European Journal of Cardio-Thoracic Surgery最新文献

{"title":"Valve-sparing aortic root replacement for valves with paracommissural fenestrations: which valve will fail?","authors":"Fabian A Kari, Martin Czerny, Michael Borger, Martin Misfeld, Bartosz Rylski, Emmanuel Zimmer, Matthias Siepe, Christian Hagl, Christian Detter, Johannes Petersen, Doreen Richardt, Stephan Ensminger, Paul Werner, Martin Andreas, Sven Peterss, Maximilian Pichlmaier, Christoph S Mueller","doi":"10.1093/ejcts/ezaf034","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf034","url":null,"abstract":"<p><strong>Objectives: </strong>To define morphologic risk constellations during valve-sparing aortic root replacement (VSARR) for aortic valves with paracommissural fenestrations.</p><p><strong>Patients and methods: </strong>Patients from the multicentre prospective intention-to-treat VSARR- registry German Aortic Root Repair Registry (GEARR) were screened for paracommissural cusp fenestrations. We studied a combined end-point of residual aortic regurgitation (rAR) on post-CPB TEE, mid-term progress of rAR (TTE) and aortic valve replacement for AR.</p><p><strong>Results: </strong>Of a total of 762 registry patients (operated 2016-2024), 145 were identified with ≥1 paracommissural cusp fenestration. Eighteen patients (12%) were not treated as planned but underwent composite valved graft (CVG) implantation. Mean follow-up time was 3 years. Upon post-CPB TEE rAR grade 1 or 2 were present in 44 (33%) and 3 (2%) patients. 50% of patients with fenestrations in more than one cusp showed early progression of rAR. At three years, freedom from the combined end-point was 78% (99% CI 74-79%) for the complete study cohort. Patients with a maximum free margin length difference of < 5mm, reflecting balanced root anatomy with respect to sinus and cusp sizes, had a significantly better outcome than those with ≥5mm: at three years, freedom from the combined end-point was 86% (99% CI 80-91%) vs 41% (99% CI 38-46%, p = 0.011). Outcome was worst for patients with cusp prolapse and a free margin length difference of > 5mm (30% vs 70%, p = 0.018).</p><p><strong>Conclusions: </strong>Fenestrations in more than one cusp, inhomogeneities of cusp free margin lengths, and additional prolapse are associated with inferior outcome after VSARR for valves with paracommissural fenestrations.</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":"143074128","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":"Optimal duration of ex-vivo lung perfusion for heat stress-mediated therapeutic reconditioning of damaged rat donor lungs.","authors":"Roumen Parapanov, Anne Debonneville, Manon Allouche, Jérôme Lugrin, Tanguy Lugon-Moulin, Etienne Abdelnour-Berchtold, Lucas Liaudet, Thorsten Krueger","doi":"10.1093/ejcts/ezaf027","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf027","url":null,"abstract":"<p><strong>Objective: </strong>Transient heat stress (HS) application during experimental ex-vivo lung perfusion (EVLP) of warm ischemic (WI) rat lungs produces a range of therapeutic benefits. Here, we explored whether different EVLP durations after HS application would influence its therapeutic effects.</p><p><strong>Methods: </strong>In protocol 1, WI rat lungs were exposed to HS (41.5 °C, 60-90 min EVLP), and EVLP was maintained for 3, 4.5 or 6h (n = 5/group), followed by physiological measurements (compliance, edema, oxygenation capacity). In protocol 2, WI rat lungs treated with (HS groups) or without HS (control groups) were maintained for 3 or 4.5h EVLP (n = 5/group), followed by physiological evaluation and measurements (lung tissue) of heat shock proteins (HSP70, HSP27, HS90, GRP78), endogenous proteins (SP-D, CC16, PECAM-1), anti-apoptotic (Bcl2, Bcl-xL) and pro-apoptotic proteins (Bax, CHOP), anti-oxidant enzymes (HO-1, NQO1) and nitrotyrosine (oxidative stress biomarker).</p><p><strong>Results: </strong>In protocol 1, physiological variables were stable after 3 and 4.5h but deteriorated after 6h. In protocol 2, at 3h EVLP, HS-treated lungs differed from controls by higher expression of HSP70 and HO-1, and lower CC16 expression. In contrast, at 4.5h EVLP, HS-treated lungs displayed improved physiology, higher levels of all HSPs, preserved or increased expression of SP-D, CC-16 and PECAM-1, increased antioxidant and anti-apoptotic proteins, and reduced pro-apoptotic proteins and nitrotyrosine.