The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Apr 2023
Editorial CommentCommentary: To classify means to choose a threshold.
Classification requires a threshold; however, methods like C-statistic and AUC obfuscate this. Luckily, there is a sensible strategy for imbalanced data thresholding.
-
J. Thorac. Cardiovasc. Surg. · Apr 2023
Impact of valve repair on mild tricuspid insufficiency in rheumatic mitral surgery.
Tricuspid valve repair for mild tricuspid regurgitation during rheumatic mitral valve surgery is controversial. We evaluated the benefit of tricuspid valve repair for mild tricuspid regurgitation in rheumatic mitral valve surgery. ⋯ Tricuspid valve repair for mild tricuspid regurgitation in rheumatic mitral valve surgery provides no overt clinical benefit.
-
J. Thorac. Cardiovasc. Surg. · Apr 2023
Prediction of operative mortality for patients undergoing cardiac surgical procedures without established risk scores.
Current cardiac surgery risk models do not address a substantial fraction of procedures. We sought to create models to predict the risk of operative mortality for an expanded set of cases. ⋯ Machine learning models trained on preoperative patient data can predict operative mortality at a high level of accuracy for cardiac surgical procedures without established risk scores. Such procedures comprise 23% of all cardiac surgical procedures nationwide. This work also highlights the value of using local institutional data to train new prediction models that account for institution-specific practices.
-
J. Thorac. Cardiovasc. Surg. · Apr 2023
Structural abnormalities after aortic root replacement with stentless xenograft.
In complex and high-risk aortic root disease, the porcine Freestyle stentless bioprosthesis (Medtronic Inc, Minneapolis, Minn) is an important surgical treatment option. We aimed to determine prevalence and clinical effect of structural and functional abnormalities after full-root Freestyle implantation. ⋯ Structural and functional abnormalities of the aortic root are frequent after Freestyle implantation and TTE appears to be insufficient for follow-up. Abnormalities might be associated with increased risk of reintervention and potentially adverse clinical outcomes. Longer follow-up and larger study populations are needed to further clarify the clinical implications of abnormalities identified with 4DCT.
-
J. Thorac. Cardiovasc. Surg. · Apr 2023
Outcomes of procedural complications in transfemoral transcatheter aortic valve replacement.
As the application of transcatheter aortic valve replacement (TAVR) expands, the longitudinal implications of periprocedural complications are increasingly relevant. We examine the influence of TAVR complications on midterm survival. ⋯ Severe stroke was independently associated with decreased 5-year survival and initial risks associated with paravalvular leak may be attenuated over the midterm following transfemoral TAVR. Strategies to minimize the incidence of stroke and paravalvular leak must be prioritized to improve longitudinal outcomes after TAVR.