The Journal of cardiovascular surgery最新文献

{"title":"Initial experience and results of a single-branched TEVAR system in Scandinavia.","authors":"Samuel Saers, Reshaabi Srinanthalogen, Tomas Ohrlander, Sofia Strömberg, Timothy A Resch, Jacob Budtz-Lilly, Robert C Lind","doi":"10.23736/S0021-9509.25.13330-2","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13330-2","url":null,"abstract":"<p><strong>Background: </strong>Thoracic endovascular aortic repair (TEVAR) often requires landing in zone 1 or 2 thereby compromising flow through the supra-aortic branch vessels. The Castor (Microport Medical, Shanghai, China) single branched TEVAR system has an incorporated side branch allowing treatment of pathologies reaching zone 2 and 3, whilst preserving flow to aortic arch side branches. This study aims to report on the initial experience and short-term results of all Castor cases done in Scandinavia.</p><p><strong>Methods: </strong>All patients treated with a Castor stent graft in Scandinavia were included in this study. Pre- and postoperative radiologic imaging were examined. Medical journals were investigated. Operative data, technical success, survival, major adverse events and reinterventions were recorded and analyzed retrospectively.</p><p><strong>Results: </strong>Twenty-three patients received a Castor in four different Scandinavian hospitals and were included in this study. Treated pathology included type B dissection (N.=10), penetrating aortic ulcer (N.=3), degenerative aortic aneurysm (N.=7), infective native aortic aneurysm (N.=1), Lusorian aneurysm (N.=1) and a proximal stent graft induced new entry after a previous TEVAR (N.=1). The Castor was deployed in zone 2 with side branch placement in the left subclavian artery (N.=16) or zone 1 with side branch placement in the left common carotid artery (N.=7). Technical success was achieved in 96% (N.=22). Median follow-up was 359 (147-664) days with a side branch patency of 95%. No major adverse events occurred within 30 days. Two reinterventions were performed during follow-up due to a distal stent graft induced new entry. One patient died from myocardial infarction 92 days after the Castor procedure.</p><p><strong>Conclusions: </strong>This multicenter retrospective study represents largest contemporary European series. Short-term results and initial experience were good with no peri-operative strokes, spinal cord ischemia or death reported.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164184","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":"Repair of thoracoabdominal aneurysm and dissection with branched and fenestrated technology.","authors":"Marcelo Ferreira, Matheus Mannarino, Rodrigo Cunha, Diego Ferreira, Luis F Capotorto, Guilherme Mannarino","doi":"10.23736/S0021-9509.25.13333-8","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13333-8","url":null,"abstract":"<p><p>Endovascular repair has transformed the management of complex aortic aneurysms and chronic aortic dissections, providing a minimally invasive alternative to open surgery. The introduction of fenestrated and branched endografts (FBEVAR) has significantly expanded the anatomical eligibility for endovascular repair, allowing for the treatment of thoracoabdominal and complex abdominal aneurysms with improved patient outcomes. This review provides a comprehensive analysis of recent advancements in FBEVAR, focusing on technical success, durability, reintervention rates, and the evolving strategies to mitigate complications such as spinal cord ischemia. While FBEVAR has demonstrated high procedural success and mid-term efficacy, challenges related to long-term durability, bridging stent performance, and spinal cord protection remain critical areas of ongoing research.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 2","pages":"80-91"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082995","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":"Chronic kidney disease as a predictor of long-term adverse cardiovascular outcomes in patients with aortoiliac disease: a prospective cohort study.","authors":"Mariana Alves, Ana-Daniela Pias, Joana Marques, Conceição Miranda, António Pereira-Neves, Mohammed Shahat, José Vidoedo, José P Andrade, João Rocha-Neves, Ana Marreiros","doi":"10.23736/S0021-9509.24.13135-7","DOIUrl":"10.23736/S0021-9509.24.13135-7","url":null,"abstract":"<p><strong>Background: </strong>Aortoiliac disease poses a significant cardiovascular (CV) risk, especially in individuals with chronic kidney disease. This study aimed to assess the predictive role of chronic kidney disease in long-term major adverse CV events in patients submitted to aortoiliac revascularization due to severe aortoiliac atherosclerotic disease.