Publications by authors named "Tom Nguyen"

185 Publications

Commentary: Type A dissection: What a shame, you left a DANE!

JTCVS Tech 2021 Oct 1;9:15-16. Epub 2021 Jul 1.

Division of Adult Cardiothoracic Surgery, UCSF Medical Center, San Francisco, Calif.

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http://dx.doi.org/10.1016/j.xjtc.2021.06.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501198PMC
October 2021

Surgeon Strength: Ergonomics and Strength Training in Cardiothoracic Surgery.

Semin Thorac Cardiovasc Surg 2021 Sep 28. Epub 2021 Sep 28.

Division of Adult Cardiothoracic Surgery, Department of Surgery, UCSF Health, San Francisco, CA. Electronic address:

With the high prevalence of musculoskeletal pain in surgeons and interventionalists, it is critical to analyze the impact of ergonomics on cardiothoracic surgeon health. Here, we review the existing literature and propose recommendations to improve physical preparedness for surgery both in and outside the operating room. For decades, cardiothoracic surgeons have suffered from musculoskeletal pain, most commonly in the neck and back due to a lack of proper ergonomics during surgery. A lack of dedicated ergonomics curriculum during training may leave surgeons at a high predisposition for work-related musculoskeletal disorders. We searched PubMed, Google Scholar, and other sources for studies relevant to surgical ergonomics and prevalence of musculoskeletal disease among surgeons and interventionalists. Whenever possible, data from quantitative studies and meta-analyses are presented. We also contacted experts and propose an exercise routine to improve physical preparedness for demands of surgery. To date, many studies have reported astonishingly high rates of work-related pain in surgeons with rates as high as 87% in minimally-invasive surgeons. Several optimizations regarding correct table height, monitor positioning, and loupe angles have been discussed. Lastly, implementation of ergonomics training at some programs have been effective at reducing the rates of musculoskeletal pain among surgeons. Surgical work-related stress injuries are more common than we think. Many factors including smaller incisions and technological advancements have led to this plight. Ultimately, work-related injuries are underreported and understudied and the field of surgical ergonomics remains open for investigative study.
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http://dx.doi.org/10.1053/j.semtcvs.2021.09.015DOI Listing
September 2021

Machine Learning to Predict Outcomes and Cost by Phase of Care after Coronary Artery Bypass Grafting.

Ann Thorac Surg 2021 Sep 25. Epub 2021 Sep 25.

Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. Electronic address:

Background: Machine learning may enhance prediction of outcomes after coronary artery bypass grafting (CABG). We sought to develop and validate a dynamic machine learning model to predict CABG outcomes at clinically relevant pre- and postoperative timepoints.

Methods: The Society of Thoracic Surgeons (STS) registry data elements from 2,086 isolated CABG patients were divided into training and testing datasets and input into XGBoost decision-tree machine learning algorithms. Two prediction models were developed based on data from the pre- (80 parameters) and postoperative (125 parameters) phases of care. Outcomes included operative mortality, major morbidity or mortality, high-cost, and 30-day readmission. Machine learning and STS model performance was assessed using accuracy and the area under the precision-recall curve (AUC-PR).

Results: Preoperative machine learning models predicted mortality (Accuracy=98%; AUC-PR=0.16; F1=0.24), major morbidity or mortality (Accuracy =75%; AUC-PR=0.33; F1=0.42), high cost (Accuracy =83%; AUC-PR=0.51; F1=0.52), and 30-day readmission (Accuracy =70%; AUC-PR=0.47; F1=0.49) with high accuracy. Preoperative machine learning models performed similar to the STS for prediction of mortality (STS AUC-PR=0.11;p=0.409) and outperformed STS for prediction of mortality or major morbidity (STS AUC-PR=0.28;p<0.001). Addition of intraoperative parameters further improved machine learning model performance for major morbidity or mortality (AUC-PR=0.39;p<0.01) and high cost (AUC-PR=0.64;p<0.01), with cross-clamp and bypass times emerging as important additive predictive parameters.

