General Thoracic and Cardiovascular Surgery最新文献

{"title":"Gastroparesis following anatomical resection for lung cancer: clinical characteristics and implications.","authors":"Hiromu Keira, Mariko Fukui, Takeshi Matsunaga, Aritoshi Hattori, Kazuya Takamochi, Kenji Suzuki","doi":"10.1007/s11748-026-02305-8","DOIUrl":"10.1007/s11748-026-02305-8","url":null,"abstract":"<p><strong>Objective: </strong>Gastroparesis is a rare complication of thoracic surgery, defined as delayed gastric emptying without mechanical obstruction. Gastroparesis may worsen outcomes; however, data after lung resection are scarce. We aimed to determine the incidence, perioperative factors, and course of postoperative gastroparesis after anatomical lung resection for lung cancer.</p><p><strong>Methods: </strong>We retrospectively reviewed records of 1623 adult patients who underwent anatomical lung resection (2018-2022). Gastroparesis was defined as postoperative upper gastrointestinal symptoms with radiographic gastric dilatation without mechanical obstruction. Univariate comparisons were performed using the Wilcoxon rank-sum or Fisher's exact tests. Because of the infrequency of events, an exploratory multivariate analysis was conducted using Firth-penalized logistic regression with pre-specified covariates (clinical stage, lesion laterality, and extent of lymph node dissection).</p><p><strong>Results: </strong>Eight patients developed postoperative gastroparesis (0.49%, 8/1623). Affected patients tended to have left-sided and clinically advanced disease, and a longer operative time (median 210 vs. 147 min), greater blood loss (median 90 vs. 10 mL), and longer hospital stay (median 26 vs. 8 days). Onset occurred on postoperative days 2-6. All patients recovered with conservative management, without surgery. In Firth regression, left-sided resection and advanced stage increased odds of gastroparesis (adjusted odds ratio 3.67, 95% confidence interval 0.93-20.04; p = 0.064 and 3.17, 0.78-16.17; p = 0.108), respectively, whereas extent of lymph node dissection was not associated (1.44, 0.24-15.16; p = 0.706).</p><p><strong>Conclusions: </strong>Postoperative gastroparesis, although rare, was associated with prolonged hospitalization. Early recognition and supportive management are warranted, particularly after complex procedures.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"982-991"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Larger common femoral artery diameter is a risk factor for type A acute aortic dissection.","authors":"Makoto Ikematsu, Keiji Uchida, Tomoki Cho, Kenichi Fushimi, Norihisa Tominaga, Ryo Izubuchi, Tomoyuki Minami, Shota Yasuda, Yoshiyuki Kobayashi, Aya Saito","doi":"10.1007/s11748-026-02308-5","DOIUrl":"10.1007/s11748-026-02308-5","url":null,"abstract":"<p><strong>Objectives: </strong>The etiology of type A acute aortic dissection (TAAAD) remains unclear. This study aimed to investigate whether the diameter of the common femoral artery (CFA) could serve as a predictor of TAAAD.</p><p><strong>Methods: </strong>This retrospective study included 100 patients aged 20-70 years who underwent surgery for TAAAD and had postoperative contrast-enhanced (CT) performed before discharge (TAAAD group). The control group comprised 100 patients who underwent elective surgery for stage ≤ 2 colorectal cancer without preoperative bowel obstruction or perforation between April 2021 and March 2024. CFA diameters measured on postoperative CT images in the TAAAD group were compared with those measured on preoperative CT images in the control group.</p><p><strong>Results: </strong>The TAAAD group had a higher proportion of men (76% vs. 59%; p = 0.016), larger body surface area (1.78 [1.65-1.91] vs. 1.70 [1.57-1.83]; p = 0.004), younger age (57 [52-64] vs. 60 [54-67]; p = 0.011), and larger CFA diameter (11.2 mm [10.1-12.1] vs. 9.0 mm [8.5-9.8]; p < 0.001). Receiver operating characteristic curve analysis for CFA diameter demonstrated good discriminatory performance (area under the curve, 0.88; 95% confidence interval, 0.84-0.93). An optimal cutoff value of 10.5 mm yielded a sensitivity of 70% and a specificity of 90%. In multivariable logistic regression analysis, CFA diameter remained significantly associated with TAAAD (OR 5.45, 95% confidence interval 3.47- 9.31, p < 0.001).</p><p><strong>Conclusions: </strong>The CFA diameter was significantly larger among patients with TAAAD. These findings suggest that CFA diameter may be associated with the risk of TAAAD.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"970-976"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A practical approach to procedural planning for robot-assisted segmentectomy using a lobectomy-based surgical simulator.","authors":"Keiji Yamanashi, Ryo Miyata, Takeshi Kawaguchi, Masatsugu Hamaji","doi":"10.1007/s11748-026-02343-2","DOIUrl":"10.1007/s11748-026-02343-2","url":null,"abstract":"<p><p>Preoperative planning for robot-assisted segmentectomy requires accurate understanding of segmental anatomy and the sequence of vascular and bronchial division. Although three-dimensional computed tomography provides detailed anatomical information, it does not allow stepwise prediction of intraoperative anatomical changes. We applied a lobectomy-based da Vinci surgical simulator for preoperative planning of robot-assisted apical-anterior segmentectomy. A 62-year-old woman with a 10-mm pulmonary nodule suspected to be stage IA1 non-small cell lung cancer underwent the procedure. The method focuses on rehearsing the sequence of dissection and anticipating post-division anatomical relationships rather than replicating patient-specific anatomy. Although the procedure can be performed without simulation, this approach may provide additional value by enabling procedural rehearsal and reducing intraoperative uncertainty. The simulated workflow closely corresponded to intraoperative findings, suggesting that this approach may serve as a practical adjunct to conventional imaging in selected cases.