Interactive cardiovascular and thoracic surgery最新文献

{"title":"An effective balance is based on many pillars.","authors":"Augusto D'Onofrio, Gino Gerosa","doi":"10.1093/icvts/ivac154","DOIUrl":"https://doi.org/10.1093/icvts/ivac154","url":null,"abstract":"their about our recently published study. Annular stabilization is the main concern of cardiac surgeons for long-term durability of transapical neochords implantation (NC) due to our well-established surgical technique. Transcatheter edge-to-edge mitral repair is always done with no annular stabilization but apparently, this is not seen as a major concern among interventional cardiologists who have demonstrated to be perseverant and keep on expanding indications and performing trials (REPAIR MR ClinicalTrials.gov and PRIMARY ClinicalTrials.gov Identifier: As a matter of fact, so far data do not support the lack of mitral annulus stabilization as a potential cause of NC failure. In entire experience with transapical-NC [1], failure has never been related to mitral annular enlargement. Furthermore, it has demonstrated that annular remodelling (reduction of annular di- ameter) occurs in patients undergoing this procedure [2]. Early referral and consequently early treatment of patients with degenerative mitral regurgita- tion (DMR) is likely going to reduce the need for annular stabilization. It is true that conventional surgery for DMR provides optimal results in terms of mortality and complications as well as of freedom from recurrent mitral regurgitation (MR) in centres of excellence that are dedicated and highly commit- ted to this procedure [3] but the real world is a different thing [3, 4]. Our data show no statistical differences between conventional surgery and NC at follow-up in patients with type A anatomy in terms of recurrence of moderate MR (63.9% vs 74.6%), severe MR (79.3% vs 79%)","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50157813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective continuous ventilation strategy during cardiopulmonary bypass in children undergoing surgery for congenital heart disease: a prospective study.","authors":"Massimo A Padalino,&nbsp;Luca Vedovelli,&nbsp;Manuela Simonato,&nbsp;Andrea Bandini,&nbsp;Greta Paganini,&nbsp;Laura Mezzalira,&nbsp;Nicola Faganello,&nbsp;Cristiana Carollo,&nbsp;Dario Gregori,&nbsp;Vladimiro Vida,&nbsp;Paola Cogo","doi":"10.1093/icvts/ivac084","DOIUrl":"https://doi.org/10.1093/icvts/ivac084","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to evaluate if a 'protective' (low-tidal/low-frequency) ventilation strategy can shorten the postoperative ventilation time and minimize acute lung injury in children with congenital heart disease (CHD) undergoing repair with cardiopulmonary bypass (CPB).</p><p><strong>Methods: </strong>This is a single-centre prospective, interventional study, including children with CHD under the age of 5 years, undergoing open-heart surgery with a CPB >60 min, in hypothermia, haemodynamically stable, and without evident genetic abnormalities. Assist-control ventilation (tidal volume of 4 ml/kg, 10 breaths/min, positive end-expiratory pressure 5 cmH2O and FiO2 0.21) was applied in a cohort of patients during CPB. We compared clinical outcomes and in fully ventilated versus non-ventilated (control) patients. Propensity score was used to weigh ventilated and control groups to correct for the effect of other confounding clinical variables. Clinical and ventilation parameters and lung inflammatory biomarkers in tracheal aspirates were measured. The primary outcome was the postoperative intubation time of more or less than 48 h.</p><p><strong>Results: </strong>We included 140 children (53 ventilated, 87 non-ventilated) with different CHD. There were no deaths or adverse events in ventilated patients. Using a weighted generalized linear model, we found no sufficient evidence for an effect of intraoperative ventilation on postoperative intubation time [estimate 0.13 (95% confidence interval, -0.08; 0.35), P = 0.22].</p><p><strong>Conclusions: </strong>Continuous low-tidal/low-frequency mechanical ventilation during CPB is safe and harmless. However, no significant advantages were found when compared to non-ventilated patients in terms of postoperative ventilation time.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40326072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From macro-effective to microinvasive: what is the right balance?","authors":"Anton Tomšič,&nbsp;Robert J M Klautz,&nbsp;Meindert Palmen","doi":"10.1093/icvts/ivac171","DOIUrl":"https://doi.org/10.1093/icvts/ivac171","url":null,"abstract":"Traditionally, mitral valve (MV) surgery has been performed through median sternotomy. In an attempt to reduce surgical trauma, minimally invasive surgical techniques and, recently, even less invasive MV repair techniques, without the support of cardiopulmonary bypass, have been developed. The comparison between transapical and surgical MV repair by D’Onofrio et al. [1] is interesting as it provides valuable insights in the real-world perfor-mance of new technology (Neochord Inc., St. Louis Park, MN, USA) in MV re- pair. The authors report a high rate of recurrent regurgitation in the Neochord group. Even in the presence of the most favourable anatomy (isolated central posterior leaflet prolapse/flail; 80 patients from both groups were left for analysis after matching), freedom from moderate regurgitation was only 63.9% (95% confidence interval 44.4–91.8%) at 5 years, compared to 74.6% (95% confidence interval 58.7–94.8%) seen in the median sternotomy group. While the difference was statistically not significant, the difference would be significant with a higher number of patients included in the analysis or if the freedom from recurrent regurgitation was higher with conventional surgery (recently, freedom from recurrent regurgitation rate as high as 93% at 10years after surgical MV repair for posterior leaflet prolapse was reported [2]). Recurrent regurgitation is not an innocent observation but is related to im- paired outcomes [3]. A durable repair is the primary goal of therapy and it remains questionable if this is achievable without annular stabilization.