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

{"title":"Safety and Learning Curve of Totally Endoscopic Mitral Valve Plasty: Initial 125 Cases Evaluated by Operative Time and RA-CUSUM Method.","authors":"Hidekazu Nakai, Akitoshi Yamada, Chihiro Okubo, Ryo Thoma, Yoshihisa Morimoto","doi":"10.1177/15569845261447264","DOIUrl":"10.1177/15569845261447264","url":null,"abstract":"<p><strong>Objective: </strong>Totally endoscopic mitral valve plasty (TEMVP) requires technical proficiency, which may be insufficient during the initial adoption phase. This study evaluated the learning curve and perioperative outcomes during the early experience with TEMVP, using operation time and complications as key metrics.</p><p><strong>Methods: </strong>We retrospectively analyzed 125 consecutive patients who underwent TEMVP between October 2021 and April 2025. Despite the early adoption phase, 40 patients met criteria for complex pathology (i.e., concomitant procedures, infective endocarditis, reoperation, narrow thoracic cage, or difficult aortic cross-clamping) and were defined as the complex group. The remaining 85 patients formed the control group. Surgical outcomes were compared between groups. The learning curve was assessed using operation time and risk-adjusted cumulative sum (RA-CUSUM) analysis based on predicted morbidity (Japan Score).</p><p><strong>Results: </strong>The complex group had longer operative times (335 ± 71 vs 282 ± 61 min, <i>P</i> < 0.001) and higher complication rates (17.5% vs 3.5%, <i>P</i> = 0.012). Two-year survival was 94.7% in the complex group and 100% in the control group (<i>P</i> = 0.03); freedom from reoperation was 100% and 94.2%, respectively (<i>P</i> = 0.30). Operation time significantly decreased over time in the overall and control groups but not in the complex group. RA-CUSUM analysis showed favorable cumulative trends below the predicted risk threshold, with no group exceeding the sequential probability ratio test decision limit of ±3.74.</p><p><strong>Conclusions: </strong>Despite the inclusion of complex cases, early TEMVP outcomes were favorable and within acceptable safety limits. RA-CUSUM and operation time analysis supported the presence of a manageable learning curve at our institution.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"231-240"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054411","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":"COR-KNOT Repair of Iatrogenic Tracheal Injury During VATS Right Upper Lobectomy in a 65-Year-Old Female Patient.","authors":"Sarah Al-Fayyadh, Bassem Gadallah, Joseph Zacharias","doi":"10.1177/15569845261453380","DOIUrl":"10.1177/15569845261453380","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"289-290"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264521","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":"EZ2-BSAFER Type A Aortic Dissection: Reducing Pseudoaneurysm Formation and Reintervention.","authors":"Alexandra Murillo-Solera, Omar M Sharaf, Vaishnavi Karanam, Lindsey M Brinkley, Oscar Holmvard, Thomas M Beaver","doi":"10.1177/15569845261447283","DOIUrl":"10.1177/15569845261447283","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"285-286"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148602484","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":"Artificial Intelligence for Predicting Perioperative Outcomes in Cardiac Surgery: A Systematic Review.","authors":"Jason Ha, Hunaid A Vohra","doi":"10.1177/15569845261457046","DOIUrl":"10.1177/15569845261457046","url":null,"abstract":"<p><strong>Objective: </strong>Cardiac surgery carries a significant risk of complications and mortality. Artificial intelligence (AI), particularly machine learning (ML), is increasingly being explored to enhance perioperative risk prediction and support clinical decision-making. This systematic review evaluates the clinical applications, predictive performance, and limitations of AI models in cardiac surgery.</p><p><strong>Methods: </strong>PubMed and Embase were searched for studies published between January 2020 and July 2025. Of 939 records identified, 178 studies met the inclusion criteria following screening and full-text review. Included studies applied AI to predict clinical outcomes in patients undergoing cardiac surgery. Key outcomes assessed were model performance metrics and their clinical utility.</p><p><strong>Results: </strong>Among the 178 included studies, 114 (64%) were conducted in the United States or China. Most studies (<i>n</i> = 168, 94%) used retrospective designs and focused on adult populations. Random forest (<i>n</i> = 82, 46%), logistic regression (<i>n</i> = 82, 46%), and eXtreme Gradient Boosting (<i>n</i> = 70, 39%) were the most frequently used algorithms. AI applications primarily targeted the prediction of postoperative complications (<i>n</i> = 102, 57%) and mortality (<i>n</i> = 70, 39%), with common outcomes including acute kidney injury and stroke. ML models consistently outperformed traditional clinical risk scores (<i>n</i> = 39). SHapley Additive exPlanations was the most common interpretability method (<i>n</i> = 66, 37%). Only 26% of studies included external validation, and just 19% adhered to TRIPOD guidelines.</p><p><strong>Conclusions: </strong>AI models demonstrate superior predictive performance in cardiac surgery compared with traditional risk scores, but concerns regarding validation, transparency, and generalizability must be addressed to enable implementation.