</p><p><strong>Methods: </strong>From 2013 to 2023, patients who underwent aortoiliac revascularization for TASC II type D lesions, including those with chronic kidney disease, were selected from a prospective cohort study. Demographic, clinical, and postoperative data were collected. Prognostic factors were evaluated for their independent impact on outcomes using survival analysis with a multivariate Cox regression model.</p><p><strong>Results: </strong>The study included 135 patients, 93.3% male, with a mean age of 62.39±9.20 years. Chronic kidney disease was associated with higher prevalence of short-term myocardial injury after noncardiac surgery (54.5%, P=0.014) and was a long-term predictor of acute heart failure (Hazard Ratio=4.884; 95% confidence interval 2.377-22.802; P=0.007), major adverse CV events (HR 2.992; 95% CI 1.498-5.975, P=0.002) and all-cause mortality (HR 3.296; 95% CI 1.626-6.682, P<0.001). The multivariable analysis revealed significant associations between major adverse CV events and the following predictors: chronic kidney disease (adjusted HR=2.416, 95% CI 1.171-4.984, P=0.017) and congestive heart failure (adjusted HR=2.633, 95% CI 1.233-5.623, P=0.012).</p><p><strong>Conclusions: </strong>Chronic kidney disease is a recognized CV risk factor and an independent predictor of long-term acute heart failure, major adverse CV events, and all-cause mortality. These findings underscore the importance of early identification of CV complications and stricter long-term follow-up for chronic kidney disease patients undergoing aortoiliac revascularization.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"109-119"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960935","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":"Secondary interventions and surveillance after elective abdominal aortic aneurysm repair.","authors":"Filipa Jácome, Beatriz Ribeiro, João Rocha-Neves, José F Teixeira, Marina Dias-Neto","doi":"10.23736/S0021-9509.25.13183-2","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13183-2","url":null,"abstract":"<p><strong>Background: </strong>The early survival benefits of endovascular aneurysm repair (EVAR) appear to diminish over time, and late aneurysm-related mortality remains a significant concern. Our aim is to determine the rate of secondary interventions (SI) and assess compliance with post-EVAR surveillance.</p><p><strong>Methods: </strong>This retrospective cohort study included consecutive patients who underwent elective EVAR between February 2009 and May 2019 at a tertiary center. The primary outcomes were freedom from SI and compliance with follow-up (imaging performed within a time interval of no more than 18 months). Secondary outcome was overall patient survival.</p><p><strong>Results: </strong>A total of 214 patients underwent EVAR, with a median follow-up of 44 months. During this period, 42 SI were performed in 25 patients. Of all SI, 33.3% (14/42) were due to symptomatic complications. Freedom from SI was 96.3±1.3% at 30 days and 93.6±1.7%, 90.3±2.2% and 85.9±3.0 at 1, 3 and 5 years, respectively. Endoleaks were the main cause of SI after EVAR (N.=26), primarily type 1 and type 2. At 5 years, patient survival rates were similar (76.7±4.1% vs. 84.4±7.2%, P=0.386). Compliance with surveillance was 80.4±2.9% at 1 year, and 37.7±5.4% at 5 years.</p><p><strong>Conclusions: </strong>SI after EVAR were frequent, with endoleaks being the leading cause and associated with cases of aneurysm sac rupture. Although compliance with surveillance decreases over longer follow-up periods, the impact of this trend on long-term outcomes after EVAR warrants further investigation.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 2","pages":"120-132"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082996","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":"Hybrid transatrial valve in mitral annular calcification: planning and midterm outcomes.","authors":"Calixte de la Bourdonnaye, Thierry Bourguignon, Olivier Fouquet, Marin Thery, Hervé Corbineau, Jean-Philippe Verhoye, Amedeo Anselmi","doi":"10.23736/S0021-9509.25.13007-3","DOIUrl":"10.23736/S0021-9509.25.13007-3","url":null,"abstract":"<p><strong>Background: </strong>Severe mitral annular calcification is a surgical challenge. The implantation of a Sapien-3^© valve in the mitral position through an open transatrial route is an option. We present early/midterm outcomes and analyse planning/technical issues of this option.</p><p><strong>Methods: </strong>Under cardiopulmonary bypass sapien-3^© were implanted and secured with several U-stitch. We analyzed data from 2016 to 2022 in three tertiary center. All patients undergoing the described technique were included consecutively. Data were collected retrospectively from August 2022 to February 2023, and patients were asked about their quality of life (KCCQ-12). A preoperative planning has been done retrospectively to search information which may help the surgeon.