Organ Failure Assessment of 5 or more (odds ratio, 0.35; 95% CI, 0.2-0.63; <em>P</em> < .001), and lower odds of maximum vasoactive-inotropic score at 24 hours of 13 or more (odds ratio, 0.56; 95% CI, 0.33-0.97; <em>P</em> = .039). Differences were also observed across individual Sequential Organ Failure Asse","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"32 ","pages":"Article 101887"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-01Epub Date: 2026-04-07DOI: 10.1016/j.xjon.2026.101745
Samuel M. Hoenig BA, David Bruckman MS, Karl F. Welke MD, MS, Justin Robinson MD, MS, Anusha Jegatheeswaran MD, PhD, Rashed Mahboubi MD, Belinda Udeh PhD, Jarod Dalton PhD, Md M. Hossain MSc, PhD, Tara Karamlou MD, MSc
Objective
Management of cyanotic neonates with tetralogy of Fallot (ToF) remains an important clinical challenge without Level 1 evidence. The present study employs the Healthcare Cost and Utilization Project Kids Inpatient Dataset to evaluate a national sample of neonates undergoing intervention for ToF.
Methods
A 4-stage algorithm was designed to capture records for neonates with ToF who underwent primary repair, ductal stents, and systemic-to-pulmonary shunts in the Healthcare Cost and Utilization Project Kids Inpatient Dataset (2016, 2019, and 2022). National hospitalization estimates and percent reported reflect weighted results based on survey design. Resource utilization was represented by median hospital length of stay and inflation-adjusted cost in 2023 US dollars.
Results
An estimated 159.5 discharges were identified for primary repair, 145.3 for ductal stents, and 407.4 for surgical systemic to pulmonary shunts. An estimated 256.3 discharges were identified for infants undergoing definitive repairs following ductal stents. From 2016 to 2022, ductal stent utilization increased (linear trend P = .0011), whereas surgical shunt use decreased (trend P = .0012). There was a trend toward a decrease in primary repair (trend P= .12). Over this time frame, there was a significant increase in the median cost for ductal stent (difference, $77,252 [2023 dollars], P = .035) and surgical shunt (difference, $81,111 [2023 dollars]; P = .043) palliations and a decrease in primary repair cost (difference, $76,337 [2023 dollars]; P = .44).
Conclusions
This investigation demonstrated increased utilization of ductal stents for neonatal ToF across the United States. Despite this increase, changes in cost may reflect a complex paradigm shift in patient/center-specific decision making.
{"title":"Managing cyanotic neonates with tetralogy of Fallot: A national perspective on surgical approaches","authors":"Samuel M. Hoenig BA, David Bruckman MS, Karl F. Welke MD, MS, Justin Robinson MD, MS, Anusha Jegatheeswaran MD, PhD, Rashed Mahboubi MD, Belinda Udeh PhD, Jarod Dalton PhD, Md M. Hossain MSc, PhD, Tara Karamlou MD, MSc","doi":"10.1016/j.xjon.2026.101745","DOIUrl":"10.1016/j.xjon.2026.101745","url":null,"abstract":"<div><h3>Objective</h3><div>Management of cyanotic neonates with tetralogy of Fallot (ToF) remains an important clinical challenge without Level 1 evidence. The present study employs the Healthcare Cost and Utilization Project Kids Inpatient Dataset to evaluate a national sample of neonates undergoing intervention for ToF.</div></div><div><h3>Methods</h3><div>A 4-stage algorithm was designed to capture records for neonates with ToF who underwent primary repair, ductal stents, and systemic-to-pulmonary shunts in the Healthcare Cost and Utilization Project Kids Inpatient Dataset (2016, 2019, and 2022). National hospitalization estimates and percent reported reflect weighted results based on survey design. Resource utilization was represented by median hospital length of stay and inflation-adjusted cost in 2023 US dollars.