ObjectiveThis study aimed to identify factors associated with adenoma recurrence within three years after endoscopic mucosal resection (EMR) and to develop an individualized predictive model.MethodsPatients undergoing their first EMR for colorectal polyps at the Affiliated Hospital of Xuzhou Medical University (September 2018–May 2025) were retrospectively included and randomly divided into training and testing cohorts (7:3). Patients from the Third Affiliated Hospital of Xuzhou Medical University served as the external validation cohort. Least absolute shrinkage and selection operator (LASSO) regression was used to select predictors. Logistic regression (LR), random forest (RF), support vector machine (SVM), gradient boosting machine (GBM), and extreme gradient boosting (XGBoost) models were constructed. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). SHapley additive explanations (SHAP) values were applied to interpret variable contributions, and an online prediction tool was developed.ResultsA total of 1,454 patients were enrolled, of whom 731 developed adenoma recurrence within three years. LASSO identified ten predictors: infection of Helicobacter pylori (H. pylori), the number of adenomas, age, triglyceride level, body mass index (BMI), diarrhea, smoking history, family history, adenoma size, and fecal occult blood positivity. GBM achieved the highest mean AUC in repeated cross-validation (0.813) and maintained robust discrimination in the testing (AUC = 0.818) and external validation cohorts (AUC = 0.775), with good calibration and clinical utility. SHAP analysis identified H. pylori infection, adenoma number, and age as the leading contributors to model predictions.ConclusionGBM demonstrated favorable discrimination, calibration, and clinical utility across validation cohorts, supporting its use for individualized risk stratification. The resulting online calculator may further facilitate risk assessment and inform follow-up strategies in clinical practice.

Objective:In patients with non-small cell lung cancer (NSCLC) complicated by pulmonary embolism (PE), the clinical manifestations become more complex and the diagnosis is more difficult. We aimed to develop and validate an individualized nomogram for differentiating the PE of NSCLC. Methodology:Patients with NSCLC at the First People's Hospital of Linping District, Hangzhou were enrolled from September 2021 to March 2024. Least Absolute Shrinkage and Selection Operator (LASSO) and multivariate logistic regression analyses were performed to recognize risk factors. An individualized nomogram was subsequently developed. The model's performance was validated using the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA). Results:We enrolled 390 NSCLC patients, of whom 89 (22.8%) had PE. Using multivariate logistic regression, we finally identified seven independent risk factors for PE: pathological type, tumor-node-metastasis (TNM) staging, indwelling central venous catheter (CVC), chemotherapy, hemoglobin, white blood cell count (WBC), and neutrophil-to-lymphocyte ratio (NLR). The model showed good predictive ability, with an area under the ROC curve of 0.909 (95% CI: 0.875-0.942). The calibration curves of the model showed good agreement between actual and predicted probabilities. The ROC and DCA curves demonstrated that the nomogram exhibited a good predictive performance. Conclusions:The nomogram model for predicting the risk of PE in NSCLC has good predictive performance and is potentially useful for screening of high-risk patients in clinical practice.

Non-pharmacological techniques designed to reduce anxiety, pain, and healthcare utilization have shown effectiveness in pediatric and non-surgical adult populations; however, their application has not been widely evaluated among adult surgical patients. This study randomized opioid-naive adults undergoing first-time, elective cardiac surgery to receive either targeted interventions from a trained “comfort coach” or usual care. The primary outcome assessed was healthcare utilization, specifically measured as the number of days at home within the first 30 days post-surgery. Secondary outcomes included postoperative opioid use and patient-reported outcomes, collected via validated surveys. Additionally, 50 participants in the intervention group completed semi-structured qualitative interviews to explore their experience and acceptability of the intervention. Among the 160 randomized subjects (COACH: n = 77; USUAL CARE: n = 79), three did not undergo surgery and one was excluded for dementia, leaving 156 participants with a mean age of 63 years, 33% of whom were female. The primary outcome was not statistically different between groups, with the COACH group averaging 22.8 ± 4.4 days at home and the USUAL CARE group 22.0 ± 4.5 days (p = 0.26). Both groups exhibited similar decreases in anxiety and depression from preoperative clinic to 90-days postoperatively, and discharge pain scores averaged below 3/10. Notably, opioid prescriptions were larger than patient-reported consumption (p < 0.001). Qualitative analysis revealed the comfort coach intervention was highly valued, with participants identifying positive themes regarding the role and impact of the coach. These findings suggest that a comfort coach is a valued, novel healthcare role for cardiac surgery patients, and further research should prioritize comprehensive patient-reported outcomes.

