European Journal of Cardio-Thoracic Surgery最新文献

{"title":"Comparative oncological features of centrally and peripherally located small-sized radiologically solid-dominant non-small-cell lung cancer.","authors":"Norifumi Tsubokawa, Takahiro Mimae, Yoshihiro Miyata, Chiaki Kanno, Yujin Kudo, Takuya Nagashima, Hiroyuki Ito, Norihiko Ikeda, Morihito Okada","doi":"10.1093/ejcts/ezaf072","DOIUrl":"10.1093/ejcts/ezaf072","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare the oncological features of centrally and peripherally located small-sized (≤2 cm), radiologically solid-dominant, cN0 non-small-cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>We retrospectively reviewed 1240 patients who underwent lobectomy or segmentectomy for radiologically solid-dominant cN0 NSCLC tumours ≤2 cm in size. Tumours were categorized as centrally (inner two-thirds of the pulmonary parenchyma) or peripherally (outer one-third) located. Clinicopathological characteristics and prognoses were compared between the 2 groups.</p><p><strong>Results: </strong>Among the 1240 patients, 299 had centrally located and 941 had peripherally located tumours. Centrally located tumours showed a significantly higher proportion of pure solid tumours and pathological lymph node upstaging than peripherally located tumours (P = 0.018 and P = 0.038, respectively). Multivariable logistic regression analysis identified central location as an independent predictor for pN1 (odds ratio, 1.91; 95% confidence interval, 1.09-3.36; P = 0.024), but not for pN2, upstaging. The cumulative incidence of loco-regional and distant recurrences did not significantly differ between the 2 groups (P = 0.455 and P = 0.383, respectively). Overall survival and recurrence-free survival rates were also similar among patients with central and peripheral tumours (P = 0.267 and P = 0.269, respectively).</p><p><strong>Conclusions: </strong>Patient prognosis following complete anatomical resection was comparable between centrally and peripherally located radiologically solid-dominant cN0 NSCLC tumours ≤2 cm in size. However, centrally located tumours were associated with a higher risk of pN1 upstaging, highlighting the importance of thorough hilar lymph node dissection in these patients.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":"67 4","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959059","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":"Implications of pacemaker implantation after aortic valve surgery for endocarditis: a nationwide study†.","authors":"Lisa O F Bearpark, Michael Dismorr, Anders Franco-Cereceda, Ulrik Sartipy, Natalie Glaser","doi":"10.1093/ejcts/ezaf125","DOIUrl":"10.1093/ejcts/ezaf125","url":null,"abstract":"<p><strong>Objectives: </strong>Infective endocarditis (IE) is associated with a high risk of atrioventricular block and surgery adds to the risk of receiving a permanent pacemaker. The clinical impact of pacemaker implantation in IE patients is insufficiently studied. Our objective was to analyse long-term clinical outcomes in patients who receive a permanent pacemaker after IE surgery.</p><p><strong>Methods: </strong>We conducted a nationwide observational cohort study, including all patients undergoing surgery for aortic valve IE in Sweden 1997-2022. The exposure group was patients who received a permanent pacemaker within 30 days of surgery. We used inverse probability of treatment weighting to account for inter-group differences and flexible parametric models to estimate hazards and cumulative incidences. Outcomes were all-cause mortality, heart failure and reinfection in the prosthetic valve.</p><p><strong>Results: </strong>Among 2175 patients who underwent surgery for aortic valve endocarditis, 168 (8%) received a permanent pacemaker. The mean age was 59 years; 18% were female. During a mean follow-up of 8.0 years (maximum 26 years), 822 patients (38%) died. At 15 years, the cumulative incidence of all-cause mortality was 60% versus 50% in the pacemaker versus the no pacemaker group; for heart failure, it was 21% versus 16%. We found no association of pacemaker implantation with mortality [hazard ratio (HR) 1.17; 95% confidence interval (CI) 0.86-1.58], heart failure (HR 1.42; 95% CI 0.89-2.29) or reinfection (HR 0.85; 95% CI 0.50-1.45).</p><p><strong>Conclusions: </strong>Pacemaker implantation after surgery for aortic valve IE is common but was not associated with an increased risk of death, heart failure or reinfection. Although pacemaker need suggests more advanced disease, these results show that lifesaving surgery is not importantly jeopardised by the need for a pacemaker.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802711","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":"Femoral vessel cannulation strategies in minimally invasive cardiac surgery: single Perclose ProGlide versus open cut-down†.","authors":"Majd Ismail, Dilara Merve Berberoglu Aydin, Jang-Sun Lee, Markus Schönburg, Efstratios Charitos, Yeong-Hoon Choi, Oliver Joannis Liakopoulos","doi":"10.1093/ejcts/ezaf118","DOIUrl":"10.1093/ejcts/ezaf118","url":null,"abstract":"<p><strong>Objectives: </strong>Surgical cut-down is commonly used for femoral cannulation in minimally invasive cardiac surgery, but is associated with higher rates of wound healing disorders. Percutaneous cannulation using vascular closure devices offers a less invasive alternative with potentially fewer complications. The aim of this study was to assess the feasibility and safety of using a single ProGlide system for primary access-site closure in comparison with surgical cut-down. Additionally, we analysed the learning curve for adopting this strategy.