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"1030-1033"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic left S10 segmentectomy preserving an A9 branch missed on initial 3D-CT reconstruction: a lung base-flip approach.","authors":"Shuji Mishima, Yuichi Oguchi, Daisuke Nakamura, Yukihiro Terada, Kazutoshi Hamanaka, Kimihiro Shimizu","doi":"10.1007/s11748-026-02410-8","DOIUrl":"https://doi.org/10.1007/s11748-026-02410-8","url":null,"abstract":"<p><p>Accurate anatomical assessment is essential for precise pulmonary segmentectomy. We report a robotic left S10 segmentectomy in a 72-year-old woman in whom the initial three-dimensional computed tomography (3D-CT) reconstruction showed no pulmonary artery accompanying B9bii and focal irregularity of A10b. Re-evaluation of the contrast-enhanced CT images revealed a small A9bii arising from A10b that had not been depicted on the initial reconstruction. Manual correction of the 3D-CT images clarified the arterial anatomy and guided surgical planning. A lung base-flip approach provided a favorable caudal view of the deep A10b-A9bii bifurcation, enabling identification and preservation of A9bii. This case highlights the importance of recognizing anatomical discrepancies on reconstructed images, reassessing the CT images, and selecting an appropriate surgical approach to preserve anomalous pulmonary arterial branches.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative computed tomographic assessment of aortic root geometry after Y-incision aortic root enlargement in patients with small aortic annuli.","authors":"Yusuke Motoji, Tadashi Kitamura, Masaomi Fukuzumi, Yoshimi Tamura, Kagami Miyaji","doi":"10.1007/s11748-026-02407-3","DOIUrl":"https://doi.org/10.1007/s11748-026-02407-3","url":null,"abstract":"<p><strong>Objectives: </strong>Y-incision aortic root enlargement enables implantation of larger surgical prostheses in patients with small aortic annuli. However, postoperative computed tomography angiography-based data on aortic root geometry, prosthetic valve orientation, and coronary clearance in small-bodied patients remain limited.</p><p><strong>Methods: </strong>We retrospectively studied 13 consecutive patients who underwent Y-incision aortic root enlargement between May 2023 and February 2024. Pre- and postoperative electrocardiogram-gated cardiac computed tomography angiography was available in 11 patients and analyzed using a workflow analogous to transcatheter aortic valve implantation planning. Measurements included left ventricular outflow tract area, annular geometry, sinuses of Valsalva and sinotubular junction dimensions, coronary height, prosthetic valve angle, and valve-to-coronary/valve-to-aorta distances. Transthoracic echocardiography was performed in all patients.</p><p><strong>Results: </strong>Annular area increased significantly (3.9 ± 0.7 to 4.6 ± 0.6 cm²; p = 0.014), with enlargement of the sinuses of Valsalva and sinotubular junction area, while left ventricular outflow tract area was unchanged. Mean valve-to-coronary distance was 7.9 ± 2.0 mm for the left coronary artery and 6.4 ± 1.4 mm for the right coronary artery; no computed tomography angiography-evaluable case met the established high-risk thresholds of valve-to-coronary distance ≤4 mm or valve-to-aorta distance ≤2 mm. Thirty-day mortality was 0%.</p><p><strong>Conclusions: </strong>Postoperative computed tomography angiography demonstrated aortic root enlargement without clinically meaningful prosthetic valve angulation or reduction in valve-to-coronary/valve-to-aorta distance below established high-risk thresholds. These preliminary findings may provide anatomical information relevant to future valve-in-valve planning, although larger studies with longer follow-up and valve-specific simulation data are required.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"mid-term hemodynamic and structural valve outcomes of bovine pericardial and porcine bioprostheses after surgical aortic valve replacement\".","authors":"Fevzi Ayyıldız, Ömer Faruk Rahman","doi":"10.1007/s11748-026-02408-2","DOIUrl":"https://doi.org/10.1007/s11748-026-02408-2","url":null,"abstract":"","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Landiolol or a perioperative care bundle? Interpreting POAF prevention after OPCAB.","authors":"Güney Sarıoğlu","doi":"10.1007/s11748-026-02394-5","DOIUrl":"https://doi.org/10.1007/s11748-026-02394-5","url":null,"abstract":"","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic minimally invasive direct coronary artery bypass (MIDCAB): a standardised operative technique.","authors":"Lucy Manuel, Levi Bassin","doi":"10.1007/s11748-026-02405-5","DOIUrl":"https://doi.org/10.1007/s11748-026-02405-5","url":null,"abstract":"<p><p>Minimally invasive direct coronary artery bypass (MIDCAB) enables left internal mammary artery (LIMA) to left anterior descending artery (LAD) revascularisation without sternotomy or cardiopulmonary bypass. Robotic-assisted LIMA harvest improves visualisation and maximises conduit length while preserving the benefits of minimal access surgery. We describe a standardized technique for off-pump robotic-assisted MIDCAB (LIMA- LAD) developed in an experienced robotic coronary program, including operative setup, technical execution, postoperative care, and key considerations that allow reproducible outcomes.