Conclusions: Machine learning can predict mortality, major morbidity, high cost, and readmission after isolated CABG. Prediction based on the phase of care allows for dynamic risk assessment through the hospital course, which may benefit quality assessment and clinical decision making.
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http://dx.doi.org/10.1016/j.athoracsur.2021.08.040DOI Listing
September 2021

Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair: Mid-Term Outcomes From the CUTTING-EDGE International Registry.

JACC Cardiovasc Interv 2021 Sep;14(18):2010-2021

San Raffaele University Hospital, Milan, Italy.

Objectives: The aim of this study was to determine clinical and echocardiographic characteristics, mechanisms of failure, and outcomes of mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER).

Background: Although >100,000 mitral TEER procedures have been performed worldwide, longitudinal data on MV surgery after TEER are lacking.

Methods: Data from the multicenter, international CUTTING-EDGE registry were retrospectively analyzed. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 9.0 months (interquartile range [IQR]: 1.2-25.7 months) after MV surgery, and follow-up was 96.1% complete at 30 days and 81.1% complete at 1 year.

Results: From July 2009 to July 2020, 332 patients across 34 centers underwent MV surgery after TEER. The mean age was 73.8 ± 10.1 years, median Society of Thoracic Surgeons risk for MV repair at initial TEER was 4.0 (IQR: 2.3-7.3), and primary/mixed and secondary mitral regurgitation were present in 59.0% and 38.5%, respectively. The median interval from TEER to surgery was 3.5 months (IQR: 0.5-11.9 months), with overall median Society of Thoracic Surgeons risk of 4.8% for MV replacement (IQR: 2.8%-8.4%). The primary indication for surgery was recurrent mitral regurgitation (33.5%), and MV replacement and concomitant tricuspid surgery were performed in 92.5% and 42.2% of patients, respectively. The 30-day and 1-year mortality rates were 16.6% and 31.3%, respectively. On Kaplan-Meier analysis, the actuarial estimates of mortality were 24.1% at 1 year and 31.7% at 3 years after MV surgery.

Conclusions: In this first report of the CUTTING-EDGE registry, the mortality and morbidity risks of MV surgery after TEER were not negligible, and only <10% of patients underwent MV repair. These registry data provide valuable insights for further research to improve these outcomes.
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http://dx.doi.org/10.1016/j.jcin.2021.07.029DOI Listing
September 2021

Multi-Institutional Evaluation of a Debate-Style Journal Club for Cardiothoracic Surgery Trainees.

Ann Thorac Surg 2021 Sep 18. Epub 2021 Sep 18.

Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Electronic address:

Background: Traditional journal clubs address individual articles and are limited in terms of breadth and depth of content covered. The present study describes the outcomes of a novel debate-style journal club in a multi-institutional setting.

Methods: Participating institutions were recruited through the Thoracic Education Cooperative Group (TECoG). The distributed curriculum included instructions, debate scenarios, suggested article lists, moderator slides, debate scoresheets, exams, and feedback surveys.

Results: Six institutions participated in the study (2015-2019), consisting of a total of 10 years' worth of cumulative debates. Cardiothoracic surgery trainees participated in 10 monthly debates over each academic year. Trainee performance on the written examination in the realm of evidence-based medicine and critical appraisal improved over the course of the academic year (beginning 55.2% vs end 76.3%, p=0.040). Importantly, written examination after debates revealed a significant improvement in scores on questions relating to topics that were debated as compared to those that were not (+27.1% vs +2.5%, p=0.006), emphasizing the importance of the debates as compared to other sources of knowledge gain. Surveys completed by trainees and faculty overall favored the debate-style journal club as compared to the traditional journal club in gaining familiarity with seminal literature in the field, improving upon oral presentation skills, and applying published literature to questions encountered clinically.

Conclusions: In this multi-institutional prospective study, we demonstrate that the novel debate-style cardiothoracic surgery journal club is an effective educational intervention for cardiothoracic surgical trainees to acquire, retain, and gain practice in applying literature-based evidence to case-based scenarios.
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http://dx.doi.org/10.1016/j.athoracsur.2021.07.104DOI Listing
September 2021

Commentary: The right horse for the race in the repair of secondary mitral regurgitation.

J Thorac Cardiovasc Surg 2021 Sep 3. Epub 2021 Sep 3.

Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, Calif.

