European Journal of Cardio-Thoracic Surgery最新文献

{"title":"Serial changes of systemic ventricular function and atrioventricular valve function in patients with failing Fontan.","authors":"Muneaki Matsubara, Vincent Dahmen, Paula Gaebert, Jonas Palm, Carolin Niedermaier, Takuya Osawa, Thibault Schaeffer, Paul Philipp Heinisch, Christoph Röhlig, Nicole Piber, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono","doi":"10.1093/ejcts/ezaf005","DOIUrl":"10.1093/ejcts/ezaf005","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigated the longitudinal changes in ventricular function and atrioventricular valve function to clarify the timing and the mechanisms of failing Fontan.</p><p><strong>Methods: </strong>Patients who underwent total cavopulmonary connection between 1994 and 2023 were reviewed, and longitudinal echocardiographic examinations of ventricular function and atrioventricular valve regurgitation were analysed.</p><p><strong>Results: </strong>A total of 650 patients were included. The most frequent primary diagnosis was hypoplastic left heart syndrome in 175 patients. Dominant right ventricle was observed in 337 patients (51.8%). The median age at total cavopulmonary connection was 2.3 (1.8-3.3) years. Failing Fontan was observed in 78 patients (12%) during the median follow-up of 6.2 years. Among them, dominant right ventricle was observed in 51 patients (65.4%). Patients with protein-losing enteropathy or plastic bronchitis (n = 37) developed Fontan failure early (median 2.6 years post-total cavopulmonary connection). Still, patients maintained ventricular function (93.1% normal at 5 years) and atrioventricular valve competence (no case of moderate/severe regurgitation at 5 years) over time. Patients who developed failing Fontan associated with progression of heart failure (n = 41) had later onset (median 8.3 years post-total cavopulmonary connection) but indicated progressive ventricular dysfunction (68.3% normal at 5 years, 53.8% normal at 10 years) and atrioventricular valve regurgitation (12.3% moderate/severe at 5 years, 15.3% moderate/severe at 10 years).</p><p><strong>Conclusions: </strong>Patients with failing Fontan indicated different serial ventricular and atrioventricular valve function profiles. Ventricular function was preserved in failing Fontan patients with protein-losing enteropathy or plastic bronchitis, whereas progressive ventricular dysfunction was observed in failing Fontan patients with heart failure.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left-handed cardiac surgery simulation training: making things right.","authors":"Eric E Vinck, Mona Bickel-Dabadghao, Roberto V P Ribeiro, Darío Andrade, Peyman Sardari Nia","doi":"10.1093/ejcts/ezaf011","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf011","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":"67 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting women in cardiothoracic surgery: when women are in, everyone wins!","authors":"Busra Cangut, Deniz Piyadeoglu, Mara B Antonoff","doi":"10.1093/ejcts/ezaf009","DOIUrl":"10.1093/ejcts/ezaf009","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors and outcomes in patients undergoing surgery for acute type A aortic dissection requiring concomitant venoarterial extracorporeal membrane oxygenation support-a retrospective multicentre cohort study.","authors":"Leonard Pitts, Simone Gasser, Murat Uzdenov, Christopher Gaisendrees, Maris Bartkevics, Maximilian Kreibich, Maximilian Luehr, Jörg Kempfert, Florian Schoenhoff, Volkmar Falk, Julia Dumfarth","doi":"10.1093/ejcts/ezae467","DOIUrl":"10.1093/ejcts/ezae467","url":null,"abstract":"<p><strong>Objectives: </strong>The study's aim was to investigate the outcomes and risk factors for mortality in patients undergoing surgery for acute type A aortic dissection receiving concomitant venoarterial extracorporeal membrane oxygenation (ECMO) support.</p><p><strong>Methods: </strong>Patients from 5 European centre who underwent surgery for acute type A aortic dissection and received perioperative venoarterial ECMO support were included. A multivariable binary logistic regression analysis was performed to identify risk factors for 30-day mortality. A receiver operating characteristic curve and restricted cubic splines were designed to investigate the association between pre-ECMO lactate peak and survival.</p><p><strong>Results: </strong>The final cohort comprised 117 patients. Mean time on ECMO support was 3 days (interquartile range 1-7). In 36 patients (31%), successful ECMO weaning was achieved. Thirty-day mortality was 72%, leading cause for early mortality was multiorgan failure (39%). In total, 20% of patients were discharged from hospital. Pre-ECMO lactate peak [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.005-1.032], presence of preoperative shock (OR 9.47, 95% CI 1.749-98.257) and need for total arch replacement (OR 6.628, 95% CI 1.492-33.373) were identified as associates for 30-day mortality. For pre-ECMO lactate peak, the area under the curve showed an acceptable value of 0.73 and restricted cubic splines showed a significant correlation to survival (P = 0.004) with an increased risk above a lactate level of 85 mg/dl.