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Special Issue "Cardiothoracic Surgery: State of the Art and Future Perspectives - Part II"

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1. Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Suite 715, Shadyside Medical Building, 5200 Centre Avenue, Pittsburgh, PA 15232, USA
2. VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA
Interests: thoracic cancers; lung cancer immunotherapy; malignant pleural effusions; radiomics
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Dear Colleagues,

Cardiothoracic surgery deals with some of the most important disease states faced by humanity. The efforts to improve the longevity for those who suffer from coronary artery disease, aortic aneurysms, lung failure, lung cancer, and esophageal cancer have given surgeons the opportunity to be on the cutting edge of our greatest medical advances. The last three decades have seen the introduction and adoption of minimally invasive techniques, robotic-assisted procedures, artificial-intelligence-assisted diagnostics, immunotherapeutic treatments, and biomarker-based risk assessment, among others. The rate of advance is staggering, and the next decade will likely usher in the ability to drastically improve our diagnostic and therapeutic capabilities. This Special Issue of the Journal of Clinical Medicine, “Cardiothoracic Surgery: State of the Art and Future Perspectives – Part II”, highlights the most recent advances in the field as related to the diagnosis and treatment of disease states faced by cardiothoracic surgeons.

Dr. Rajeev Dhupar
Guest Editor

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Keywords

cardiothoracic surgery advances
minimally invasive surgery
artificial intelligence
immunotherapy in thoracic cancers
lung transplant
esophageal cancer
lung cancer
aortic aneurysm

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Open AccessFeature PaperArticle

Lung Transplantation Outcomes in Recipients Aged 70 Years or Older and the Impact of Center Volume

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J. Clin. Med. 2023, 12(16), 5372; https://doi.org/10.3390/jcm12165372 - 18 Aug 2023

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Abstract

Objective: To evaluate trends and outcomes of lung transplants (LTx) in recipients ≥ 70 years. Methods: We performed a retrospective analysis of the UNOS database identifying all patients undergoing LTx (May 2005–December 2022). Baseline characteristics and postoperative outcomes were compared by age (<70 years, ≥70 years) and center volume. Kaplan–Meier analyses were performed with pairwise comparisons between subgroups. Results: 34,957 patients underwent LTx, of which 3236 (9.3%) were ≥70 years. The rate of LTx in recipients ≥ 70 has increased over time, particularly in low-volume centers (LVCs); consequently, high-volume centers (HVCs) and LVCs perform similar rates of LTx for recipients ≥ 70. Recipients ≥ 70 had higher rates of receiving from donor after circulatory death lungs and of extended donor criteria. Recipients ≥ 70 were more likely to die of cardiovascular diseases or malignancy, while recipients < 70 of chronic primary graft failure. Survival time was shorter for recipients ≥ 70 compared to recipients < 70 old (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.28–1.44, p < 0.001). HVCs were associated with a survival advantage in recipients < 70 (HR: 0.91, 95% CI: 0.88–0.94, p < 0.001); however, in recipients ≥ 70, survival was similar between HVCs and LVCs (HR: 1.11, 95% CI: 0.99–1.25, p < 0.08). HVCs were more likely to perform a bilateral LTx (BLT) for obstructive lung diseases compared to LVCs, but there was no difference in BLT and single LTx likelihood for restrictive lung diseases. Conclusions: Careful consideration is needed for recipient ≥ 70 selection, donor assessment, and post-transplant care to improve outcomes. Further research should explore strategies that advance perioperative care in centers with low long-term survival for recipients ≥ 70. Full article

(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives - Part II)

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CT-Derived Body Composition Is a Predictor of Survival after Esophagectomy

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J. Clin. Med. 2023, 12(6), 2106; https://doi.org/10.3390/jcm12062106 - 08 Mar 2023

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Background: Body composition can be accurately quantified based on computed tomography (CT) and typically reflects an individual’s overall health status. However, there is a dearth of research examining the relationship between body composition and survival following esophagectomy. Methods: We created a cohort consisting of 183 patients who underwent esophagectomy for esophageal cancer without neoadjuvant therapy. The cohort included preoperative PET-CT scans, along with pathologic and clinical data, which were collected prospectively. Radiomic, tumor, PET, and body composition features were automatically extracted from the images. Cox regression models were utilized to identify variables associated with survival. Logistic regression and machine learning models were developed to predict one-, three-, and five-year survival rates. Model performance was evaluated based on the area under the receiver operating characteristics curve (ROC/AUC). To test for the statistical significance of the impact of body composition on survival, body composition features were excluded for the best-performing models, and the DeLong test was used. Results: The one-year survival model contained 10 variables, including three body composition variables (bone mass, bone density, and visceral adipose tissue (VAT) density), and demonstrated an AUC of 0.817 (95% CI: 0.738–0.897). The three-year survival model incorporated 14 variables, including three body composition variables (intermuscular adipose tissue (IMAT) volume, IMAT mass, and bone mass), with an AUC of 0.693 (95% CI: 0.594–0.792). For the five-year survival model, 10 variables were included, of which two were body composition variables (intramuscular adipose tissue (IMAT) volume and visceral adipose tissue (VAT) mass), with an AUC of 0.861 (95% CI: 0.783–0.938). The one- and five-year survival models exhibited significantly inferior performance when body composition features were not incorporated. Conclusions: Body composition features derived from preoperative CT scans should be considered when predicting survival following esophagectomy. Full article

(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives - Part II)

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Special Issue "Cardiothoracic Surgery: State of the Art and Future Perspectives - Part II"

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