The Journal of cardiovascular surgery最新文献

{"title":"Outcomes of two suture-mediated closure devices for transfemoral percutaneous access endovascular aortic procedures.","authors":"Baban Assaf, Nikolaos Tsilimparis, Jan Stana, Alexia Amvrazi, Zsuzsanna Mihály, Barbara Rantner, Nikolaos Konstantinou","doi":"10.23736/S0021-9509.25.13341-7","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13341-7","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the effectiveness of percutaneous approach and compare two suture-mediated closure devices, the older generation Pergolide^™ and newer generation ProStyle^™ (Abbott Cardiovascular, Lake County, Chicago, IL, USA) in patients undergoing endovascular aortic repair.</p><p><strong>Methods: </strong>A retrospective, single-center, comparative study on consecutive patients undergoing endovascular aortic procedures from January to November 2022 was undertaken. Arterial calcification was assessed using the peripheral artery calcification scoring system (PACSS). Closure device technical success without the need for open surgical conversion was defined as the primary endpoint. Secondary endpoints were access vessel complications (bleeding, hematoma, vessel occlusion or high-grade stenosis and pseudoaneurysm) and the need for additional closure devices to achieve hemostasis. Logistic regression was used to identify confounders; results are presented as odds ratio (OR) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Between January and November 2022, 147 patients (mean age 71±10 years; 77.6% males) underwent percutaneous endovascular aortic repair. A total of 237 vessels were punctured, 63.3% were treated with ProGlide^™ and 36.7% with ProStyle^™. Technical success of closure devices was 91.6% (ProGlide^™ 94% vs. ProStyle^™ 87.4%, P=0.091). Severe vessel calcification (PACSS 3-4) significantly reduced success rates (81% vs. 95.4%, P=0.001). Major complications occurred in 8.4% of cases, with higher rates in severely calcified vessels (P=0.006) and larger sheath sizes (P=.008). Multivariate analysis identified the number of closure devices used per vessel as the sole independent predictor of technical failure (OR 0.11, 95% CI 0.03-0.36, P=0.001). Additional devices were required in 35.9% of cases, influenced by prior surgery and sheath size.</p><p><strong>Conclusions: </strong>Both the older generation ProGlide^™ and newer generation ProStyle^™ closure devices demonstrated high technical success rates with few access vessel complications. Severe calcification and large sheath sizes could potentially impact technical success negatively.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 4","pages":"283-290"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126619","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":"Endovascular repairs of complex chronic post-dissection thoracoabdominal aortic aneurysm using modular patient-specific fenestrated-branched stent-graft components.","authors":"Alejandro Pizano, Joshua Wong, Marina F Dias-Neto, Guilherme B Lima, Emanuel R Tenorio, Gustavo S Oderich","doi":"10.23736/S0021-9509.25.13290-4","DOIUrl":"10.23736/S0021-9509.25.13290-4","url":null,"abstract":"<p><p>Chronic post-dissection thoracoabdominal aortic aneurysms (pD-TAAAs) pose unique challenges for endovascular repair due to true lumen compression, vessel origin from separate lumens, and extension of dissection into side branches. We report two cases of pD-TAAA with persistent false lumen perfusion and progressive aortic dilatation. In both cases, the celiac axis was perfused from an isolated false lumen due to occlusion of the reentrance tear, with the remaining patent target vessels originating from the true lumen. The first case is a 74-year-old man with chronic extent-III TAAA with a prior type-<inf>B3,9</inf> acute dissection. The second case is a 68-year-old man with a chronic extent-II TAAA with a prior type-A<inf>0-9</inf> acute dissection. Both patients underwent patient-specific fenestrated-branched endovascular aortic repair using a proximal branched-stent-graft and a distal fenestrated-stent-graft. Two-component modular stent-grafts provide an additional therapeutic option for complex post-dissection aneurysms involving visceral vessels, encompassing both true and false lumens.