The Journal of cardiovascular surgery最新文献

{"title":"Carotid body tumor contemporary management in a high-volume centre.","authors":"D. Mascia, G. Esposito, A. Ferrante, A. Grandi, G. Melissano, R. Chiesa","doi":"10.23736/S0021-9509.19.10496-X","DOIUrl":"https://doi.org/10.23736/S0021-9509.19.10496-X","url":null,"abstract":"BACKGROUND\u0000The aim of this study is to report our results with carotid body tumour (CBT) surgical management.\u0000\u0000\u0000METHODS\u0000Between 2010 and 2018, 100 CBTs (mean age: 48.0 years, range 21-80 years old) were treated in our centre. The patients were classified in 3 groups according to the size: group I (< 3cm), group II (3 to 5 cm) and group III (>5 cm).\u0000\u0000\u0000RESULTS\u0000Surgical resection was performed in 88 patients and conservative treatment in 2 cases. Nine patients were treated for bilateral involvement and one of them was also treated again for a relapse. Postoperatively, cranial nerve injury (CNI) was significantly higher in group II [3 (8.3%) vs 16 (31.4%) vs 2 (15.4%); p = 0.030] with no statistical differences between the CN involved. At univariate analysis for CNI, CBT group (p=0.030), maximum diameter (p=0.046), patients presenting with dysphonia (p=0.035) and dysphagia (p=0.007) and patients suffering from any intraoperative complication (p=0.047) were statistically significant. At multivariate analysis the only significant variable was CBT group II (p=0.016). For blood loss, CBT group III (p<0.001), Shamblin class III (p<0.001), Pulmonary disease (p=0.034) and surgery time (p<0.001) were statistically significant. The follow-up of 79 patients (87.8%) showed a 100% overall survival at median follow-up of 37.7 months (range 2-84.7 months) with freedom from local recurrence of 97.8% (77/79).\u0000\u0000\u0000CONCLUSIONS\u0000Surgical resection remains the gold standard to obtain complete recovery, although tumour size is to be considered a risk factor for CNI because large CBTs remain at high risk for CNIs.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124232813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management strategies for true and dissecting visceral artery aneurysms.","authors":"P. Keschenau, N. Kaisaris, H. Jalaie, J. Grommes, D. Kotelis, J. Kalder, M. Jacobs","doi":"10.23736/S0021-9509.19.11036-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.19.11036-1","url":null,"abstract":"BACKGROUND\u0000Visceral artery aneurysms (VAA) are rare and the literature regarding management strategies is limited. The study aim was to evaluate our 13-year experience with VAA treatment including conservative, open surgical and endovascular therapy.\u0000\u0000\u0000METHODS\u0000This retrospective single-center study included 37 patients (31 male, median age 70 years [46-79 years]) with true and dissecting VAA treated between January 2006 and December 2018. Indications for invasive therapy were ruptured (n=1) and symptomatic (n=8) VAA or asymptomatic VAA >20 mm (n=15). The decision on the treatment type was made after interdisciplinary (vascular surgeons/radiologists) discussion.\u0000\u0000\u0000RESULTS\u0000The aneurysms affected the celiac trunk (n=18, 49%), the splenic artery (n=11, 30%), the superior mesenteric artery (SMA, n=6, 16%), the hepatic artery (n=5, 14%) and proximal SMA side branches (n=2, 5%). Six patients had multiple VAA, one had an intrahepatic artery aneurysm and one had peripheral mesocolic artery aneurysms plus a VAA. 46% of the patients (n=17) had coexisting aneurysms in other vascular territories. Thirteen patients were managed conservatively (median VAA diameter 15 [14-25] mm), 18 underwent open surgery with venous or prosthetic bypass or interposition graft implantation and 6 were treated by endovascular means (coiling (n=3) or endograft (n=3)). Median follow-up (FU) was 21 months (4-123 months). In-hospital mortality was 0%. Median length of hospital stay was 11 days (5-28 days) after surgical and 3 days (2-71 days) after endovascular treatment. Complications included an early type I endoleak, 3 secondary open abdominal surgeries for bleeding/peritonitis after endovascular treatment of a ruptured intrahepatic aneurysm, anasymptomatic aorto-truncal bypass occlusion and aneurysm recurrence after a venous SMA interposition graft. None of the conservatively treated VAA required invasive treatment during FU.\u0000\u0000\u0000CONCLUSIONS\u0000Small (<20mm) asymptomatic VAA can be managed conservatively. Whenever invasive treatment is indicated, both open and endovascular treatments can be performed with low complication rates. In order to choose the optimal therapeutic approach, anatomical features and patient comorbidities should be considered and, ideally, discussed interdisciplinarily.