European Journal of Cardio-Thoracic Surgery最新文献

{"title":"Statistical primer: an introduction into the principles of Bayesian statistical analyses in clinical trials.","authors":"Samuel Heuts, Michal J Kawczynski, Bart J J Velders, James M Brophy, Graeme L Hickey, Mariusz Kowalewski","doi":"10.1093/ejcts/ezaf139","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf139","url":null,"abstract":"<p><p>Trials in cardiac surgery are often hampered at the design level by small sample sizes and ethical considerations. The conventional analytical approach, combining frequentist statistics with null hypothesis significance testing, has known limitations and its associated P-values are often misinterpreted, leading to dichotomous conclusions of trial results. The Bayesian statistical framework may overcome these limitations through probabilistic reasoning and is subsequently introduced in this Primer. The Bayesian framework combines prior beliefs and currently obtained data (the likelihood), resulting in updated beliefs, also known as posterior distributions. These distributions subsequently facilitate probabilistic interpretations. Several previous cardiac surgery trials have been performed under a Bayesian framework and this Primer enhances the understanding of their basic concepts by linking results to graphical presentations. Furthermore, contemporary trials that were initially analysed under a frequentist framework, are re-analysed within a Bayesian framework to demonstrate several interpretative advantages.</p>","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990796","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":"Prognosis of adenocarcinoma with innumerable pure ground-glass nodules and/or part-solid nodules.","authors":"Hirofumi Takenaka, Kazuo Nakagawa, Masaya Yotsukura, Yukihiro Yoshida, Shun-Ichi Watanabe","doi":"10.1093/ejcts/ezaf130","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf130","url":null,"abstract":"<p><strong>Objectives: </strong>Although many studies have examined lung adenocarcinoma with multiple additional lesions with ground-glass opacity on high-resolution computed tomography including pure ground-glass nodules and part-solid nodules, no study has yet investigated patients who had resected adenocarcinoma with lesions of pure ground-glass nodule and/or part-solid nodule that were so numerous that it was impossible to resect all of them.</p><p><strong>Methods: </strong>Among 5076 patients with resected adenocarcinoma, 877 (17.3%) had additional lesions of pure ground-glass nodule and/or part-solid nodule. Numerous lesions for which it is impossible to resect all of them (innumerable lesions) were defined as follows: 10 or more lesions are seen in 3 or more different lobes and at least 1 lesion is located in the inner two-thirds of each lobe. Of these, 73 patients with innumerable pure ground-glass nodules and/or part-solid nodules, and with clinical N0 were investigated in terms of clinicopathological features and oncological outcomes.</p><p><strong>Results: </strong>For the main adenocarcinoma, 35 patients (47.9%) underwent sublobar resection. After the initial surgery, 23 patients (31.5%) showed the growth of residual lesions and this growth was often observed more than 2 years from the initial surgery. Surgery was selected for 19 (82.6%) of these 23 patients with lesions that had grown. The 5-year overall survival rate was 86.2%.</p><p><strong>Conclusions: </strong>The prognosis of patients with resected adenocarcinoma with innumerable pure ground-glass nodules and/or part-solid nodules was favourable. Due to the possibility of the growth of residual lesions, sublobar resection should be considered for the main tumour at the initial surgery.</p>","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":"143989195","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":"Subxiphoid uniportal robotic thymectomy using da Vinci Xi system†.","authors":"Takashi Suda, Mizuki Morota, Takahiro Negi, Daisuke Tochii, Sachiko Tochii","doi":"10.1093/ejcts/ezaf127","DOIUrl":"10.1093/ejcts/ezaf127","url":null,"abstract":"<p><p>We report subxiphoid uniportal robotic thymectomy without intercostal access using the da Vinci Xi multi-port robot system. A 4-cm vertical incision was made 1 cm caudal to the xiphoid process. The AIRSEAL ROBOTIC SOLUTION, an air seal system compatible with the da Vinci port was used to insufflate CO2 at 8 mmHg. During port insertion, the left and right hands were crossed into the wound, with the camera, left hand, and right hand inserted in the order from the anterior chest to the dorsal side. To reduce the interference between the ports at the head, a key technique is to pull the camera port forward to prevent it from colliding with the other ports. Subxiphoid uniportal robotic thymectomy using the da Vinci Xi is a technique that combines excellent surgical visibility from the subxiphoid process, minimal invasiveness and enhanced operability provided by the robotic system.