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"347-352"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183100","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":"Aortic endothelial preservation during trans-catheter aortic valve explantation.","authors":"Ali Akamkam, Bastien Poitier, Antoine Lafont, Paul Achouh","doi":"10.23736/S0021-9509.25.13274-6","DOIUrl":"10.23736/S0021-9509.25.13274-6","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"353-354"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144277317","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":"Impact of center experience on unibody anatomically fixed systems utilization: insight from a multicentric, international, non-randomized, prospective registry - the AFX2-LIVE Study.","authors":"Francesco Andreoli, Pasqualino Sirignano, Andrea Gaggiano, Giancarlo Acciarino, Nicola Tusini, Filippo Benedetto, Pierfrancesco Veroux, Stefano Pirelli, Nicola Leone, Roberto Silingardi, Maurizio Taurino, Francesco Speziale","doi":"10.23736/S0021-9509.25.13337-5","DOIUrl":"10.23736/S0021-9509.25.13337-5","url":null,"abstract":"<p><strong>Background: </strong>The present study evaluates the impact of procedural volume on intraoperative and short-term outcomes of endovascular aneurysm repair (EVAR) using the AFX2 unibody endograft in a large, multicenter cohort.</p><p><strong>Methods: </strong>A secondary analysis of the AFX2 LIVE study was conducted, including 535 EVAR procedures performed across 43 centers from November 2019 to August 2021. Centers were categorized into four quartiles based on case volume. Procedural efficiency (operative time, fluoroscopy time, contrast media use) and clinical outcomes (technical success, 30-day clinical success, major adverse events) were analyzed. A nonlinear regression model identified a volume threshold for improved technical outcomes.</p><p><strong>Results: </strong>Higher-volume centers demonstrated significantly shorter operative times (Q1=80 min vs. Q4=60 min, P=0.003), reduced contrast media usage (Q1=89.6 mL vs. Q4=61.9 mL, P=0.001), and lower fluoroscopy times (Q1=714 s vs. Q4=520 s, P=0.001). Logistic regression indicated that each additional 10 cases increased the likelihood of optimal procedural performance (OR=1.29, P=0.001). A threshold of 30 cases per center was identified, above which the probability of achieving optimal technical outcomes exceeded 50%. Despite these efficiency improvements, primary technical success (Q1-2=97.9% vs. Q3-4=98.0%, P=0.928) and 30-day MAE rates remained comparable across all quartiles.</p><p><strong>Conclusions: </strong>Institutional experience significantly influences procedural efficiency in EVAR with the AFX2 device, with a learning curve effect evident beyond 30 cases. However, technical success and safety remain high across all centers, reinforcing the device's feasibility even in lower-volume institutions. These findings support current European guidelines recommending a minimum annual EVAR caseload of 30 procedures per center.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"274-282"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034991","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":"Mid-term outcomes of frozen elephant trunk versus hemiarch in acute of type A aortic dissections.","authors":"Juliette Piccoli, Pan Dan, Tristan Ehrlich, Elodie Phamisith, Yihua Liu, Giuseppe Lauria, Juan-Pablo Maureira","doi":"10.23736/S0021-9509.25.13252-7","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13252-7","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to compare the postoperative morbidity and mortality between total replacement of the aortic arch using the frozen elephant trunk technique versus replacement of the hemiarch in patients with acute type A aortic dissection and dissection of arch branch vessels without cerebral malperfusion.</p><p><strong>Methods: </strong>Between January 2015 and April 2023, 156 patients with acute type A aortic dissections were treated in our Center. Only patients with TAE2M2- (Type A or Type non-A non-B, with entry tear in arch aorta extend to arch branch vessels dissection without symptoms) were included. Patients were analyzed according to the surgical techniques: FET or hemiarch replacement.</p><p><strong>Results: </strong>Forty-two patients were included in our study. In hospital mortality was similar between the groups (FET: 12%, Hemiarch: 0%; P=0.2593). Survival at 5 years was 88% in the FET group and 94.1% in the hemiarch group (P=0.5243). Patients treated with FET showed a higher incidence of additional procedures on the remaining aorta (36.4% versus 0%, P=0.0056). Stroke with permanent neurologic dysfunction were similar between the groups (FET 8% and Hemiarch 11.8%; P=1.0000).