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123935841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The convergent procedure: a hybrid approach for long lasting persistent atrial fibrillation ablation, the French experience.","authors":"K. Zannis, Wissam Alam, F. Sebag, T. Folliguet, C. Bars, Miche Fahed, J. Ternacle, E. Bergoend, D. Hamon, N. Lellouche","doi":"10.23736/S0021-9509.19.10701-X","DOIUrl":"https://doi.org/10.23736/S0021-9509.19.10701-X","url":null,"abstract":"BACKGROUND\u0000Atrial fibrillation (AF) is associated with increased risk of stroke, heart failure and all-cause mortality. The Cox-Maze procedure is the most effective approach to ablate persistent AF but presents a significant morbidity and mortality. Additionally, the classical endocardial ablation approach has limited efficacy to treat long lasting persistent AF. We described a new, minimally invasive hybrid approach, combining an endocardial and epicardial ablation named convergent procedure to treat long lasting persistent AF patients.\u0000\u0000\u0000METHODS\u0000We studied 55 consecutive patients with long lasting persistent AF who underwent the convergent procedure in 2 French centers between 2010 and 2015. All patients had at least one previous failed endocardial ablation and were highly symptomatic. Patients with a history of thoracic surgery were excluded. A 24 hour-Holter ECG was performed systematically at 3, 6 and 12 months after the convergent procedure. All patients reached 1 year follow-up.\u0000\u0000\u0000RESULTS\u0000No death, stroke, phrenic nerve palsy or tamponade occurred immediately after the procedure. Post-surgery average length of stay was 8±4 days. Later, 3 patients (5%) developed diaphragmatic hernia resulting in a modified surgery technique. At 12 months, 76% of patients were in sinus rhythm after an average of 1.43 ablation procedure. Finally, 91% of patients were maintained on antiarrhythmic drugs.\u0000\u0000\u0000CONCLUSIONS\u0000Thoracoscopic hybrid epicardial-endocardial ablation technique proved to be effective and safe to treat long lasting persistent AF patients with previous failed endocardial AF ablation.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121287881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is size of infarct or clinical picture that should delay urgent carotid endarterectomy? A meta-analysis.","authors":"R. Pini, G. Faggioli, A. Vacirca, Mortalla Dieng, S. Fronterré, E. Gallitto, C. Mascoli, A. Stella, M. Gargiulo","doi":"10.23736/S0021-9509.19.11120-2","DOIUrl":"https://doi.org/10.23736/S0021-9509.19.11120-2","url":null,"abstract":"INTRODUCTION\u0000The best timing for carotid endarterectomy in patients with stroke is still matter of debate, particularly in case of significant cerebral ischemic lesion or neurological deterioration. The present review and meta-analysis aims to report the best evidence in the outcome of patients submitted to urgent (<48h) or standard elapsing time (<2-week) CEA for stroke and to evaluate the impact of cerebral ischemic lesion size and clinical manifestation in the postoperative outcome.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000A systematic review and meta-analysis was performed by searching through Scopus and PubMed all papers reporting CEA outcome (stroke and stroke/death) in patients who suffered a stable stroke, treated within 48h and 2 weeks from symptoms. A subgroup analysis of studies reporting the presence and size of cerebral lesion and clinical manifestation was planned. The pooled 30-day stroke and stroke/death risk (effect size) was expressed by crude percentage and 95% confidence interval (CI), by random effect model.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000Sixteen studies were included in the meta-analysis, 7 reporting the CEA outcome performed <48h from stroke and 13 reporting the outcome of CEA performed <2-week. The effect size of stroke and stroke/death of CEA performed <48h from symptoms was 7.4% (95% CI: 3.7-11.2) and 7.9% (95% CI: 4.0-11.8) respectively, and for CEA <2-week was 4.5% (95% CI: 2.8- 6.3) and 5.4% (95% CI: 3.4-7.4) respectively. Due to the extremely high heterogeneity of the studies data, the effect size was not calculated, however the authors agreed in considering the severity of stroke and the volume of the cerebral ischemic lesion a risk factor for postoperative complication. Two studies evaluated the effect of the cerebral ischemic lesion distribution; the presence of a border- zone infarct was associated with a significant increase in the risk of post-operative stroke/death rate compared with territorial cerebral ischemic lesion (OR: 6.0; 95%CI 1.1-32.0).