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 753 patients who underwent minimally invasive cardiac surgery at our centre between January 2018 and February 2024. Femoral access was achieved via open cut-down in 377 patients and percutaneous cannulation using a single ProGlide system in 376. The percutaneous cohort was categorized into 2 subgroups: early era (2020-2021, N = 102) versus late era (2022-2024, N = 274). The primary end-point was late access-site-related complications, while the secondary end-point was device failure requiring open femoral revision.</p><p><strong>Results: </strong>Access-site complications including lymph fistula, healing disorders were significantly higher in the open cut-down group compared to the percutaneous group (lymph fistula: 10.6% cut-down vs 0.3% percutaneous, P = 0.004, healing disorders: 3.4% cut-down vs 0% vascular closure device, P < 0.001). The success rate of a single vascular closure device strategy improved from 65.7% in the early era to 91.6% in the late era (P < 0.001), with fewer device failures (2.9% vs 11.7%; P = 0.001).</p><p><strong>Conclusions: </strong>Percutaneous cannulation using single ProGlide is observed as a safe and feasible alternative to open femoral cut-down and showed excellent results after an initial learning curve.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12000529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779385","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":"Twenty-five-year milestone for the ECHSA database: time to focus on patient survival rather than procedural success.","authors":"Richard A Jonas","doi":"10.1093/ejcts/ezaf136","DOIUrl":"10.1093/ejcts/ezaf136","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":"67 4","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973672","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 outcome of Fontan procedure in heterotaxy-towards further improvement of outcome.","authors":"Shunji Sano, Yasuyuki Kobayashi","doi":"10.1093/ejcts/ezaf074","DOIUrl":"10.1093/ejcts/ezaf074","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623978","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":"Annuloplasty for narrowing of the aortic annulus.","authors":"Vadim Irimie, Paul P Urbanski","doi":"10.1093/ejcts/ezaf093","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf093","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":"67 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979019","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":"Too much of a good thing? Redefining open in open access.","authors":"Dominique Vervoort","doi":"10.1093/ejcts/ezaf092","DOIUrl":"10.1093/ejcts/ezaf092","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673621","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":"Surgeon proclivity for coronary endarterectomy during isolated coronary artery bypass grafting in Medicare beneficiaries†.","authors":"John B Eisenga, Kyle A McCullough, Austin Kluis, Jasjit K Banwait, Sarah Hale, Michael J Mack, J Michael DiMaio, Justin M Schaffer","doi":"10.1093/ejcts/ezaf064","DOIUrl":"10.1093/ejcts/ezaf064","url":null,"abstract":"<p><strong>Objectives: </strong>Coronary endarterectomy (CE) is an adjunct to coronary artery bypass grafting (CABG) in patients with one or more diffusely diseased coronary arteries. Although associated with increased perioperative morbidity and mortality, it remains a therapeutic strategy to potentially improve late outcomes by facilitating the revascularization of an otherwise ungraftable target.</p><p><strong>Methods: </strong>Medicare beneficiaries undergoing CABG from 2001 to 2019 were identified. Surgeon proclivity for endarterectomy was determined; surgeons were stratified by quintile of endarterectomy frequency. Overlap propensity score weighting risk-adjusted measured confounding variables. Risk-adjusted survival was compared between surgeons.</p><p><strong>Results: </strong>1 500 710 Medicare beneficiaries underwent isolated CABG, of whom 32 302 (2.2%) underwent concomitant CE. Surgeons were divided into never-endarterectomizers (0% frequency, 267 245 surgeries by 1839 surgeons), occasional-endarterectomizers (0-4% frequency, 1 001 310 surgeries by 2207 surgeons) and frequent-endarterectomizers (≥4% frequency, 232 155 surgeries by 756 surgeons). Beneficiaries undergoing surgery by a never-endarterectomizer had a risk-adjusted median survival of 10.05 [95% CI: 10.00, 10.09] versus 9.90 [9.86, 9.95] years in those undergoing surgery by a frequent-endarterectomizer, a difference of 1.71 [1.08, 2.37] months, P < 0.001 for risk-adjusted survival comparison. Similarly, beneficiaries undergoing surgery by an occasional-endarterectomizer had a risk-adjusted median survival of 9.94 [9.91, 9.96] versus 9.85 [9.80, 9.90] years for those undergoing surgery by a frequent-endarterectomizer, a difference of 1.05 [0.56, 1.74] months, P < 0.001 for risk-adjusted survival comparison.