European Journal of Cardio-Thoracic Surgery最新文献

{"title":"Subcoronary versus full-root Ross procedure for the paediatric population: an early-to-midterm bicentric experience.","authors":"Viktoria Weixler, Peter Murin, Bana Samman, Julia Gaal, Alison Howell, Marcus Kelm, Peter Kramer, Chelsea Christie, Gloria Ho, Kyle Runeckles, Mimi Xiaoming Deng, Mi-Young Cho, David J Barron, Joachim Photiadis, Osami Honjo","doi":"10.1093/ejcts/ezaf062","DOIUrl":"10.1093/ejcts/ezaf062","url":null,"abstract":"<p><strong>Objectives: </strong>With 2 different Ross autograft implantation techniques: subcoronary versus full-root evolving, the question remains which strategy demonstrates the better early/mid-term performance, especially concerning autograft durability.</p><p><strong>Methods: </strong>Patients (0-18 years) undergoing Ross procedure from January 2012 to December 2022 in 2 high-volume centres were included. Patients undergoing both subcoronary and full-root Ross were analysed for early mortality, direct postoperative complications, 5-year survival, incidence of reinterventions/reoperations and autograft durability over time. Propensity score matching and regression analysis were used to overcome institutional differences.</p><p><strong>Results: </strong>A total of 205 paediatric patients were included [median age at Ross: 7.6 years (1.9-13.5), 67% males]. No differences in baseline characteristics were noted between the groups, except for prior aortic valve repair, which occurred more frequently in the full-root Ross (19% vs 6.9%; P = 0.03). Cardiopulmonary bypass durations (median 265 vs 221 min, P < 0.01), ventilatory support and hospital stay were significantly longer in the subcoronary Ross (P = 0.02) with no differences in any postoperative complications. No differences were noted in 5-year survival [full-root: 93.3% (87.5-96.5) versus subcoronary: 96.5% (86.6-99.1), P = 0.45], incidence of autograft reoperations [full-root: 3.2% (1-9.9) versus subcoronary: 2.1% (0.3-14.9), P = 0.98] or incidence of autograft regurgitation ≥ moderate [full-root: 9.8% (5.3-18.2) versus subcoronary: 9.7% (3.1-30.5), P = 0.85) between the groups, also after matching.</p><p><strong>Conclusions: </strong>Independent of the technique, Ross procedure is performed with excellent survival and low autograft reoperation rates in high-volume centres. The longer, technically more challenging subcoronary Ross demonstrated no differences in early postoperative complications. A superiority in autograft durability has so far not been noticed either in the medium-term follow-up.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556261","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":"Challenges of conventional and novel approaches to clinical trial designs in cardiovascular medicine.","authors":"Torsten Doenst, Hristo Kirov, Emilia Bagiella, André Scherag, Elmir Omerovic","doi":"10.1093/ejcts/ezaf056","DOIUrl":"10.1093/ejcts/ezaf056","url":null,"abstract":"<p><p>Randomized controlled trials (RCTs) are the gold standard for guiding treatment recommendations. Their results reflect the average treatment effect generated in samples from a selected patient population. Observational studies may serve as external validation of RCT findings but are influenced by various biases. Conducting clinical trials in the cardiovascular field faces many challenges, including financial constraints, end point selection, including determining their value for doctors and patients, and assessment of long-term treatment effects. In addition, there is renewed debate about the optimal statistical approach for the evaluation of trial outcomes. These factors occur in parallel to efforts to develop novel clinical trial designs that address the above challenges. Pragmatic trials, for instance, may use data already collected during patient care. As an alternative to fixed sample size, two-arm designs and adaptive trial designs have been introduced, which allow for pre-specified adaptations throughout a trial. Master protocols are used to govern platform, umbrella and basket trial designs, all allowing to address more than 1 aspect at a time (e.g. the impact of multiple treatments on a single condition or a single treatment on multiple conditions). Cluster designs may allow the evaluation of new treatments into clinical routine. Here, we review strengths and limitations of conventional and novel trial designs. We provide a general description of current topics with a focus on treatment comparisons in the field of cardiovascular research.