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"210-216"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436487","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":"Impact of Applied Force on Latency-Induced Errors in Endovascular Procedures: Experimental Cross-Sectional Study.","authors":"Vilius Dambrauskas, Vaidas Labunskas, Gabija Žymantaitė, Augustė Melaikaitė, Artūras Mackevičius, Gediminas Vaitėnas, Vaida Baltrūnienė, Sigitas Urbonavičius, Augustinas Baušys, Tomas Baltrunas","doi":"10.1177/15569845261453087","DOIUrl":"10.1177/15569845261453087","url":null,"abstract":"<p><strong>Objective: </strong>Telesurgery has the potential to overcome geographical barriers in surgical care, yet data transmission latency remains a major challenge, impairing operator performance. Although haptic feedback may mitigate latency effects, optimal parameters, such as applied force, have not been well defined in the context of robotic surgical procedures. This study aimed to investigate how varying visual feedback latency and applied force levels affect task performance in an endovascular simulation and assess whether lower applied forces can mitigate performance degradation under latency.</p><p><strong>Methods: </strong>In this prospective, experimental, cross-sectional study, healthy volunteers aged 18 to 65 years performed guidewire advancement tasks using a custom-built endovascular simulator under 12 different combinations of latency (0, 100, 200, 400 ms) and applied force (0.6, 1.2, 1.8 N). The primary outcome was the duration (ms) during which participants maintained the target force during a 10-second period.</p><p><strong>Results: </strong>A total of 116 participants participated in the study. The median performance time was 5,890 ms (interquartile range, 4,550 to 7,150 ms). Increased latency significantly reduced performance, with the most pronounced drop (-1,380 ms) between 100 ms and 200 ms (<i>P</i> < 0.05). Lower applied force (0.6 N) was associated with significantly better performance compared with higher force (1.8 N), independent of latency (-1,097.5 ms, <i>P</i> < 0.05). Younger participants (18 to 25 years) outperformed older participants (55 to 65 years) across all conditions (<i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>This study confirms the detrimental effect of visual feedback latency on performance in simulated robotic surgical procedures and demonstrates that reduced applied force can partially compensate for increased latency. Therefore, optimizing force parameters may improve performance and safety in telesurgical systems, particularly for older operators.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"256-263"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520298","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.Kocher Technique: A Simplified Universally Applicable Approach for Aortic Root Enlargement.","authors":"Alfred Kocher, Emilio Osorio, Severin Laengle, Marek Ehrlich, Iuliana Coti, Daniel Zimpfer, Paul Werner","doi":"10.1177/15569845261450957","DOIUrl":"10.1177/15569845261450957","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"287-288"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054402","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":"Modified Right Vertical Infra-Axillary Thoracotomy Technique: A 2 to 5 cm Incision Approach for Repair of Various Congenital Heart Diseases in All Age Groups.","authors":"Heqi Zhang, Hua Cao, Weijie Liang, Haoju Dong, Shubo Song, Taibing Fan","doi":"10.1177/15569845261453374","DOIUrl":"10.1177/15569845261453374","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the surgical outcomes of the modified right vertical infra-axillary thoracotomy (MRVIAT) technique for the treatment of various congenital heart diseases (CHDs) across all age groups.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 1,513 patients with CHD who underwent surgery using the MRVIAT technique between January 2022 and June 2024. Incisions were 2 to 5 cm, and peripheral extracorporeal circulation was not used. Twelve primary surgical procedures were executed across all age groups.</p><p><strong>Results: </strong>All 1,513 patients successfully underwent surgery without the need for conversion to a median sternotomy or any in-hospital mortality. The median patient age was 1.1 years (range, 0.1 to 57 years), with 62 patients aged 18 years or older. The median weight was 9 kg (range, 1.8 to 101.6 kg), with 859 patients (56.8%) weighing ≤10 kg, 588 patients (39.9%) weighing between 10 kg and 50 kg, and 66 patients (4.4%) weighing ≥50 kg. Two patients (0.1%) required early reoperation: 1 (0.1%) due to third-degree atrioventricular block and 1 (0.1%) due to postoperative bleeding. Other postoperative complications included mild residual shunt in 20 patients (1.3%), pneumothorax in 2 patients (0.1%), wound infection in 3 patients (0.2%), and pulmonary infection in 4 patients (0.3%). The median follow-up period was 1.3 years (range, 0.3 to 2.5 years). During follow-up, no surgery-related thoracic deformities were noted.</p><p><strong>Conclusions: </strong>The MRVIAT technique is a safe and viable method for treating CHD patients across all age groups. This technique, which involves a smaller, less prominent incision, offers a promising alternative to median sternotomy methods.