</p><p><strong>Conclusions: </strong>The protective effects of HS application during EVLP of WI damaged rat lungs strictly depend on the duration of post-HS recovery. An EVLP duration of 4.5h appears to optimize the therapeutic potential of HS, while maintaining lungs in a stable physiological state.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070781","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":"Prognostic impact of one-year permanent pacemaker implantation after mitral valve surgery with the Cox-maze procedure.","authors":"Jun Ho Lee, Yun Jin Kim, Ji Eon Kim, Kyungsub Song, Yonghoon Shin, Jae Seung Jung, Ho Sung Son, Seung Hyun Lee, Hee Jung Kim","doi":"10.1093/ejcts/ezaf018","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf018","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the prognostic impact of permanent pacemaker (PPM) implantation within the first year after mitral valve (MV) surgery combined with the Cox-maze procedure, focusing on long-term outcomes, including overall mortality, infective endocarditis (IE), and ischaemic stroke.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from the National Health Insurance Service (NHIS) in South Korea, identifying 10,127 patients who underwent MV surgery with the Cox-maze procedure between 2005 and 2020. Patients were classified into the PPM and non-PPM groups based on PPM implantation within one year postoperatively. The primary outcome was overall mortality, and secondary outcomes included risk factors for overall mortality, IE and ischaemic stroke. Multivariable Cox proportional hazards regression and Fine-Gray competing risk models were utilized for statistical analysis.</p><p><strong>Results: </strong>Of the total cohort, 178 patients (1.76%) underwent PPM implantation. The overall mortality during the follow-up period was 20.5%, with no significant difference between the PPM and non-PPM groups. PPM implantation was not a significant risk factor for overall mortality (Hazard ratio [HR], 0.825; 95% confidence interval [CI], 0.598-1.140; p = 0.244) or ischaemic stroke. However, PPM implantation was associated with a significantly increased risk of IE (HR, 2.015; 95% CI, 1.179-3.442; p = 0.010).</p><p><strong>Conclusions: </strong>PPM implantation within the first year after MV surgery with the Cox-maze procedure does not significantly impact long-term mortality or ischaemic stroke risk but is associated with an increased risk of IE. The Cox-maze procedure remains advisable for patients with atrial fibrillation undergoing MV surgery.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058535","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":"Impact of cardiac position, morphology and operative technique on long-term fontan outcomes in heterotaxy.","authors":"Sachiko Kadowaki, Chun-Po Steve Fan, Yasmin Zahiri, Kok Hooi Yap, Teerapong Tocharoenchok, Anne I Dipchand, Osami Honjo, David J Barron","doi":"10.1093/ejcts/ezaf025","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf025","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the outcomes of heterotaxy patients undergone the Fontan operation, focusing on morphological features and surgical techniques.</p><p><strong>Methods: </strong>Eighty-two consecutive heterotaxy patients who underwent the Fontan operation from 1985 to 2021 were compared to 150 patients with tricuspid atresia (TA) and 144 patients with hypoplastic left heart syndrome (HLHS). The Kaplan-Meier method and Cox proportional hazard model were used to analyze transplant-free survival and predictor of outcomes.</p><p><strong>Results: </strong>The 20-year transplant-free survival rates were comparable between Right Atrial Isomerism (RAI, n = 45) and Left Atrial Isomerism (LAI, n = 37) (RAI vs LAI, 76% [95% confidence interval, 57-87%] vs 68% [47-82%], p = 0.22), although more pulmonary vein interventions at Fontan were needed in RAI. Surgical techniques included extracardiac conduit in 66%, intra-atrial conduit in 9%, lateral tunnel in 18% of the cases. Cardiac position and apicocaval juxtaposition did not influence outcomes, but the inferior vena cava (IVC)-contralateral PA Fontan was associated with 100% survival, while the IVC-ipsilateral PA Fontan at the cardiac apex showed a 67% [34-87%] survival rate at 20 years. In-hospital mortality was higher in heterotaxy (9.8% [5-19%]) compared to TA (1.3% [0.3-5.3%], p < 0.01) and HLHS (2.8% [1.1-7.3%], p = 0.02), with no early death after 2000 in any group. The 20-year transplant-free survival in heterotaxy (72% [59-82%]) was similar to that in HLHS (80% [69-87%], p = 0.11).