</p><p><strong>Results: </strong>Twenty-one patients were included (70±5.6 years, STS-score: 5.65±3.69). Thirty postoperative days: three cardiovascular deaths (14%), 7 ≥2/4 leakage (33.8%), seven (39%) mean trans-mitral gradient >5 mmHg, one outflow tract obstruction, one early migration, no myocardial or stroke. 30-days to one-year: two cardiovascular deaths (12.5%), one endocarditis with stroke. One-year echocardiography: one leakage ≥2/4 (8%), eight mean trans-mitral gradient >5 mmHg (60%). Two-years: one hospitalization for heart failure (no added outcomes or death). Mid-term quality of life is significatively improved (preoperative-KCCQ.12: 36.76±23.46 vs. postoperative-KCCQ.12: 73.90±21.13, P value <0.05). Mortality decreased with center experience. CT-scan gives paramount information for the surgeon (existence and length of calcification-free leaflet for adding U-stitches, subvalvular apparatus).</p><p><strong>Conclusions: </strong>This procedure is associated with mortality, which may decrease with the learning curve (CT-scan planning, technical details). Quality of life is improved and paravalvular leaks seem to decrease with time.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 2","pages":"98-108"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083075","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 versus open thoracoabdominal aortic aneurysm repair: how patients' selection and lack of randomized trial will bias the future vascular practice.","authors":"Ottavia Borghese, Yamume Tshomba","doi":"10.23736/S0021-9509.25.13367-3","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13367-3","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 2","pages":"57-59"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082969","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":"One-stage off-pump transapical repair of ventricular pseudoaneurysm with coils and mitral paravalvular leak closure with plugs.","authors":"Luca Di Marco, Antonio Piperata, Riccardo Nania, Francesco Buia, Mauro Cassese, Davide Pacini","doi":"10.23736/S0021-9509.25.13193-5","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13193-5","url":null,"abstract":"<p><p>We present the case of a 74-year-old male with a medical history of hypertension, type 2 diabetes, and dyslipidemia, who had previously undergone two cardiac surgeries: the first for coronary artery disease and severe mitral regurgitation, and the second for mitro-aortic endocarditis. The patient developed a large inferolateral ventricular pseudoaneurysm, an anterolateral mitral paravalvular leak with moderate mitral regurgitation, and a complete atrioventricular block. Given the high risk associated with a third conventional open-heart surgery, a hybrid off-pump transapical approach was proposed. The patient was successfully treated with coil closure of the pseudoaneurysm, repair of the paravalvular leak using an Amplatzer device, and implantation of definitive epicardial electrodes via a transapical approach, with complete procedural success.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 2","pages":"133-136"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082991","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":"Open repair of thoracoabdominal aortic aneurysms under left heart bypass.","authors":"Enrico Rinaldi, Andrea Kahlberg, Daniele Mascia, Nicola Favia, Germano Melissano, Roberto Chiesa","doi":"10.23736/S0021-9509.25.13354-5","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13354-5","url":null,"abstract":"<p><strong>Background: </strong>Thoracoabdominal aortic aneurysm (TAAA) open surgical repair (OSR) is a highly complex procedure associated with significant mortality and morbidity. Despite advancements in surgical techniques and organ protection strategies, TAAA OSR remains a challenge. This study analyzes nearly 35 years of experience at a single center, with a focus on the evolution of surgical approaches and adjuncts, particularly the use of left heart bypass (LHBP) for organ perfusion maintenance.</p><p><strong>Methods: </strong>This retrospective study was performed on all the patients who underwent elective TAAA OSR at our institution between 1989 and 2024. Patients were divided into two groups: Group 1 (1989-2009), where adjuncts were used selectively, and Group 2 (2010-2024), where a systematic multimodal approach was implemented. Preoperative, intraoperative, and postoperative data were analyzed to assess the impact of evolving surgical techniques, adjuncts, and patient outcomes. Key adjuncts included cerebrospinal fluid drainage (CSFD), motor and somatosensory evoked potentials (MEP&SSEP), LHBP, renal perfusion strategy, and rotational thromboelastometry.