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

{"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":"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":"27-32"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","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":"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":"65-72"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","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":"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":"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":"48-56"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","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":"10 Commandments of Surgical Atrial Fibrillation Ablation in Coronary Bypass Patients.","authors":"Stephen D Waterford, Niv Ad","doi":"10.1177/15569845251313720","DOIUrl":"10.1177/15569845251313720","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"3-9"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","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":"Safe Training Method for ITA Harvesting via Median Sternotomy in Minimally Invasive Coronary Artery Bypass Surgery Using Harmonic Scalpel.","authors":"Keita Kikuchi, Kunihiko Yoshino, Hiroki Sakai, Yoshun Sai, Kaito Masuda, Joji Ito","doi":"10.1177/15569845241290240","DOIUrl":"10.1177/15569845241290240","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"111-113"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545305","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 Surgical Repair for a Failed Transcatheter Left Atrial Appendage Occlusion Device.","authors":"Hiroyuki Tsukui, Mitsugu Ogawa, Michael H Culig","doi":"10.1177/15569845241311301","DOIUrl":"10.1177/15569845241311301","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"22-24"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407315","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":"Atrial Fibrillation Surgery in the Era of Minimally Invasive Surgery: Biatrial Versus Left Atrial Maze.","authors":"Omar M Sharaf, Alexandra Murillo-Solera, Thomas M Beaver","doi":"10.1177/15569845251315746","DOIUrl":"10.1177/15569845251315746","url":null,"abstract":"<p><strong>Objective: </strong>Atrial fibrillation management is rapidly evolving, particularly for patients who are intolerant to medical therapy. Several catheter-based, surgical, and hybrid approaches currently exist, each with unique benefits that may be harnessed to provide optimal outcomes for these patients. This review focuses on the use of a biatrial lesion set versus an isolated left atrial lesion set for ablation.</p><p><strong>Methods: </strong>Major representative articles for each ablation strategy were identified and included. Terms searched on PubMed, Google Scholar, and Scopus included \"atrial fibrillation ablation,\" \"atrial fibrillation surgery,\" and \"maze procedure,\" among others. Additional articles were included based on expert opinion.</p><p><strong>Results: </strong>The complete Cox maze biatrial lesion set has the highest efficacy but requires cardiopulmonary bypass. An isolated left atrial lesion set can also be performed, and these approaches are often less invasive but not as efficacious as the traditional complete maze operation.</p><p><strong>Conclusions: </strong>Although biatrial ablation may carry a higher risk of conduction abnormalities than isolated left atrial ablation in the setting of atrial fibrillation, biatrial ablation is more efficacious in maintaining sinus rhythm.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"13-18"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425235","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 Mitral and Aortic Valve Surgery Through a Right Minithoracotomy: A Single-Center Experience.","authors":"Mariafrancesca Fiorentino, Elisa Mikus, Alberto Tripodi, Diego Sangiorgi, Simone Calvi, Elena Tenti, Antonino Costantino, Carlo Savini","doi":"10.1177/15569845251314025","DOIUrl":"10.1177/15569845251314025","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive combined mitral and aortic valve surgery is still uncommon. We report our experience performing multiple valve procedures through a right-sided minithoracotomy.</p><p><strong>Methods: </strong>We present an observational case series with a retrospective analysis of 38 patients who underwent double valve surgery through right anterior thoracotomy from November 2013 to November 2023.</p><p><strong>Results: </strong>The median age of our population was 72 years, and 61% were female patients. The median EuroSCORE II was 2.27. Three patients (7.9%) had redo operations. The median cardiopulmonary bypass (CPB) and cross-clamp times were 98 and 85 min, respectively. No conversion to full sternotomy was necessary. In-hospital mortality was 2.6% (1 patient); the patient died of septic shock and consequent multiorgan failure. Of the patients, 53% required transfusions with packed blood cells. Postoperative atrial fibrillation was observed in 12 patients (32%), and 2 patients (5.2%) required pacemaker implantation due to third-degree atrioventricular block. Also, 1 stroke (2.6%) and 1 rethoracotomy for bleeding were observed. The median ventilation time was 10 h. The median intensive care unit and postoperative length of stay were 2 days and 7.5 days, respectively. Survival at 1, 3, 5, and 10 years was 93.8%, 86.3%, 86.3%, and 77.2%, respectively, with a median follow-up time of 6.5 years. Freedom from reintervention at 1, 3, 5, and 10 years was 96.8%, 89.5%, 85.0%, and 69.5%, respectively, with a median follow-up time of 5.7 years.</p><p><strong>Conclusions: </strong>In our experience, a minimally invasive approach for combined aortic and mitral valve surgery is safe and feasible, with acceptable CPB and cross-clamp times and good outcomes. Therefore, it can be an attractive option for patients with double valve diseases.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"73-79"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425258","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":"10.1177/15569845241297165","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"102-103"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","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}