</p><p><strong>Conclusions: </strong>Various routing techniques can be successfully applied to overcome anatomical challenges in heterotaxy. Despite higher in-hospital mortality, overall survival was similar to HLHS. RAI had comparable survival to LAI with more pulmonary vein interventions at Fontan.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058523","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":"Aortic valve repair in adults: long-term clinical outcomes and echocardiographic evolution in different valve repair techniques.","authors":"Francesco Zito, Kevin M Veen, Giovanni Melina, Emmanuel Lansac, Hans-Joachim Schäfers, Laurent de Kerchove, Johanna J M Takkenberg, Jolanda Kluin, M Mostafa Mokhles","doi":"10.1093/ejcts/ezaf020","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf020","url":null,"abstract":"<p><strong>Objective: </strong>Aortic valve repair/sparing have been established as effective treatments for aortic regurgitation and/or aortic aneurysms. However, concerns remain regarding long-term durability, reproducibility, and patient selection. This study aims to asses long-term clinical and echocardiographic outcomes, with a focus on aortic regurgitation grade and left ventricular ejection fraction evolution, in adults undergoing these procedures.</p><p><strong>Methods: </strong>Adult patients in the Heart Valve Society Aortic Valve Database, undergoing any aortic valve repair/sparing technique were included. Time-to-event analyses were used for clinical outcomes and mixed-effects-models for left ventricular ejection fraction and aortic regurgitation evolution. Techniques: isolated valve repair (GROUP-1), ascending aortic replacement +valve repair (GROUP-2), partial-root replacement +/-valve repair (GROUP-3), and valve-sparing root replacement +/-valve repair (GROUP-4).</p><p><strong>Results: </strong>Survival at 10-years was comparable to the general population in each group. The 10-year cumulative incidence of reintervention was 19.5%(95%CI:16.70-22.40%) in GROUP-1 [Including only double external annuloplasty in GROUP-1, reintervention was not significantly different between techniques (p = 0.112)], 13.8% (95%CI: 10.10-18.10%) in GROUP-2, 12.7%(95%CI:5.50-22.90%) in GROUP-3, and 8.5%(95%CI:7.00-10.10%) in GROUP-4 (p < 0.001). Severe preoperative aortic regurgitation grade [HR: 1.95(95%CI:1.19-3.21),p<0.001] and left ventricular end-diastolic diameter [HR:1.03(95%CI:1.00-1.05),p<0.001] were predictive of reintervention in GROUP-4, patch use was a predictor in all groups. Predicted left ventricular ejection fraction (%) initially increased(p < 0.001) and then stabilized.</p><p><strong>Conclusion: </strong>This study found that aortic valve repair/sparing techniques provide a viable and effective treatment option that should be considered for all eligible patients with aortic regurgitation and/or aortic root/ascending aortic aneurysms, given their potential to restore life expectancy and provide good hemodynamic outcomes with an acceptable hazard of reintervention.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051614","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 survival from a randomized controlled trial of lobectomy by video-assisted thoracoscopic surgery versus thoracotomy for early-stage lung cancer.","authors":"Finn Amundsen Dittberner, Morten Bendixen, Peter Bjørn Licht","doi":"10.1093/ejcts/ezaf017","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf017","url":null,"abstract":"<p><strong>Objectives: </strong>We previously did a randomized clinical trial of lobectomy by VATS or thoracotomy for early-stage lung cancer and found that patients who underwent VATS had less postoperative pain and better quality of life compared with thoracotomy. VATS has since been regarded the preferred surgical method for early-stage lung cancer. It is assumed that long-term survival is not influenced by surgical approach, but this assumption primarily rests on non-randomized comparative studies. We decided to do a long-term follow-up of patients who entered our previous randomized trial.