General Thoracic and Cardiovascular Surgery最新文献

{"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}

{"title":"Methodological considerations in comparing intraoperative CT and VAL-MAP workflows.","authors":"Saqlain Shah, Abdul Rehman, Mohammad Hayat","doi":"10.1007/s11748-026-02403-7","DOIUrl":"10.1007/s11748-026-02403-7","url":null,"abstract":"","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":"148982078","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":"Effectiveness of free pericardial fat pad reinforcement for air leak control in pulmonary lobectomy.","authors":"Takeshi Kawaguchi, Daiki Yoshikawa, Keiji Yamanashi, Ryo Miyata, Mitsuharu Hosono, Masatsugu Hamaji","doi":"10.1007/s11748-026-02401-9","DOIUrl":"https://doi.org/10.1007/s11748-026-02401-9","url":null,"abstract":"<p><strong>Objective: </strong>Intraoperative management of air leak is essential for favorable recovery after lung cancer resection. We present our approach using a free pericardial fat pad (FPFP) for injured lung parenchyma and analyze the postoperative course and radiological changes over time to evaluate the usefulness of this method.</p><p><strong>Methods: </strong>From January 2020 to December 2023, 345 pulmonary lobectomies were performed for primary lung cancer. Postoperative course was compared between patients who received an FPFP for intraoperative air leak management (FPFP group, n = 63) and those managed without an FPFP (non-FPFP group, n = 282). Time-dependent radiological changes in the implanted FPFP were evaluated in 47 patients with computed tomography scans available at 6, 12, and 24 months postoperatively.</p><p><strong>Results: </strong>Although the drainage duration differed significantly between the FPFP and non-FPFP groups (P = 0.001), the postoperative hospital stay (P = 0.257) and occurrence of prolonged air leak (P = 0.163) were comparable. Radiological analysis showed that the implanted FPFP gradually shrank over time (P < 0.001). Despite this change, no complications related to FPFP shrinkage were observed.</p><p><strong>Conclusion: </strong>Harvesting and implanting the FPFP was straightforward and easy to perform. Although the implanted FPFP gradually decreased in size on computed tomography, this did not adversely affect the postoperative course. FPFP application is a promising clinical option for managing intraoperative air leak in pulmonary lobectomy.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976490","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":"Comments on \"Intraoperative assessment of pulmonary fissure morphology in a large surgical series: implications for operative strategy\".","authors":"Fajar Farid, Haider Imran","doi":"10.1007/s11748-026-02402-8","DOIUrl":"10.1007/s11748-026-02402-8","url":null,"abstract":"","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967813","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":"Completion pneumonectomy across distinct ischemic, septic, and oncologic scenarios: a single-center experience.","authors":"Giuseppe Mangiameli, Debora Brascia, Emanuela Re Cecconi, Umberto Cariboni, Alberto Testori, Marco Alloisio, Giuseppe Marulli","doi":"10.1007/s11748-026-02391-8","DOIUrl":"https://doi.org/10.1007/s11748-026-02391-8","url":null,"abstract":"<p><strong>Objective: </strong>Completion pneumonectomy (CP), defined as removal of the remaining lung after prior ipsilateral resection, is a high-risk procedure associated with significant morbidity and mortality, most commonly performed for benign lung disease, recurrent malignancy, or post-resection complications. This study aimed to investigate the impact of surgical timing and indication on short-term outcomes (morbidity and mortality) and long-term survival after CP.</p><p><strong>Methods: </strong>Prospective observational study at a high-volume thoracic surgery center (2014-2024). Among 286 pneumonectomies, 38 were completion pneumonectomies. Patients were classified as Rescue CP (< 90 days from initial resection) or Elective CP (> 90 days), with subgroups \"Very Early\" (< 10 days) and \"Early\" (11-90 days).</p><p><strong>Primary endpoint: </strong>30- and 90-day mortality. Secondary endpoints: postoperative complications (Clavien-Dindo ≥ II), bronchopleural fistula (BPF), and long-term survival. Statistical analysis included Chi-square/Fisher's test and Kaplan-Meier/log-rank test.</p><p><strong>Results: </strong>Indications differed by surgical timing (p < 0.0001). Very early and early CP were mainly performed for residual lobe infarction and BPF, while late CP was for oncological relapse or bronchial stenosis. Rescue CP was associated with higher morbidity and 90-day mortality compared with elective CP (45% vs. 5.5%). The worst outcomes were observed in the 11-90 day interval, whereas very early CP (< 10 days) showed better survival. Long-term survival was significantly better after elective CP.