European Journal of Cardio-Thoracic Surgery最新文献

{"title":"Seven-year outcomes after surgical aortic valve replacement with a stented bovine pericardial bioprosthesis in over 1100 patients: a prospective multicentre analysis.","authors":"Joseph F Sabik, Vivek Rao, Francois Dagenais, Michael G Moront, Michael J Reardon, Himanshu J Patel, Jae K Oh, Shinichi Fukuhara, Louis Labrousse, Ralf Günzinger, Kamran Baig, Saki Ito, Tianhua Wu, Robert J M Klautz","doi":"10.1093/ejcts/ezae414","DOIUrl":"10.1093/ejcts/ezae414","url":null,"abstract":"<p><strong>Objectives: </strong>Safety, efficacy and durability are important considerations when selecting a bioprosthesis for aortic valve replacement (AVR). This study assessed 7-year clinical outcomes and haemodynamic performance of the Avalus bioprosthesis.</p><p><strong>Methods: </strong>Patients indicated for surgical AVR were enrolled in this prospective, nonrandomized trial, conducted across 39 sites globally. The primary end-point of this analysis was freedom from surgical explant or percutaneous valve-in-valve reintervention due to structural valve deterioration (SVD) at 7 years of follow-up, determined using Kaplan-Meier (KM) analysis. We also evaluated a composite end-point of SVD and/or severe haemodynamic dysfunction requiring reintervention. Survival, valve-related safety events and haemodynamic performance were assessed. Deaths and safety events were adjudicated by an independent clinical events committee.</p><p><strong>Results: </strong>A total of 1132 patients underwent surgical AVR. Mean age was 70 years; 854 patients (75%) were men. The mean STS risk of mortality was 2.0 ± 1.4%, and 659 patients (58%) had a New York Heart Association classification of I/II. One or more concomitant procedures were performed in 577 patients (51%). At 7 years, the Kaplan-Meier rate of freedom from SVD/severe haemodynamic dysfunction requiring reintervention was 1.2% (0.5-2.5%) with no cases adjudicated as SVD. The survival rate was 82.6% (79.5-85.0%). The KM event rate was 5.7% (4.3-7.7%) for reintervention, 6.3% (4.9-8.3%) for endocarditis and 0.4% (0.1-1.1%) for valve thrombosis. Mean aortic gradient, dimensionless velocity index and effective orifice area were 13.8 ± 5.9 mmHg, 0.42 ± 0.09 and 1.99 ± 0.53 cm2, respectively.</p><p><strong>Conclusions: </strong>This analysis demonstrated excellent durability of the Avalus valve with good clinical outcomes and stable haemodynamic performance through 7 years of follow-up.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681147","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":"Enhancing machine learning based mortality predictions in cardiac surgery: unlocking the full potential of ML-based risk scores.","authors":"Hamrish Kumar Rajakumar","doi":"10.1093/ejcts/ezaf001","DOIUrl":"10.1093/ejcts/ezaf001","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002595","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":"Do socioeconomic factors impair uptake of neoadjuvant therapy for patients with locoregional oesophageal cancer?","authors":"Rajika Jindani, Jorge Humberto Rodriguez-Quintero, Isaac Loh, Grace Ha, Justin Olivera, Justin Rosario, Roger Zhu, Mohamed K Kamel, Marc Vimolratana, Neel P Chudgar, Brendon M Stiles","doi":"10.1093/ejcts/ezae462","DOIUrl":"10.1093/ejcts/ezae462","url":null,"abstract":"<p><strong>Objectives: </strong>The benefits of neoadjuvant therapy prior to surgery for patients with locally advanced oesophageal cancer have been well established by multiple trials. However, there may be socioeconomic barriers impacting equitable administration. We aim to identify whether disparities exist in the uptake of neoadjuvant therapy among patients with loco-regional oesophageal cancer.</p><p><strong>Methods: </strong>We queried the National Cancer Database to identify patients with clinical stage II-III oesophageal cancer who underwent surgical resection (2006-2020). Logistic regression was performed to identify associations between sociodemographic factors and uptake of neoadjuvant therapy. In propensity score-matched groups, survival was evaluated using the Kaplan-Meier method.