</p><p><strong>Methods: </strong>Between 2008 and 2014 we randomly assigned 206 patients to VATS (n = 103) or anterolateral thoracotomy (n = 103) for proven or suspected early-stage NSCLC. Records from patients with NSCLC on final pathology were identified in the national electronic patient-record system and the Danish Lung Cancer Registry. Overall, disease-free, and cancer-specific survival were estimated using the Kaplan-Meier method and log-rank test was used to compare the two interventions.</p><p><strong>Results: </strong>A total of 196 patients had NSCLC on final histopathology. Four patients were lost to follow-up and the remaining 192 were included in this follow-up study with 128 events used for overall survival analysis, 100 events for disease-free survival analysis and 79 events for cancer-specific survival analysis. VATS was used in 99 patients versus 93 by thoracotomy. Median age at time of surgery was 66 years (range 41-85 years). After a median follow-up time of 12.8 years (range 9.9-15.8 years), 33% of patients were alive. Overall, disease-free, and cancer-specific survival were not significantly different between VATS and thoracotomy: Overall survival (p = 0.29), disease-free survival (p = 0.17) and cancer-specific survival (p = 0.31).</p><p><strong>Conclusions: </strong>We did not find any statistically significant differences in overall, disease-free, or cancer-specific survival between VATS and thoracotomy. However, larger trials with better power for survival analysis are needed to fully explore if there are differences. Alternatively, differences in survival between thoracotomy and VATS for early-stage NSCLC could be investigated by pooling survival data from two similar randomized trials that have since been published.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051567","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":"Ross procedure for aortic regurgitation versus stenosis in adults with and without autograft support.","authors":"Karen B Abeln, Lennart Froede, Tristan Ehrlich, Idriss Souko, Hans-Joachim Schäfers","doi":"10.1093/ejcts/ezaf021","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf021","url":null,"abstract":"<p><strong>Objectives: </strong>The Ross procedure for aortic regurgitation (AR) and abnormal aortic valve morphologies is associated with an increased risk of autograft dilatation. Autograft support may ameliorate this problem. We analyzed the results for all haemodynamic lesions and the effect of autograft support.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of patients who underwent a Ross procedure at Saarland University Medical Center between December 1995 and December 2023. (315 patients undergoing full-root replacement with or without autograft support). Twenty-three (7%) were younger than 18 years and were excluded. The cohort was divided into 3 groups: Patients with aortic stenosis (AS), AR, and combined disease (CD). Endpoints included survival, freedom from reoperation and AR, and aortic root dimensions; these were compared between the three groups. Median follow-up was 3.6[range 0.01-26.6] and 95% complete.</p><p><strong>Results: </strong>Overall, 292 adult patients (male 74%; mean age 39 years(SD : 10) were analyzed with (n = 209) or without autograft support (n = 83). Patients with AS (n = 79; 28%) were compared to those with AR (n = 77; 25%) and those with CD (n = 136; 50%). Valve morphology was unicuspid (n = 141; 48%), bicuspid (n = 109; 38%), or tricuspid (n = 42; 14%). Survival at 15 years was similar across the groups (AR 86%; AS 93%; CD 94%; p = 0.123). Freedom from autograft reoperation was 90% at 10 years (AR 80%; AS 95%; CD 92%; p = 0.009). With autograft support, it was 93% at 10 years (AR 90%; AS 93%; CD 95%; p = 0.179). Neither UAV (HR 1.072; 95% CI 0.34-3.43; p = 0.907) nor BAV (HR 0.102; 95% CI 0.08-1.26; p = 0.102) were associated with reoperation.