</p><p><strong>Conclusions: </strong>Medicare beneficiaries undergoing CABG by never- or occasional-endarterectomizers had small early risk-adjusted survival advantages and similar late outcomes compared to those undergoing surgery by frequent-endarterectomizers. CE remains a valuable tool in selected cases; however, it may be reasonable for surgeons to adopt a never- or occasional-endarterectomy approach to CABG.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623989","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":"Optimized outcome of the Ross procedure in children: single-centre experience†.","authors":"Peter Murin, Julia Gaal, Robin Stenzel, Viktoria Weixler, Olga Romanchenko, Raphael Seiler, Stanislav Ovroutski, Felix Berger, Mi-Young Cho, Joachim Photiadis, Marcus Kelm","doi":"10.1093/ejcts/ezaf102","DOIUrl":"10.1093/ejcts/ezaf102","url":null,"abstract":"<p><strong>Objectives: </strong>The Ross procedure with autograft reinforcement has been proposed as a strategy to prevent autograft failure in adults, but outcome data in children during somatic growth remain limited. We investigated long-term outcomes following an individualized autograft reinforcement protocol to evaluate survival and reintervention rates.</p><p><strong>Methods: </strong>Between January 1995 and December 2022, 233 patients <18 years [median age: 7 (1-13) years] underwent the Ross procedure, including 60 infants (26%). Most frequently free-root autograft implantation without reinforcement was performed (n = 156, 67%). Autograft reinforcement was applied in 77 patients (33%) using either subcoronary implantation (n = 65, 28%) or external prosthetic support (n = 12, 5%). Kaplan-Meier survival estimates were used for survival and reintervention analyses. Risk factors for reintervention were identified by Cox proportional hazards regression.</p><p><strong>Results: </strong>Reinforcement was associated with improved survival (5-year survival rates of 97.1% vs 87.0%, 10-year survival rates of 97.1% versus 86.99%, P = 0.017). No differences in autograft reintervention between the groups were found (1-year rates of 100% vs 99.4%, 5-year rates of 100%, P = 0.4852). Right ventricle-pulmonary artery (RV-PA) reintervention-free survival at 5 years was higher for homografts compared to xenografts (96.9% vs 79.4%, P < 0.001).</p><p><strong>Conclusions: </strong>The Ross procedure in children demonstrated excellent long-term outcomes with low autograft reintervention rates in both groups. Reinforcement was associated with improved long-term survival while autograft-related reinterventions did not differ significantly between groups. Older age at Ross and homograft use correlated with lower RV-PA reintervention risk. Multicentre evaluation of reinforcement techniques is required to assess the outcome differences observed in this single-centre experience.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700066","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":"Imaging-based biomechanical parameters for assessing risk of aortic dissection and rupture in thoracic aortic aneurysms.","authors":"Nitish Bhatt, Hijun Seo, Kate Hanneman, Nicholas Burris, Craig A Simmons, Jennifer C-Y Chung","doi":"10.1093/ejcts/ezaf128","DOIUrl":"10.1093/ejcts/ezaf128","url":null,"abstract":"<p><strong>Objectives: </strong>Imaging-based methods of measuring aortic biomechanics may provide superior and a more personalized in vivo risk assessment of patients with thoracic aortic aneurysms compared to traditional aortic size criteria such as maximal aortic diameter. We aim to summarize the data on in vivo imaging techniques for evaluation of aortic biomechanics.</p><p><strong>Methods: </strong>A thorough search of literature was conducted in MEDLINE, EMBASE and Google Scholar for evidence of various imaging-based biomechanics techniques. All imaging modalities were included. Data involving preclinical/animal models or exclusively focussed on abdominal aortic aneurysms were excluded.</p><p><strong>Results: </strong>The various imaging-based biomechanical parameters can be divided into categories of increasing complexity: strain-based, stiffness-based and computational modelling-derived. Strain-based and stiffness-based parameters are more simply calculated and can be derived using multiple imaging modalities. Initial studies are promising towards linking these parameters with clinically relevant end-points, including aortic dissection, though work is required for standardization. Computationally derived parameters provide detail of stress exerted on the aortic wall with great spatial resolution. However, they are highly dependent on the assumptions applied to the models, such as material properties of the aortic wall.</p><p><strong>Conclusions: </strong>Imaging-based aortic biomechanics represent a major technical advancement for personalized in vivo risk stratification of patients with ascending thoracic aortic aneurysm. The next steps in clinical translation require large-scale validation of these markers towards predicting aortic dissections and comparison against the gold standard ex vivo aortic biomechanics as well as development of a user-friendly, low-cost algorithm that can be widely adopted.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":"67 4","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973793","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}