</p><p><strong>Conclusions: </strong>FET and hemiarch replacement showed similar short- and mid-term results. The FET technique offers advantages for distal aorta protection and future endovascular interventions but is associated with longer circulatory arrest and higher transfusion requirements. No significant survival or neurological benefits were observed for FET over ODA in the absence of malperfusion.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 4","pages":"308-315"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126367","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":"Surgical management of late infection following fenestrated endovascular aneurysm repair.","authors":"Simone Cuozzo, Antonio Luparelli, Ottavia Borghese, Silvia Lorusso, Giovanni Tinelli, Yamume Tshomba","doi":"10.23736/S0021-9509.25.13440-X","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13440-X","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 4","pages":"355-356"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126710","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":"Patterns of visceral artery involvement and radiological malperfusion in aortic dissections.","authors":"Amine Fikani, Jerome Jouan, Marouane Boukhris, Patrick Lermusiaux, Antoine Millon, Philippe Tresson","doi":"10.23736/S0021-9509.25.13025-5","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13025-5","url":null,"abstract":"<p><strong>Background: </strong>The aim of the present study was to analyze visceral arteries involvement in both acute type A (ATAAD) and type B (ATBAD) aortic dissection comparing the different types of radiological malperfusion.</p><p><strong>Methods: </strong>Forty consecutive patients with ATAAD and 40 consecutive patients with ATBAD were included. Multiplanar reconstruction was used to analyze the luminal origin and the corresponding malperfusion of the coeliac trunk, the superior mesenteric artery, the left and the right renal arteries. Branch perfusion patterns were categorized into a simplified classification (true lumen, false lumen, dual lumen) and into a more detailed one: Class I, dissection involving but not extending into the branch; Class II, dissection extending into the branch and Class III, dissection causing ostial avulsion. The primary endpoints of the study were to assess patterns of visceral artery involvement and to evaluate mechanisms of radiological malperfusion in ATAAD and ATBAD.</p><p><strong>Results: </strong>A total of 320 arterial branches were analyzed. Significant differences were found between ATAAD and ATBAD regarding the origin of the superior mesenteric artery (more Class I in ATBAD 87.5% vs. 67.5% in ATAAD, P=0.03) and left renal artery (more Class I in ATBAD 70% vs. 42.5% in ATAAD, P=0.04). Radiological malperfusion patterns were also different in ATAAD and ATBAD (more malperfusion from arteries originating from true lumen in ATBAD compared to ATAAD, P=0.05). There were no anatomical predictive factors for branch artery involvement.</p><p><strong>Conclusions: </strong>Visceral branch artery involvement and mechanisms of radiological malperfusion were significantly different between ATAAD and ATBAD. These findings should be considered when guiding the optimal treatment strategy in acute aortic dissection.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 4","pages":"259-265"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126562","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":"Technical success and early outcomes of mechanical thrombectomy and thrombo-aspiration for acute limb ischemia: a systematic review and meta-analysis.","authors":"Marie Bonnet, Maxime Dubosq-Lebaz, Audrey Fels, Gilles Chatellier, Yann Gouëffic","doi":"10.23736/S0021-9509.25.13360-0","DOIUrl":"10.23736/S0021-9509.25.13360-0","url":null,"abstract":"<p><strong>Introduction: </strong>In recent years, thrombo-aspiration (TA) and mechanical thrombectomy (MT) have emerged as endovascular alternatives to conventional treatments such as surgical thrombectomy or catheter-directed thrombolysis (CDT) for acute limb ischemia (ALI). To date, no meta-analysis has assessed the outcomes of TA and MT in this setting. This study aims to evaluate the short-term safety and effectiveness of these techniques in patients with ALI.</p><p><strong>Evidence acquisition: </strong>Systematic searches on studies evaluating the safety and efficacy of TA or MT in ALI were conducted in PubMed/Medline and Cochrane Central from 2010 to 2023. The meta-analysis followed PRISMA guidelines. The primary endpoint was amputation rate at 30 days. Secondary endpoints included 30-day mortality, technical success alone, and success with adjuvant treatment (angioplasty, stenting, CDT).