General Thoracic and Cardiovascular Surgery最新文献

{"title":"A nation-wide survey of myocardial protection in cardiovascular surgery.","authors":"Hideki Yotsuida, Tomoyuki Fujita, Hiroshi Yamamoto, Minoru Ono, Noboru Motomura, Aya Saito, Yuji Hiramatsu, Hirotsugu Fukuda, Takako Miyazaki, Yuko Wada, Yoshiki Sawa, Hitoshi Ogino","doi":"10.1007/s11748-025-02161-y","DOIUrl":"https://doi.org/10.1007/s11748-025-02161-y","url":null,"abstract":"<p><strong>Objective: </strong>A nationwide questionnaire survey was conducted by the Research and Education Committee of the Japanese Association for Thoracic Surgery to investigate current practices of myocardial protection using cardioplegia (CP) in cardiovascular surgery, with the aim of developing a recommendation statement on CP.</p><p><strong>Methods: </strong>The survey was sent to 521 facilities and focused on adult cardiac surgery (ACS), aortic surgery (AS), and pediatric cardiac surgery (PCS). The response rate was 86.0%, with 448 institutions participating.</p><p><strong>Results: </strong>Among the participating hospitals, 64.3% used blood CP (BCP), 22.5% crystalloid CP (CCP), and 13.2% a combination of both. In CCP, the most common base solution was Miotector®, an extracellular fluid. In approximately half of the cases where CCP was used initially, BCP was employed for subsequent infusions. In BCP, a customized or modified version of Miotector® was also used as the base solution in over 50% of the cases. The ratio of blood to crystalloid solutions varied across institutions. For both forms of CP, the initial infusion volumes were typically around 20 ml/kg, with subsequent infusions averaging 10 ml/kg. A combined antegrade and retrograde CP infusion method was preferred by most institutions, and terminal warm CP was used in approximately 75% of institutions. Notably, the CP techniques used in minimally invasive cardiac surgery were consistent with those used in conventional surgery via median sternotomy.</p><p><strong>Conclusions: </strong>This survey provides valuable insights into the diverse practices of myocardial protection, highlighting the need for further comprehensive studies to develop standardized guidelines for CP in cardiovascular surgery.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157933","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":"Thoracoscopic ligation by using an extrathoracic looping technique for secondary spontaneous pneumothorax in patients with smoking-induced emphysema.","authors":"Yoshifumi Shimada, Takahiro Homma, Yoshinori Doki, Toshihiro Ojima, Naoya Kitamura, Yushi Akemoto, Keitaro Tanabe, Koichiro Shimoyama, Tomoshi Tsuchiya","doi":"10.1007/s11748-025-02160-z","DOIUrl":"https://doi.org/10.1007/s11748-025-02160-z","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the efficacy of thoracoscopic ligation for secondary spontaneous pneumothorax performed via an extrathoracic looping technique in patients with smoking-induced emphysema.</p><p><strong>Methods: </strong>We retrospectively analyzed clinical data of 58 patients with secondary spontaneous pneumothorax who had histories of smoking and emphysematous lung changes on chest computed tomography. These patients underwent thoracoscopic surgery at our institute between April 2016 and March 2023. We then compared clinical outcomes of ligation (n = 26) and conventional bullectomy (n = 29).</p><p><strong>Results: </strong>We found no significant differences in preoperative characteristics of the groups. The operation time (ligation vs bullectomy groups, respectively: median 71 min [interquartile range 52-95] vs 94 min [70-124], p = 0.016); amount of postoperative air leakage (0 mL/min [0-0] vs 50 mL/min [0-70], p < 0.001); duration of postoperative drainage (1 day [1-2] vs 4 days [1-5], p < 0.001); and length of postoperative hospital stay (4 days [3-5] vs 6 days [4-11], p = 0.012) were significantly better for ligation. No patients in the ligation group required postoperative treatment of prolonged air leakage; eight patients (27.6%) in the bullectomy group underwent postoperative treatments including pleurodesis (n = 8), bronchial occlusion (n = 2), or reoperation (n = 2) (p = 0.004). The postoperative complications and recurrence rates were not significantly different between groups.</p><p><strong>Conclusions: </strong>Because the thoracoscopic ligation technique proposed here allows closing a pulmonary fistula without resecting the visceral pleura, it is a reliable surgical treatment of secondary spontaneous pneumothorax in patients with smoking-induced emphysema.