</p><p><strong>Results: </strong>In total, 1211 patients underwent elective TAAA OSR, with 455 patients in Group 1 and 756 in Group 2. A modified surgical approach was employed in the two groups, with significant differences in terms of sites of aortic cross-clamping, techniques for vessel reconstruction, and approach in the management of intercostal artery. In addition, significant differences between the groups were observed for what concern the use of adjuncts. Regarding the outcomes, Group 2 demonstrated a significantly lower 30-day mortality rate (7.5% in Group 2 vs. 13.4% in Group 1; P=0.001), and a reduction in permanent spinal cord ischemia (SCI) (7.4% in Group 2 vs. 11.9% in Group 1; P=0.012). Additionally, Group 2 exhibited trends toward reduced respiratory failure and renal complications, but these differences were not statistically significant.</p><p><strong>Conclusions: </strong>This single-center experience highlights the evolution of TAAA OSR over 35 years, demonstrating a significant reduction in mortality and SCI with the use of a comprehensive, multimodal approach. Although there were improvements in postoperative complications, further advancements are needed in this complex field to optimize outcomes. The ongoing refinement of surgical techniques and adjuncts continues to play a crucial role in improving patient care.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 2","pages":"60-70"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082993","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 Journal of Cardiovascular Surgery: glancing backward, rushing forward.","authors":"Nikolaos Tsilimparis","doi":"10.23736/S0021-9509.25.13374-0","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13374-0","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 2","pages":"53-56"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083086","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":"Guidelines on prevention, diagnosis and treatment of thoracic and thoracoabdominal aortic pathology: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE).","authors":"Francesco Speziale, Wassim Mansour, Stefano Ancetti, Michele Antonello, Daniele Bissacco, Gian A Boschetti, Stefano Camparini, Maurizio Cariati, Elda C Colacchio, Ada Dajci, Giuseppe Deiana, Marco Femia, Enrico Gallitto, Mauro Gargiulo, Genadi Genadiev, Viviana Grassi, Franco Grego, Giulia Ianni, Maria L Iocca, Massimo Lenti, Diletta Loschi, Germano Melissano, Claudio Novali, Massimiliano Orso, Domenico Palombo, Gabriele Piffaretti, Giovanni Pratesi, Enrico Rinaldi, Sonia Ronchey, Andrea Spertino, Santi Trimarchi, Gaetano Lanza","doi":"10.23736/S0021-9509.25.13270-9","DOIUrl":"10.23736/S0021-9509.25.13270-9","url":null,"abstract":"<p><p>The aim of these Guidelines was to refresh and enhance the earlier 2015 Italian Guidelines regarding Thoracic and Thoracic - Abdominal Aortic Disease, aligning them with the National Guidelines System (SNLG) to assist all healthcare professionals in adopting the most appropriate treatment approach for this condition. The update utilized the GRADE-SIGN version methodology, adhering to the AGREE checklist for quality reporting. The initial step involved crafting clinical questions in the PICO (Population, Intervention, Comparison, Outcome) format to base the Recommendations on. Following this, systematic literature reviews were conducted for each PICO question or for related clusters of questions, leading to article selection and evaluation of their methodological quality via qualitative checklists. Subsequently, a Considered Judgment form was completed for each clinical question, assessing the overall evidence to facilitate the conversion from evidence level to recommendation strength and direction. These guidelines outline the best practices for managing thoracic-abdominal aortic disease, with a focus on screening and monitoring. They explore medical treatments and criteria for surgical intervention, including a thorough preoperative analysis of the patient's history and an assessment of surgical risks. Following the determination of surgical necessity, the guidelines compare traditional open surgery with endovascular procedures, paying particular attention to define new recommendations where there were not. Systematic literature reviews were executed for each PICO question. Considered judgments were made through evaluating the evidence level, and the recommendations, direction and strength. The document concludes by outlining protocols for both immediate and prolonged postoperative care. Recent literature has not only validated and refined previous recommendations but also introduced new ones on emerging topics.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 2","pages":"142-164"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082973","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}