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"264-272"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264554","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":"Redefining Resectability in Lung Cancer: The Impact of Modern Multimodality Perioperative Therapies on Surgical Management.","authors":"Emily P Rabinovich, Linda W Martin","doi":"10.1177/15569845261456696","DOIUrl":"10.1177/15569845261456696","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"187-194"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520275","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":"Does Robot-Assisted Hybrid Coronary Revascularization Matter? Insights From a Single-Center Experience in Patient Quality of Life.","authors":"Salman W Bafageeh, Hani I Barnawi, Mohammed A Ashour, Marah M Alsulami, Yara Aljefri, Ibrahim Zabani, Hisham Khalil, Omer Elamin, Ahmed Jamjoom, Uthman AlUthman","doi":"10.1177/15569845261441274","DOIUrl":"10.1177/15569845261441274","url":null,"abstract":"<p><strong>Objective: </strong>Coronary artery disease (CAD) significantly affects patient quality of life (QoL). Robot-assisted hybrid coronary revascularization (RHCR) emerged as a minimally invasive alternative to conventional coronary artery bypass grafting (CABG), offering enhanced recovery and improved QoL outcomes. This study evaluates the QoL outcomes of RHCR compared with conventional CABG preoperatively and 4 weeks and 6 months postoperatively using the validated 36-Item Short Form (SF-36) questionnaire.</p><p><strong>Methods: </strong>This prospective study included 96 patients (48 RHCR, 48 CABG) with multivessel CAD treated at King Faisal Specialist Hospital between July 2018 and December 2020. QoL was assessed using the SF-36 questionnaire across 8 domains with scores obtained preoperatively and at 4 weeks and 6 months after surgery. Statistical analyses were conducted to compare changes between groups.</p><p><strong>Results: </strong>The RHCR group consistently reported higher scores for physical functioning and role limitations due to physical health, mental health, social functioning, and general health at all time points. At 4 weeks, RHCR patients experienced significantly better scores in physical functioning (75.4 vs 62.6, <i>P</i> < 0.001), social functioning (72.5 vs 64.2, <i>P</i> = 0.003), and bodily pain (76.8 vs 54.0, <i>P</i> < 0.001). At 6 months, RHCR maintained superiority in physical functioning (94.7 vs 88.0, <i>P</i> < 0.001), general health (84.1 vs 78.1, <i>P</i> = 0.020), and mental health (83.5 vs 75.4, <i>P</i> = 0.002).</p><p><strong>Conclusions: </strong>RHCR is associated with greater improvements in QoL compared with conventional CABG, particularly in domains related to physical functioning, role limitations due to physical health, and general health perception.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"241-249"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770269","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":"Thoracotomy Versus Uniportal and Multiportal Video-Assisted Thoracoscopic Approaches for Lymph Node Dissection in Lung Cancer: A Propensity-Matched Analysis.","authors":"Zeynep Çırak, Melek Ağkoç, Kamil Kaynak, Ezel Erşen, Hasan Volkan Kara, Akif Turna","doi":"10.1177/15569845261457086","DOIUrl":"10.1177/15569845261457086","url":null,"abstract":"<p><strong>Objective: </strong>Video-assisted thoracoscopic surgery (VATS), via multiportal and uniportal approaches, has largely replaced thoracotomy for lung cancer surgery. However, the comparative effectiveness of these techniques in optimal lymph node dissection remains under active investigation.</p><p><strong>Methods: </strong>A retrospective review included 763 patients who underwent lung resection for primary lung cancer between October 2001 and January 2024. Demographic, clinical, and pathological data were collected. Patients were stratified into 3 VATS learning phases: early (2001 to 2016), intermediate (2017 to 2020), and late (2021 to 2024). Propensity score matching (PSM; 1:1) was performed based on age, gender, tumor-node-metastasis staging, and preoperative mediastinal staging status. The number of dissected lymph nodes among groups was compared using the Kruskal-Wallis test.</p><p><strong>Results: </strong>Six hundred patients (78.3%) were male, with a mean age of 61.28 ± 10.18 years. In this cohort, 469 patients (61.2%) underwent thoracotomy, 147 (19.2%) multiportal VATS, and 150 (19.6%) uniportal VATS. The mean number of dissected lymph nodes was 22.1 ± 17.2 for thoracotomy, 16.8 ± 11.1 for multiportal VATS, and 12.8 ± 10.8 for uniportal VATS (<i>P</i> < 0.001). After PSM, mean lymph node counts were 21.0 ± 18.5, 17.4 ± 11.5, and 13.4 ± 11.1 for thoracotomy, multiportal, and uniportal VATS, respectively (<i>P</i> < 0.001). In the late phase, thoracotomy had a higher mean lymph node count (<i>P</i> = 0.006); however, after PSM, differences were not statistically significant (<i>P</i> = 0.158).</p><p><strong>Conclusions: </strong>Thoracotomy allows more extensive lymphadenectomy in lung cancer patients. However, following the learning curve, multiportal and uniportal VATS approaches may yield comparable outcomes.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"273-278"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316893","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}