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110404","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":"Between precision and prudence: reappraising robotic resection for thoracic apex tumors.","authors":"Muhammad Khubaib Iftikhar, Qurat Ul Ain Iftikhar","doi":"10.1007/s11748-025-02158-7","DOIUrl":"https://doi.org/10.1007/s11748-025-02158-7","url":null,"abstract":"<p><p>In response to the article by Fukui et al. on robotic-assisted thoracic surgery (RATS) for neurogenic tumors at the thoracic apex, we offer a critical appraisal emphasizing the risks and overlooked safeguards associated with this approach. While this study highlights the feasibility of preoperative imaging in surgical selection, it reports notably high rates of postoperative neurological complications, including persistent deficits. We argue that advanced imaging modalities, such as three-dimensional CT and omission of intraoperative neuromonitoring (IONM), merit deeper scrutiny, especially given the proximity to critical neural structures. Additionally, we question the ethical implications of applying aggressive surgical techniques to benign and often asymptomatic lesions. We advocate for a more nuanced, patient-centered approach that balances technical ambition with functional preservation. Our commentary underscores the need for introspective surgical decision-making in the era of robotics.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093422","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 novel program of cadaver surgical training for young surgeons at the Clinical Anatomy Laboratory Nagoya (CALNA).","authors":"Shota Nakamura, Harushi Ueno, Yoshito Imamura, Shoji Okado, Yuji Nomata, Hirofumi Takenaka, Hiroki Watanabe, Yuta Kawasumi, Yuka Kadomatsu, Taketo Kato, Tetsuya Mizuno, Toyofumi Fengshi Chen-Yoshikawa","doi":"10.1007/s11748-025-02157-8","DOIUrl":"https://doi.org/10.1007/s11748-025-02157-8","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the effectiveness of a cadaver surgical training program at the Clinical Anatomy Laboratory Nagoya (CALNA), focusing on its impact on procedural skills, confidence, and anatomical understanding among young and mid-career thoracic surgeons.</p><p><strong>Methods: </strong>From 2016 to 2024, 13 cadaver surgical training sessions were conducted, divided into basic, advanced, and specialized courses. The program included hands-on practice using cadavers preserved with Thiel or hypertonic saline methods. The surveys were administered post-training to assess confidence, satisfaction, and practical applicability. Statistical analysis was performed on the survey results.</p><p><strong>Results: </strong>A total of 100 participants attended the training sessions (mean: 12.5/session). The survey responses indicated that 92% of participants rated the training content as \"good\" or \"excellent,\" and 88% found the training \"applicable\" or \"highly applicable\" to clinical practice. Reflective discussions following each session facilitated iterative program refinement. The key improvements included enhanced surgical instrument availability and optimized trainee-to-instructor ratios.</p><p><strong>Conclusions: </strong>Our cadaver surgical training program was shown to significantly enhance surgical skills, boost confidence, and deepen thoracic anatomical understanding, demonstrating its value in advancing thoracic surgical education. Further development of standardized programs across institutions is needed to enable novice surgeons to acquire advanced skills efficiently.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077280","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":"Intraoperative echocardiographic indicator for optimal bilateral pulmonary artery banding.","authors":"Tetsuri Takei, Yukihiro Kaneko, Ryoichi Kondo, Naho Morisaki, Ikuya Achiwa","doi":"10.1007/s11748-025-02156-9","DOIUrl":"https://doi.org/10.1007/s11748-025-02156-9","url":null,"abstract":"<p><strong>Background: </strong>We aimed to establish the most predictive echocardiographic indicator of appropriate tightness of bilateral pulmonary artery banding (BPAB).</p><p><strong>Methods: </strong>In part A of the study, we retrospectively analyzed the peak flow velocity (PV) and nadir flow velocity (NV) across the band and the ratio of NV to PV (velocity ratio: VR) to determine appropriate band tightness. In part B, we prospectively studied the utility of the best predictive indicators.