</div></div><div><h3>Results</h3><div>An estimated 159.5 discharges were identified for primary repair, 145.3 for ductal stents, and 407.4 for surgical systemic to pulmonary shunts. An estimated 256.3 discharges were identified for infants undergoing definitive repairs following ductal stents. From 2016 to 2022, ductal stent utilization increased (linear trend <em>P</em> = .0011), whereas surgical shunt use decreased (trend <em>P</em> = .0012). There was a trend toward a decrease in primary repair (trend <em>P</em>= .12). Over this time frame, there was a significant increase in the median cost for ductal stent (difference, $77,252 [2023 dollars], <em>P</em> = .035) and surgical shunt (difference, $81,111 [2023 dollars]; <em>P</em> = .043) palliations and a decrease in primary repair cost (difference, $76,337 [2023 dollars]; <em>P</em> = .44).</div></div><div><h3>Conclusions</h3><div>This investigation demonstrated increased utilization of ductal stents for neonatal ToF across the United States. Despite this increase, changes in cost may reflect a complex paradigm shift in patient/center-specific decision making.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"32 ","pages":"Article 101745"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148704089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-01Epub Date: 2026-02-12DOI: 10.1016/j.xjon.2026.101677
Nika Samadzadeh Tabrizi MD, Yasuhiro Hoshino MD, PhD, Shinya Unai MD, Hiromasa Hayama MD, Mikio Takatoo MD, Nagaki Kiyohara MD, Masami Goda MD, Schinichiro Shimura MD, PhD, Shiho Ide MD, Takuto Naiki MD, William C. Frankel MD, Matthew A. Thompson MD, Xiaowen Li MS, Jeevanantham Rajeswaran PhD, Eugene H. Blackstone MD, Gösta B. Pettersson MD, PhD, Shigeyuki Ozaki MD, PhD
Objective
To compare the hemodynamic performance and durability of the Ozaki procedure in patients with end-stage renal disease on chronic dialysis between patients not on dialysis and patients on dialysis undergoing bioprosthetic aortic valve replacement (bAVR).
Methods
Between January 1, 2007, and May 1, 2021, 155 adults on dialysis underwent the Ozaki procedure at Toho University Ohashi Medical Center. Mean aortic valve gradient, aortic regurgitation grade, and freedom from reoperation were compared between 121 propensity score–matched patients not on dialysis undergoing the Ozaki procedure and 125 age-matched patients on dialysis undergoing valve replacement with a stented bovine pericardial bioprosthesis at Cleveland Clinic between January 1, 2001, and January 1, 2022.
Results
Five years after the Ozaki procedure, matched patients on dialysis were less likely to have moderate/severe regurgitation (1.7%) compared to those not on dialysis (4.1%). In the 2 groups, mean aortic gradient was 7 mmHg and 9 mm Hg, respectively (P = .06), and freedom from aortic valve reoperation was 91% and 96%, respectively (P = .4). Age-matched patients on dialysis undergoing the Ozaki procedure and those undergoing bAVR had a mean gradient of 9 mm Hg and 13 mm Hg, respectively, at 6 months (P < .001) and 11 mm Hg and 14 mm Hg at 5 years (P < .001). At 5 years, the prevalence of moderate/severe regurgitation was 1.3% and 2.0%, and freedom from reoperation was 91% and 96% (P = .4).
Conclusions
In patients on chronic dialysis undergoing the Ozaki procedure, hemodynamics and durability are similar compared with those not on dialysis, and mean gradients are lower compared with those receiving a bioprosthesis. These findings support use of the Ozaki procedure in patients on dialysis requiring aortic valve replacement.