BACKGROUND:In an effort to enhance recovery after cardiac surgery, intraoperative extubation has been targeted as possibly beneficial. This multicenter cohort study aimed to assess this by evaluating the outcomes of operating room (OR) extubation versus extubation within 6 hours of intensive care unit (ICU) arrival (early ICU extubation). Furthermore, we assessed time to ICU extubation and mortality and morbidity. METHODS:Patients undergoing on-pump cardiac surgery across 79 hospitals between 2011 and 2020 were included to (1) compare outcomes among OR extubation and early ICU extubation patients and (2) assess time to overall ICU extubation and outcomes. RESULTS:The overall study cohort comprised 163,982 patients, including 95,982 patients (OR extubation: n = 2529 [2.6%] and early ICU extubation: n = 93,453 [97.4%]) who underwent comparison of OR with early ICU extubation. After overlap weighting, patients with OR extubation had longer OR times (5.6 vs 5.1 hours, P < . 0001) and greater rates of reintubation (5.2% vs 2.9%, P = .003), prolonged ventilation (3% vs 2%, P = .021), reoperation for bleeding (1.5% vs 0.7%, P < .01), pneumonia (1.9% vs 1.1%, P < .006), and greater in-hospital mortality on multivariable regression (odds ratio, 1.34, P < .001). Patients with OR extubation at centers with low OR extubation rates (<10%, n = 60) had greater mortality (odds ratio, 1.6, P = .001). Beyond 22 hours of postoperative ICU ventilation, the risk of morbidity and mortality increased significantly. CONCLUSIONS:Few patients who undergo cardiac surgery are extubated in the OR, which is associated with no clinical benefit and with increased morbidity. Cardiac surgery programs should reconsider OR extubation after cardiopulmonary bypass. In addition, increased intubation time, in particular >22 hours, is associated with an increase in adverse outcomes.

Background: There is currently little data in the literature evaluating the long-term outcomes of reoperative aortic root replacement after previous aortic root replacement, and there are no studies comparing how these outcomes differ based on the approach of the initial aortic root replacement. Our objective was to determine the outcomes of reoperative aortic root replacement following prior aortic root replacement with either the total root or inclusion root techniques.Methods: This study was a retrospective cohort analysis of 260 patients who underwent redo aortic root replacement from September 1994 to July 2024. Previous root replacements were done with the total root technique in 90 patients and inclusion root technique in 170 patients. The primary outcomes of the study were perioperative complications, operative mortality, and late survival.Results: The median age of the entire cohort was 57 years, and 79% were males. The prior total root group was younger, had more Marfan syndrome, and more concomitant ascending/arch replacement. Perioperatively, the groups had similar recovery times and complication rates, though there was more postoperative sepsis in the prior total root group (5.6% vs. 0.6%), Operative mortality was 4.2% in the whole cohort; 5.6% in the total root group versus 3.5% in the inclusion root group, p=0.44. Survival at 5 and 10 years was 84% and 70% in the whole cohort, respectively. The 5-year survival was similar between the groups at 81% in the total root group and 85% in the inclusion root group, p=0.82. Cox proportional hazards regression showed infection as a primary indication and was a significant risk factor for late mortality (hazard ratio 2.55 [95% CI: 1.45, 4.50], p=0.001), as was diabetes (HR: 2.00 [95% CI: 1.04, 3.82], p=0.037), but previous total root versus inclusion root procedure was not (hazard ratio 1.10 [95% CI: 0.58, 2.09], p=0.77).Conclusions: Reoperative aortic root replacement following prior root replacement can be performed with good short- and long-term outcomes after either total root or inclusion root replacement.