</p><p><strong>Results: </strong>Thirty-one patients undergoing BPAB were enrolled in part A and identified as having appropriate pulmonary blood flow (APF), high pulmonary blood flow (HPF), or low pulmonary blood flow (LPF) during the postoperative period. The areas under the receiver operating characteristic curve (AUC) for HPF were 0.92 for PV, 0.99 for NV, and 0.99 for VR; the velocity thresholds were 2.47, 1.15, and 0.45 m/sec, respectively. For LPF, the AUCs were 0.63 for PV, 0.78 for NV, and 0.81 for VR, and the velocity thresholds were 2.70, 1.59, and 0.58 m/sec, respectively; thus, VR best indicated band tightness. In part B, we performed BPAB in 34 patients, adjusting the bands to achieve VRs between 0.45 and 0.58. The prevalence of HPF was significantly lower in part B than in part A, whereas those of LPF did not differ.</p><p><strong>Conclusion: </strong>In BPAB, we consider the optimal range of VR at banding site is between 0.45 and 0.58.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015622","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":"\"Critical insights into the analysis of the changes in health‑related quality of life and employment status after surgery in patients with lung cancer\".","authors":"Minahil Laraib Asif, Ayesha Ahmad, Hafsa Shuja","doi":"10.1007/s11748-025-02159-6","DOIUrl":"https://doi.org/10.1007/s11748-025-02159-6","url":null,"abstract":"","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981684","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":"Novel transparent patch as an adjunct to adult pulmonary valve replacement.","authors":"Hajime Ichikawa, Shigemitsu Iwai, Yasumi Nishiwaki, Kousuke Kikuchi","doi":"10.1007/s11748-025-02154-x","DOIUrl":"https://doi.org/10.1007/s11748-025-02154-x","url":null,"abstract":"<p><strong>Objective: </strong>Patients with congenital heart defects, such as tetralogy of Fallot (TOF) or right ventricular outflow tract stenosis or atresia, often require pulmonary valve replacement (PVR) decades after the primary repair. The purpose of this study was to assess the safety and efficacy of a novel synthetic hybrid fabric (SHF) for PVR in adult congenital heart disease.</p><p><strong>Methods: </strong>SHF, consisting of bio-absorbable and non-absorbable yarns coated with cross-linked gelatin, was used in a prospective, multicenter, single-arm pivotal clinical trial involving subjects with an age range of 0-59 years. The overall study was registered in the Japan Registry of Clinical Trials (jRCT1080224691). This paper specifically presents a subgroup analysis focusing on five adult patients (aged 18-42 years) from the multicenter trial.</p><p><strong>Results: </strong>The procedures were performed similarly to those using existing products, with no SHF-specific complications observed. The SHF material allowed surgeons to clearly observe the bioprosthetic valve annulus during suturing. None of the patients required blood transfusion or developed adverse events. At a mean follow-up of 4.5 years (range 4.0-4.9 years), no re-interventions or reoperations were needed.</p><p><strong>Conclusion: </strong>SHF shows promise as a patch material for PVR, offering significant benefits such as clear visualization during surgery, which facilitates precise valve placement. This transparency is crucial for adults with repaired TOF, as it helps reduce surgery time and complication risks. This study suggests that SHF could be a valuable material for adult PVR, extending its potential applications beyond pediatric cardiology.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996095","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 portal right upper sleeve lobectomy with pulmonary arterioplasty.","authors":"Ryusuke Sumiya, Shinsuke Uchida, Takeshi Matsunaga, Yukio Watanabe, Mariko Fukui, Kenji Suzuki","doi":"10.1007/s11748-025-02147-w","DOIUrl":"https://doi.org/10.1007/s11748-025-02147-w","url":null,"abstract":"<p><p>The importance of complex robotic lung resection should increase because of growing experience with robotic surgery worldwide. However, there have been no reports on robotic portal pulmonary arterioplasty because clamping the main pulmonary artery without thoracotomy is challenging. A 67-year-old female patient who was clinically diagnosed with lung adenocarcinoma cT1bN2M0 stage IIIA underwent induction chemo-immunotherapy, which resulted in a conventional and metabolically partial response. Subsequently, robotic portal right upper sleeve lobectomy with pulmonary arterioplasty was performed using a combination of bulldog clamp forceps and a cotton tape to clamp the main pulmonary artery.