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

{"title":"Advancing the Treatment Paradigm for Multivessel Coronary Artery Disease: Hybrid Coronary Revascularization.","authors":"Parth M Patel, Ryon L Arrington, Amalia Jonsson, Jane W Wei, Jose Binongo, Chandan Devireddy, William Nicholson, Wissam Jaber, Stephane Rinfret, Michael E Halkos","doi":"10.1177/15569845241311292","DOIUrl":"https://doi.org/10.1177/15569845241311292","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to examine the longitudinal safety and efficacy of hybrid coronary revascularization (HCR) in a large cohort of patients with multivessel coronary artery disease (CAD).</p><p><strong>Methods: </strong>From 2009 to 2020, 561 consecutive patients (median age 64.0 years, predicted risk of mortality 1.3% ± 1.8%, 403 with 2-vessel disease and 158 with 3-vessel disease) underwent a planned HCR procedure with a robot-assisted off-pump left internal mammary artery to left anterior descending (LIMA-LAD) coronary artery bypass graft (CABG) combined with percutaneous coronary intervention (PCI) of non-LAD vessels. Multivariable regression analysis was used to identify risk factors for short-term and longer-term outcomes.</p><p><strong>Results: </strong>Operative mortality and stroke occurred in 4 (0.7%) and 5 patients (0.9%), respectively. Postoperative angiography revealed LIMA patency in 415 of 425 patients (98%). Median follow-up was 4.5 years and was 93% complete. Repeat revascularization occurred in 44 patients (8%) at a median of 2.7 years. Freedom from repeat revascularization and survival at 5 years was similar between patients with 2-vessel and 3-vessel disease (<i>P</i> = 0.73 and <i>P</i> = 0.19, respectively). Completely revascularized patients had 5-year survival of 91% versus 64% for incompletely revascularized patients (hazard ratio = 3.8, <i>P</i> < 0.001). Age (<i>P</i> = 0.03), renal failure (<i>P</i> < 0.001), and history of myocardial infarction (<i>P</i> = 0.01) were risk factors for late adverse events.</p><p><strong>Conclusions: </strong>HCR is a safe and effective minimally invasive alternative to conventional CABG or multivessel PCI with a low incidence of late repeat revascularization and mortality. HCR can be safely applied to carefully selected patients with either 2-vessel or 3-vessel CAD; however, incomplete revascularization may result in lower long-term survival.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845241311292"},"PeriodicalIF":1.6,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079647","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":"10 Commandments of Surgical Atrial Fibrillation Ablation in Coronary Bypass Patients.","authors":"Stephen D Waterford, Niv Ad","doi":"10.1177/15569845251313720","DOIUrl":"https://doi.org/10.1177/15569845251313720","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251313720"},"PeriodicalIF":1.6,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079646","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":"Midterm Outcomes of Minimally Invasive Aortic Valve Replacement via Right Lateral Minithoracotomy.","authors":"Akira Furutachi, Yoshitsugu Nakamura, Kusumi Niitsuma, Masaki Ushijima, Yuto Yasumoto, Daiki Yoshiyama, Miho Kuroda, Kosuke Nakamae, Yujiro Hayashi, Taisuke Nakayama, Ryo Tsuruta, Yujiro Ito","doi":"10.1177/15569845241308005","DOIUrl":"https://doi.org/10.1177/15569845241308005","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive aortic valve replacement (MIAVR) procedures have been found to have good short-term results. However, no known reports regarding outcomes of MIAVR via a right lateral minithoracotomy (LT) approach over longer terms have been presented. The aim of the present study was to analyze the midterm outcomes of the use of MIAVR with the right LT approach over an 8-year period.</p><p><strong>Methods: </strong>Between September 2014 and February 2023, MIAVR was performed for 348 patients with severe aortic valve stenosis and regurgitation at our hospital. Operative mortality, all-cause mortality, and valve-related events were retrospectively examined.</p><p><strong>Results: </strong>The mean patient age was 72.3 ± 10.9 years, while 78 patients (22.4%) were more than 80 years old. Surgical, cardiopulmonary bypass, and cross-clamp times were 194.7 ± 43.2, 118.6 ± 28.7, and 89.4 ± 23.3 min, respectively. The 30-day mortality rate was 0.3%. The mean follow-up period was 35.6 ± 25.9 months. Overall survival shown by Kaplan-Meier analysis at 1, 3, and 5 years was 96.4%, 90.3%, and 83.2%, respectively, and freedom from valve-related events at those time points was noted in 100%, 99.5%, and 96.9% of the cases, respectively.