</p><p><strong>Results: </strong>Among 19 748 clinical stage II-III patients, 85% (n = 16 781) received neoadjuvant therapy and 15% (n = 2967) underwent upfront surgery. Rates of neoadjuvant uptake increased over time. On multivariable analysis after adjusting by clinical stage, factors associated with lower rates of neoadjuvant therapy included older age (age ≥70, adjusted odds ratio 0.52; 95% confidence interval 0.47-0.57; P < 0.001), female sex (0.76; 0.69-0.85; P < 0.001), Black race (0.77; 0.63-0.94; P = 0.009), more comorbidities (0.76; 0.65-0.85; P < 0.001) and government rather than private insurance (0.84; 0.76-0.93; P < 0.001). In a propensity-matched cohort accounting for these variables, neoadjuvant treatment was associated with improved 5-year overall survival compared to upfront surgery (41.1% vs 35.4%, P < 0.001).</p><p><strong>Conclusions: </strong>Several sociodemographic factors are associated with the delivery of neoadjuvant therapy in patients with oesophageal cancer, including age, sex, race, and insurance status. Interventions can be put into place to target vulnerable patients and ensure equitable delivery of care.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970211","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":"Posterior cricoid plate drill enlargement in idiopathic subglottic stenosis.","authors":"Beatrice Trabalza Marinucci, Cecilia Menna, Fabiana Messa, Giorgia Piccioni, Giacomo Argento, Matteo Tiracorrendo, Anna Maria Ciccone, Alessandra Siciliani, Giulio Maurizi, Antonio D'Andrilli, Claudio Andreetti, Erino Angelo Rendina, Mohsen Ibrahim","doi":"10.1093/ejcts/ezae457","DOIUrl":"10.1093/ejcts/ezae457","url":null,"abstract":"<p><strong>Objectives: </strong>Idiopathic subglottic stenosis (ISS) is an airway stricture between larynx and trachea, within 1 cm from the vocal cords. Resection-reconstruction present technical issues because of the need to resect the anterior portion of the cricoid cartilage, but not the posterior plate beyond which the recurrent laryngeal nerves access the vocal cords. The main surgical challenge consists of the minute airway calibre short below the cords, ensuing after the resection. We propose drill posterior cricoid plate moulding to obtain antero-posterior and lateral amplification of the laryngo-tracheal anastomosis.</p><p><strong>Methods: </strong>This is a retrospective study of patients who underwent laryngo-tracheal resection with drill enlargement between January 2023 and June 2024. Laryngo-tracheal resection was performed according to Pearson's technique. At this point, airway calibre is gauged by endotracheal tubes of increasing size. To enlarge the air space, the inner surface of the posterior plate was moulded by drill. Breathing, complications, voice and swallowing function were recorded.</p><p><strong>Results: </strong>Our study includes 23 consecutive patients with ISS. No mortality was described. Fifteen patients (65.2%) described voice alteration and 7 (30.4%) experienced transient swallowing impairment. The mean operative time was 94.56 (±28.72) min. All patients breathed well at discharge. Overall early success rate was excellent (no sequelae) in 7 (30.4%) patients, and good (grade A: voice/breathing changes not influencing the quality of life; grade B: abnormal voice and shortness of breath, not hindering normal activities) in 15 (65.2%). At the mean follow-up of 10.5 ± 5.5 months, definitive success was achieved.</p><p><strong>Conclusions: </strong>This is the first study describing this technique. The results of our early experience with drill moulding of the posterior cricoid plate are promising. It is an innovative, simple, safe, and effective method for subglottic airway enlargement in ISS, resulting in low post-operative complications, and in good to excellent results.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846335","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":"European Society of Thoracic Surgeons Presidential Address 2024. Adapting to change: embracing lifelong learning curves.","authors":"József Furák","doi":"10.1093/ejcts/ezae446","DOIUrl":"https://doi.org/10.1093/ejcts/ezae446","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":"67 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893178","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":"Diminished spinal cord perfusion despite distal aortic perfusion: an acute translational large animal experiment with occluded segmental arteries.","authors":"Josephina Haunschild, Zara Dietze, Susann Ossmann, Konstantin Von Aspern, Jörg Naumann, Michael A Borger, Christian D Etz","doi":"10.1093/ejcts/ezae460","DOIUrl":"10.1093/ejcts/ezae460","url":null,"abstract":"<p><strong>Objectives: </strong>Neuroprotective measures have been established in open thoraco-abdominal aortic aneurysm repair to reduce the incidence of postoperative paraplegia. Distal aortic perfusion (DaP) is meant to increase blood flow to the abdominal organs and the spinal cord. Cerebrospinal fluid (CSF) drainage is part of peri- and postoperative clinical routine. We aimed to investigate the effect of both techniques on spinal cord perfusion in an acute large animal model with segmental artery occlusion.