</p>","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996308","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":"Prevalence, clinical characterization, management and evolution of bicuspid aortic valve classified according to the 2021 International Consensus Statement in a tertiary care hospital.","authors":"Vincenzo Rizza, Francesco Ancona, Giacomo Ingallina, Stefano Stella, Davide Margonato, Annamaria Tavernese, Martina Belli, Federico Biondi, Giorgio Fiore, Monica Barki, Damiano Cecchi, Alessandro Castiglioni, Michele De Bonis, Ottavio Alfieri, Francesco Maisano, Eustachio Agricola","doi":"10.1093/ejcts/ezaf109","DOIUrl":"10.1093/ejcts/ezaf109","url":null,"abstract":"<p><strong>Objectives: </strong>The 2021 International Consensus for the congenital bicuspid aortic valve (BAV) condition recognizes 3 morphologies of BAV (fused, two-sinus and partial-fusion) and 3 types of aortopathy (ascending, root and extended). The clinical impact of BAV phenotyping on aortopathy evolution has not been evaluated so far. The aims were to assess: (i) prevalence of BAV phenotypes; (ii) frequency of BAV-related aortic valve dysfunction and aortopathy; and (iii) inter-phenotypic differences in aortopathy progression in a real-world population.</p><p><strong>Methods: </strong>This was an observational cohort study on patients with BAV referred to our tertiary hospital between January 2018 and November 2022 to undergo a comprehensive transthoracic echocardiography. Baseline clinical, ultrasonographic and computed tomographic data were evaluated; even echocardiographic progression of aortic dilatation was assessed.</p><p><strong>Results: </strong>Three hundred and two patients were evaluated: 245 (81.1%) had fused, 41 (13.6%) two-sinus and 16 (5.3%) partial fusion BAV. Aortopathy was documented in 101 (33.6%) cases and it was prevalent among patients with the fused type. The prevalence of aortic valve dysfunction was instead similar among the 3 groups. Two hundred and twelve patients underwent invasive management of clinically relevant aortic valve or aortic disease. Non-operated fused type presented the highest progression rate of aortic dilatation, whilst, among the interventional subpopulation, a more pronounced evolution was observed in the two-sinus type, at a median follow-up of 2 years.</p><p><strong>Conclusions: </strong>Fused type represented the BAV phenotype with the highest frequency and the most significant association with aortopathy. In terms of aortopathic progression, the mid-term growth rate of the thoracic aorta was more significant in the non-interventional fused BAVs.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700068","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":"Knowledge is a right: fixing open access flaws.","authors":"Khaled Moustafa, Akram Adam","doi":"10.1093/ejcts/ezaf095","DOIUrl":"10.1093/ejcts/ezaf095","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":"143708515","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":"Disparities in heart transplant survival and graft rejection outcomes persist in the modern era: a call to race towards a more equitable future.","authors":"Ahad Firoz, Daniel Remer, Huaqing Zhao, Xiaoning Lu, Eman Hamad","doi":"10.1093/ejcts/ezaf141","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf141","url":null,"abstract":"<p><strong>Objectives: </strong>Racial and ethnic disparities remain an ongoing challenge in healthcare. Such inequities have been reported in heart transplantation (HTx); however, there is limited data within the modern era. Additionally, there is scarce information on outcomes besides death, such as graft rejection. Therefore, our investigation aims to add further data on contemporary racial and ethnic disparities on post-transplant outcomes.</p><p><strong>Methods: </strong>Adult isolated HTx recipients who were transplanted between 1/2000 and 9/2023 were analysed using the United Network for Organ Sharing (UNOS) database. Inclusion criteria included 'White', 'Black', 'Hispanic' and 'Asian' recipients. Two primary outcomes of interest were analysed: mortality and cardiac allograft vasculopathy (CAV). Survival was assessed using a cause-specific model, whereas CAV analysis utilized a competing-risk approach. Subgroup survival analysis was conducted for patients listed in the years prior to (11/2013-10/2018) and after (10/2018-9/2023) the 2018 heart allocation policy (HAP) changes.