</p><p><strong>Conclusions: </strong>MIAVR via a right LT approach was found to be associated with excellent short-term and midterm outcomes and is considered to have the potential to become an established surgical option.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845241308005"},"PeriodicalIF":1.6,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079648","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 Suction Debulking and Surgery in Patients With Isolated Tricuspid Valve Endocarditis.","authors":"Roshan D Modi, Hiroki A Ueyama, Andy Tully, Isida Byku, Adam B Greenbaum, Joe X Xie, Patrick T Gleason, Mani Daneshmand, Vasilis C Babaliaros, Brent Keeling","doi":"10.1177/15569845241298283","DOIUrl":"https://doi.org/10.1177/15569845241298283","url":null,"abstract":"<p><strong>Objective: </strong>Percutaneous vegetation debulking has been reported to treat tricuspid valve infective endocarditis (TVIE), but data on feasibility compared with conventional surgical strategies are limited. We aimed to compare short-term outcomes of suction debulking with partial venovenous bypass to conventional open surgery in this population.</p><p><strong>Methods: </strong>This was a single-center, retrospective study that included all patients with isolated TVIE who underwent suction debulking with partial venovenous bypass or tricuspid valve surgery between January 2010 and December 2022. Patient characteristics, procedural data, and clinical outcomes were compared.</p><p><strong>Results: </strong>Of the 45 patients included, 16 (35.6%) underwent suction debulking and the remainder (64.4%) underwent surgery. Baseline characteristics were comparable, including high rates of preprocedure hemodialysis (11.1%), prior infectious endocarditis (44.4%), intravenous drug use (60.0%), presence of tricuspid bioprostheses (24.4%), and septic shock (40.0%). Suction debulking had a shorter procedure time than surgery (206 [176 to 224] min vs 400 [325 to 487] min, <i>P</i> < 0.001) and was associated with numerically lower rates of various complications including acute kidney injury requiring hemodialysis, limb ischemia, and dysrhythmia requiring pacemaker. Over a mean follow-up period of 473 ± 604 days, recurrent endocarditis (37.5% vs 17.2%, <i>P</i> = 0.25) and the need for reintervention (50.0% vs 17.2%, <i>P</i> = 0.048) were higher with suction debulking. However, all-cause mortality was similar between the groups (12.5% vs 10.3%, <i>P</i> > 0.99).</p><p><strong>Conclusions: </strong>Suction debulking can safely be performed in patients with isolated TVIE with shorter procedural times and similar midterm all-cause mortality compared with surgery. Suction debulking may be appropriate initial therapy for this complex population.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845241298283"},"PeriodicalIF":1.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033088","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":"Clinical Outcomes and Financial Impact of a POEM Program at a Rural Tertiary Medical Center: Our First five Years.","authors":"Joseph Bethea, Brandon Peine, Tyler Fleming, Jesse Mendes, Olajide Olatidoye, Robert Allman, Aundrea Oliver, Mark Iannettoni, James Speicher, Carlos Anciano","doi":"10.1177/15569845241300256","DOIUrl":"https://doi.org/10.1177/15569845241300256","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to assess the 5-year impact of a per oral endoscopic myotomy (POEM) program on both clinical and financial outcomes for our hospital system and the rural community we serve.</p><p><strong>Methods: </strong>We evaluated the clinical and financial outcomes of all patients who underwent POEM for achalasia. Patients were also contacted by phone to complete the Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) questionnaire postoperatively. Financial data for all robot-assisted laparoscopic Heller myotomy patients from our institution during the same period were also obtained for cost comparison.</p><p><strong>Results: </strong>A total of 107 patients underwent POEM in the first 5 years following program implementation, with a mean age of 61.4 ± 17.9 years. There were 75 patients (70%) who participated in the GERD-HRQL survey at a mean follow-up of 84 weeks (range, 6 to 244 weeks). There were 88.2% of respondents who reported no or minimal dysphagia symptoms, and 93.4% of respondents reported no or minimal reflux symptoms. On postoperative upper endoscopy, 19.1% of patients had esophagitis. Implementation of the POEM program resulted in a substantial increase in case volume, growing from 5 myotomy cases per year to 24 myotomy cases per year after 2017. Cost analysis demonstrated a significantly lower index encounter cost for POEM compared with robot-assisted laparoscopic Heller myotomy of approximately $6,000.