</p><p><strong>Conclusion: </strong>Completion pneumonectomy should be considered a spectrum of operations performed under distinct clinical conditions. Surgical timing reflects the underlying clinical scenario and is strongly associated with perioperative risk and long-term survival.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967730","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":"Outcomes of mitral valve surgery for nonischemic ventricular functional mitral regurgitation.","authors":"Takahiro Ishigaki, Hiraku Kumamaru, Hisateru Tachimori, Satoru Wakasa, Noboru Motomura","doi":"10.1007/s11748-026-02387-4","DOIUrl":"https://doi.org/10.1007/s11748-026-02387-4","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the outcomes of mitral valve surgery for nonischemic ventricular functional mitral regurgitation (left ventricular ejection fraction ≤ 40%).</p><p><strong>Methods: </strong>Study subjects were identified from the Japan Cardiovascular Surgery Database. Early and late mortality were assessed relative to established risk models. The extent of postoperative left ventricular reverse remodeling was also investigated.</p><p><strong>Results: </strong>A total of 131 patients were categorized into four groups: mitral valve repair alone (n = 25), mitral valve repair with subvalvular procedures (n = 18), mitral valve replacement alone (n = 81), and mitral valve replacement with subvalvular procedures (n = 7). Estimated operative mortality was 5.9%, 5.5%, 12.8%, and 11.6% for each group, while observed mortality was 8.0%, 16.7%, 11.1%, and 0% (corresponding to observed-to-estimated ratio of 1.36, 3.03, 0.87, and 0.00, respectively). Observed 2-year mortality rates were 19.5%, 25.6%, 24.5%, and 16.7% for each group, and were lower than the corresponding estimated mortality across all groups. Subvalvular procedures were associated with greater postoperative left ventricular reverse remodeling. Furthermore, papillary muscle suspension was associated with lower operative mortality (observed-to-estimated ratio = 0.77 vs. 4.03 without suspension), whereas papillary muscle approximation was not.</p><p><strong>Conclusions: </strong>Given the favorable risk-adjusted outcomes and postoperative reverse remodeling, mitral valve surgery, particularly when combined with a subvalvular procedure, remains a feasible option for patients with nonischemic VFMR even in the era of catheter-based treatment.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967807","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 punch-assisted unroofing technique for anomalous aortic origin of coronary arteries.","authors":"Kiyotoshi Oishi, Takuya Kawabata, Junya Nabeshima, Eiki Nagaoka, Tatsuki Fujiwara, Tomoyuki Fujita","doi":"10.1007/s11748-026-02395-4","DOIUrl":"https://doi.org/10.1007/s11748-026-02395-4","url":null,"abstract":"<p><p>We describe a punch-assisted unroofing technique for anomalous aortic origin of coronary arteries (AAOCA) with an intramural course. Conventional unroofing can be technically demanding because the extent of resection must balance adequate relief of stenosis against the risk of aortic wall or valvular injury. A 4-mm aortic punch, selected based on the long-axis diameter of the slit-like coronary orifice, was used to create stepwise, controlled resection of the common wall between the aorta and the intramural coronary artery. The punch provided a predefined resection width and facilitated enlargement of the neo-ostium. Four overlapping punch applications achieved approximately 4-5 mm of unroofing, and the resection margin was reinforced with continuous 7-0 monofilament sutures. Postoperative computed tomography confirmed enlargement of the coronary orifice and resolution of stenosis. This technique provides a simple and reproducible method for unroofing that may reduce operator-dependent variability and facilitate standardized surgical management in selected patients with AAOCA.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929603","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 critical appraisal of \"Mid-term outcomes of xenopericardial roll graft replacement for thoracic and thoracoabdominal native aortic and prosthetic graft infection: a single-centre retrospective study\".","authors":"Muhammad Raafay Jamil, Muhammad Zeeshan Surani, Khawaja Abdul Qadir, Muhammad Rameez Jamil, Muhammad Talha","doi":"10.1007/s11748-026-02398-1","DOIUrl":"https://doi.org/10.1007/s11748-026-02398-1","url":null,"abstract":"","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919378","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}