目的比较非透析患者和透析患者行生物人工主动脉瓣置换术（bAVR）的终末期肾脏疾病慢性透析患者的Ozaki手术的血流动力学性能和持久性。方法：在2007年1月1日至2021年5月1日期间，155名透析成人在东宝大学大桥医学中心接受了Ozaki手术。研究人员比较了2001年1月1日至2022年1月1日克利夫兰诊所121名倾向评分匹配的非透析患者接受Ozaki手术和125名年龄匹配的透析患者接受支架牛心包生物假体瓣膜置换术的平均主动脉瓣梯度、主动脉反流等级和再次手术的自由度。结果Ozaki手术后5年，接受透析的匹配患者发生中度/重度反流的可能性（1.7%）低于未接受透析的患者（4.1%）。两组患者主动脉梯度平均值分别为7mmhg和9mmhg (P = 0.06)，主动脉瓣再手术成功率分别为91%和96% （P = 0.04）。年龄匹配的接受Ozaki手术的透析患者和接受bAVR的患者在6个月时的平均梯度分别为9 mm Hg和13 mm Hg (P < 0.001)，在5年时的平均梯度为11 mm Hg和14 mm Hg （P < 0.001）。5年时，中/重度反流发生率分别为1.3%和2.0%，再次手术成功率分别为91%和96% （P = 0.4）。结论在接受Ozaki手术的慢性透析患者中，血液动力学和持久性与未接受透析的患者相似，平均梯度低于接受生物假体的患者。这些发现支持在需要主动脉瓣置换术的透析患者中使用Ozaki手术。
{"title":"Mid-term valve performance and durability of the Ozaki procedure in patients on chronic dialysis","authors":"Nika Samadzadeh Tabrizi MD, Yasuhiro Hoshino MD, PhD, Shinya Unai MD, Hiromasa Hayama MD, Mikio Takatoo MD, Nagaki Kiyohara MD, Masami Goda MD, Schinichiro Shimura MD, PhD, Shiho Ide MD, Takuto Naiki MD, William C. Frankel MD, Matthew A. Thompson MD, Xiaowen Li MS, Jeevanantham Rajeswaran PhD, Eugene H. Blackstone MD, Gösta B. Pettersson MD, PhD, Shigeyuki Ozaki MD, PhD","doi":"10.1016/j.xjon.2026.101677","DOIUrl":"10.1016/j.xjon.2026.101677","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the hemodynamic performance and durability of the Ozaki procedure in patients with end-stage renal disease on chronic dialysis between patients not on dialysis and patients on dialysis undergoing bioprosthetic aortic valve replacement (bAVR).</div></div><div><h3>Methods</h3><div>Between January 1, 2007, and May 1, 2021, 155 adults on dialysis underwent the Ozaki procedure at Toho University Ohashi Medical Center. Mean aortic valve gradient, aortic regurgitation grade, and freedom from reoperation were compared between 121 propensity score–matched patients not on dialysis undergoing the Ozaki procedure and 125 age-matched patients on dialysis undergoing valve replacement with a stented bovine pericardial bioprosthesis at Cleveland Clinic between January 1, 2001, and January 1, 2022.</div></div><div><h3>Results</h3><div>Five years after the Ozaki procedure, matched patients on dialysis were less likely to have moderate/severe regurgitation (1.7%) compared to those not on dialysis (4.1%). In the 2 groups, mean aortic gradient was 7 mmHg and 9 mm Hg, respectively (<em>P</em> = .06), and freedom from aortic valve reoperation was 91% and 96%, respectively (<em>P</em> = .4). Age-matched patients on dialysis undergoing the Ozaki procedure and those undergoing bAVR had a mean gradient of 9 mm Hg and 13 mm Hg, respectively, at 6 months (<em>P</em> < .001) and 11 mm Hg and 14 mm Hg at 5 years (<em>P</em> < .001). At 5 years, the prevalence of moderate/severe regurgitation was 1.3% and 2.0%, and freedom from reoperation was 91% and 96% (<em>P</em> = .4).</div></div><div><h3>Conclusions</h3><div>In patients on chronic dialysis undergoing the Ozaki procedure, hemodynamics and durability are similar compared with those not on dialysis, and mean gradients are lower compared with those receiving a bioprosthesis. These findings support use of the Ozaki procedure in patients on dialysis requiring aortic valve replacement.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"32 ","pages":"Article 101677"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703796","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}
Massive or torrential tricuspid regurgitation is associated with poor survival; however, its impact on surgical results remains uncertain. Outcomes following tricuspid valve surgery in patients with severe versus massive or torrential tricuspid regurgitation were compared.