</p><p><strong>Conclusions: </strong>This study demonstrates the effectiveness and positive financial impact for both our community and hospital system following implementation of a POEM program at a tertiary medical center serving a large, rural population.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845241300256"},"PeriodicalIF":1.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004764","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":"A New Design for Aortic Arch Surgery: Ex Vivo Implantation and Computerized Flow Evaluation of the ISLAND Graft.","authors":"Giovanni A Chiariello, Piergiorgio Bruno, Robin Heijmen, Gianclaudio Mecozzi, Massimo Mariani, Maria Boumpouli, Andrea Mazza, Natalia Pavone, Paolo Zamboni, Massimo Massetti, Jacob Zeitani","doi":"10.1177/15569845241298624","DOIUrl":"https://doi.org/10.1177/15569845241298624","url":null,"abstract":"<p><strong>Objective: </strong>Both the en bloc island technique and the branched graft technique (BGT) present advantages but also limitations in aortic arch surgery. Here is the first presentation of an innovative prosthesis for aortic arch replacement, conceived to overcome the disadvantages of both techniques.</p><p><strong>Methods: </strong>The novel ISLAND graft is a tubular Dacron or hybrid prosthesis with an additional extended Dacron graft (\"bubble\") on the superior aspect, for en bloc island graft anastomosis. To verify the technical feasibility, following bench study, 3 prostheses were implanted in human cadavers in which the distal anastomosis was performed either in zone 2 or 3. A flow analysis and a computational simulation were performed in different configurations. The flows of the \"full-bubble,\" the \"cut-bubble,\" and the traditional branched grafts were compared. The wall shear stress, time-averaged wall shear stress (TAWSS), oscillatory stress index (OSI), and relative residence time (RRT) were compared in the 3 settings.</p><p><strong>Results: </strong>The novel prosthesis appeared easy to implant with significant technical advantages. The manipulation of epiaortic vessels was reduced with expected lower risk of neurologic events. The fenestration of the external cuff could be tailored to the island segment, thus eliminating most pathological aortic tissue. The flows in the supraortic branches were more favorable in the ISLAND graft, in which the angles of the branches were maintained, and with reduced cuff height (cut-bubble), in which higher values of TAWSS and lower values of OSI and RRT were calculated.</p><p><strong>Conclusions: </strong>The novel ISLAND graft device overcomes the disadvantages of the traditional island technique and benefits from the advantages of the BGT. Given the first results, the next step would represent the in vivo implantation.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845241298624"},"PeriodicalIF":1.6,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046463","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":"Applications and Benefits of Intra-Aortic Endoscopy in Aortic Surgery: A Journey Into the Aorta.","authors":"Robert Pruna-Guillen, Ana Lopez-Marco, Benjamin Adams, Aung Oo","doi":"10.1177/15569845241297165","DOIUrl":"https://doi.org/10.1177/15569845241297165","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845241297165"},"PeriodicalIF":1.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726930","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 for the Ross Procedure.","authors":"Nader S Aboelnazar, Katie Losenno, Lin-Rui Guo, Michael W A Chu","doi":"10.1177/15569845241294051","DOIUrl":"10.1177/15569845241294051","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"575-583"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564401","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":"Tricuspid Anterior and Posterior Patch (TRAPP) Repair of Functional Tricuspid Regurgitation.","authors":"Hannah J Rando, Rachael W Quinn, Zachary Darby, Emily L Larson, Emily Rodriguez, Jin Kook Kang, Ifeanyi Chinedozi, James S Gammie","doi":"10.1177/15569845241287772","DOIUrl":"10.1177/15569845241287772","url":null,"abstract":"<p><strong>Objective: </strong>Annuloplasty is the most common strategy for repair of functional tricuspid regurgitation (FTR) but is not effective in patients with massive/torrential FTR or leaflet tethering. To address the deficits of tricuspid annuloplasty, TRicuspid Anterior and Posterior Patch (TRAPP) repair was developed, which is a pericardial patch augmentation of the anterior and posterior leaflets.