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/43/ivac171.PMC9270862.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40560079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Romano et al.","authors":"Gowthanan Santhirakumaran,&nbsp;Ali Abbasi,&nbsp;Mohammad Shah,&nbsp;Ian Hunt","doi":"10.1093/icvts/ivac172","DOIUrl":"https://doi.org/10.1093/icvts/ivac172","url":null,"abstract":"","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9282267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40598021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes following surgical repair of absent pulmonary valve syndrome: 30 years of experience from a Swedish tertiary referral centre.","authors":"Vasileios Avdikos,&nbsp;Jens Johansson Ramgren,&nbsp;Katarina Hanséus,&nbsp;Torsten Malm,&nbsp;Petru Liuba","doi":"10.1093/icvts/ivac193","DOIUrl":"https://doi.org/10.1093/icvts/ivac193","url":null,"abstract":"<p><strong>Objectives: </strong>Absent pulmonary valve syndrome is a rare congenital heart defect with pulmonary artery dilatation and secondary airway compression. Although preoperative respiratory support and early surgical repair with pulmonary arterioplasty are often required in patients with airway compromise, the need for extensive plasty in these patients and for plasty in general in those with no or mild respiratory issues remains debatable.</p><p><strong>Methods: </strong>We performed a retrospective survey of patients with this diagnosis and repair from 1988 to 2018.</p><p><strong>Results: </strong>Twenty patients were identified. The median age and weight at repair were 0.8 (0.1-2.4) years and 7.0 (2.5-13.8) kg and included a valved conduit in 17 (85%) patients and a transannular patch in 3 patients. Five (29%) patients were ventilator-dependent prior to repair at the age of 0.3 (0.1-0.4) years. Pulmonary arterioplasty was performed in 7 patients (35%), including all 5 with ventilator dependency and 2 with respiratory symptoms due to recurrent infections. Two patients (10%) with preoperative ventilator dependency underwent extensive intrahilar arterioplasty. Preoperative ventilator dependency was associated with earlier repair and reinterventions (P < 0.05). There were 3 late deaths among cases with repair after 2000 (n = 14), none with preoperative ventilator dependency.</p><p><strong>Conclusions: </strong>The long-term outcomes of patients with this rare defect are good, comparable to those of other previous studies. Reduction pulmonary arterioplasty, which in this study was used only in patients with respiratory distress and ventilator dependency, is associated with excellent survival. Reinterventions are common in these patients.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9341845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40639008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explanted malignancies after lung transplantation: the University of Michigan experience.","authors":"Jarred R Mondoñedo,&nbsp;Tao Huang,&nbsp;Jules Lin,&nbsp;Elliot Wakeam","doi":"10.1093/icvts/ivac203","DOIUrl":"https://doi.org/10.1093/icvts/ivac203","url":null,"abstract":"<p><p>The management of patients with an explanted malignancy after lung transplantation is not well understood. We reviewed our institutional experience and outcomes at a single academic medical centre between December 1997 and April 2021 for patients with malignancies of all histologic types identified on explant pathology. Primary lung cancers were reclassified using the 8th Edition TNM staging and the 2021 World Health Organization histologic classification of lung cancers. Of the 733 patients undergoing lung transplantation, 15 (2.05%) were found to have malignancy on the explanted lungs, including 6 (0.82%) primary lung cancers. Four patients were found to have early-stage lung cancers, while 2 patients had advanced-stage IV disease. Survival ranged from 0 to 109 months for the entire cohort with median 23.2 [49.9] months in those with primary lung cancers. There were 2 recurrences following explanted stage I (15 months) and stage IV (53 months) diseases. Other explant pathologies included carcinoid tumourlets in 6 patients, lymphoma in 2 and metastatic leiomyosarcoma in 1. In conclusion, explanted lung malignancies are an infrequent but significant finding on explant pathology. Further data are needed to better characterize and stratify this patient cohort.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/41/69/ivac203.PMC9341308.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40646820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 20-year experience with cryopreserved allografts as the valve replacement of choice in aortic root reconstruction for destructive endocarditis with abscess formation.","authors":"Afram Yousif,&nbsp;Khaldoun Ali,&nbsp;Marcel Anssar,&nbsp;Wolfgang Harringer,&nbsp;Aschraf El-Essawi,&nbsp;René Brouwer","doi":"10.1093/icvts/ivac188","DOIUrl":"https://doi.org/10.1093/icvts/ivac188","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this retrospective study was to assess the early- and long-term outcomes following the use of cryopreserved allografts in aortic valve endocarditis with peri-annular abscess formation.