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http://dx.doi.org/10.1016/j.jtcvs.2021.08.059DOI Listing
September 2021

Commentary: Reversing the irreversible ischemic fibrosis with extracellular vesicle therapy.

J Thorac Cardiovasc Surg 2021 Aug 13. Epub 2021 Aug 13.

Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, Calif. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2021.08.016DOI Listing
August 2021

Response to Hopkins, Kichenadasse, Logan, et al.

J Natl Cancer Inst 2021 Aug 27. Epub 2021 Aug 27.

Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, USA.

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http://dx.doi.org/10.1093/jnci/djab161DOI Listing
August 2021

The Effect of COVID-19 on Adult Cardiac Surgery in the United States in 717 103 Patients.

Ann Thorac Surg 2021 Jul 31. Epub 2021 Jul 31.

Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.

Background: COVID-19 has changed the world as we know it, and the United States continues to accumulate the largest number of COVID-related deaths worldwide. There exists a paucity of data regarding the effect of COVID-19 on adult cardiac surgery trends and outcomes on regional and national levels.

Methods: The Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried from January 1, 2018, to June 30, 2020. The Johns Hopkins COVID-19 database was queried from February 1, 2020, to January 1, 2021. Surgical and COVID-19 volumes, trends, and outcomes were analyzed on a national and regional level. Observed-to-expected ratios were used to analyze risk-adjustable mortality.

Results: The study analyzed 717 103 adult cardiac surgery patients and more than 20 million COVID-19 patients. Nationally, there was a 52.7% reduction in adult cardiac surgery volume and a 65.5% reduction in elective cases. The Mid-Atlantic region was most affected by the first COVID-19 surge, with 69.7% reduction in overall case volume and 80.0% reduction in elective cases. In the Mid-Atlantic and New England regions, the observed-to-expected mortality for isolated coronary bypass increased as much as 1.48 times (148% increase) pre-COVID rates. After the first COVID-19 surge, nationwide cardiac surgical case volumes did not return to baseline, indicating a COVID-19-associated deficit of cardiac surgery patients.

Conclusions: This large analysis of COVID-19-related impact on adult cardiac surgery volume, trends, and outcomes found that during the pandemic, cardiac surgery volume suffered dramatically, particularly in the Mid-Atlantic and New England regions during the first COVID-19 surge, with a concurrent increase in observed-to-expected 30-day mortality.
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http://dx.doi.org/10.1016/j.athoracsur.2021.07.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325556PMC
July 2021

We Asked the Experts: Surgical Ergonomics: Stop Suffering in Silence.

World J Surg 2021 Nov 31;45(11):3304-3305. Epub 2021 Jul 31.

Chief of Adult Cardiothoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, UCSF, San Francisco, USA.

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http://dx.doi.org/10.1007/s00268-021-06249-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476391PMC
November 2021

RESPONSE: Approaching Truly Collaborative Training in Structural Heart Disease: Seeking the Middle Path.

J Am Coll Cardiol 2021 Aug;78(5):535-536

Department of Cardiothoracic Surgery, University of California-San Francisco, San Francisco, California, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jacc.2021.04.108DOI Listing
August 2021

Commentary: Superior vena cava syndrome should not hinder use of a percutaneous right ventricular assist device.

JTCVS Tech 2021 Apr 25;6:95-96. Epub 2020 Dec 25.

Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Tex.

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http://dx.doi.org/10.1016/j.xjtc.2020.12.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8300904PMC
April 2021

Commentary: Less-invasive approaches to big complex problems in patients with end-stage heart disease.

JTCVS Tech 2020 Dec 16;4:200-201. Epub 2020 Sep 16.

Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Memorial Hermann Hospital-Heart and Vascular Institute, Houston, Tex.

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http://dx.doi.org/10.1016/j.xjtc.2020.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306215PMC
December 2020

Commentary: Reoperative transapical transcatheter aortic valve implantation for a degenerated biological valve: An approach with caution or a mission impossible?

JTCVS Tech 2020 Dec 22;4:121. Epub 2020 Oct 22.

Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Memorial Hermann Hospital-Heart and Vascular Institute, Houston, Tex.