Methods
From 2010-2024, 164 symptomatic patients (mean age 71.2 ± 10.4 years) with severe (n = 69, 42%) or massive/torrential tricuspid regurgitation (n = 95, 58%) underwent tricuspid valve surgery, with or without concomitant procedures. Postoperative tricuspid regurgitation grade was the primary endpoint. Mortality and heart failure hospitalization predictors were analyzed. The mean follow-up was 4.6 ± 3.9 years.
Results
Tricuspid repair was performed more frequent in patients with severe than with massive/torrential tricuspid regurgitation (96% vs 80%, P = .004). In-hospital mortality rates were 0% and 2.1%, respectively (P = .506). Postoperatively, tricuspid regurgitation improved significantly in both groups, with similar rates of residual tricuspid regurgitation mild or less (73.9% vs 72.3%, P = .930). During the follow-up period, 26 patients died and 38 were re-hospitalized for heart failure. Five-year survival was similar between the groups (85% vs 81%, P = .358). Higher left ventricular ejection fraction (adjusted hazard ratio 0.97, P = .027) and estimated glomerular filtration rate (adjusted hazard ratio 0.98, P = .016) were independently protective for adverse outcomes, whereas baseline tricuspid regurgitation severity was not.
Conclusions
Tricuspid valve surgery for severe or massive/torrential tricuspid regurgitation can be performed with low perioperative mortality, and provides favorable long-term outcomes. Prognosis is determined primarily by baseline cardiac and renal function, rather than preoperative tricuspid regurgitation severity.
目的：三尖瓣严重或剧烈反流与生存不良相关；然而，其对手术结果的影响仍不确定。我们比较了三尖瓣手术后严重三尖瓣反流与大量三尖瓣反流或重度三尖瓣反流的结果。方法2010-2024年，164例重度（n = 69, 42%）或大面积/重度三尖瓣反流（n = 95, 58%）有症状的患者（平均年龄71.2±10.4岁）行三尖瓣手术，伴行或不伴行手术。术后三尖瓣反流等级为主要终点。分析死亡率和心力衰竭住院率的预测因素。平均随访4.6±3.9年。结果重度三尖瓣反流患者修复三尖瓣的频率高于重度三尖瓣反流患者（96% vs 80%, P = 0.004）。住院死亡率分别为0%和2.1% （P = .506）。两组术后三尖瓣返流明显改善，残余三尖瓣返流轻度或轻度发生率相似（73.9% vs 72.3%, P = 0.930）。在随访期间，26例患者死亡，38例因心力衰竭再次住院。两组5年生存率相似（85% vs 81%, P = .358）。较高的左心室射血分数（校正风险比0.97,P = 0.027）和估计的肾小球滤过率（校正风险比0.98,P = 0.016）对不良结局具有独立的保护作用，而基线三尖瓣反流严重程度则没有保护作用。结论对重度或大面积/重度三尖瓣反流患者行瓣膜手术治疗，围手术期死亡率低，远期预后良好。预后主要由基线心脏和肾脏功能决定，而不是术前三尖瓣反流严重程度。
{"title":"Isolated or concomitant tricuspid valve surgery for massive or torrential tricuspid regurgitation","authors":"Hironobu Sakurai MD, PhD, Satoshi Kainuma MD, PhD, Naonori Kawamoto MD, PhD, Kizuku Yamashita MD, PhD, Kota Suzuki MD, PhD, Takashi Kakuta MD, PhD, Ayumi Ikuta MD, PhD, Rieko Kutsuzawa MD, Yuki Tadokoro MD, Kazuki Miyatani MD, Shinichi Kurashima MD, Yuki Irie MD, Kenji Moriuchi MD, Masashi Amano MD, PhD, Atsushi Okada MD, PhD, Makoto Amaki MD, PhD, Hideaki Kanzaki MD, PhD, Takeshi Kitai MD, PhD, Chisato Izumi MD, PhD, Kazuhiro Yamamoto MD, PhD, Satsuki Fukushima MD, PhD","doi":"10.1016/j.xjon.2026.101944","DOIUrl":"10.1016/j.xjon.2026.101944","url":null,"abstract":"<div><h3>Objective</h3><div>Massive or torrential tricuspid regurgitation is associated with poor survival; however, its impact on surgical results remains uncertain. Outcomes following tricuspid valve surgery in patients with severe versus massive or torrential tricuspid regurgitation were compared.