Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery最新文献

{"title":"The 7 Pillars of Pain Management for Minimally Invasive Cardiac Surgery.","authors":"Alexander J Gregory, Christopher D Noss, William D T Kent, Corey Adams, Rakesh C Arora, Rawn Sallenger","doi":"10.1177/15569845251358225","DOIUrl":"https://doi.org/10.1177/15569845251358225","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251358225"},"PeriodicalIF":1.6,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I Do It: Zone 2 Arch With Sequential Single-Branch TEVAR for Acute Type A Aortic Dissection.","authors":"John J Kelly, Brittany J Cannon, Grace J Wang, Nimesh D Desai","doi":"10.1177/15569845251352817","DOIUrl":"https://doi.org/10.1177/15569845251352817","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251352817"},"PeriodicalIF":1.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beating Versus Arrested Heart Technique for Isolated Tricuspid Valve Surgery: A Meta-Analysis of Reconstructed Time-to-Event Data.","authors":"Tulio Caldonazo, Hristo Kirov, Isabel Niedworok, Angelique Runkel, Johannes Fischer, Murat Mukharyamov, Torsten Doenst","doi":"10.1177/15569845251351904","DOIUrl":"https://doi.org/10.1177/15569845251351904","url":null,"abstract":"<p><strong>Objective: </strong>Isolated tricuspid valve (TV) surgery remains underused despite guideline recommendations. This underuse may be related to perceived high risk in comorbid patients but also to high reported needs for postoperative permanent pacemaker implantation (PPI). It is conceivable that PPI can be prevented by operating on the beating heart (BH). We conducted a systematic review and meta-analysis assessing the influence of BH versus arrested heart (AH) technique on short-term and long-term outcomes after isolated TV surgery with a specific focus on PPI requirements.</p><p><strong>Methods: </strong>Three databases were assessed. The primary outcome was the rate of postoperative PPI. Secondary endpoints included short-term and long-term survival, cardiopulmonary bypass (CPB) and procedural duration, intensive care unit (ICU) and hospital stay, and postoperative stroke incidence. Hazard ratios, odds ratios, and 95% confidence intervals were calculated. A pooled Kaplan-Meier survival curve after reconstruction analysis was generated for the endpoint of long-term survival. Random-effects models were used.</p><p><strong>Results: </strong>A total of 1,157 studies were identified. Six observational studies from different countries were included in the analysis. The cohorts receiving either BH or AH technique for isolated TV surgery showed no significant differences in the rate of PPI (range: 6.3% to 18.2%) or any secondary outcomes, including short-term and long-term survival, CPB and procedural duration, ICU and hospital stay, or stroke incidence.</p><p><strong>Conclusions: </strong>Our meta-analysis suggests that performing TV surgery on the BH is not likely to be associated with a reduced risk of postoperative PPI or with different incidences of major clinical endpoints.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251351904"},"PeriodicalIF":1.6,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 10 Commandments of Robotic Bilateral Internal Thoracic Artery Harvesting.","authors":"Hugo Monteiro Neder Issa, Andres Parisi, Daniel Goubran, Marc Ruel","doi":"10.1177/15569845251350280","DOIUrl":"https://doi.org/10.1177/15569845251350280","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251350280"},"PeriodicalIF":1.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 10 Commandments of On-Table Extubation After Cardiac Surgery: Why and How to Increase Adoption.","authors":"Pietro Giorgio Malvindi, Paolo Berretta, Christopher Munch, Marco Di Eusanio","doi":"10.1177/15569845251348231","DOIUrl":"https://doi.org/10.1177/15569845251348231","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251348231"},"PeriodicalIF":1.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of 3-Dimensional Total Endoscopic Surgery for Partial Atrioventricular Septal Defect in Children: A Single-Center Experience in Vietnam.","authors":"Tien Anh Do, Tran-Thuy Nguyen, Minh Ngoc Le, Thanh Ngoc Le","doi":"10.1177/15569845251351945","DOIUrl":"https://doi.org/10.1177/15569845251351945","url":null,"abstract":"<p><strong>Objective: </strong>To assess the midterm outcomes and feasibility of using 3-dimensional total endoscopic surgery (3D TES) for complete correction of partial atrioventricular septal defect (PAVSD) in children.