\u0000\u0000\u0000CONCLUSIONS\u0000CEA for patients with a recent stroke is associated with 5.4% and 7.9% of stroke/death. A large volume of the cerebral ischemic lesion and a deteriorated neurological status are associated with a higher perioperative risk; urgent carotid revascularization seems to further increase this risk.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134199642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CEA vs stent in patients with acute strokes: are they equally effective?","authors":"X. Caliste, A. Laser, R. Darling","doi":"10.23736/S0021-9509.19.11137-8","DOIUrl":"https://doi.org/10.23736/S0021-9509.19.11137-8","url":null,"abstract":"INTRODUCTION\u0000Stroke is the 3rd leading cause of death worldwide with 15 million strokes annually. Extracranial carotid stenosis contributes to major stroke morbidity and mortality as a significant etiology of ischemic strokes. For acute stroke, in addition to optimal medical management, patients may be candidates for carotid endarterectomy and/or carotid stenting for secondary stroke reduction. This paper set out to review the data currently available regarding equivalency of the two intervention options.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000A comprehensive literature review was performed through PubMed and other sources using the key words carotid endarterectomy, carotid artery stent, acute stroke, symptomatic carotid stenosis, flow reversal, TCAR. Studies which solely evaluated patients with asymptomatic disease were ineligible for the study.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000Review of landmark trials such as NASCET and CREST in addition to more recent studies demonstrates the effectiveness of surgical management with carotid endarterectomy of acute stroke. Carotid stenting has also been shown to have acceptable outcomes in certain patient populations.\u0000\u0000\u0000CONCLUSIONS\u0000Carotid endarterectomy continues to demonstrate effectiveness and safety for management of acute strokes, while carotid stenting has limitations. Carotid artery stenting has been shown to be non-inferior in some patient populations, but more recent and future technologic developments may expand the potential acceptable patient selection criteria.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128714517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive coronary artery bypass surgery via lower mini-sternotomy.","authors":"I. Martinovic, S. Lindemann, Lucija Martinovic, A. Včev, Luka Malenica, T. Wittlinger","doi":"10.23736/S0021-9509.19.10920-2","DOIUrl":"https://doi.org/10.23736/S0021-9509.19.10920-2","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129322598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericardiectomy.","authors":"H. B. Shumacker, J. Roshe","doi":"10.32388/e9qmbe","DOIUrl":"https://doi.org/10.32388/e9qmbe","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127595894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of automated fastener device Cor-Knot versus manually tied knot in minimally-invasive isolated aortic valve replacement surgery.","authors":"M. Morgant, G. Malapert, A. Petrosyan, Charline Pujos, S. Jazayeri, O. Bouchot","doi":"10.23736/S0021-9509.19.10792-6","DOIUrl":"https://doi.org/10.23736/S0021-9509.19.10792-6","url":null,"abstract":"BACKGROUND\u0000The aim of our prospective study was to evaluate the efficacy and the safety of the Cor-Knot device in isolated aortic valve replacement by right anterior minithoracotomy.\u0000\u0000\u0000METHODS\u0000A single-center, prospective study was conducted between September 2009 and June 2018. Four hundred and forty patients were operated on for aortic valve replacement by right anterior minithoracotomy. Of these patients, 221 underwent isolated AVR surgery with stented prosthesis. Sutures were secured using the Cor-Knot titanium fastener in 63 patients (28.5%) and knots were hand-tied in 158 (71.5%). Statistical analyses were done using a propensity score with 1:1 matching for the automatically tied (AT) and manually tied (MT) patients.\u0000\u0000\u0000RESULTS\u0000The aortic cross-clamping and cardiopulmonary bypass times were significantly decreased in the AT group (74 ± 13.8 minutes vs 90.4 ± 23.7 minutes, p<0.0001, and 100.8 ± 20.6 minutes vs 117.6 ± 33.1 minutes, p<0.0001), compared with the MT group. Clinical outcomes were similar in the two groups, whether in the analysis of non-matched or matched groups. There was no difference in 30 day-mortality (1.2% vs 0%, p=0.37), and the stroke and transient ischemic attack rates were comparable (2.5% vs 1.6%; p=0.67). There was no significant increase in pacemaker implantation in the AT group (1.3% vs 0%, p=0.36), and the rate of aortic regurgitation ≥ 2 was lower (3.9% vs 0%; p=0.11) but not statistically significant.