The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2025
Multicenter StudyMachine Learning and Decision Making in Aortic Arch Repair.
Decision making during aortic arch surgery regarding cannulation strategy and nadir temperature are important in reducing risk, and there is a need to determine the best individualized strategy in a data-driven fashion. Using machine learning (ML), we modeled the risk of death or stroke in elective aortic arch surgery based on patient characteristics and intraoperative decisions. ⋯ Using ML, we can more accurately identify patients at risk of death and stroke, as well as the strategy that better reduces the risk of adverse events compared to traditional prediction models. Operative decisions made may be tailored based on a patient's specific characteristics, allowing for maximized, personalized benefit.
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J. Thorac. Cardiovasc. Surg. · Jan 2025
Preoperatively Predicting Survival Outcome for Clinical Stage IA Pure-Solid Non-Small Cell Lung Cancer by Radiomics-based Machine Learning.
Clinical stage IA non-small cell lung cancer (NSCLC) showing a pure-solid appearance on computed tomography is associated with a worse prognosis. This study aimed to develop and validate machine-learning models using preoperative clinical and radiomic features to predict overall survival (OS) in clinical stage IA pure-solid NSCLC. ⋯ A radiomics-based machine-learning model can preoperatively and accurately predict OS and improve survival stratification in clinical stage IA pure-solid NSCLC.
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J. Thorac. Cardiovasc. Surg. · Jan 2025
Natural History of the Distal Aorta Following Elective Root Replacement in Patients with Marfan Syndrome.
It is unclear if the addition of a prophylactic arch operation is beneficial at the time of root replacement in patients with Marfan syndrome (MFS). This project aims to understand the fate of the distal aorta following elective root replacement in patients with MFS. ⋯ The distal aorta (including the clamp and cannulation site) overall appears stable in patients with MFS following elective root replacement without prophylactic arch operation. Development of TBAD seems to be the primary driver of distal degeneration. Factors associated with TBAD development included hypertension, underscoring the importance of strict blood pressure control in these patients.
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J. Thorac. Cardiovasc. Surg. · Jan 2025
Outcomes of thoracoabdominal aortic aneurysm repair in patients with a prior myocardial infarction.
Many patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair have had a previous myocardial infarction (MI). To address the paucity of data regarding outcomes in such patients, we aimed to compare outcomes after open TAAA repair in patients with and without previous MI. ⋯ Although previous MI was not associated with early mortality after TAAA repair, patients with a previous MI had greater rates of cardiac complications and delayed paraparesis. Patients with a previous MI also trended toward poorer survival.
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J. Thorac. Cardiovasc. Surg. · Jan 2025
Reversibility of Precapillary Pulmonary Hypertension and Outcomes After Heart Transplantation Bridged with Left Ventricular Assist Devices: Insight from the UNOS.
In light of the updated lowered threshold for diagnosing pulmonary hypertension (PH), the reversibility of precapillary PH with left ventricular assist device (LVAD) and the associated post-heart transplantation (HT) outcomes remain unclear. ⋯ Many recipients of HT bridged with LVAD remain with PVR >2 after LVAD implantation, which is associated with increased risk of death after HT compared with patients with normalized PVR after LVAD.