</p><p><strong>Methods: </strong>Eight pigs underwent minimally invasive segmental artery coil embolization prior to establishment of cardiopulmonary bypass with DaP. After initiation of DaP, CSF pressure was increased 3-fold by infusion of blood plasma. Collateral network near-infrared spectroscopy was used as an additional real-time monitoring method for indirect perfusion monitoring. Microspheres were injected for post-mortem regional spinal cord blood flow analysis.</p><p><strong>Results: </strong>DaP led to an increase in spinal cord perfusion limited to the very lower spinal cord (L3-S, up to 400% of baseline) and the corresponding paraspinous muscle area. The most vulnerable region between T8 and L2 was not reached by DaP (between 14% and 46% of baseline). After initiation of DaP, a 10% increase in oxygenation via collateral network near-infrared spectroscopy was observed for the low lumbar region. The increase in CSF pressure counteracted enhanced perfusion inflow leading to a decrease in net tissue perfusion.</p><p><strong>Conclusions: </strong>DaP is effective in increasing blood flow to the distal spinal cord (effectively counteracting CSF pressure increase) and paraspinous muscles, despite occluded segmental arteries, resulting in hyperperfusion potentially leading to spinal cord oedema and delayed paraplegia postoperatively.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893176","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 impact of restricted chests on long-term lung function parameters following lung transplantation in patients with interstitial lung disease.","authors":"Keita Nakanishi, Thomas Schweiger, Stefan Schwarz, Shahrokh Taghavi, Caroline Hillebrand, Merjem Begic, Sophia Auner, Panja M Boehm, Berta Mosleh, Peter Jaksch, Alberto Benazzo, Toyofumi Fengshi Chen-Yoshikawa, Konrad Hoetzenecker","doi":"10.1093/ejcts/ezae465","DOIUrl":"10.1093/ejcts/ezae465","url":null,"abstract":"<p><strong>Objectives: </strong>In patients with interstitial lung disease (ILD), the diaphragm typically rises as the lungs chronically shrink. However, the grade of restriction differs in each patient. It is currently unknown, how disparities between actual and predicted recipient total lung capacity (TLC), impact changes in lung function parameters and long-term outcomes following lung transplantation (LTx).</p><p><strong>Methods: </strong>This retrospective study included 170 LTx for the patients with ILD performed in a European high-volume LTx center between 09/2011 and 12/2022. The preoperative median ratio of recipient actual to predicted (a/p) TLC was 0.55. Patients were stratified into two groups: low a/p TLC ratio group, corresponding to a more restricted chest cavity (<0.55: n = 85), and high a/p TLC ratio group, corresponding to a more preserved chest cavity (≥0.55: n = 85). Perioperative and long-term outcomes, including lung function and overall survival, were analysed.</p><p><strong>Results: </strong>Between the two groups, tracheostomy and reintubation rates, length of mechanical ventilation, ICU-stay and hospital-stay were not significantly different. Although lung function measurements obtained early after LTx were better in the high a/p TLC ratio group, no significant differences were observed in the long term. Five-year overall survival was not significantly different between the two groups.</p><p><strong>Conclusions: </strong>Although LTx for ILD patients with a restricted chest is considered technically more challenging, the perioperative course is similar to ILD patients with a preserved chest. In addition, no significant differences were observed between both groups in long-term lung function and overall survival, suggesting an improvement in chest wall compliance.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881584","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":"Post-implant transcatheter aortic prosthesis deformation: tricuspid versus bicuspid valve.","authors":"Marco Moscarelli, Aniket Venkatesh, Katelynne Berland, Breandan Yeats, Taylor Becker, Gregorio Zaccone, Vincenzo Pernice, Sabrina Milo, Adriana Zlahoda-Huzior, Dariusz Dudek, Francesca Trizzino, Giuseppe Speziale, Lakshmi Prasad Dasi, Khalil Fattouch","doi":"10.1093/ejcts/ezae451","DOIUrl":"10.1093/ejcts/ezae451","url":null,"abstract":"<p><strong>Objectives: </strong>We sought to assess whether post-implant transcatheter aortic valve prosthesis multidetector computed characteristics differ between patients with native tricuspid and bicuspid aortic valve stenosis, as well as the effect on valve performance and clinical implications.