</p><p><strong>Conclusions: </strong>Patients with AR and an unsupported root replacement do have an increased risk of reintervention, irrespective of aortic valve morphology. With autograft support, however, autograft stability is excellent, irrespective of the underlying lesion. Thus, the Ross procedure in its supported version can be offered to all haemodynamic types and valve morphologies.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051727","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":"The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) of the European Association for Cardio-Thoracic Surgery Fourth report: Focus on standardized outcome ratios.","authors":"Kevin M Veen, Mazen Ahmed, Christoffer Stark, Luca Botta, Kyriakos Anastasiadis, Alexander Bernhardt, Michael Berchtold-Herz, Kadir Caliskan, David Reineke, Kevin Damman, Arnt Fiane, Angeliki Gkouziouta, Can Gollmann-Tepeköylü, Emil Najjar, Michal Hulman, Attilio Iacovoni, Antonio Loforte, Bela Merkely, Francesco Musumeci, Marina Comisso, Petr Němec, Ivan Netuka, Mustafa Özbaran, Evgenij Potapov, Yuri Pya, Gregorio Rábago, Faiz Ramjankhan, Anna Mara Scandroglio, Marina Pieri, Hermann Reichenspurner, Alexey Dashkevich, Bernard Stockman, Marc Vanderheyden, Laurens Tops, Thorsten Wahlers, Piotr Przybyłowski, Daniel Zimpfer, Brian Bridal Løgstrup, David Santer, Gloria Färber, Jan Gummert, Bart Meyns, Theo M M H de By, Felix Schoenrath","doi":"10.1093/ejcts/ezaf016","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf016","url":null,"abstract":"<p><strong>Objectives: </strong>This fourth report aimed to provide insights into patient characteristics, outcomes, and standardized outcome ratios of patients implanted with durable Mechanical Circulatory Support across participating centers in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) registry.</p><p><strong>Methods: </strong>All registered patients receiving durable mechanical circulatory support up to August 2024 were included. Expected number of events were predicted using penalized logistic regression. Standardized outcome ratios (Observed/Expected events) were presented in plots to assess 30-day and 1-year mortality, ischaemic stroke, and major bleeding outcomes. Expected events were estimated using penalized logistic regression using demographics and comorbidities as predictors. Centers with <90% follow-up completeness were excluded from standardized outcome ratio assessment.</p><p><strong>Results: </strong>Analysis included 6962 implants in 6408 patients (457 patients underwent repeated implants) registered in EUROMACS from 17 countries (32 centres) (median age: 58 years, 83% males, 17% INTERMACS class 1). Thirty-day mortality, major bleeding and ischaemic stroke probabilities were 9.6, 12.6%, and 2.1%, respectively. Standardized mortality ratios showed variability between centres, ranging from 0 (95% CI : 0-0) to 1.4 (95% CI : 1.2-1.7). Higher standardized bleeding outcome ratios correlated with higher standardized ischaemic stroke ratio's (Spearman r: 0.56, P = 0.008).</p><p><strong>Conclusions: </strong>Most included centers perform as expected given the demographics and comorbidities of patients. A positive correlation was found between standardized bleeding and ischaemic stroke ratios, reflecting the need of continuously monitoring of adverse events by quality improvement programs.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058539","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":"Perioperative extra corporeal membrane oxygenation in neonates with transposition of the great arteries: 15 years of experience.","authors":"Jesse A Weeda, Roel L F Van Der Palen, Heleen E Bunker-Wiersma, Lena Koers, Eelco Van Es, Mark G Hazekamp, Arjan B Te Pas, Peter Paul Roeleveld","doi":"10.1093/ejcts/ezae442","DOIUrl":"https://doi.org/10.1093/ejcts/ezae442","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) can act as a bridge to recovery in both pre-and postoperative patients with transposition of the great arteries (TGA). However, literature on its use in these patients is scarce.</p><p><strong>Methods: </strong>Retrospective single-centre cohort study encompassing all TGA patients who received ECMO between January 2009 and March 2024.