BACKGROUND:We aimed to determine the effect of aortic annular enlargement on the midterm outcomes of aortic valve replacement surgery by comparing patients with the same-sized (≤23 mm) native aortic annuli. METHODS:From January 2011 to June 2022, 1328 patients underwent isolated aortic valve replacement-1163 without aortic annular enlargement (AVR group) and 165 with aortic annular enlargement (AVR+AAE group). Propensity score matching identified 112 pairs, controlling for native aortic annulus diameter, age, sex, diabetes, chronic lung disease, dialysis, ejection fraction, prior cardiac surgery, indication, hypertension, dyslipidemia, valve type, prior stroke, prior myocardial infarction, and case status. RESULTS:Demographic and preoperative variables were similar, except body surface area was larger in the AVR+AAE group (2.1 m2 vs 1.9 m2). Median native aortic annulus diameter was 23 mm in both groups. Median prosthesis size was 25 in the AVR+AAE group and 23 in the AVR group. The AVR+AAE group had longer cardiopulmonary bypass (143 vs 111 minutes) and cross-clamp (115 vs 82 minutes) times. Incidences of perioperative complications, including operative mortality (1.8% AVR+AAE vs 3.6% AVR) were similar between groups. Survival at 6 years was 98% in the AVR+AAE group and 74% in the AVR group (P = .016). Aortic annular enlargement was an independent protective factor for midterm mortality, with a hazard ratio of 0.19 (P = .006). The rate of moderate/severe patient-prosthesis mismatch was 19% in the AVR+AAE group and 31% in the AVR group (P = .16). CONCLUSIONS:Patients with small native aortic annuli (≤23 mm) undergoing isolated aortic valve replacement may benefit from aortic annular enlargement.

Objective: Cardiac surgeons experience unpredictable overnight operative responsibilities, with variable rest before same-day, fi rst-start scheduled cases. This study evaluated the frequency and associated impact of a surgeon's ' s overnight operative workload on the outcomes of their same-day, fi rst-start operations. Methods: A statewide cardiac surgery quality database was queried for adult cardiac surgical operations between July 1, 2011, and March 1, 2021. Nonemergency, fi rst-start, Society of Thoracic Surgeons predicted risk of mortality operations were stratified fi ed by whether or not the surgeon performed an overnight operation that ended after midnight. A generalized mixed effect model was used to evaluate the effect of overnight operations on a Society of Thoracic Surgeons composite outcome (5 major morbidities or operative mortality) of the fi rst-start operation. Results: Of all fi rst-start operations, 0.4% % (239/56,272) had a preceding operation ending after midnight. The Society of Thoracic Surgeons predicted risk of morbidity and mortality was similar for fi rst-start operations whether preceded by an overnight operation or not (overnight operation: 11.3%; % ; no overnight operation: 11.7%, % , P = .42). Unadjusted rates of the primary outcome were not significantly fi cantly different after an overnight operation (overnight operation: 13.4%; % ; no overnight operation: 12.3%, % , P = .59). After adjustment, overnight operations did not signifi- fi- cantly impact the risk of major morbidity or mortality for fi rst-start operations (adjusted odds ratio, 1.1, P = .70). Conclusions: First-start cardiac operations performed after an overnight operation represent a small subset of all fi rst-start Society of Thoracic Surgeons predicted risk operations. Overnight operations do not significantly fi cantly influence fl uence the risk of major morbidity or mortality of fi rst-start operations, which suggests that surgeons exercise proper judgment in determining appropriate workloads. (JTCVS Open 2024;20:101-11)

Objective: Professional standards recommend stopping cardiotomy suction termination of cardiopulmonary bypass before protamine administration based perceived safety concerns. This study evaluated a multidisciplinary collaborative quality-improvement intervention promoting this agreed-upon cardiotomy suction practice during coronary artery bypass grafting (CABG). Methods: A statewide intervention (eg, unblinded surgeon and perfusionist back, evidence-based lectures, evaluating barriers to change) involved 32 centers participating in the PERForm (ie, Perfusion Measures and Outcomes) Registry standardize cardiotomy suction practices at cardiopulmonary bypass termination during CABG. Four non-Michigan registry participating centers were not exposed to collaborative learning. Cardiotomy suction practice was defined fi ned as the absence of or stopping cardiotomy suction before protamine administration. The practice changes attributed to the intervention, including Michigan and non-Michigan parisons, were evaluated with the change of time effect modeled using splines. Multivariable regression was used to evaluate the intervention's ' s associated impact (eg, mortality, reoperation, transfusion). Results: Among 10,394 patients undergoing CABG at Michigan centers, 80.7% achieved agreed-upon cardiotomy suction practices. The Michigan centers nonsignificant fi cant changes in agreed-upon cardiotomy suction practices during preintervention period (P P 1 / 4 .24), with significant increased monthly change in tice thereafter, absent adjusted morbidity and mortality increases. The Michigan centers achieved a significantly fi cantly greater adjusted monthly improvement agreed-upon practices relative to non-Michigan centers within 7 months the intervention (adjusted odds ratio for change of trends: 2.53, P < .001). Conclusions: This initiative demonstrates the effectiveness of multidisciplinary collaborative quality improvement in advancing agreed-upon cardiotomy suction practices without negatively impacting clinical outcomes. (JTCVS 2024;17:121-44)

