Journal of Thoracic and Cardiovascular Surgery

OBJECTIVE: Tricuspid regurgitation (TR) is often caused by leaflet splaying from displaced papillary muscles or ventricular dilatation. Traditional annuloplasty may not address this mechanism. The present study describes a single institution's experience using right ventricular papillary muscle approximation (RVPMA) for tricuspid valve (TV) repair. METHODS: RVPMA consists of suturing the anterior papillary muscle to a point of the septum (septum or septal papillary muscle) that optimizes leaflet coaptation...

OBJECTIVE: Despite the growing relevance of immunotherapy for non-small cell lung cancer (NSCLC), there is limited consensus on the optimal treatment strategy for locally advanced NSCLC. This study evaluated the overall survival of patients with stage III-N2 NSCLC undergoing induction chemoimmunotherapy with surgery ("CT/IO+Surgery") and definitive concurrent chemoradiation followed by immunotherapy ("cCRT+IO"). METHODS: Patients with cT1-3, N2, M0 NSCLC in the National Cancer Database (2013-2019) were included and stratified by treatment regimen: CT/IO+Surgery or cCRT+IO...

OBJECTIVE: (s): To determine whether discriminatory performance of a computational risk model in classifying pulmonary lesion malignancy using demographic, radiographic, and clinical characteristics is superior to the opinion of experienced providers. We hypothesized that computational risk models would outperform providers. METHODS: Outcome of malignancy was obtained from selected patients enrolled in the NAVIGATE trial (NCT02410837). Five predictive risk models were developed using an 80:20 train-test split: 1) univariable logistic regression model based solely on provider opinion (POULR), 2) multivariable logistic regression model (MLVR), 3) random forest classifier (RFC), 4) extreme gradient boosting (XGB) model, and 5) artificial neural network (ANN)...

OBJECTIVES: We evaluate the independent effects of patient and aortic tissue characteristics on biaxial physiologic mechanical metrics in aneurysmal and non-aneurysmal tissues, and uniaxial failure metrics in aneurysmal tissue, comparing longitudinal and circumferential behavior. METHODS: From 2/2017-10/2022, 382 aortic specimens were collected from 134 patients; 268 specimens underwent biaxial and 114 uniaxial testing. Biaxial testing evaluated Green-Lagrange transition strain and low and high tangent moduli...

OBJECTIVES: We aim to evaluate the heterogeneous treatment effects of coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy, and to identify a group of patients to have greater benefits from CABG compared with medical therapy alone. METHODS: Machine learning causal forest modeling was performed to identify the heterogeneous treatment effects of CABG in ischemic cardiomyopathy patients from the Surgical Treatment for Ischemic Heart Failure (STICH) trial...

OBJECTIVES: To evaluate if there is a shortage of thoracic surgeons in the U.S. and whether any potential shortage is impacting lung cancer treatment and outcomes. DESIGN: Using the U.S. Area Health Resources File and Surveillance Epidemiology End Results database, we assessed the number of cardiothoracic surgeons per 100,000 people and the number of stage I NSCLC diagnoses in the U.S. in 2010 versus 2018. Changes in the percentage of patients diagnosed with stage I NSCLC who underwent surgery and stereotactic body radiotherapy (SBRT) and changes in overall survival of patients with stage I NSCLC from 2010-2018 in the National Cancer Database were evaluated using multivariable logistic regression and Cox proportional hazards modeling...

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OBJECTIVE: Restrictions to care access during the pandemic along with the increasing complexity of patients awaiting cardiac surgery provides unique challenges for care delivery. The University of Ottawa Heart Institute (UOHI) has developed a novel multidisciplinary digital platform, the Prehab Automated Follow-Up (AFU) Program, which delivers patient/caregiver teaching regarding risk factor mitigation, tracks patient symptoms and screens for optimization using best practice guidelines...

OBJECTIVE: The purpose of this study was to quantitate the impact of heart donation after circulatory death (DCD) donor utilization on both waitlist and post-transplant outcomes in the United States. METHODS: The United Network for Organ Sharing database was queried to identify all adult waitlisted and transplanted candidates between 10/18/2018-12/31/2022. Waitlisted candidates were stratified according to whether they had been approved for donation after brain death (DBD) offers only, or also approved for DCD offers...

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OBJECTIVE: Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is often considered to be "benign" despite recent data suggesting worse outcomes. There are no guidelines for the amount of POAF that triggers anticoagulation or for postoperative surveillance. We examined the rate of POAF, incidence of neurologic events, development of permanent AF, and mortality in patients undergoing isolated mitral valve surgery at a Mitral Foundation reference center. METHODS: This is a retrospective cohort study of 922 adult patients from 2011-2022 with no preoperative history of arrhythmias...

OBJECTIVE: Approximately 3 million Americans served in the armed forces during the Vietnam War1 . Veterans have a higher incidence rate of lung cancer compared to the general population, which may be related to exposures sustained during service2 . Agent Orange (AO), one of the tactical herbicides utilized by the armed forces as a means of destroying crops and clearing vegetation, has been linked to development of several cancers including non-small cell lung cancer (NSCLC). However, traditional risk models of lung cancer survival and recurrence often do not include such exposures2, 3 ...

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OBJECTIVE: This study aims to report the two-year outcomes of patients with clinical stage N2-3 esophageal squamous cell carcinoma (ESCC) who received neoadjuvant chemotherapy and immunotherapy (Chemo-IO) followed by surgery from a phase II NICE trial. METHODS: Eligible patients with clinical stage N2-3 ESCC were screened and enrolled, then treated with regimen of nab-paclitaxel (100mg/m2 , days 1, 8, 15), carboplatin (AUC = 5, day 1), camrelizumab (200 mg, day 1) of two 21-days cycles and esophagectomy 4-6 weeks after the last chemotherapy...