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http://dx.doi.org/10.1016/j.xjtc.2020.10.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308337PMC
December 2020

Impact of the Coronavirus Disease 2019 Pandemic on Cardiac Surgical Education in North America.

Innovations (Phila) 2021 Jul-Aug;16(4):350-357. Epub 2021 Jun 25.

12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.

Objective: We report the impact of the coronavirus disease 2019 (COVID-19) pandemic on cardiac surgery trainee education in North America.

Methods: A survey was sent to participating academic adult cardiac surgery centers in North America. Data regarding the effect of COVID-19 on cardiac surgery training were analyzed.

Results: Responses were received from 53 academic institutions with diverse geographic distribution. Cardiac surgery trainee re-deployment to alternative clinical duties peaked at the height of the pandemic. We stratified institutions based on high ( = 20) and low burden ( = 33) of patients hospitalized with COVID-19. The majority of institutions have converted didactics (high burden 90% vs low burden 73%) and interviews for jobs/fellowships (high burden 75% vs low burden 73%) from in-person to virtual. Institutions were mixed in preference for administration of the licensing examination, with the most common preference for examinations to be held remotely on normal timeline (high burden 45% vs low burden 30%) or in person with more than 3-month delay (high burden 20% vs low burden 33%). Despite the challenges experienced during the COVID-19 pandemic on trainee clinical experience, re-deployment, and decreased operative volume, institutions expected their trainees to graduate on schedule (high burden 95% vs low burden 91%).

Conclusions: Our study demonstrates that actions taken during the COVID-19 pandemic has led to disruptions in cardiac surgery training with transition of didactics and interviews virtually and re-deployment to alternative duties. Despite this, institutions remain optimistic that their trainees will graduate on schedule.
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http://dx.doi.org/10.1177/15569845211011459DOI Listing
October 2021

Artificial Heart Valves.

JAMA 2021 06;325(24):2512

University of California, San Francisco.

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http://dx.doi.org/10.1001/jama.2020.19936DOI Listing
June 2021

Cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic.

J Card Surg 2021 Sep 12;36(9):3040-3051. Epub 2021 Jun 12.

Division of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, California, USA.

Background: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on health care and cardiac surgery. We report cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic.

Methods: A detailed survey was sent to recruit participating adult cardiac surgery centers in North America. Data regarding cardiac surgeons' perceptions and changes in practice were analyzed.

Results: Our study comprises 67 institutions with diverse geographic distribution across North America. Nurses were most likely to be redeployed (88%), followed by advanced care practitioners (69%), trainees (28%), and surgeons (25%). Examining surgeon concerns in regard to COVID-19, they were most worried with exposing their family to COVID-19 (81%), followed by contracting COVID-19 (68%), running out of personal protective equipment (PPE) (28%), and hospital resources (28%). In terms of PPE conservation strategies among users of N95 respirators, nearly half were recycling via decontamination with ultraviolet light (49%), followed by sterilization with heat (13%) and at home or with other modalities (13%). Reuse of N95 respirators for 1 day (22%), 1 week (21%) or 1 month (6%) was reported. There were differences in adoption of methods to conserve N95 respirators based on institutional pandemic phase and COVID-19 burden, with higher COVID-19 burden institutions more likely to resort to PPE conservation strategies.

Conclusions: The present study demonstrates the impact of COVID-19 on North American cardiac surgeons. Our study should stimulate further discussions to identify optimal solutions to improve workforce preparedness for subsequent surges, as well as facilitate the navigation of future healthcare crises.
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http://dx.doi.org/10.1111/jocs.15681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8447333PMC
September 2021

Smoking History as a Potential Predictor of Immune Checkpoint Inhibitor Efficacy in Metastatic Non-Small Cell Lung Cancer.

J Natl Cancer Inst 2021 Jun 11. Epub 2021 Jun 11.

Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, USA.

Background: Despite the therapeutic efficacy of immune checkpoint inhibitors (ICIs) in a subset of patients, consistent and easily obtainable predictors of efficacy remain elusive.