</div></div><div><h3>Methods</h3><div>From 2010-2024, 164 symptomatic patients (mean age 71.2 ± 10.4 years) with severe (n = 69, 42%) or massive/torrential tricuspid regurgitation (n = 95, 58%) underwent tricuspid valve surgery, with or without concomitant procedures. Postoperative tricuspid regurgitation grade was the primary endpoint. Mortality and heart failure hospitalization predictors were analyzed. The mean follow-up was 4.6 ± 3.9 years.</div></div><div><h3>Results</h3><div>Tricuspid repair was performed more frequent in patients with severe than with massive/torrential tricuspid regurgitation (96% vs 80%, <em>P</em> = .004). In-hospital mortality rates were 0% and 2.1%, respectively (<em>P</em> = .506). Postoperatively, tricuspid regurgitation improved significantly in both groups, with similar rates of residual tricuspid regurgitation mild or less (73.9% vs 72.3%, <em>P</em> = .930). During the follow-up period, 26 patients died and 38 were re-hospitalized for heart failure. Five-year survival was similar between the groups (85% vs 81%, <em>P</em> = .358). Higher left ventricular ejection fraction (adjusted hazard ratio 0.97, <em>P</em> = .027) and estimated glomerular filtration rate (adjusted hazard ratio 0.98, <em>P</em> = .016) were independently protective for adverse outcomes, whereas baseline tricuspid regurgitation severity was not.</div></div><div><h3>Conclusions</h3><div>Tricuspid valve surgery for severe or massive/torrential tricuspid regurgitation can be performed with low perioperative mortality, and provides favorable long-term outcomes. Prognosis is determined primarily by baseline cardiac and renal function, rather than preoperative tricuspid regurgitation severity.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"32 ","pages":"Article 101944"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-01Epub Date: 2026-05-03DOI: 10.1016/j.xjon.2026.101834
Niyi O. Odewade MD, Rami Bikdash BS, Ezra S. Brooks MD, Phoebe Otchere MD, MBA, Boateng Kubi MD, MPH, Marle Sabatino MD, Sameer Hirji MD, MPH, Thoralf M. Sundt MD, Asishana A. Osho MD, MPH, Ashraf A. Sabe MD, Antionia Kreso MD, Louis L. Nguyen MD, MBA, MPH
Objective
To evaluate the cost-effectiveness of multiarterial grafting (MAG) compared with single artery grafting (SAG) using institutional outcomes and a linked perioperative-chronic Markov model.
Methods
This was a retrospective cohort study of 3583 adults undergoing isolated coronary artery bypass grafting between 2008 and 2022 at 2 tertiary hospital centers. Operative and perioperative data were obtained from the institutional Society of Thoracic Surgeons database. Propensity score overlap weighting was used to balance baseline covariates. A 2-phase (30-day perioperative and 10-year chronic) Markov state-transition model, informed by weighted institutional outcomes and supplemented with national Society of Thoracic Surgeons and Centers for Medicare & Medicaid Services data, was used to estimate long-term costs and quality-adjusted life years.
Results
Among 3583 patients at 2 academic centers, MAG was associated with similar operative mortality and morbidity compared with SAG. In a linked perioperative-chronic Markov model, MAG yielded greater quality-adjusted survival (+0.241 quality-adjusted life-years) and lower 10-year discounted costs (–$7755 per patient). Sensitivity analyses demonstrated that MAG was not consistently cost-effective in the perioperative period but was robustly dominant in the chronic phase, with long-term results stable across a wide range of cost assumptions.