</p><p><strong>Methods: </strong>A descriptive study from January 2018 to June 2024 involved 20 patients with PAVSD who underwent surgical repair using 3D TES. The average patient age and average weight were 9.1 (range: 4 to 15) years and 25.02 kg, respectively. Mitral valve regurgitation was classified as mild in 2 patients, moderate in 12, and severe in 6, whereas tricuspid valve regurgitation was mild in 13 patients and moderate in 7.</p><p><strong>Results: </strong>Peripheral circulation was established in all patients. Cardiopulmonary bypass and aortic cross-clamp times were 86.2 min and 142.2 min, respectively. The mechanical ventilation time averaged 4.9 h. Postoperative echocardiography included complete closure of the atrial septal defect, with mild mitral valve regurgitation in 16 patients and no regurgitation in 4. Tricuspid valve regurgitation was mild in 11 patients, and 9 patients had no regurgitation. During an average postoperative follow-up period of 3.35 years, there were no mortalities or cases requiring reoperation.</p><p><strong>Conclusions: </strong>The 3D TES demonstrates feasibility, safety, and efficacy in treating PAVSD in children, with apparent aesthetic advantages.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251351945"},"PeriodicalIF":1.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Mitral Valve Replacement With Balloon-Expandable Valve Using Fibrillatory Arrest.","authors":"David Zapata, Douglas Anderson, Kevin Ho, Dana McCloskey, Reney Henderson, Bradley Taylor","doi":"10.1177/15569845251348209","DOIUrl":"https://doi.org/10.1177/15569845251348209","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251348209"},"PeriodicalIF":1.6,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Totally Endoscopic Management of Mitral Annular Calcification: A Single-Center Experience.","authors":"Mario Castillo-Sang, Matias Rios, Tom Wilkinson, Niem Khan, Masroor Alam, Sean Degrande, Prashant Nayak","doi":"10.1177/15569845251348207","DOIUrl":"10.1177/15569845251348207","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive surgery for mitral annular calcification (MAC) has been reported sporadically, but data on endoscopic surgery are scarce. We summarize current surgical understanding of MAC and how it applies to endoscopic surgery through our experience.</p><p><strong>Methods: </strong>All patients with severe MAC undergoing endoscopic mitral surgery at a single institution (December 2020 to August 2024) were studied.</p><p><strong>Results: </strong>Twenty-five patients (3 female patients) with an average left ventricular ejection fraction of 52.12% (46.25% to 60%), average age of 69.13 (64 to 75.7) years, average body surface area of 1.92 (1.69 to 2.09) m², and average Society of Thoracic Surgeons predicted risk of mortality score of 8.30% (2.13% to 8.66%) underwent endoscopic surgery. Twelve patients had regurgitation (48%), 10 had stenosis (48%), and 3 had a combination (12%). Circumferential MAC was found in 4 patients (16%), 80% circumference in 7 (28%), 60% circumference in 7 (28%), and 40% circumference in 7 (28%). Mitral valve replacement was done in 72% (<i>n</i> = 18) with tissue valves (<i>n</i> = 11), mechanical valves (<i>n</i> = 4), or transcatheter balloon-expandable valves (<i>n</i> = 3). Seven patients (28%) had repairs. There were no operative deaths, atrioventricular complications, or strokes. The average duration of surgery was 5 h 40 min (4 h 13 min to 8 h 22 min), with average cardiopulmonary bypass and cross-clamp times of 214 (166 to 241) min and 152 (117 to 193) min, respectively. MAC was debrided in 20 patients with ultrasonic emulsification (<i>n</i> = 13) or mechanical debridement (<i>n</i> = 7).</p><p><strong>Conclusions: </strong>Endoscopic surgery for severe MAC can be safely and successfully performed using a combination of surgical techniques including ultrasonic decalcification, mechanical debridement, annular patching, and direct implantation of balloon-expandable valves.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251348207"},"PeriodicalIF":1.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Arch and Thoracoabdominal Aortic Intervention in Patients With Connective Tissue Diseases: A Case Series Spanning 17 Years.","authors":"Griffin P Stinson, Carlos A Valdes, Ahmet Bilgili, Liam Kugler, Fabian Jimenez Contreras, Christopher Bobba, Matthew Purlee, Suzannah Patterson, T Everett Jones, Zain Shahid, Thomas M Beaver, Salvatore Scali, John R Spratt","doi":"10.1177/15569845251346161","DOIUrl":"10.1177/15569845251346161","url":null,"abstract":"<p><strong>Objective: </strong>Open aortic repair is considered the standard of care for patients with connective tissue disease (CTD) due to the perceived durability advantages compared with endovascular intervention. However, some complex CTD patient presentations increase risk with open repair, favoring endovascular intervention. This analysis sought to review our experience with endovascular intervention in CTD patients and identify scenarios in which this approach may reasonably be considered.