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001310","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":"The utility of neocuspidization in the surgical management of congenital aortic valve pathology: mid-term results of single-center experience with AVNeo procedure in children.","authors":"Igor Mokryk, Illia Nechai, Olena Dudko, Dmytro Harbuz, Ihor Stetsyuk, Borys Todurov","doi":"10.1007/s11748-025-02153-y","DOIUrl":"https://doi.org/10.1007/s11748-025-02153-y","url":null,"abstract":"<p><strong>Background: </strong>Aortic valve (AV) pathology in children presents a significant surgical challenge, with mid- and long-term outcomes of current techniques remaining controversial. This study evaluates our experience with aortic valve neocuspidization (AVNeo) in the pediatric population, analyzing immediate and mid-term results.</p><p><strong>Methods: </strong>Ten children underwent AVNeo between June 2017 and August 2019. The clinical data were prospectively collected and retrospectively analyzed. The primary outcomes included failure to perform AVNeo, intraoperative conversion to the alternative technique, in-hospital mortality, and major adverse events. The secondary outcomes included aortic stenosis or regurgitation, valve-related events, reoperations, and mortality during follow-up.</p><p><strong>Results: </strong>The median age was 9 (range: 2-17) years. AVNeo was feasible in all cases. Five children underwent previous cardiac interventions. Neocuspidization was feasible in all cases. No in-hospital mortality or significant postoperative complications occurred. Before discharge, average peak and mean pressure gradients were 13.5 mmHg and 6.5 mmHg, respectively. Aortic insufficiency was grade 0 or 1 in all cases. Seven patients required reoperation for valve dysfunction over a median follow-up of 73 months. The median time to reoperation was 62 months, with six patients undergoing mechanical valve replacement and one receiving a Ross procedure.</p><p><strong>Conclusion: </strong>AVNeo offers excellent hemodynamic outcomes for children with AV pathology in the immediate postoperative period. However, the mid-term results revealed significant valve degeneration, necessitating reoperations in most cases. Unlike in adults, we do not consider AVNeo a definitive solution in children with AV disease. We see this technique as a valuable tool in the staged management of this congenital heart pathology.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017595","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":"Lymphatic complication in open venous harvesting versus endoscopic venous harvesting: a systematic review and meta-analysis.","authors":"Alireza Razavi, Mehrdad Mahalleh, Amirparsa Vanaki, Amirhossein Fallah, Amirhossein Bahanesteh, Ali Ahmadi, Hossein Yarmohammadi, Morteza Solati Kooshkqazi, Masood Soltanipur","doi":"10.1007/s11748-025-02126-1","DOIUrl":"10.1007/s11748-025-02126-1","url":null,"abstract":"<p><strong>Background: </strong>The methods for saphenous vein (SV) harvesting include bridging vein harvesting (BVH), open vein harvesting (OVH), and endoscopic vein harvesting (EVH). Lymphatic complications, such as lymphatic leak, lymphedema, lymphangitis, and lymphocele, can arise following SV-harvesting surgery. This study aims to compare the incidence of lymphatic complications in SV harvesting using the OVH surgical method versus EVH.</p><p><strong>Methods: </strong>We have systematically searched databases including Scopus, PubMed, and Web of Science until April 2024. Studies were considered eligible for inclusion if they performed SV harvesting and compared lymphatic complications in the EVH with OVH or BVH. Various lymphatic complications and follow-up periods were extracted. A meta-analysis was conducted comparing the relative risk (RR) of lymphatic complications in the EVH group versus the OVH group.</p><p><strong>Results: </strong>Twelve studies were included. A total of 1934 patients were involved and the majority were male. Follow-up times were from 6 days to 34 months. Results of the meta-analysis showed that the pooled lymphatic complications, lymphatic leak, and lymphedema are significantly higher in OVH versus EVH (RR = 6.78, p value < 0.01; RR = 17.33, p value < 0.01; RR = 8.88, p value < 0.01, respectively). No significant differences in lymphocele rates between the two methods (RR = 1.2, p value = 0.77). Both short-term and long-term follow-ups showed elevated lymphatic complication risks in OVH relative to EVH (RR = 4.91, p value < 0.01; RR = 30.27, p value = 0.03, respectively).</p><p><strong>Conclusion: </strong>EVH is linked to reduced rates of lymphatic complications. Also, OVH had a higher risk of lymphatic complications in the short and long term compared to EVH.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"297-311"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440622","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}