Annals of Thoracic Surgery

BACKGROUND: Due to staffing changes at scheduled intervals and decreases in essential staff in the evenings, late intensive care unit (ICU) arrivals may be at risk for suboptimal outcomes. Utilizing a regional collaborative, we sought to determine the effect of ICU arrival timing on outcomes in elective isolated coronary artery bypass (CABG). METHODS: Adults undergoing elective, isolated CABG from 17 hospitals between 2013-2023 were identified. Patients with missing predicted risk of mortality or missing ICU arrival time were excluded...

BACKGROUND: We aim to evaluate the impact of antegrade stenting of the distal arch and proximal descending aorta combined with non-total arch procedures in acute type A aortic dissection. METHODS: From 2005 to 2022, 733 non-syndromic patients presented with acute DeBakey type I aortic dissection and underwent non total arch procedure. Ninety-five patients underwent antegrade stenting and 638 did not. Propensity-score analysis was performed, and 95 optimal pairs were created...

BACKGROUND: Tissue necrosis from persistent mesenteric ischemia after aortic dissection may progress to sepsis and death without emergent laparotomy. However, the signs of mesenteric necrosis are common in patients experiencing non-survivable multisystem failure after aortic catastrophe. No study has yet examined when and whether laparotomy offers a chance for meaningful survival in these patients. METHODS: A total of 145 patients treated for acute Type A or Type B aortic dissection with mesenteric ischemia were identified from a single institution from 2006 to 2022...

BACKGROUND: Congenital aortic and truncal valve disease is challenging in infants and children given the lack of available prostheses in very small sizes and the limited durability of homograft aortic valve replacement. METHODS: A comprehensive literature search was performed using the PubMed database. Studies were included either if the report included patients less than 1 year of age or if the technique was tailored to accommodate for somatic growth. RESULTS: Techniques for aortic and truncal valve repair addressing each aspect of the aortic valve complex - the aorta, aortic annulus, commissures, and cusps - were reviewed...

BACKGROUND: Lung cancer screening guidelines were introduced in the United States in 2013, with variable implementation. This study aimed to evaluate temporal diagnostic trends in non-small cell lung cancer (NSCLC) diagnosis since the introduction of these guidelines. METHODS: This retrospective cohort analysis used the VA Corporate Data Warehouse and the National Cancer Database. We evaluated temporal trends in the distribution of NSCLC stage at the time of diagnosis, including differences based on insurance coverage type (including uninsured, privately insured, Medicare, Medicaid, and VA coverage) with adjustment for clinically relevant variables...

BACKGROUND: Consensus guidelines recommend surgical aortic valve replacement (SAVR) over transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis aged < 65 years. This analysis evaluates clinical practice and outcomes of TAVR and SAVR in patients < 60 years. METHODS: We identified 2,360 patients aged < 60 years including 523 TAVR (22.2%) and 1,837 SAVR (77.8%) procedures from 2013-2021 using the California Department of Health Care Access and Information database...

BACKGROUND: Video-assisted thoracic surgery is currently the recommended treatment for patients with empyema thoracis. However, open window thoracostomy (OWT) is not uncommon and is performed in patients who are in poor general condition or with complicated empyema as a last resort. Although several professional associations have recommended vacuum-assisted closure (VAC) as an adjunct to standard treatment, exact data regarding the clinical role of intrathoracic VAC are not available...

Operative techniques and perioperative management for thoracoabdominal aortic aneurysm (TAAA) have been modified and refined but the morbidity and mortality remain high. Major challenges in open TAAA repair are prevention of ischemic insults to multiorgan, especially spinal cord, and minimizing bleeding. The purpose of this narrative review is to provide currently available techniques and management strategies for open TAAA repair that optimize outcomes.

No abstract text is available yet for this article.

BACKGROUND: We present our surgical experience with cardiac myxomas in the setting of Carney Complex (CNC). METHODS: We searched our institutional data explorers to identify patients diagnosed with CNC. We gathered clinical, surgical, and recurrence data from electronic medical records. In total, 38 patients with Carney Complex were documented from 1970 through 2023. RESULTS: There were 24 (63.1%) patients who developed cardiac myxomas in the setting of Carney Complex...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Atrial fibrillation (AF) occurs commonly following cardiac surgery and is associated with multiple adverse outcomes. Older randomized trials suggested that perioperative beta blockade reduced postoperative AF, and the Society of Thoracic Surgeons (STS) CABG composite measure includes beta blocker administration preoperatively within 24 hours of surgery and at discharge. However, some more recent studies suggest preoperative beta blockade has limited value and question its continuation as an STS quality measure...

No abstract text is available yet for this article.

BACKGROUND: Recovery of hearts from donation after circulatory death donors has been performed with either direct procurement and perfusion (DPP) using Transmedics Organ Care System®(OCS) or with normothermic regional perfusion (NRP) with subsequent cold storage. It remains unclear which of these two strategies yields optimal post-transplant outcomes. METHODS: All heart transplant recipients from donors after circulatory death donors were reviewed (02/2020-01/2023)...

BACKGROUND: Bioprosthetic surgical mitral valve replacement (SMVR) remains an important treatment option in the era of transcatheter valve interventions. We present 10-year clinical outcomes of Medicare beneficiaries undergoing SMVR with a contemporary low-profile mitral porcine valve. METHODS: This is a single-arm observational study using Medicare fee-for-service claims data. De-identified patients undergoing SMVR with the Epic™ Mitral valve (Abbott, Minnesota, USA) in the United States between 1/1/2008-12/31/2019 were selected by ICD-9/10 procedure codes and then linked to a manufacturer device tracking database...

BACKGROUND: Contemporary national outcomes of open and endovascular aortic repair for descending thoracic (DTAA) and thoracoabdominal aortic aneurysms (TAAA) are unclear. We evaluated this using the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS-ACSD). METHODS: From 07/01/2017 to 6/30/2022, we identified 3522 adults undergoing planned DTAA repair (open 328, endovascular 1895) or TAAA repair (open 870, endovascular 429), after excluding ascending aorta or aortic arch aneurysms (zone 0, 1, or 2), interventions with a proximal extent in zone 0 or zone 1, juxtarenal/infrarenal aortic interventions, hybrid procedures, aortic trauma, and aortic infection...

BACKGROUND: Understanding characteristics associated with survival following esophagectomy for cancer is critical to preoperative risk stratification. This study sought to define predictors for long-term survival following esophagectomy for cancer in Medicare patients. METHODS: The STS GTSD was queried for patients age>65 who underwent esophagectomy for cancer between 2012-2020 and linked to CMS data using a deterministic matching algorithm. Patient, hospital, and treatment variables were assessed using a multivariable Cox proportional hazards model to evaluate characteristics associated with long-term mortality and readmission...

No abstract text is available yet for this article.

BACKGROUND: Lymphadenectomy around the recurrent laryngeal nerve (RLN) is an essential part of curative surgery for esophageal cancer. Although several single-center studies have shown that intraoperative nerve monitoring (IONM) can avoid RLN palsy, this has not been confirmed in a large-scale multicenter study. This study was performed to evaluate whether IONM can reduce postoperative RLN palsy during minimally invasive esophagectomy (MIE) for esophageal cancer using a national database...