</p><p><strong>Results: </strong>Twenty-two neonates received ECMO during the study period, with an overall median age and weight at time of ECMO cannulation of 6.5 (1.8-10) days and 3.7 (3.3-4.0) kg, respectively. Twelve neonates received ECMO prior to the arterial switch operation because of severe persistent pulmonary hypertension (83%), respiratory failure due to severe pulmonary atelectasis (8%) or hypoxia after pulmonary arterial banding procedure (8%). Postoperative ECMO was used in eleven patients; of these, 1/11 (9%) also had ECMO preoperatively. Postoperative indications for the remaining patients included failure to wean from cardiopulmonary bypass (50%), low cardiac output in Intensive Care Unit (20%), or after cardiopulmonary arrest (30%). Overall, median ECMO duration for all TGA patients was 75 (45-171) hours, with a survival rate of 59% to hospital discharge. Among the preoperative ECMO patients, five patients (42%) died (4 preoperatively, 1 postoperatively performed while on ECMO). In the postoperative ECMO group, survival rate was 60%.</p><p><strong>Conclusion: </strong>In this single-centre retrospective study, TGA neonates received ECMO preoperatively primarily for severe pulmonary hypertension and postoperatively for failure to wean from cardiopulmonary bypass. This study showed a 58 and 60% survival to hospital discharge in ECMO patients supported preoperatively and those supported postoperatively, respectively.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022589","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":"Revisiting ascending aortic resection in the elective valve-sparing root replacement: assessing the benefits and necessity of hemiarch replacement at three centres.","authors":"Murat Yildiz, Florian Schoenhoff, Victoria Werdecker, Maria Nucera, Selim Mosbahi, Yu Zhao, Nicholas Goel, Mikolaj Berezowski, Kendall Lawrence, Sankrit Kapoor, Maximillian Kreibich, Tim Berger, Joseph Kletzer, Joseph Bavaria, Wilson Szeto, Matthias Siepe, Martin Czerny, Nimesh Desai","doi":"10.1093/ejcts/ezaf006","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf006","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to determine the indication and optimal timing for performing a hemiarch procedure in patients undergoing valve-sparing root replacement (VSRR).</p><p><strong>Methods: </strong>We conducted a retrospective study on 986 patients undergoing VSRR at three tertiary care centres. Inclusion criteria were all patients undergoing elective VSRR. Exclusion criteria were age <18 years, Stanford type A dissection, dissection in the arch, total aortic arch replacement or previous aortic arch replacement. We performed propensity score matching in a 1:1 ratio. The primary endpoint is a composite outcome that includes mortality, aortic arch reintervention, new aortic dissection during follow-up, and cerebrovascular incidents within the first 30 days.</p><p><strong>Results: </strong>A total of 401 patients (41%) had a hemiarch replacement, while 585 (59%) did not. Root phenotype was present in 565 (57%). The mean follow-up time was 4.7 years (SD ± 4.6).In the matched population, there was no significant difference in the 10-year freedom from the composite outcome between the non-hemiarch and hemiarch groups (87.3% vs. 85.0%, p > 0.999). Similarly, no difference was found for aortic reinterventions (p = 0.13) or survival (p = 0.5). This was also true for patients with heritable thoracic aortic disease. However, in patients with a bicuspid aortic valve, the intervention rate was significantly higher in the hemiarch group (10.8% vs. 0%, p = 0.016).There was no significant difference in the 30-day incidence of cerebrovascular accidents between the groups (5% vs. 2.7% in the hemiarch group, p = 0.117). Only the distal ascending diameter showed a tendency with better outcome over 45mm for the hemiarch procedure, otherwise we found no reliable cut-off values based on asecending length, diameter-to-height index, or ascending length-to-height index.</p><p><strong>Conclusions: </strong>Our findings conclusively demonstrate that concomitant hemiarch replacement does not increase the perioperative risk in young patients undergoing VSRR. However, concomitant replacement does not seem to protect from aortic reinterventions during medium term follow-up.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002599","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}