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467408","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":"Developing a career in cardio-thoracic research: 'Do what you can, with what you have, where you are'.","authors":"Andrea Amabile, Samuel Burton, Amaya Ramírez, Anne Dijkstra, Ibrahim Gökçe, Matthias Siepe","doi":"10.1093/ejcts/ezaf057","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf057","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":"67 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585048","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":"Proximal ligation of the pulmonary vein stump to prevent postoperative cerebral infarction after a lobectomy†.","authors":"Tomoki Nishimura, Satoru Okada, Kenji Kameyama, Kazuki Honda, Chiaki Nakazono, Ryosuke Tokuda, Shunta Ishihara, Satoshi Teramukai, Masayoshi Inoue, Yasuo Ueshima","doi":"10.1093/ejcts/ezaf041","DOIUrl":"10.1093/ejcts/ezaf041","url":null,"abstract":"<p><strong>Objectives: </strong>Our goal was to assess whether proximal ligation of the pulmonary vein stump (PVS) outside the pericardium reduces the incidence of postoperative cerebral infarction (PCI) after a lobectomy.</p><p><strong>Methods: </strong>A single-institution retrospective review was conducted of 683 patients undergoing a lobectomy for lung cancer, metastatic lung tumours and benign diseases. Associations among PCI within 90 days, ligation of the PVS and clinicopathological features were analysed. Effects of PVS ligation on PCI were assessed using multivariable regression. PVS length measured on three-dimensional computed tomographic angiography was compared between the non-ligation and ligation groups.</p><p><strong>Results: </strong>The non-ligation and ligation groups included 356 (January 2010-March 2018) and 327 patients (April 2018-November 2023), respectively. Seven non-ligation group patients (1.96%) had PCIs [3 in a left upper lobectomy (LUL) and left lower lobectomy (LLL) and 1 in a right lower lobectomy]; no ligation group patients suffered PCIs (P = 0.016). Univariable analysis showed that LUL, LLL, chronic kidney disease (CKD), heart failure, cardiovascular disease and PVS ligation were significantly associated with PCIs. Multivariable analysis demonstrated that PVS ligation (P = 0.034) was correlated with decreased PCI and LUL (P = 0.011), LLL (P = 0.010) and CKD (P = 0.004) with increased PCIs. After ligation, PVS length was shortened in each lobe in a subset analysis of 109 patients.</p><p><strong>Conclusions: </strong>Proximal ligation of the PVS outside the pericardium may be an option to prevent a PCI during a lobectomy. Patients with CKD and those undergoing left-sided lobectomy are at higher risk for PCI and may benefit from more intensive management.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413735","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":"Funnelling the funnel chest debate into evidence-based care: current landscape of pectus excavatum surgery.","authors":"Jamie Walsh, Karen C Redmond","doi":"10.1093/ejcts/ezaf039","DOIUrl":"10.1093/ejcts/ezaf039","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373814","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":"Direct perfusion for mesenteric ischaemia in acute type A aortic dissection: a glimpse into the mist of uncertainties.","authors":"Wei-Guo Ma, Xia Gao, Bu-Qing Ni, Prashanth Vallabhajosyula","doi":"10.1093/ejcts/ezaf044","DOIUrl":"10.1093/ejcts/ezaf044","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413733","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 smoking habits on postoperative outcomes following lung surgery for cancer: results from the Epithor database.","authors":"Francesco Leo, Giuseppe Migliaretti, Simona Sobrero, Dan Angelescu, Tarun Mc Bride, Marcel Dahan, Jacques Jougon","doi":"10.1093/ejcts/ezaf048","DOIUrl":"10.1093/ejcts/ezaf048","url":null,"abstract":"<p><strong>Objectives: </strong>Smoking is a modifiable risk factor for lung resections but to what extent preoperative smoking cessation reduces that risk remains unclear. The study hypothesis was that the potential benefit of smoking cessation can be assessed by measuring the risk difference between active and former smokers in a large cohort of patients.</p><p><strong>Methods: </strong>Data were extracted from the French Society of Thoracic and Cardiovascular Surgeons (Société Française de Chirurgie Thoracique et Cardiovasculaire) database. The study cohort comprised patients who underwent lung resection for cancer from January 2002 to December 2020 and for which information on smoking status was available. The risk of overall and specific postoperative complications according to smoking status was defined by logistic regression models, and results were presented in terms of odds ratios (ORs) and relative 95% confidence intervals (CIs) adjusted for confounding factors.</p><p><strong>Results: </strong>Of the 7204 analysed patients at the time of their operations, 20.2% were active smokers, 60.7% were ex-smokers and 19.1% were never smokers. Compared to former smokers, active smokers experienced a higher rate of respiratory complications (OR 1.5, CI 1.2-1.7) and infections (OR 1.6, CI 1.3-1.9). Postoperative atelectasis was significantly reduced in former smokers (3%) compared to active smokers (6.9%, P < 0.01). In active smokers, the risk was related to the level of exposure, being higher for smokers of more than 40 pack-year.</p><p><strong>Conclusions: </strong>After lung surgery, active smokers experience a higher risk of respiratory complications, infections and prolonged air leak compared to former smokers. This risk seems to be related to the level of exposure.