</p><p><strong>Evidence synthesis: </strong>A total of 591 articles were screened, and 10 studies (1083 patients, 1092 limbs) were included. The pooled one-month major amputation rate was 5% [95% CI: 1-8%]. In subgroup analysis, the amputation rate was 0% [95% CI: 0-1%] for TA and 8% [95% CI: 4-13%] for MT, reflecting differences in patient severity profiles. One-month mortality was 3% [95% CI: 1-5%]. Technical success alone was 57% [95% CI: 39-75%] overall, with a marked difference between TA (73% [95% CI: 54-93%]) and MT (48% [95% CI: 16-80%]). Assisted technical success reached 97% [95% CI: 94-100%].</p><p><strong>Conclusions: </strong>Short-term outcomes of TA and MT suggest these techniques are promising for ALI treatment. However, their effectiveness relies heavily on adjunctive therapies, especially for MT. Future randomized trials and cost-effectiveness analyses with long-term follow-up are needed to define the true value of these approaches.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 4","pages":"337-346"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126729","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":"Real world outcomes with the TREO endograft (Terumo Aortic): results from the European TiGER registry.","authors":"Emiel W Huistra, Michel M Reijnen, Clark J Zeebregts, Alexander Hyhlik-Duerr, Stoyan Kondov, Pierfrancesco Veroux, Robert H Geelkerken, Vincent Riambau","doi":"10.23736/S0021-9509.25.13372-7","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13372-7","url":null,"abstract":"<p><strong>Background: </strong>The Terumo Aortic Global Endovascular Registry (TiGER) was established to monitor the real-world performance of Terumo Aortic endografts. Reported here are the two-year outcomes of this multi-center experience with the TREO^® Abdominal Stent Graft System for the treatment of infrarenal abdominal aortic aneurysms.</p><p><strong>Methods: </strong>Between November 2019 and September 2024, 330 subjects (90.3% male; mean age 73.8±7.3 years) were treated with a TREO^® Abdominal Stent Graft System at 23 sites across seven European countries. Subjects received elective (N.=312) or emergency (N.=18) endovascular aortic repair.</p><p><strong>Results: </strong>Technical success was achieved at 97.3% (318/327). Failures were due to inability to advance the device (N.=2), stent-graft kinking or twisting (N.=3), type Ia endoleak (N.=2), concomitant type Ia and Ib endoleak (N.=1), and type IIIa endoleak (N.=1). The concomitant type Ia and Ib endoleak resulted in a contained rupture, treated successfully by open reconstruction. Four deaths (1.2%) occurred within 30 days of the procedure. During a mean follow-up of 464.3±362.4 days, an additional ten subjects experienced a type I/III endoleak, four of which had reinterventions to address the observation. There were ten subjects (3.0%) with limb occlusions, of which one subject required three reinterventions to address limb occlusion. Overall survival at two years was 85.3±3.8%.</p><p><strong>Conclusions: </strong>Initial results from this real-world, multi-center registry showed the safe and effective use of the TREO^® Abdominal Stent Graft System for treatment of infrarenal abdominal aortic aneurysms. Long-term outcomes from TiGER are necessary to validate the durability of these results.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755582","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":"Transcatheter endothermal septotomy in complex endovascular repair of dissected aortic aneurysms.","authors":"Eric J Finnesgard, Kris M Boelitz, Andres Schanzer","doi":"10.23736/S0021-9509.25.13331-4","DOIUrl":"10.23736/S0021-9509.25.13331-4","url":null,"abstract":"<p><p>Extensive aortic aneurysms with chronic dissection present a challenge in complex endovascular aortic repair due to limited luminal working room, suboptimal landing zones, and target vessels which may originate from the false lumen. Adjunctive endothermal septotomy is a technique to modify the aortic anatomy to a state more amenable to minimally invasive repair. This technique uses radiofrequency energy to transect the aortic septum, creating a common lumen within which to conduct the aortic repair. In this narrative review, the technique for endothermal septotomy is described and the supporting literature is summarized. While rigorous study of the technique remains limited at present, early experience has demonstrated feasibility and safety.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"227-231"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236395","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}