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypo-attenuated leaflet thickening after surgical aortic valve replacement with INSPIRIS RESILIA valve.","authors":"Takanori Kono, Kazuyoshi Takagi, Hiroki Mine, Kosuke Saku, Ryo Kanamoto, Yusuke Shintani, Takahiro Shojima, Hiroyuki Ohtsuka, Koichi Arinaga, Eiki Tayama","doi":"10.1007/s11748-026-02400-w","DOIUrl":"https://doi.org/10.1007/s11748-026-02400-w","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the incidence and early clinical impact of hypo-attenuated leaflet thickening (HALT) after surgical aortic valve replacement (SAVR) using the INSPIRIS RESILIA valve.</p><p><strong>Methods: </strong>Between August 2020 and January 2025, 182 patients underwent SAVR with the INSPIRIS RESILIA valve, of whom 121 (66.5%) underwent cardiac computed tomography 1 week postoperatively. Anticoagulation consisted of heparin (target activated partial thromboplastin time, 1.5-2.0× control) followed by warfarin (target prothrombin time-international normalized ratio [PT-INR], 1.6-2.5). Parameters were compared between the HALT and non-HALT groups.</p><p><strong>Results: </strong>HALT was detected in 22.3% (27/121) of patients. Among warfarin-treated patients (n = 94), mean PT-INR was 1.7 in the HALT group and 1.8 in the non-HALT group (p = 0.61). Patients with HALT were older (76.2 vs. 73.0 years, p = 0.10), and sex-adjusted odds ratio of HALT was 4.68 for patients aged ≥ 80 years as compared with those aged < 70 years (p = 0.03). Those with HALT had lower body surface area (1.46 vs. 1.58 m², p = 0.002). HALT was not associated with impaired early prosthetic valve function, and no patient had a mean pressure gradient > 20 mmHg. No in-hospital deaths or thromboembolic events were reported. No cerebral infarction occurred in the HALT group, whereas two occurred in the non-HALT group (p = 1.00).</p><p><strong>Conclusions: </strong>HALT occurred in approximately one-fifth of patients after SAVR with the INSPIRIS RESILIA valve. No signal of an increased risk of thromboembolic events associated with HALT was observed in this small cohort with a short-term follow-up.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148989360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sealing strength and application efficiency of the microbubble fibrin sealant technique: influence of PGA sheet type in an ex vivo porcine lung model.","authors":"Ryuji Nakamura, Katsuhiro Okuda, Shin Hosokawa, Eiji Nakatani, Takayuki Murase, Singo Inaguma, Kensuke Iguchi, Kensuke Chiba, Tsutomu Tatematsu, Keisuke Yokota","doi":"10.1007/s11748-026-02393-6","DOIUrl":"https://doi.org/10.1007/s11748-026-02393-6","url":null,"abstract":"<p><strong>Objective: </strong>We previously proposed the microbubble fibrin sealant application technique (microbubble technique) for the precise and efficient delivery of fibrinogen to air leak sites. However, its sealing strength and application efficiency are still unclear. This study aimed to assess the non-inferiority of the microbubble technique in sealing strength, the influence of polyglycolic acid (PGA) sheet type, and its effect on reducing fibrin sealant runoff.</p><p><strong>Methods: </strong>Pleural defects were created in ex vivo porcine lungs. Fibrin sealant was applied using either the conventional or microbubble technique with two types of PGA sheets. Seal-breaking pressure was measured, and the non-inferiority of the microbubble technique was assessed. The interaction between the application technique and the PGA sheet type was analyzed. In addition, the fibrin sealant runoff was evaluated on an inclined lung surface.</p><p><strong>Results: </strong>Using the Neoveil® PGA sheet, the microbubble technique demonstrated seal-breaking pressure not inferior to that of the conventional technique (40.2 ± 8.4 vs. 40.9 ± 6.0 cmH₂O; mean difference - 0.72 cmH₂O; one-sided 95% confidence interval - 3.62 to infinity). The Neoveil® nano NJ type PGA sheet improved sealing strength with the conventional technique, but reduced it with the microbubble technique. A significant interaction between the PGA sheet type and the application technique was observed (P < 0.001). Histological analysis supported these findings. The microbubble technique significantly reduced fibrin sealant runoff (P < 0.001).</p><p><strong>Conclusion: </strong>The microbubble technique demonstrated sealing strength comparable to that of the conventional technique while reducing fibrin sealant runoff. However, sealing performance appeared to depend on the PGA sheet type.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}