</p><p><strong>Conclusions: </strong>Venoarterial ECMO support may not be futile but should be well balanced against the high-risk profile in this patient cohort. The pre-ECMO lactate peak is an independent risk factor and a valid predictor of 30-day mortality.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The optimal annual case volume for acute type A aortic dissection surgery in relation to long-term outcomes.","authors":"Michal J Kawczynski, Sander M J van Kuijk, Jules R Olsthoorn, Jos G Maessen, Suzanne Kats, Elham Bidar, Samuel Heuts","doi":"10.1093/ejcts/ezaf022","DOIUrl":"10.1093/ejcts/ezaf022","url":null,"abstract":"<p><strong>Objectives: </strong>Previous analyses of the volume-outcome relationship have focused on short-term outcomes such as early mortality. The current study aims to update a novel statistical methodology, facilitating the evaluation of the relation between procedural volume and time-to-event outcomes such as long-term survival, using surgery for acute type A aortic dissection as an illustrative example.</p><p><strong>Methods: </strong>This study employed an existing dataset of type A dissection outcomes, retrieved from literature. Studies were included when reporting on annual case load and long-term survival, which served as the primary outcome of interest. Individual patient data were reconstructed from the included studies, and a hazard ratio was determined per study in relation to overall survival, after which the calculated hazard ratios were incorporated in a restricted cubic-spline model, facilitating the application of the elbow method.</p><p><strong>Results: </strong>Fifty-two studies were included (n = 14 878 patients), with a median follow-up of 5 years. One-, 3-, 5- and 10-year survival of the overall cohort were 82% [95% confidence interval (CI) 82-83%], 79% (95% CI 78-80%), 74% (95% CI 74-75%) and 60% (95% CI 59-62%), respectively. A significant non-linear volume-outcome relation for long-term survival was observed in both the unadjusted and adjusted analyses (P = 0.030 and P = 0.002), with an optimal annual case load of 32 cases/year (95% CI 31-33).</p><p><strong>Conclusions: </strong>Based on the available data, these findings imply that the annual case volume to achieve optimal long-term survival is located near a procedural volume of 32 cases/year. After accrual of more annual procedures, long-term survival may no longer significantly improve any further.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single lung transplantation is safe when the other lung is declined.","authors":"Richa Asija, Joshua Fuller, Joseph Costa, Alexey Abramov, Harpreet Grewal, Luke Benvenuto, Gabriela Magda, Lori Shah, Angela Dimango, Hilary Robbins, Bryan Payne Stanifer, Joshua Sonett, Selim Arcasoy, Frank D'Ovidio, Philippe Lemaitre","doi":"10.1093/ejcts/ezaf028","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf028","url":null,"abstract":"<p><strong>Objectives: </strong>Single lung transplant (SLT) is an acceptable treatment modality for certain patients with end stage lung disease. SLT occurs when two appropriate donor lungs are split between recipients (\"split singles\") or when one donor lung is adequate for transplant and the other lung is declined (\"isolated single\"). There is a paucity of literature investigating the outcomes in patients who received an isolated SLT. This study analyzes the characteristics and survival outcomes of isolated SLT recipients.</p><p><strong>Methods: </strong>The transplant database at our institution was queried for all lung transplants between 2010 and 2021. The primary outcome of survival was assessed using Kaplan-Meier curves and Cox regression modeling. Secondary outcomes were assessed using Cox regression and Fisher's exact test.</p><p><strong>Results: </strong>Of 759 lung transplant recipients, 164 patients underwent a split SLT and 271 patients underwent an isolated SLT. There was no significant difference when comparing most demographic characteristics between isolated SLT and split SLT patients. Isolated SLT recipients had similar overall mortality when compared to split SLT recipients (HR 0.97, CI 0.72-1.33, p = 0.87). There was no difference in post-operative need for extracorporeal membrane oxygenation (p = 0.209), duration of postoperative ventilation (p = 0.408) and length of hospitalization (p = 0.443).</p><p><strong>Conclusions: </strong>Our analysis demonstrating similar overall survival between recipients of isolated SLT and split SLT shows that a well-selected isolated donor lung can be used safely in the appropriate recipient population. This practice allows expansion of a known scarce donor lung pool and reduction of the waitlist mortality in lung transplant candidates.