IntroductionWe aimed to investigate the association between renal dysfunction at discharge and long-term survival in acute type A aortic dissection (ATAAD) patients following surgery.MethodsFrom 2000 to 2021, 784 patients underwent aortic repair for an ATAAD. Patients were stratified based on creatinine (Cr) level at discharge alive or dead: normal Cr (n = 582) and elevated Cr defined as >1.3 mg/dL for males and >1.0 mg/dL for females or on dialysis at discharge (n = 202).ResultsPreoperatively, both groups had similar rates of comorbidities except for the elevated-Cr group which had more diabetes, chronic obstructive pulmonary disease, and chronic and acute renal insufficiency. Both groups had similar open ATAAD repair procedures. Postoperative outcomes in the elevated-Cr group were significantly worse, including six times higher operative mortality (20% versus 3.4%, P < 0.0001). The landmark long-term survival after discharge alive was significantly worse in the elevated-Cr group than the normal-Cr group (10-y survival: 48% versus 69%, P = 0.0009). The elevated Cr on dialysis at discharge group had significantly worse five-year survival (40%) than the elevated Cr not on dialysis at discharge group (80%, P = 0.02) and the normal-Cr group (87%, P < 0.0001). Additionally, the elevated Cr not on dialysis had a worse five-year survival than the normal-Cr group (80% versus 87%, P = 0.02). Elevated Cr at discharge on dialysis was a significant risk factor for late mortality (hazard ratio = 4.22, 95% confidence interval: [2.07, 8.61], P < 0.0001).ConclusionsRenal dysfunction at discharge was associated with significantly decreased short-term and long-term survival following open ATAAD repair. Surgeons should aggressively prevent renal dysfunction, especially new-onset dialysis, at discharge as it is correlated with significantly worse short-term and long-term outcomes.

BACKGROUND:The Perfusion Measures and Outcomes (PERForm) registry was established in 2010 to advance cardiopulmonary bypass (CPB) practices and outcomes. The registry is maintained through the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and is the official registry of the American Society of Extracorporeal Technology.METHODS:This first annual PERForm registry report summarizes patient characteristics as well as CPB-related practice patterns in adult (≥18 years of age) patients between 2019 and 2022 from 42 participating hospitals. Data from PERForm are probabilistically matched to institutional surgical registry data. Trends in myocardial protection, glucose, anticoagulation, temperature, anemia (hematocrit), and fluid management are summarized. Additionally, trends in equipment (hardware/disposables) utilization and employed patient safety practices are reported.RESULTS:A total of 40,777 adult patients undergoing CPB were matched to institutional surgical registry data from 42 hospitals. Among these patients, 54.9% underwent a CABG procedure, 71.6% were male, and the median (IQR) age was 66.0 [58.0, 73.0] years. Overall, 33.1% of the CPB procedures utilized a roller pump for the arterial pump device, and a perfusion checklist was employed 99.6% of the time. The use of conventional ultrafiltration decreased over the study period (2019 vs. 2022; 27.1% vs. 24.9%) while the median (IQR) last hematocrit on CPB has remained stable [27.0 (24.0, 30.0) vs. 27.0 (24.0, 30.0)]. Pump sucker termination before protamine administration increased over the study period: (54.8% vs. 75.9%).CONCLUSION:Few robust clinical registries exist to collect data regarding the practice of CPB. Although data submitted to the PERForm registry demonstrate overall compliance with published perfusion evidence-based guidelines, noted opportunities to advance patient safety and outcomes remain.