Methods: This study was conducted on 644 advanced non-small cell lung cancer (NSCLC) patients treated with ICI monotherapy between April 2013 and September 2020 at the Dana-Farber Cancer Institute and Brigham and Women's Hospital. Patient smoking history, clinicopathological characteristics, tumor mutation burden (TMB) by clinical targeted next generation sequencing, and PD-L1 tumor proportion score (TPS) by immunohistochemistry were prospectively collected. The association of smoking history with clinical outcomes of ICI monotherapy in metastatic NSCLC patients was evaluated after adjusting for other potential predictors. All statistical tests were 2-sided.

Results: Of 644 advanced NSCLC patients 105 (16.3%) were never smokers, 375 (58.2%) were former smokers (median pack-years = 28), and 164 (25.4%) were current smokers (median pack-years = 40). Multivariable logistic and Cox proportional hazards regression analyses suggested that doubling of smoking pack-years is statistically significantly associated with improved clinical outcomes of patients treated with ICI monotherapy (objective response rate odds ratio = 1.21, 95% confidence interval [CI] = 1.09-1.36, P < .001; progression-free survival hazard ratio = 0.92, 95% CI = 0.88-0.95, P < .001; overall survival hazard ratio = 0.94, 95% CI = 0.90-0.99, P = .01). Predictive models incorporating pack-years and PD-L1 TPS yielded additional information and achieved similar model performance compared to using TMB and PD-L1 TPS.

Conclusions: Increased smoking exposure had a statistically significant association with improved clinical outcomes in metastatic NSCLC treated with ICI monotherapy independent of PD-L1 TPS. Pack-years may serve as a consistent and readily obtainable surrogate of ICI efficacy when TMB is not available to inform prompt clinical decisions and allow more patients to benefit from ICIs.
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http://dx.doi.org/10.1093/jnci/djab116DOI Listing
June 2021

Commentary: To operate or wait? Contextualizing early outcomes of cardiac surgery in COVID-19-positive patients.

J Thorac Cardiovasc Surg 2021 08 27;162(2):e373-e374. Epub 2021 Apr 27.

Division of Cardiothoracic Surgery, Department of Surgery, University of San Francisco, San Francisco, Calif. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2021.04.059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078055PMC
August 2021

Catastrophic Cardiac Events During Transcatheter Aortic Valve Replacement.

Can J Cardiol 2021 May 14. Epub 2021 May 14.

Department of Anesthesiology, The University of Texas at Houston, McGovern Medical School/Memorial Hermann Heart and Vascular Institute, Houston, Texas, USA.

Background: Perioperative complications of transcatheter aortic valve replacement (TAVR) are decreasing but can be catastrophic when they occur. Systematic reports of the nature of these events are lacking in the contemporary era. Our study aimed to report the incidence, outcomes, and perioperative management of catastrophic cardiac events in patients undergoing TAVR and to propose a working strategy to address these complications.

Methods: This is a retrospective cohort study of patients who developed catastrophic cardiac events during or immediately after TAVR between 2015 and 2019 at a single academic centre.

Results: Of 2102 patients who underwent TAVR, 51 (2.5%) developed catastrophic cardiac events. The causes included cardiac perforation and tamponade (n = 19, 37.3%), acute left- ventricular failure (n = 10, 19.6%), coronary artery obstruction (n = 10, 19.6%), aortic-root disruption (n = 7, 13.7%), and device embolization (n = 5, 9.8%). Twenty-four patients (47.0%) with catastrophic cardiac events required stabilization by either intra-aortic balloon counter-pulsation or extracorporeal membrane oxygenation. The in-hospital mortality rate increased by 11.7-fold for patients with catastrophic cardiac events compared with those without (25.5% vs 2.0%, P < 0.001). Patients who developed aortic root disruption had the highest mortality rate (42.8%) compared with the others. The incidence of catastrophic cardiac events remained stable over a 5-year period, but the associated mortality decreased from 38.5% in 2015 to 9.1% in 2019.

Conclusions: Catastrophic cardiac events during TAVR are rare, but they account for a dramatic increase in perioperative mortality. Early recognition and development of a standardized perioperative team approach can help manage patients experiencing these complications.
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http://dx.doi.org/10.1016/j.cjca.2021.05.002DOI Listing
May 2021

Commentary: Coronary artery bypass grafting during COVID: Safe for some, but where are the rest?

