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":"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":"57-64"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","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":"Axillary Artery Versus Femoral or Central Arterial Cannulation in Minithoracotomy Mitral Surgery: Is There a Difference in Early Outcomes?","authors":"Jeffrey G Gaca, Brittany A Zwischenberger, Keith Carr, Andrew Wang, Donald D Glower","doi":"10.1177/15569845251315728","DOIUrl":"10.1177/15569845251315728","url":null,"abstract":"<p><strong>Objective: </strong>Axillary artery cannulation techniques continue to improve and find application throughout cardiac surgery. Yet, early outcomes are poorly documented versus femoral or central arterial cannulation in right minithoracotomy mitral surgery.</p><p><strong>Methods: </strong>There were 3,044 consecutive adult patients undergoing mitral valve surgery via right thoracotomy from 1996 to 2022 examined from a prospectively maintained database. Propensity score matching was used to compare outcomes of axillary versus aortic cannulation in 241 matched pairs and axillary versus femoral cannulation in 356 matched pairs.</p><p><strong>Results: </strong>Arterial cannulation was axillary (770 of 3,044; 25%) versus femoral (149 of 3,044; 5%) or central aortic (2,125 of 3,044; 70%). Axillary versus aortic or femoral patients were older (<i>P</i> < 0.001), more often redo (<i>P</i> < 0.001), more urgent (<i>P</i> < 0.001), and had more mitral replacement (<i>P</i> < 0.001) and tricuspid procedures (<i>P</i> < 0.001). After propensity score matching, cannulation groups did not differ in patient characteristics or concurrent surgical procedures. For matched patients, axillary artery cannulation was not independently associated with operative mortality (<i>P</i> = 0.3), postoperative respiratory failure (<i>P</i> = 0.3), perioperative stroke (<i>P</i> = 0.7), renal insufficiency (<i>P</i> = 0.4), pump time (<i>P</i> = 0.6), clamp time (<i>P</i> = 0.2), transfusion (<i>P</i> = 0.5), perioperative length of stay (<i>P</i> = 0.7), or survival (<i>P</i> = 0.6). Axillary cannulation increased operative time by 14 ± 7 min (<i>P</i> = 0.04) versus aortic or femoral artery cannulation.</p><p><strong>Conclusions: </strong>Right axillary artery cannulation is a safe alternative for right minithoracotomy mitral surgery. Advantages may include avoidance of the aorta in reoperations or older patients, avoidance of peripheral atherosclerosis in older patients, and a low incidence of limb ischemia or wound infection. Disadvantages may include longer access time and an additional chest incision.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"80-86"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425239","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":"Do Right in the Left (Chest): Considering the Role of Adjunct Left Atrial Appendage Ligation During Lung Cancer Resection.","authors":"Zach M DeBoard, Nishith N Patel","doi":"10.1177/15569845241309635","DOIUrl":"10.1177/15569845241309635","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"10-12"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467962","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":"Novel Treatment of Palmar Hyperhidrosis With Robotic Hybrid Cryoablation Sympathectomy.","authors":"Taoyuan Beninato, Kristen Kent, Pauline H Go","doi":"10.1177/15569845241298256","DOIUrl":"10.1177/15569845241298256","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":"20 1","pages":"106-108"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604773","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}

{"title":"Acute Postinfarction Ventricular Septal Defect Repair Through the Left Minithoracotomy.","authors":"Oleksandr Babliak, Dmytro Babliak, Yevhenii Melnyk, Katerina Revenko, Oleksii Stohov","doi":"10.1177/15569845241311598","DOIUrl":"10.1177/15569845241311598","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"104-105"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189137","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":"Initial Experience of Left Atrial Appendage Ligation Using Penditure in a Minimally Invasive Cardiac Surgical Approach.","authors":"Olatoye Olutola, Yasir Abu-Omar, Gregory D Rushing","doi":"10.1177/15569845241311596","DOIUrl":"10.1177/15569845241311596","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"19-21"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407311","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":"Three-Dimensional Lung Reconstructions for Preoperative Planning of Uniportal Video-Assisted Thoracoscopic Segmentectomies Using Visible Patient Software.","authors":"Iris E W G Laven, Geert H J M Verkoulen, Koen C H A Verkoulen, Aimée J P M Franssen, Lori M van Roozendaal, Michiel H M Gronenschild, Karel W E Hulsewé, Yvonne L J Vissers, Erik R de Loos","doi":"10.1177/15569845251315450","DOIUrl":"10.1177/15569845251315450","url":null,"abstract":"<p><p>In this article, we present the use of 3-dimensional (3D) lung reconstructions performed by Visible Patient software and share our experience with the first 5 patients who were scheduled for a segmentectomy. These reconstructions provided useful insights into more accurate lung nodule locations, resulting in a preoperative change in the surgical plan in 3 of the 5 patients. In addition, surgeons were better prepared for surgery with the preoperative knowledge of anatomical variations identified in 4 patients. These findings highlight the critical role of preoperative 3D lung reconstructions in determining the appropriate surgical indication and refining the surgical plan when thoracoscopic segmentectomy is initially indicated.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"87-95"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457879","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":"Robot-Assisted Thoracoscopic Surgery Can Be Safely Performed in Patients With Obesity from the Early Stages of Implementation.","authors":"Hiroyuki Tao, Shohei Waki, Mao Yoshikawa, Yujiro Kubo, Hisao Mizutani","doi":"10.1177/15569845241311320","DOIUrl":"10.1177/15569845241311320","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the perioperative outcomes of robot-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) for lung cancer in patients with obesity.</p><p><strong>Methods: </strong>Anatomical pulmonary lobectomy or segmentectomy performed at a single institution from April 2018 to September 2023 in patients with obesity (body mass index ≥25 kg/m²) were statistically compared in terms of perioperative clinical factors including operative time, blood loss, chest tube duration, pain score, intraoperative events, and early postoperative complications between RATS and VATS.</p><p><strong>Results: </strong>In all, 89 patients were evaluated; 43 underwent RATS and 46 underwent VATS. All RATS procedures were performed using the da Vinci Xi system. Patient characteristics were comparable between the 2 groups. The operative time, blood loss, number of dissected lymph nodes, intraoperative events, and conversion rate to open thoracotomy were similar between the 2 groups. The frequencies of postoperative complications and chest tube placement duration between the groups were also similar. The median pain scores were slightly higher in the RATS group on postoperative day 1 but were equivalent between the 2 groups on postoperative day 7. The RATS group had a shorter postoperative hospital stay than the VATS group (<i>P</i> < 0.01).</p><p><strong>Conclusions: </strong>A surgical team proficient in conventional VATS can safely introduce RATS in patients with obesity and lung cancer with equivalent perioperative outcomes.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"33-38"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189088","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":"Combined Robotic Endoscopic Aortic Valve Replacement and Robotic Totally Endoscopic Coronary Bypass: Dual Case Report With 3-Year Follow-Up.","authors":"Hiroto Kitahara, Sarah Nisivaco, Yazan AlJamal, Husam H Balkhy","doi":"10.1177/15569845241313465","DOIUrl":"10.1177/15569845241313465","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"109-110"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425261","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":"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":"39-47"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","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}