</p><p><strong>Results: </strong>A total of 50 243 patients were included in our analysis. Black recipients were the only group found to have an increased overall (hazard ratio [HR] = 1.30, P < 0.001) and post-HAP (HR = 1.36, P < 0.001) mortality risk. Asian (HR = 1.19, P= 0.001) and Hispanic (HR = 1.15, P < 0.001) recipients had elevated risks of CAV, whereas Black patients had similar risk (HR = 1.00, P = 0.864) as White recipients.</p><p><strong>Conclusions: </strong>Our investigation suggests that disparities continue to exist for minority groups after HTx. Notably, the 2018 allocation changes may have introduced or exacerbated such inequities for Black recipients.</p>","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973670","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":"Think twice before diagnosing tension pneumothorax: a retrospective analysis of pseudotension pneumothorax.","authors":"Linyan Xie, Lili Song, Jiajia Wang, Zailiang Wang, Wei Lei","doi":"10.1093/ejcts/ezaf098","DOIUrl":"10.1093/ejcts/ezaf098","url":null,"abstract":"<p><strong>Objectives: </strong>Tension pneumothorax (TP) is a clinical emergency that requires immediate treatment. However, there are specific cases that may be misdiagnosed as TP in clinical settings, potentially leading to iatrogenic injury. The goal of this study was to analyse and summarize instances of misdiagnosis in order to improve the clinician's ability to recognize and distinguish pseudotension pneumothorax (PTP).</p><p><strong>Methods: </strong>Cases misdiagnosed as TP were retrospectively analysed by literature retrieval, and the related clinical characteristics were summarized.</p><p><strong>Results: </strong>A total of 45 cases were misdiagnosed as TP, including 27 (60.0%) cases of diaphragmatic hernia (DH), 9 cases of giant pulmonary bullae, 8 cases of cystic lung lesions and 1 case of pulmonary hydatid cyst. A total of 77.8% cases occurred in emergency and paediatric departments. Among patients with DH, 92.6% had the condition on the left with a younger onset age, and 85.2% presented with a history of digestive system diseases, surgery, trauma or digestive system manifestations. The onset of giant pulmonary bullae was mild, without haemodynamic abnormalities, and 66.7% of the patients were males. Cystic lung lesions occurred mainly in infants. Among 45 cases, 93.3% were misdiagnosed by chest X-ray, which showed 'pseudo-pneumothorax line', with compressed lung displaced centrifugally away from hilum. In DH, the diaphragm appeared indistinct without gastric bubbles, whereas the air-fluid level might be noted. Finally, 66.7% of patients were definitely diagnosed from computed tomography scans and others by thoracotomy, thoracic drainage, X-ray after gastric tube insertion, and so forth. Thoracic tube drainage was performed in 91.1% of patients, with 24.4% of patients draining fluid, and 9.8% of patients deteriorated after drainage. A total of 41.5% of patients suffered complications, including gastric perforation, haemopneumothorax and subcutaneous emphysema. Except for 1 patient who did not report the treatment and prognosis, all other patients recovered and were discharged after treatment.</p><p><strong>Conclusions: </strong>Distinguishing PTP from TP is clinically challenging. A thorough medical history, detailed clinical features, chest X-ray, ultrasound, computed tomography and strategic gastric tube insertion can provide important information of value for differential diagnosis. Clinicians need to think twice before placing a thoracic drainage tube to prevent additional iatrogenic injury.