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving evidence certainty in aortic arch replacement outcomes.","authors":"Mehrab Neyazi, Rachana Mehta, Shubham Kumar, Ranjana Sah","doi":"10.1093/ejcts/ezaf014","DOIUrl":"10.1093/ejcts/ezaf014","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Passing the learning curve in robotic mitral valve repair-what do we know in 2025?","authors":"Johannes Bonatti","doi":"10.1093/ejcts/ezaf012","DOIUrl":"10.1093/ejcts/ezaf012","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term clinical outcomes in patients between the age of 50-70 years receiving biological versus mechanical aortic valve prostheses.","authors":"Jeremy Chan, Pradeep Narayan, Daniel P Fudulu, Tim Dong, Hunaid A Vohra, Gianni D Angelini","doi":"10.1093/ejcts/ezaf033","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf033","url":null,"abstract":"<p><strong>Objectives: </strong>The last two decades have seen an incremental use of biological over mechanical prostheses. However, while short-term clinical outcomes are largely equivalent, there is still controversy about long-term outcomes.</p><p><strong>Methods: </strong>All patients between the ages of 50-70 years undergoing elective/urgent isolated aortic valve replacement at our institute between 1996 to 2023 were included. Trends, early and long term outcomes were investigated.</p><p><strong>Results: </strong>A total of 1708 (61% male) patients with a median age of 63.60 (IQR : 58.28,67.0) years were included of which 1191 (69.7%) received a biological prosthesis.After inverse propensity score weighting, there were no short-term differences when comparing patients receiving biological and mechanical valves. However, patients who received mechanical prostheses had better long-term survival (p < 0.001). Sub-group analysis revealed that patients with biological size 19 mm prosthesis had the worse long-term survival. Patients with a size 21 mm mechanical prosthesis had better survival compared to both size 19 mm (HR: 0.25, 95% CI: 0.17,0.37, p < 0.001), 21 mm (HR: 0.33, 95% CI: 0.23,0.48, p < 0.001) and 23 mm (HR: 0.40, 95% CI: 0.27,0.60, p = <0.001) biological prosthesis.Additionally, patients with severe patient-prosthesis mismatch exhibited the lowest survival rate compared to those with moderate or no (HR 1.56, 95% CI 1.21, 2.00, p < 0.001).</p><p><strong>Conclusions: </strong>Patients aged between 50-70 years with a mechanical aortic prosthesis had better long-term survival compared to those with a biological prosthesis. Our study underscores the need for a critical re-evaluation of prosthesis selection strategies in this age group.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of patients with mitral annular disjunction undergoing mitral valve repair.","authors":"Claudio Muneretto, Michele D'Alonzo, Massimo Baudo, Lydia Como, Anna Segala, Francesca Zanin, Fabrizio Rosati, Stefano Benussi, Lorenzo Di Bacco","doi":"10.1093/ejcts/ezaf029","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf029","url":null,"abstract":"<p><strong>Objectives: </strong>Mitral Annular Disjunction (MAD) is an abnormal displacement of the posterior mitral leaflet into the left atrial wall, potentially leading to left ventricular dysfunction, malignant ventricular arrhythmias (VA) and sudden cardiac death. This study investigates the outcomes of patients with and without MAD undergoing mitral valve repair for valve prolapse (MVP).</p><p><strong>Methods: </strong>The study retrospectively collected a single-center experience from 2021 to 2023 on 326 consecutive patients undergoing mitral valve repair for MVP. Patients were divided into two groups according to the presence of MAD. After propensity score matching 1:1, two comparable groups of 50 patients were obtained. Primary end-points included hospital survival and early failure of the repair. Composite secondary end-point included major adverse cardiac events (MACEs) such as reoperation, residual regurgitation ≥2, severe postoperative LV disfunction requiring prolonged (>3 days) inotropic support, cardiac arrhythmias and overall survival.</p><p><strong>Results: </strong>After matching, there were no significant differences between the groups in terms of preoperative characteristics. Hospital mortality was 0% in both groups and there were no significant differences in terms of early reoperation (0%), or residual mitral regurgitation ≥2 or major atrial/ventricular arrhythmias. Nevertheless, patients with MAD presented a greater need for prolonged inotropic and mechanical circulatory support (IABP/ECMO): No-MAD 0% vs MAD 10%, (p = 0.050). However composite outcome at midterm follow-up was similar between the groups.</p><p><strong>Conclusions: </strong>Mitral valve repair in patients with MAD, was associated with a significantly higher incidence of early LV disfunction requiring mechanical support. However, no difference was found in terms of survival at follow-up.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}