BACKGROUND:Safety in cardiac surgical procedures is predicated on effective team dynamics. This study associated operative team familiarity (ie, the extent of clinical collaboration among surgical team members) with procedural efficiency and Society of Thoracic Surgeons (STS) adjudicated patient outcomes. METHODS:Institutional STS adult cardiac surgery registry and electronic health record data from 2014 to 2021 were evaluated across 3 quaternary hospitals. Team familiarity was defined as the mean number of cardiac operations performed by surgeon-anesthesiologist, surgeon-perfusionist, and anesthesiologist-perfusionist dyads within 1 year of the operation. The primary outcomes were (1) safety, measured by the STS' composite major morbidity and operative mortality measure, and (2) procedural efficiency, assessed by cardiopulmonary bypass duration. Team familiarity was stratified by terciles (low, moderate, and high) for crude analyses and analyzed continuously for adjusted analyses. Multivariable logistic and linear regression models were used to assess the association between team familiarity and outcomes. RESULTS:Team familiarity was calculated for 13 581 operations. The median (interquartile range) patient age was 64 (55-72) years, and 31.9% (4328/13 581) were women. Terciles of team familiarity were defined as low (<6.00 average shared operations), moderate (6.00-9.67), and high (>9.67). Teams in lower terciles had higher observed STS morbidity and mortality rates (low, 17.9%; moderate, 18.0%; high, 16.0%; P=0.02) and longer median cardiopulmonary bypass duration (low, 137 minutes; moderate, 131 minutes; high, 118 minutes; P<0.001). After risk adjustment, team familiarity was not significantly associated with STS morbidity and mortality (estimate, -0.001 [95% CI, -0.998 to 0.997]) but was inversely associated with cardiopulmonary bypass duration (estimate, -2.02 minutes per 1 unit increase in team familiarity [95% CI, -2.30 to -1.75]). CONCLUSIONS:Increased team familiarity was not associated with STS morbidity and mortality but was inversely correlated with cardiopulmonary bypass duration, demonstrating potential benefit. Interventions aimed at improving team familiarity among operative teams may increase procedural efficiency.

Objective: To associate surgeon-anesthesiologist team familiarity (TF) with cardiac surgery outcomes. Background: TF, a measure of repeated team member collaborations, has been associated with improved operative efficiency; however, examination of its relationship to clinical outcomes has been limited. Methods: This retrospective cohort study included Medicare beneficiaries undergoing coronary artery bypass grafting (CABG), surgical aortic valve replacement (SAVR), or both (CABG+SAVR) between January 1, 2017, and September 30, 2018. TF was defined as the number of shared procedures between the cardiac surgeon and anesthesiologist within 6 months of each operation. Primary outcomes were 30- and 90-day mortality, composite morbidity, and 30-day mortality or composite morbidity, assessed before and after risk adjustment using multivariable logistic regression. Results: The cohort included 113,020 patients (84,397 CABG; 15,939 SAVR; 12,684 CABG+SAVR). Surgeon-anesthesiologist dyads in the highest [31631 patients, TF median (interquartile range)=8 (6, 11)] and lowest [44,307 patients, TF=0 (0, 1)] TF terciles were termed familiar and unfamiliar, respectively. The rates of observed outcomes were lower among familiar versus unfamiliar teams: 30-day mortality (2.8% vs 3.1%, P=0.001), 90-day mortality (4.2% vs 4.5%, P=0.023), composite morbidity (57.4% vs 60.6%, P<0.001), and 30-day mortality or composite morbidity (57.9% vs 61.1%, P<0.001). Familiar teams had lower overall risk-adjusted odds of 30-day mortality or composite morbidity [adjusted odds ratio (aOR) 0.894 (0.868, 0.922), P<0.001], and for SAVR significantly lower 30-day mortality [aOR 0.724 (0.547, 0.959), P=0.024], 90-day mortality [aOR 0.779 (0.620, 0.978), P=0.031], and 30-day mortality or composite morbidity [aOR 0.856 (0.791, 0.927), P<0.001]. Conclusions: Given its relationship with improved 30-day cardiac surgical outcomes, increasing TF should be considered among strategies to advance patient outcomes.