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467417","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 reconstruction with CardioCel: Midterm Results.","authors":"Vadim P Irimie, Wasim Nasra, Alaa Atieh, Akram Ahmidou, Lukas Lehmkuhl, Paul P Urbanski","doi":"10.1093/ejcts/ezaf049","DOIUrl":"10.1093/ejcts/ezaf049","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to evaluate the outcomes of aortic valve repair techniques using cusp patch-plasty with CardioCel.</p><p><strong>Methods: </strong>Between September 2014 and June 2021, a total of 167 patients underwent aortic valve reconstruction using cusp repair. In all patients, CardioCel patch was used exclusively. An isolated cusp repair was performed in 117 patients (70%), while 50 patients with concomitant aortopathy needed a combined valve and root repair. Seventy-two patients (43%) presented with tricuspid valve. The mean age of the entire cohort was 54.3 ± 12.3 years, with 143 patients being males.</p><p><strong>Results: </strong>Early (30-day/in-hospital) mortality was 0.6%. The survival at 2, 4, and 6 years was 98.8, 96.8, and 95.7%, respectively. During the mean follow-up of 4.2 ± 1.7 years (resulting in 697 patient-years), a relevant aortic insufficiency occurred in 10 patients (8 of them presenting with bicuspid valve). All the patients underwent a valve replacement, resulting in a 7.8 ± 2.5% cumulative risk of aortic valve reoperation and/or insufficiency ≥3+ at 6 years. The causes of reoperation were cusp tear at the suture line, progressive valve pathology, endocarditis, and unknown in 4, 4, 1, and 1, respectively. Degeneration and/or calcification of the CardioCel has not been observed.</p><p><strong>Conclusions: </strong>The intermediate results of aortic cusp repair using CardioCel are good. Anatomo-pathology of the aortic valve and quality of the cusps seem to be the main reasons for repair failure. Further investigations are needed to assess the long-term durability of CardioCel patch-plasty as an alternative to biological valve replacement in specific aortic valve pathologies.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448569","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":"Postoperative atrioventricular block after surgery for congenital heart disease: incidence, recovery and risks.","authors":"Kristin Kruse, Muneaki Matsubara, Thibault Schaeffer, Jonas Palm, Frank Klawonn, Takuya Osawa, Carolin Niedermaier, Paul Philipp Heinisch, Nicole Piber, Gunter Balling, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono","doi":"10.1093/ejcts/ezaf059","DOIUrl":"10.1093/ejcts/ezaf059","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to determine the incidence of postoperative complete atrioventricular block, the time to recovery or permanent pacemaker implantation and the predictors for postoperative atrioventricular block after congenital heart surgery.</p><p><strong>Methods: </strong>Patients who underwent open-heart surgery from January 2001 to January 2024 were analysed and predictors of atrioventricular block were identified using a logistic regression model.</p><p><strong>Results: </strong>Among 9765 congenital heart surgeries, 333 (3.4%) were complicated by atrioventricular block, and 193 patients (1.9%) underwent permanent pacemaker implantation. The highest rates of atrioventricular block were found in patients who underwent repair of congenitally corrected transposition of the great arteries (27.3%), followed by Konno procedure (20.0%), mitral valve replacement (16.0%) and arterial switch with closure of ventricular septal defect and arch repair (15.0%). In 134 (1.4%) patients with transient atrioventricular block, the median time to resolution was 4 days (interquartile range: 2-8 days). After 7 postoperative days, 75% had resolved, and after 12 postoperative days, 90% had resolved. Risk factors for the development of atrioventricular block were older age at operation (odds ratio: 1.012, P = 0.001), preoperative endocarditis (2.422, P < 0.001), longer aortic cross-clamp time (1.018, P < 0.001) and high-risk procedures (1.397, P = 0.012).</p><p><strong>Conclusions: </strong>Postoperative atrioventricular block is not rare after congenital heart surgery, with more than half of them needing permanent pacemaker implantation. Older age at operation, preoperative endocarditis, longer aortic cross-clamp time and high-risk procedures were risks for the development of atrioventricular block. Pacemaker implantation should be delayed to the 12th postoperative day, when 90% of transient blocks have resolved.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482486","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":"Reply to Sugimura et al.","authors":"Alexandra Andreeva, Paul Werner, Daniel Zimpfer, Martin Andreas","doi":"10.1093/ejcts/ezaf013","DOIUrl":"10.1093/ejcts/ezaf013","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556259","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}