Conclusions
MAG was associated with comparable perioperative outcomes but improved quality-adjusted survival and lower long-term costs compared with SAG. Broader adoption of MAG could reduce health care expenditures while improving population health by addressing barriers to MAG use, particularly in women, minority patients, and socially vulnerable populations.
{"title":"Cost-effectiveness of multiarterial versus single-arterial grafting in coronary artery bypass surgery","authors":"Niyi O. Odewade MD, Rami Bikdash BS, Ezra S. Brooks MD, Phoebe Otchere MD, MBA, Boateng Kubi MD, MPH, Marle Sabatino MD, Sameer Hirji MD, MPH, Thoralf M. Sundt MD, Asishana A. Osho MD, MPH, Ashraf A. Sabe MD, Antionia Kreso MD, Louis L. Nguyen MD, MBA, MPH","doi":"10.1016/j.xjon.2026.101834","DOIUrl":"10.1016/j.xjon.2026.101834","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the cost-effectiveness of multiarterial grafting (MAG) compared with single artery grafting (SAG) using institutional outcomes and a linked perioperative-chronic Markov model.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of 3583 adults undergoing isolated coronary artery bypass grafting between 2008 and 2022 at 2 tertiary hospital centers. Operative and perioperative data were obtained from the institutional Society of Thoracic Surgeons database. Propensity score overlap weighting was used to balance baseline covariates. A 2-phase (30-day perioperative and 10-year chronic) Markov state-transition model, informed by weighted institutional outcomes and supplemented with national Society of Thoracic Surgeons and Centers for Medicare & Medicaid Services data, was used to estimate long-term costs and quality-adjusted life years.</div></div><div><h3>Results</h3><div>Among 3583 patients at 2 academic centers, MAG was associated with similar operative mortality and morbidity compared with SAG. In a linked perioperative-chronic Markov model, MAG yielded greater quality-adjusted survival (+0.241 quality-adjusted life-years) and lower 10-year discounted costs (–$7755 per patient). Sensitivity analyses demonstrated that MAG was not consistently cost-effective in the perioperative period but was robustly dominant in the chronic phase, with long-term results stable across a wide range of cost assumptions.</div></div><div><h3>Conclusions</h3><div>MAG was associated with comparable perioperative outcomes but improved quality-adjusted survival and lower long-term costs compared with SAG. Broader adoption of MAG could reduce health care expenditures while improving population health by addressing barriers to MAG use, particularly in women, minority patients, and socially vulnerable populations.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"32 ","pages":"Article 101834"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-01Epub Date: 2026-05-13DOI: 10.1016/j.xjon.2026.101863
Shreyas Kiran BS, Phoebe Miller MS, MD, Isha Maniyar BS, Jashdeep Dhillon BA, Sarah Sullivan BS, Andrew Akcelik MD, Amy G. Fiedler MD, Jason Smith MD
Objective
Primary graft dysfunction (PGD) remains the leading cause of early morbidity and mortality after orthotopic heart transplantation. Postoperative lactate and the venoarterial carbon dioxide gap (Pv-a CO2) are routinely measured indicators of hypoperfusion, yet their relationship to PGD severity is not well characterized. This study evaluated the association between immediate posttransplant (T0) and 24-hour (T24) biomarker values and the severity of PGD.
Methods
We performed a single-center retrospective study of adult recipients of orthotopic heart transplantation (May 2020 to May 2023). PGD was defined according to International Society for Heart and Lung Transplantation criteria and categorized as none, moderate, or severe. Pv-a CO2 and serum lactate were collected at T0 for multivariable analysis and at T24 for descriptive and exploratory modeling. Patients receiving a simultaneous heart-lung transplant were excluded. Multivariable logistic regressions adjusted for age, body mass index, and sex.