Objective: To evaluate the safety and efficacy of a novel aortic annular enlargement technique. Methods: From August 2020 to February 2022, 50 consecutive cases of aortic valve replacement with Y -incision aortic annular enlargement and other combined cardiac procedures were performed primarily for severe aortic stenosis. Data were obtained through medical record review, The Society of Thoracic Surgeons database, and National Death Index data. Results: The median age was 65 (59, 71) years, 70% of patients were female, and 26% had previous cardiac surgery. Sixty-six percent patients had isolated aortic valve replacement. The preoperative mean gradient was 40 (30, 47) mm Hg, and the native aortic annular size was 21 (19, 23) mm. After aortic annular enlargement, the median prosthesis size was 27 (27, 29) with 54% of patients having a size 29 or the largest sized valve. The median increment of annulus enlargement was 3 (3, 4) valve sizes. 88% of patients received no blood transfusion. There were no major postoperative complications, including operative mortality, renal failure requiring permanent dialysis, mediastinitis, or reoperation for bleeding, except for 1 stroke. Three-month postoperative computed tomography aortogram showed the aortic root was enlarged from 27 (24, 30) to 40 (36, 41) mm without aortic pseudoaneurysm. The postoperative mean gradient was 7 (5, 8) mm Hg and valve area was 1.9 (1.7, 2.3) cm(2) at 3 to 12 months. Mitral and tricuspid valve functions were significantly improved. Survival was 100% at 18 months. Conclusions: Y -incision aortic annular enlargement was safe and effective for upsizing the aortic annulus by 3 to 4 valve sizes. (J Thorac Cardiovasc Surg 2024;167:1196-205)

BACKGROUND Prosthetic valve endocarditis (PVE) is a devastating sequela of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). However, reoperation for post-TAVR PVE is not well described. We investigated the implications of surgically managed PVE after TAVR and SAVR. METHODS Reoperations for active PVE after TAVR and SAVR from 2011 to 2021 were queried using The Society of Thoracic Surgeons (STS) database. We identified 6257 patients, consisting of 374 TAVR (6%) and 5883 SAVR recipients (94%). RESULTS Post-TAVR case volume increased from 1 in 2011 to 116 in 2020. Compared with SAVR, the TAVR group was associated with older age, more frequent preexisting pacemaker, and fewer aortic root abscesses. Intraoperatively, TAVR patients received less aortic root repair (24.9% vs 34.8%; P < .001) and had shorter cardiopulmonary bypass/ aortic cross-clamp times. Among all comers, the operative mortality in patients with previous was 13.6% for TAVR vs 10.8% for SAVR (P = .088). After risk adjustment, previous TAVR itself was not associated with operative mortality (odds ratio, 0.99; 95% CI, 0.72-1.38). In contrast, among 154 post-TAVR and 2232 post-SAVR patients with STS-indexed procedures (SAVR & PLUSMN; coronary artery bypass grafting) with available STS predicted risk of mortality, the mortality was 14.3% and 7.9% (P = .005), with corresponding observed-to-expected mortality ratio of 2.2 and 1.3, respectively. CONCLUSIONS Aortic root repair was seen less frequently after TAVR than after SAVR. Furthermore, previous TAVR was not associated with increased operative mortality. In contrast, the post-TAVR setting was associated with higher mortality regarding isolated SAVR or SAVR plus coronary artery bypass grafting. (Ann Thorac Surg 2023;116:314-21) & COPY; 2023 by The Society of Thoracic Surgeons. Published by Elsevier Inc.

Objective: The study objective was to evaluate the progression of dissected distal aorta in patients with acute type A aortic dissection with malperfusion syndrome treated with endovascular fenestration/stenting and delayed open aortic repair. Methods: From 1996 to 2021, 927 patients presented with acute type A aortic dissection. Of these, 534 had DeBakey I dissection with no malperfusion syndrome and underwent emergency open aortic repair (no malperfusion syndrome group), whereas 97 patients with malperfusion syndrome underwent fenestration/stenting and delayed open aortic repair (malperfusion syndrome group). Sixty-three patients with malperfusion syndrome treated with fenestration/stenting were excluded due to no open aortic repair, including death from organ failure (n = 31), death from aortic rupture (n = 16), and discharged alive (n = 16). Results: Compared with the no malperfusion syndrome group, the malperfusion syndrome group had more patients with acute renal failure (60% vs 4.3%, P < .001). Both groups had similar aortic root and arch procedures. Postoperatively, the malperfusion syndrome group had similar operative mortality (5.2% vs 7.9%, P = .35) and permanent dialysis (4.7% vs 2.9%, P = .50), but more new-onset dialysis (22% vs 7.7%, P < .001) and prolonged ventilation (72% vs 49%, P < .001). The growth rate of the aortic arch (0.38 vs 0.35 mm/year, P = .81) was similar between the malperfusion syndrome and no malperfusion syndrome groups. The descending thoracic aorta growth rate (1.03 vs 0.68 mm/year, P = .001) and abdominal aorta growth rate (0.76 vs 0.59 mm/year, P = .02) were significantly higher in the malperfusion syndrome group. The cumulative incidence of reoperation over 10 years (18% vs 18%, P = .81) and 15-year survival outcome (50% vs 48%, P = .43) were similar between the malperfusion syndrome and no malperfusion syndrome groups. Conclusions: Endovascular fenestration/stenting followed by delayed open aortic repair was a valid approach for patients with malperfusion syndrome.