</p><p><strong>Methods: </strong>Patients with CTD undergoing endovascular intervention at our institution from 2006 to 2023 were retrospectively reviewed. The primary outcome was freedom from aorta-related mortality. Secondary outcomes included all-cause mortality and freedom from secondary intervention.</p><p><strong>Results: </strong>Forty-five CTD patients underwent endovascular intervention. Thirty-five patients (77.8%) had at least 1 previous aortic intervention. Urgent or emergent presentation was common (<i>n</i> = 31, 68.8%). At index hospitalization, 32 patients (71.1%) underwent thoracic endovascular aortic repair, and 6 patients (13.3%) underwent fenestrated and/or branched endovascular repair. Aneurysm (<i>n</i> = 40, 88.9%) and dissection (<i>n</i> = 36, 80.0%) were the most common indications; many patients (<i>n</i> = 31, 68.9%) presented with both. Freedom from aorta-related mortality was 88.7% ± 5% and 83.2% ± 6% at 1 and 3 years, respectively. No clinical or procedural factors were predictive of aorta-related mortality. Twenty-one patients (46.7%) required secondary intervention; the median time to secondary intervention was 6.5 months (6.5, 18.9 months). Freedom from secondary intervention was 60.0% ± 8% and 51.4% ± 9% at 1 and 3 years, respectively.</p><p><strong>Conclusions: </strong>Endovascular intervention is often lifesaving in CTD patients who are not initially candidates for open repair. Aorta-related mortality was low, and fewer than half of patients required secondary intervention during the study period. This illustrates the utility of endovascular intervention in bridging CTD patients to definitive open repair.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251346161"},"PeriodicalIF":1.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Mitral Valve Surgery Using the FlexCrown Retractor: A Safe and Effective New Self-Expandable Left Atrial Exposure Device.","authors":"Sara Volpi, Joy Eldin, Bonnie Kyle, Kostas Savvatis, Oliver Guttmann, Ragi Nagib, Samir Ahad, Ulrich Franke, Magdalena Rufa, Dincer Aktuerk","doi":"10.1177/15569845251348195","DOIUrl":"https://doi.org/10.1177/15569845251348195","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive mitral valve surgery (MIMVS) is being increasingly adopted worldwide. Pivotal to the safe conduct of the procedure is optimal visualization to allow detailed valve analysis and assessment of reparability. Positioning of conventional transthoracic left atrial retractors used during MIMVS may be time-consuming and can result in a limited view or thoracic bleeding. The aim of this study was to evaluate the safety and efficacy of the FlexCrown™ retractor by Geister (Tuttlingen, Germany), an innovative self-expandable left atrial retractor, during MIMVS.</p><p><strong>Methods: </strong>A retrospective analysis was performed of 245 patients at 2 mitral specialist centers from January 2017 to July 2022. All patients underwent MIMVS via a right minianterolateral thoracotomy using the FlexCrown retractor.</p><p><strong>Results: </strong>There were 129 female (53%) and 116 male (47%) patients with a mean age of 67 ± 10 years. The etiology of the mitral valve pathology was stenosis in 11% of patients (<i>n</i> = 27), regurgitation in 80% (<i>n</i> = 196), and mixed in 9% (<i>n</i> = 22). The device was used for both mitral valve repair (<i>n</i> = 125) and replacement (<i>n</i> = 120). There were no cases of tissue damage, dislodgement, or migration of the FlexCrown retractor. The postoperative transthoracic echocardiogram showed no or trivial mitral regurgitation in 90% of patients (<i>n</i> = 220).</p><p><strong>Conclusions: </strong>The FlexCrown self-expandable left atrial retractor by Geister allows excellent and safe exposure of the mitral valve with fast deployment and removal during MIMVS. The use of this innovative retractor may represent a helpful alternative to conventional left atrial retractors.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251348195"},"PeriodicalIF":1.6,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}