</p>","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":"143699542","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":"A common exit examination for thoracic surgery in Europe-the Unified European Board of Thoracic Surgery.","authors":"Gilbert Massard, Maninder Kalkat, Richard Milton, Nuria Novoa, Toni Lerut, Yvonne Hurst, Dirk van Raemdonck, Stephen Clark","doi":"10.1093/ejcts/ezaf040","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf040","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":"143973668","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":"Veno-venous extracorporeal membrane oxygenation exacerbates lung ischaemia-reperfusion injury in a rat model.","authors":"Shi-Lin Wei, Xiao-Qian Zhang, Jian Li, Rong-Zhi Zhang, Jian-Bao Yang, Ran Zhang, Yong-Nan Li, Bin Li","doi":"10.1093/ejcts/ezaf106","DOIUrl":"10.1093/ejcts/ezaf106","url":null,"abstract":"<p><strong>Objectives: </strong>Although lung transplantation has experienced great development in the past decades, the survival rate remains low, and lung ischaemia-reperfusion injury during transplantation is a major cause of primary graft dysfunction, which causes early morbidity and death after lung transplantation. Extracorporeal membrane oxygenation (ECMO) has been increasingly used as intraoperative support during lung transplantation. However, the clinical outcomes of intraoperative ECMO in lung transplantation remain controversial. Here, we established veno-venous ECMO (VV ECMO) in a lung ischaemia-reperfusion rat model to investigate its impact on lung injury.</p><p><strong>Methods: </strong>Eighteen rats were allocated to Sham, ischemia-reperfusion (IR) and IR-ECMO group. Using left pulmonary hilum ischaemia for 1 h, VV ECMO was established during reperfusion for 2 h. Lung tissue, blood sample and bronchoalveolar lavage fluid were collected for further evaluation using haematoxylin and eosin staining, immunohistochemistry, quantitative polymerase chain reaction, bicinchoninic acid assay and enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>VV ECMO aggravates lung ischaemia-reperfusion injury; the pathological injury is more severe in the IR-ECMO group, and biomarkers of lung injury, including soluble receptor for advanced glycation end products and surfactant protein-D, also significantly increased. There are more neutrophil and macrophage infiltrations in the IR-ECMO group as well. We also observed higher expression of inflammatory factors, including interleukin-6, interleukin-1β and tumour necrosis factor-α in the lung tissues and serum.</p><p><strong>Conclusions: </strong>This study found VV ECMO significantly exacerbates lung ischaemia-reperfusion injury and pulmonary inflammatory response in a rat model after lung ischaemia-reperfusion.</p>","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":"143751784","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 Congenital Heart Surgeons Association congenital cardiac database: A 25-year summary of congenital heart surgery outcomes†.","authors":"Eleftherios Protopapas, Massimo Padalino, Zdzislaw Tobota, Tjark Ebels, Simone Speggiorin, Jurgen Horer, Andrej Kansy, Jeffrey P Jacobs, Jose Fragata, Bohdan Maruszewski, Vladimiro Vida, George Sarris","doi":"10.1093/ejcts/ezaf119","DOIUrl":"10.1093/ejcts/ezaf119","url":null,"abstract":"<p><strong>Objectives: </strong>The European Congenital Heart Surgeons Association Congenital Cardiac Database (ECHSA-CCDB), growing steadily over 25 years is the second largest in the world. In this study, we summarize overall outcomes of paediatric and congenital cardiac procedures, stratified by age groups, and the benchmark procedure groups, and we report on observed trends.</p><p><strong>Methods: </strong>All data from 1999 until August 2024 are analysed and outcome parameters hospital mortality (HM), 30-day mortality (30d-M) and length of stay are reported. Outcomes are stratified by the origin of participating centres, by age groups and by the standard 10 benchmark procedure groups. Important outcome trends are also demonstrated.</p><p><strong>Results: </strong>Over 25 years, 377 606 procedures in 294 206 patients of all ages with congenital heart disease were recorded. Overall 30d-M and HM, were 3.65% and 4.09%, respectively. The mean length of stay was 15.95 (SD 26.53) days. 30d-M and HM for neonates were 8.71% and 10.28%; for infants 3.36% and 3.90%; for children 1.68% and 1.87%; for adults 1.77% and 1.85%, respectively. For benchmark procedure groups, 30d-M and HM ranged from 0.63% and 0.72% for ventricular septal defect repair to 22.93% and 27.62% for the Norwood procedure. Reduced mortality over time was documented across the board.</p><p><strong>Conclusions: </strong>This 25-year report provides real-world outcomes of paediatric and adult congenital heart surgery in participating ECHSA-CCDB centres, unadjusted overall and stratified by age and benchmark procedure groups. Mortality has been decreasing over time. This information can be of value for research and individual centre quality improvement programs.</p>","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":"143802808","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}