JTCVS Open 2021 Jun 20;6:146-147. Epub 2021 Apr 20.

Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, Calif.

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http://dx.doi.org/10.1016/j.xjon.2021.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080169PMC
June 2021

Commentary: Thoracic aortic disease: One step closer to precision medicine.

J Thorac Cardiovasc Surg 2021 Mar 26. Epub 2021 Mar 26.

Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, Calif.

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http://dx.doi.org/10.1016/j.jtcvs.2021.03.072DOI Listing
March 2021

Training the trainee in structural heart disease: A need for change.

J Thorac Cardiovasc Surg 2021 Feb 16. Epub 2021 Feb 16.

Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Tex.

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http://dx.doi.org/10.1016/j.jtcvs.2021.02.016DOI Listing
February 2021

Commentary: Cardiac Surgery Cannot Wait in the Wings - The Show Must Go On.

Semin Thorac Cardiovasc Surg 2021 Mar 1. Epub 2021 Mar 1.

Division of Adult Cardiothoracic Surgery, UCSF Health, San Francisco, California.

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http://dx.doi.org/10.1053/j.semtcvs.2021.02.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919517PMC
March 2021

Association between Smoking History and Tumor Mutation Burden in Advanced Non-Small Cell Lung Cancer.

Cancer Res 2021 05 2;81(9):2566-2573. Epub 2021 Mar 2.

Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.

Lung carcinogenesis is a complex and stepwise process involving accumulation of genetic mutations in signaling and oncogenic pathways via interactions with environmental factors and host susceptibility. Tobacco exposure is the leading cause of lung cancer, but its relationship to clinically relevant mutations and the composite tumor mutation burden (TMB) has not been fully elucidated. In this study, we investigated the dose-response relationship in a retrospective observational study of 931 patients treated for advanced-stage non-small cell lung cancer (NSCLC) between April 2013 and February 2020 at the Dana Farber Cancer Institute and Brigham and Women's Hospital. Doubling smoking pack-years was associated with increased and less frequent and mutations, whereas doubling smoking-free months was associated with more frequent . In advanced lung adenocarcinoma, doubling smoking pack-years was associated with an increase in TMB, whereas doubling smoking-free months was associated with a decrease in TMB, after controlling for age, gender, and stage. There is a significant dose-response association of smoking history with genetic alterations in cancer-related pathways and TMB in advanced lung adenocarcinoma. SIGNIFICANCE: This study clarifies the relationship between smoking history and clinically relevant mutations in non-small cell lung cancer, revealing the potential of smoking history as a surrogate for tumor mutation burden.
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http://dx.doi.org/10.1158/0008-5472.CAN-20-3991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137661PMC
May 2021

Commentary: Cardiothoracic surgery training: Global challenges without universal solutions.

J Thorac Cardiovasc Surg 2021 Jan 20. Epub 2021 Jan 20.

Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, Calif.

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http://dx.doi.org/10.1016/j.jtcvs.2021.01.048DOI Listing
January 2021

The Safety of Tomorrow's Patients Relies on the Education of Today's Residents.

Ann Thorac Surg 2021 Feb 10. Epub 2021 Feb 10.

Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1489, Houston, TX 77030. Electronic address:

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http://dx.doi.org/10.1016/j.athoracsur.2020.12.069DOI Listing
February 2021

The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies.

Innovations (Phila) 2021 Jan-Feb;16(1):3-16. Epub 2021 Jan 25.

12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.

Objective: There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons.

Methods: Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year.

Results: Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios.

Conclusions: In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient's aortic valve disease.
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http://dx.doi.org/10.1177/1556984520978316DOI Listing
January 2021

Commentary: 10,000 hours or 10,000 cases? An argument for regionalization of coronary and cardiac valve surgery in the new era.

J Thorac Cardiovasc Surg 2020 Nov 30. Epub 2020 Nov 30.

Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, Calif.

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http://dx.doi.org/10.1016/j.jtcvs.2020.11.104DOI Listing
November 2020

Commentary: The train has left the station: Run fast or look for the next train.

J Thorac Cardiovasc Surg 2020 Nov 28. Epub 2020 Nov 28.

Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2020.11.083DOI Listing
November 2020
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