Results
Among 110 recipients, PGD occurred in 50 (45%) cases, including 39 moderate and 11 severe. At T0, both biomarkers demonstrated stepwise increases with PGD severity. Each 1-mm Hg increase in Pv-a CO2 was associated with greater odds of any PGD (odds ratio [OR], 1.53; 95% CI, 1.22-1.92), moderate PGD (OR, 1.48; 95% CI, 1.15-1.92), and severe PGD (OR, 2.07; 95% CI, 1.45-2.97). T0 lactate was independently associated with moderate PGD (OR, 1.21; 95% CI, 1.03-1.43). By 24 hours, Pv-a CO2 no longer independently differentiated PGD severity, whereas T24 lactate remained associated with moderate PGD (OR, 1.68; 95% CI, 1.13-2.49).
Conclusions
Immediate posttransplant Pv-a CO2 is a strong discriminator of PGD severity and may serve as an early, objective adjunct to International Society for Heart and Lung Transplantation criteria. In contrast, lactate reflects both initial hypoperfusion and the subsequent trajectory of metabolic recovery, with persistent elevations at 24 hours indicating ongoing physiologic stress. Together, these readily available biomarkers provide complementary information that may improve early diagnostic stratification of PGD.
{"title":"Immediate postoperative biomarkers characterize severity of primary graft dysfunction after heart transplantation","authors":"Shreyas Kiran BS, Phoebe Miller MS, MD, Isha Maniyar BS, Jashdeep Dhillon BA, Sarah Sullivan BS, Andrew Akcelik MD, Amy G. Fiedler MD, Jason Smith MD","doi":"10.1016/j.xjon.2026.101863","DOIUrl":"10.1016/j.xjon.2026.101863","url":null,"abstract":"<div><h3>Objective</h3><div>Primary graft dysfunction (PGD) remains the leading cause of early morbidity and mortality after orthotopic heart transplantation. Postoperative lactate and the venoarterial carbon dioxide gap (Pv-a CO<sub>2</sub>) are routinely measured indicators of hypoperfusion, yet their relationship to PGD severity is not well characterized. This study evaluated the association between immediate posttransplant (T0) and 24-hour (T24) biomarker values and the severity of PGD.</div></div><div><h3>Methods</h3><div>We performed a single-center retrospective study of adult recipients of orthotopic heart transplantation (May 2020 to May 2023). PGD was defined according to International Society for Heart and Lung Transplantation criteria and categorized as none, moderate, or severe. Pv-a CO<sub>2</sub> and serum lactate were collected at T0 for multivariable analysis and at T24 for descriptive and exploratory modeling. Patients receiving a simultaneous heart-lung transplant were excluded. Multivariable logistic regressions adjusted for age, body mass index, and sex.</div></div><div><h3>Results</h3><div>Among 110 recipients, PGD occurred in 50 (45%) cases, including 39 moderate and 11 severe. At T0, both biomarkers demonstrated stepwise increases with PGD severity. Each 1-mm Hg increase in Pv-a CO<sub>2</sub> was associated with greater odds of any PGD (odds ratio [OR], 1.53; 95% CI, 1.22-1.92), moderate PGD (OR, 1.48; 95% CI, 1.15-1.92), and severe PGD (OR, 2.07; 95% CI, 1.45-2.97). T0 lactate was independently associated with moderate PGD (OR, 1.21; 95% CI, 1.03-1.43). By 24 hours, Pv-a CO<sub>2</sub> no longer independently differentiated PGD severity, whereas T24 lactate remained associated with moderate PGD (OR, 1.68; 95% CI, 1.13-2.49).</div></div><div><h3>Conclusions</h3><div>Immediate posttransplant Pv-a CO<sub>2</sub> is a strong discriminator of PGD severity and may serve as an early, objective adjunct to International Society for Heart and Lung Transplantation criteria. In contrast, lactate reflects both initial hypoperfusion and the subsequent trajectory of metabolic recovery, with persistent elevations at 24 hours indicating ongoing physiologic stress. Together, these readily available biomarkers provide complementary information that may improve early diagnostic stratification of PGD.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"32 ","pages":"Article 101863"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-01Epub Date: 2026-05-04DOI: 10.1016/j.xjon.2026.101806
Jalal Cherkaoui MEng, Ines A. Martínez MD, Yassine Toufique PhD, James D. St Louis MD, Mohammed Cherkaoui PhD, Ignacio Lugones MD, PhD
Objective
Aortic valve replacement in children is challenging. The lack of accommodation for somatic growth negatively impacts long-term outcomes. Data on the use of symmetrical oversized leaflets in neocuspidization are limited. We present a computer-based simulation of patient growth after a replacement with an oversized aortic valve leaflet.