Importance There is a need to better assess the cumulative effect on morbidity and mortality in patients undergoing durable left ventricular assist device (LVAD) implantation. This study evaluates a patient-centered performance metric (days alive and out of hospital [DAOH]) for durable LVAD therapy. Objective To determine the incidence of percent of DAOH before and after LVAD implantation and (2) explore its association with established quality metrics (death, adverse events [AEs], quality of life). Design, Settings, and Participants This was a retrospective national cohort study of Medicare beneficiaries implanted with a durable continuous-flow LVAD between April 2012 and December 2016. The data were analyzed from December 2021 to May 2022. Follow-up was 100% complete at 1 year. Data from The Society of Thoracic Surgeons Intermacs registry were linked to Medicare claims. Main Outcomes and Measures The number of DAOH 180 days before and 365 days after LVAD implantation and daily patient location (home, index hospital, nonindex hospital, skilled nursing facility, rehabilitation center, hospice) were calculated. Percent of DAOH was indexed to each beneficiary's pre- (percent DAOH-BF) and postimplantation (percentage of DAOH-AF) follow-up time. The cohort was stratified by terciles of percentage of DAOH-AF. Results Among the 3387 patients included (median [IQR] age: 66.3 [57.9-70.9] years), 80.9% were male, 33.6% and 37.1% were Interfaces Patient Profile 2 and 3, respectively, and 61.1% received implants as destination therapy. Median (IQR) percent of DAOH-BF was 88.8% (82.7%-93.8%) and 84.6% (62.1-91.5%) for percent of DAOH-AF. While DAOH-BF was not associated with post-LVAD outcomes, patients in the low tercile of percentage of DAOH-AF had a longer index hospitalization stay (mean, 44 days; 95% CI, 16-77), were less likely to be discharged home (mean. -46.4 days; 95% CI, 44.2-49.1), and spent more time in a skilled nursing facility (mean, 27 days; 95% CI, 24-29), rehabilitation center (mean, 10 days; 95% CI, 8-12), or hospice (mean, 6 days; 95% CI, 4-8). Increasing percentage of DAOH-AF was associated with patient risk, AEs, and indices of HRQoL. Patients experiencing non-LVAD-related AEs had the lowest percentage of DAOH-AF. Conclusions and Relevance Significant variability existed in the percentage of DAOH within a 1-year time horizon and was associated with the cumulative AEs burden. This patient-centered measure may assist clinicians in informing patients about expectations after durable LVAD implantation. Validation of percentage DAOH as a quality metric for LVAD therapy across centers should be explored.

Pseudouridine synthase 7 (PUS7) may play key roles in cancer development. However, few studies have been conducted in this area. In the present study, we explored the function and potential mechanisms of PUS7 in colorectal cancer (CRC) progression. We found that PUS7 had higher expression in CRC tissues and cell lines. Clinically, high expression of PUS7 was associated with an unfavorable prognosis for CRC patients. Functionally, knockdown of PUS7 suppressed the proliferation of CRC cells in vitro and inhibited tumorigenicity in vivo. Mechanistically, RNA sequencing and coimmunoprecipitation (Co-IP) indicated that PUS7 exhibited oncogenic functions through the interaction of Sirtuin 1 (SIRT1) and activated the Wnt/β-catenin signaling pathway. Thus, our findings suggest that PUS7 promotes the proliferation of CRC cells by directly stabilizing SIRT1 to activate the Wnt/β-catenin pathway.