\u0000\u0000\u0000CONCLUSIONS\u0000The automated Cor-Knot fastener is an easy-to-use, time-saving device which does not increase perioperative morbidity and mortality in patients undergoing aortic valve replacement by right anterior minithoracotomy.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125752970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of chimney/snorkel versus fenestrated endovascular repair for high-risk patients with complex abdominal aortic pathologies.","authors":"G. Taneva, K. Donas, G. Pitoulias, M. Austermann, F. Veith, G. Torsello","doi":"10.23736/S0021-9509.19.11146-9","DOIUrl":"https://doi.org/10.23736/S0021-9509.19.11146-9","url":null,"abstract":"INTRODUCTION\u0000The aim of this study was to evaluate the cost-effectiveness of chimney(ch-EVAR) vs fenestrated(f-EVAR) aneurysm repair for treatment of complex abdominal aortic pathologies. Endovascular repair of complex abdominal aortic pathologies with involvement of renal arteries includes use of f-EVAR as first line treatment. However, lack of availability and suitability has necessitated an alternative strategy employing parallel or snorkel/chimney grafts (ch-EVAR).\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000Between January 2013 and January 2017, prospectively collected data of elective and symptomatic patients with complex aortic pathologies treated by single or double ch-EVAR(n=111) or by f-EVAR with 3-fenestrations(n=37) were evaluated. The primary endpoint was cost-effectiveness analysis defined as the summary of material costs, in-hospital costs and additional costs due to procedure-related reinterventions during a follow-up period averaging 37.2 months.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000No differences between both groups were found in terms of demographics (p=.32), age (p=.058) and hospital stay at initial procedure (p=.956). Index procedure and hospitalization median costs were 22.171€ for ch-EVAR and 42.116€ for f-EVAR, respectively (p<.001). The median overall costs including costs after reinterventions during follow-up were 22.872€ for ch-EVAR and 42.128€for f-EVAR (p<.001). Six patients (5.4%) in the ch-EVAR group required readmission compared to 3 patients (8,1%) required readmission for reinterventions in the f-EVAR group (p=.69).\u0000\u0000\u0000CONCLUSIONS\u0000Ch-EVAR is significantly more cost-effective compared to f-EVAR. The two procedures have comparable readmission rates for reinterventions.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133974752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A meta-analysis of ≥5-year mortality after transcatheter versus surgical aortic valve replacement.","authors":"H. Takagi, Y. Hari, Kouki Nakashima, T. Kuno, T. Ando","doi":"10.23736/S0021-9509.19.11030-0","DOIUrl":"https://doi.org/10.23736/S0021-9509.19.11030-0","url":null,"abstract":"BACKGROUND\u0000It remains unclear whether long-term survival is superior following transcatheter aortic valve implantation (TAVI) than following surgical aortic valve replacement (SAVR). We performed a meta-analysis of mortality with ≥5-year follow- up in randomized controlled trials (RCTs) and propensity-score matched (PSM) studies of TAVI versus SAVR.\u0000\u0000\u0000METHODS\u0000MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through March 2019. Eligible studies were RCTs or PSM studies of TAVI versus SAVR enrolling patients with severe aortic stenosis and reporting all- cause mortality with ≥5-year follow-up as an outcome. A hazard ratio of mortality for TAVI versus SAVR was extracted from each individual study.\u0000\u0000\u0000RESULTS\u0000Study-specific estimates were combined in the random-effects model. Our search identified 3 RCTs and 7 PSM studies enrolling 5498 patients. A pooled analysis of all 10 studies demonstrated a statistically significant 38% increase in mortality with TAVI relative to SAVR. A subgroup meta-analysis showed no statistically significant difference between TAVI and AVR in RCTs and a statistically significant 68% increase with TAVI relative to SAVR in PSM studies.\u0000\u0000\u0000CONCLUSIONS\u0000On the basis of a meta-analysis of 7 PSM studies, TAVI is associated with greater all-cause mortality with ≥5-year follow-up than SAVR. However, another meta-analysis of 3 RCTs suggests no difference in mortality between TAVI and SAVR.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116421953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}