Methods
A new aortic valve design was modeled in silico. Three computer-simulated symmetrical leaflets, each 18 mm in nominal width, were constructed for 4 simulated aortic roots with different diameters (12, 14, 16, and 18 mm). Pressure was applied to the aortic root side to simulate diastolic pressure and valve closure. The morphology of the closed valve was evaluated across different settings to examine morphologic changes during somatic growth. Three parameters of oversizing, previously described in our in vitro and in vivo studies, were assessed across the simulations: windmill shape deviation, coaptation length, and billow below the annular plane distance.
Results
A decrease in oversizing parameters was observed as the diameter of the aortic root increased. The average deviation from the windmill shape, the coaptation length, and the distance from the annular plane to the leaflet billow all decreased consistently with growth, indicating morphological adaptation of the valve geometry. These correlated changes suggest that the valve design adapts to anatomical growth by altering its functional configuration without compromising coaptation.
Conclusions
Achieving optimal outcomes in aortic valve replacement in children remains challenging. Neocuspidization with oversized aortic valve leaflets addresses important limitations of current valve replacement techniques. Larger leaflets support growth by maintaining proper coaptation.
{"title":"Simulation-based modeling of aortic valve neocuspidization with oversized pericardial leaflets","authors":"Jalal Cherkaoui MEng, Ines A. Martínez MD, Yassine Toufique PhD, James D. St Louis MD, Mohammed Cherkaoui PhD, Ignacio Lugones MD, PhD","doi":"10.1016/j.xjon.2026.101806","DOIUrl":"10.1016/j.xjon.2026.101806","url":null,"abstract":"<div><h3>Objective</h3><div>Aortic valve replacement in children is challenging. The lack of accommodation for somatic growth negatively impacts long-term outcomes. Data on the use of symmetrical oversized leaflets in neocuspidization are limited. We present a computer-based simulation of patient growth after a replacement with an oversized aortic valve leaflet.</div></div><div><h3>Methods</h3><div>A new aortic valve design was modeled in silico. Three computer-simulated symmetrical leaflets, each 18 mm in nominal width, were constructed for 4 simulated aortic roots with different diameters (12, 14, 16, and 18 mm). Pressure was applied to the aortic root side to simulate diastolic pressure and valve closure. The morphology of the closed valve was evaluated across different settings to examine morphologic changes during somatic growth. Three parameters of oversizing, previously described in our in vitro and in vivo studies, were assessed across the simulations: windmill shape deviation, coaptation length, and billow below the annular plane distance.</div></div><div><h3>Results</h3><div>A decrease in oversizing parameters was observed as the diameter of the aortic root increased. The average deviation from the windmill shape, the coaptation length, and the distance from the annular plane to the leaflet billow all decreased consistently with growth, indicating morphological adaptation of the valve geometry. These correlated changes suggest that the valve design adapts to anatomical growth by altering its functional configuration without compromising coaptation.</div></div><div><h3>Conclusions</h3><div>Achieving optimal outcomes in aortic valve replacement in children remains challenging. Neocuspidization with oversized aortic valve leaflets addresses important limitations of current valve replacement techniques. Larger leaflets support growth by maintaining proper coaptation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"32 ","pages":"Article 101806"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148704085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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