Objectives The use of del Nido cardioplegia in adult cardiac surgery is rising in popularity. The objective of this large multicenter study was to evaluate the use and associated outcomes of del Nido versus blood cardioplegia in adult cardiac surgery. Methods Patients undergoing coronary artery bypass grafting (CABG) and/or valve (mitral, aortic), and/or nondescending thoracic aortic surgery (July 2014 to March 2022) across 39 centers were extracted from the Perfusion Measures and Outcomes registry. Patients were stratified by cardioplegia type for unadjusted analysis and multivariable mixed-effects models were used for risk adjustment. Results Of 44,175 patients, 42.5% used del Nido, with use increasing 48% over time. Overall, the del Nido group had shorter median crossclamp time (74 minutes vs 87 minutes, P < .001) and lower median peak intraoperative glucose levels (161 mg/dL vs 180 mg/dL, P < .001). Use of del Nido was not associated with operative mortality (adjusted odds ratio [ORadj], 1.16; P = .075) nor major morbidity (ORadj, 1.05; P = .25). Findings for valve cases were similar, except crossclamp time differences were variable by type of valve procedure. Within the CABG subgroup there was a trend toward increased operative mortality with del Nido (ORadj, 1.24; P = .069), whereas the risk of renal failure approaches statistical significance in the aortic subgroup (ORadj, 1.54; P = .056). Conclusions In this large, multicenter study, the use of del Nido was associated with variable crossclamp time differences, lower intraoperative glucose levels, and no significant difference in major morbidity or mortality. Efficiency benefits of del Nido may be limited in valve cases, whereas outcomes in CABG and aortic cases warrant further study.

Background Existing predictive models often focus solely on overall survival (OS), neglecting the bias that other causes of death might introduce into survival rate predictions. To date, there is no strict predictive model established for cancer-specific survival (CSS) in patients with intermediate and advanced colon cancer after receiving surgery and chemotherapy. Methods We extracted the data from the Surveillance, Epidemiology, and End Results (SEER) database on patients with stage-III and -IV colon cancer treated with surgery and chemotherapy between 2010 and 2015. The cancer-specific survival (CSS) was assessed using a competitive risk model, and the associated risk factors were identified via univariate and multivariate analyses. A nomogram predicting 1-, 3-, and 5-year CSS was constructed. The c-index, area under the curve (AUC), and calibration curve were adopted to assess the predictive performance of the model. Additionally, the model was externally validated. Results A total of 18 risk factors were identified by univariate and multivariate analyses for constructing the nomogram. The AUC values of the nomogram for the 1-, 3-, and 5-year CSS prediction were 0.831, 0.842, and 0.848 in the training set; 0.842, 0.853, and 0.849 in the internal validation set; and 0.815, 0.823, and 0.839 in the external validation set. The C-index were 0.826 (se: 0.001), 0.836 (se: 0.002) and 0.763 (se: 0.013), respectively. Moreover, the calibration curve showed great calibration. Conclusion The model we have constructed is of great accuracy and reliability, and can help physicians develop treatment and follow-up strategies that are beneficial to the survival of the patients.

Background:There are many variations in valve-sparing aortic root replacement techniques. Our aim is to determine the impact of the graft on mid-term outcomes: Valsalva graft vs. two straight tubular grafts. Methods:From 2004 to 2020, 332 patients underwent valve-sparing aortic root replacement with either a Valsalva graft (Valsalva group: n = 270) or two straight tubular grafts (two-graft group: n = 62). Data were obtained through chart review and the National Death Index. Primary outcomes were mid-term survival and freedom from reoperation. Results:The preoperative characteristics of the groups were similar, but the two-graft group had more type A dissections (32% vs. 19%) and emergent operations (26% vs. 15%) and was younger (45 vs. 50 years). Intraoperatively, the groups were similar, but the two-graft group had longer cross-clamp (245 vs. 215 minutes) and cardiopulmonary bypass times (284 vs. 255 minutes). Postoperative complications including reoperation for bleeding, stroke, pacemaker implantation, and renal failure were slightly more frequent in the Valsalva group, but the differences were not significant. Operative mortality was similar between the Valsalva and two-graft groups (0.7% vs. 0%). Five-year survival in the two-graft group was 100% compared to 96% in the Valsalva group (p=0.56). Five-year freedom from reoperation in the two-graft group was 100% compared to 93% in the Valsalva group (p=0.29). Conclusions:The Valsalva and two-graft techniques both have excellent short- and mid-term outcomes. The two-graft technique might have slightly better survival and freedom from reoperation, but a larger sample size and longer follow-up are needed to determine if these advantages are significant.