</p><p><strong>Methods: </strong>To test this repair, a previously validated ex vivo model in an explanted porcine heart was used, wherein annular and leaflet geometry were evaluated using a 3-dimensional structured light scanner at 4 time points: (1) baseline, (2) induction of FTR, (3) annuloplasty repair, and (4) patch repair.</p><p><strong>Results: </strong>Compared with the regurgitant tricuspid valve, annuloplasty reduced annular circumference (13.7 to 9.5 cm) and area (13.7 vs 6.1 cm²), whereas TRAPP repair did not alter annular dimensions (circumference: 13.7 vs 13.5 cm; area: 13.7 vs 13.6 cm²). Annuloplasty increased leaflet tenting angles (anterior: 53.5° vs 41.0°; posterior: 59.7° vs 48.2°; septal: 38.9° vs 31.4°) whereas TRAPP repair relieved anterior and posterior leaflet tenting (anterior: 28.9° vs 41.0°; posterior: 34.9° vs 48.2°; septal: 33.2° vs 31.4°) and restored geometry comparable to the native tricuspid valve. Central coaptation lengths were greater with TRAPP repair than with annuloplasty for all 3 leaflets (anterior: 12.7 vs 9.5 mm; posterior: 12.2 vs 8.2 mm; septal: 7.4 vs 4.6 mm).</p><p><strong>Conclusions: </strong>Compared with annuloplasty, TRAPP repair yielded greater coaptation length, resolved leaflet tethering, and resulted in a larger annular area that may facilitate durable repair of advanced FTR, which previously would have required replacement.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"648-655"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619453","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":"Coronary Connector Facilitated Total Endoscopic Coronary Artery Bypass: An Ex Vivo Feasibility Study.","authors":"Monica Gianoli, Anne Roos de Jong, Harmen Matthijs Wassink, Paul F Gründeman, Bob Kiaii, Husam H Balkhy, Willem J L Suyker","doi":"10.1177/15569845241288540","DOIUrl":"10.1177/15569845241288540","url":null,"abstract":"<p><strong>Objective: </strong>Totally endoscopic coronary artery bypass (TECAB) procedures pose significant challenges, motivating the development of Octocon, an automated endoscopic connector designed for coronary anastomoses in off-pump and endoscopic settings. This feasibility study aimed to assess Octocon's functionality and maneuverability in closed-chest conditions during robot-assisted TECAB simulations.</p><p><strong>Methods: </strong>The Octocon deployment comprises a 3-step procedure. Initially, delicate self-aligning microstapling technology is used to attach connector halves to individual blood vessels. Subsequently, the connector halves are joined to accomplish the anastomosis process. TECAB conditions were simulated using a dedicated box housing ex vivo porcine hearts. The study, conducted by 3 experienced surgeons, investigated the feasibility and standardization potential of a robot-assisted procedure employing Octocon. It evaluated maneuverability in closed-chest conditions and assessed the effectiveness of grafting internal mammary artery segments to different heart regions using single graft, jump graft, and Y-graft constructions.</p><p><strong>Results: </strong>The robot-assisted procedure, using 4 standard instruments, successfully completed all 3 steps in 18 anastomotic procedures. In 96% of cases, the procedural steps were accomplished on the first attempt. The feasibility of constructing jump graft and Y-graft geometries on both anterior and posterior heart walls was demonstrated. Furthermore, experiences affirmed the device's endoscopic user-friendliness, ease of teachability, reproducibility, and potential to achieve expedient, leak-free anastomoses.</p><p><strong>Conclusions: </strong>This ex vivo study confirmed Octocon's potential suitability and functionality for TECAB. The device can create diverse grafting strategies and achieve wide-open vascular connections on various heart regions, highlighting its potential in advancing minimally invasive, robot-assisted coronary procedures. These promising results justify further exploration for integration into clinical practice.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"640-647"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}