</p><p><strong>Methods: </strong>We analysed 100 consecutive post-implant multidetector computed tomography scans to assess self-expandable prosthesis non-uniform expansion at 6 pre-specified valvular levels, and other specific parameters, including valvular and perivalvular thrombosis at 6 months follow-up. Echocardiographic prosthesis performance and clinical outcome were also evaluated.</p><p><strong>Results: </strong>Mean eccentricity was significantly higher in the bicuspid group (0.43 (0.09) vs 0.37 (0.08), P = 0.005, bicuspid vs tricuspid); valvular and perivalvular thrombosis were also significantly more frequent in the bicuspid than in the tricuspid group (81% vs 36.9%, P = 0.031); there was no significant difference in terms of mean prosthetic gradient at follow-up between (7.31 (5.53 mmHg) vs 7.09 (3.05 mmHg), P = 0.825); EOAi (indexed effective orifice area) was also similar between bicuspid and tricuspid (1.08 (0.12 cm2) vs 1.03 (0.13 cm2), P = 0.101), with no significant changes compared to discharge. However, the bicuspid valve was associated with a significantly higher risk of adverse events (HR: 3.72, 95% CI: 1.07-13.4, P = 0.027).</p><p><strong>Conclusions: </strong>Higher level of eccentricity, which indicates prosthesis deformation, is often detected in bicuspid valves. Although echocardiographic performance was not affected, this might have led to an increased incidence of thrombosis at valvular and perivalvular levels and worse outcomes.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822007","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 current state of the multidisciplinary heart team approach: a systematic review.","authors":"Arian Arjomandi Rad, Sebastian Streukens, Jindra Vainer, Thanos Athanasiou, Jos Maessen, Peyman Sardari Nia","doi":"10.1093/ejcts/ezae461","DOIUrl":"10.1093/ejcts/ezae461","url":null,"abstract":"<p><p>The heart team (HT) approach, recommended for managing cardiovascular diseases, emphasizes multidisciplinary collaboration. Despite its potential benefits, evidence on its effectiveness and implementation is varied and sparse. This review assesses the HT approach's impact on patient outcomes and care delivery in cardiovascular care. A systematic review was conducted across MEDLINE, EMBASE, PubMed, Cochrane and Google Scholar up to July 2023, focusing on studies that implemented an HT approach in coronary and heart valve disease management. Exclusion criteria included non-human studies, case reports and studies not focusing on HT outcomes. From 6270 identified articles, 20 met the inclusion criteria. These studies demonstrated significant variability in HT composition and organization, coupled with a lack of standardized metrics for evaluating clinical outcomes and the impact of the HT. Significant variability was observed in HT composition, with 13 of the 20 studies did not utilize structured templates, those that did demonstrated more consistent decision-making. In mitral valve interventions, HTs were linked to reduced in-hospital mortality and improved long-term survival (5-year survival probability of 0.74 vs 0.70, P = 0.04). In aortic valve interventions, 80% of patients underwent tailored valve procedures following HT evaluation. The HT approach in cardiovascular care demonstrates improved patient outcomes, particularly in specialized interventions for mitral and aortic valve diseases and coronary artery disease management. Despite these positive findings, the variability in HT implementation and the need for standardized outcome metrics call for further advances to optimize this collaborative care model.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845926","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":"Peal it roll it or leave it.","authors":"Selim Mosbahi, Matthias Siepe, Florian S Schoenhoff, David Reineke","doi":"10.1093/ejcts/ezae423","DOIUrl":"https://doi.org/10.1093/ejcts/ezae423","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":"67 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930109","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}