</p><p><strong>Methods: </strong>From 2001 to 2021, 110 consecutive patients with active infective endocarditis and peri-annular abscess, underwent a cryopreserved allograft root replacement. In 100 patients (91%), the operation was performed <48 h after admission due to refractory heart failure and or septic shock. In 95 patients (86.4%), a redo operation was performed due to a prosthetic valve endocarditis. Preoperatively, 12 patients were dialysis-dependent and 30 patients suffered from a recent stroke.</p><p><strong>Results: </strong>The 30-day mortality was 18% (20 patients). Freedom from reintervention was 98.3% (standard deviation: 1.7) at 1 year and 83.3% (standard deviation: 8.5) at 10 years. Four patients required a redo operation. Three patients did develop re-endocarditis. Freedom from re-endocarditis was 95% after 17 years of follow-up. Preoperative dialysis dependency (odds ratio: 22.75, 95% confidence interval: 4.79-108.14, P < 0.001), ejection fraction under 30% (odds ratio: 17.91, 95% confidence interval: 3.27-98.01, P < 0.001) and stroke within 14 days prior to operation (odds ratio: 5.21, 95% confidence interval: 1.28-21.2, P = 0.021) were incremental factors associated with the 30-day mortality.</p><p><strong>Conclusions: </strong>In aortic root endocarditis with abscesses formation, cryopreserved allografts exhibit excellent clinical performance with a low rate of reinfection and reintervention, which make its use as valve replacement a very desirable option. Dialysis dependency, ejection fraction under 30% and recent stroke have the highest impact on the 30-day mortality.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/07/ivac188.PMC9270860.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40479516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of coronary artery bypass grafting added to aortic valve replacement on long-term outcomes in octogenarian patients: a reconstructed time-to-event meta-analysis.","authors":"Alan Gallingani,&nbsp;Stefano D'Alessandro,&nbsp;Gurmeet Singh,&nbsp;Daniel Hernandez-Vaquero,&nbsp;Mevlüt Çelik,&nbsp;Evelina Ceccato,&nbsp;Francesco Nicolini,&nbsp;Francesco Formica","doi":"10.1093/icvts/ivac164","DOIUrl":"https://doi.org/10.1093/icvts/ivac164","url":null,"abstract":"<p><p>The long-term results in studies comparing octogenarian patients who received either isolated surgical aortic valve replacement (i-SAVR) or coronary artery bypass grafting (CABG) in addition to SAVR are still debated. We performed a reconstructed time-to-event data meta-analysis of studies comparing i-SAVR and CABG+SAVR to evaluate the impact of CABG and to analyse the time-varying effects on long-term outcome. We performed a systematic review of the literature from January 2000 through November 2021, including studies comparing i-SAVR and CABG+SAVR, which reported at least 3-year follow-up and that plotted Kaplan-Meier curves of overall survival. The primary endpoint was overall long-term survival; secondary endpoints were in-hospital/30-day mortality and postoperative outcomes. The pooled hazard ratio (HR) and odds ratio) with 95% confidence interval (CI) were calculated for primary and secondary endpoints, respectively. Random-effect model was used in all analyses. Sixteen retrospective studies were included (5382 patients, i-SAVR = 2568 and CABG+SAVR = 2814). I-SAVR showed a lower incidence of in-hospital mortality compared to CABG+SAVR (odds ratio = 0.73; 95% CI= 0.60-0.89; P = 0.002). Landmark analyses showed a significantly higher all-cause mortality within 1 year from surgery in CABG+SAVR (HR = 1.17; 95% CI = 1.01-1.36; P = 0.03); after 1 year, no significant difference was observed (HR = 0.95; 95% CI = 0.87-1.04; P = 0.35). Landmark analysis was confirmed by time-varying trend of HR. Late survival of octogenarians did not differ significantly between the 2 interventions. Interestingly, CABG added to SAVR was associated with both higher in-hospital and within 1-year mortality after surgery, whereas this difference was statistically non-significant at long-term follow-up.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40072521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategic 2-step surgery using thoracic endovascular aortic repair for an infected thoracic aortic aneurysm.","authors":"Mitsunori Nakano,&nbsp;Atsushi Miyagawa,&nbsp;Daigo Shinoda,&nbsp;Koichi Yuri","doi":"10.1093/icvts/ivac174","DOIUrl":"https://doi.org/10.1093/icvts/ivac174","url":null,"abstract":"<p><p>An 81-year-old man with multiple comorbidities developed infected thoracic aortic aneurysm, and we employed a strategic 2-step surgical approach combining thoracic endovascular aortic repair and local debridement with an omental flap during the active phase of infection. No signs of reinfection were observed at the 1-year follow-up. This strategy can be a safe and less invasive alternative to conventional open surgery in patients with high surgical risk.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9336548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40465734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on the CUSUM surgical learning curve analysis in Dimitrovska et al. (2022).","authors":"George Rakovich,&nbsp;William H Woodall,&nbsp;Stefan Steiner","doi":"10.1093/icvts/ivac184","DOIUrl":"https://doi.org/10.1093/icvts/ivac184","url":null,"abstract":"The cumulative sum (CUSUM) analysis included in the recent paper by Dimitrovska et al. [1] illustrates the major pitfall of using this popular approach to reach conclusions about the surgical learning process. Below we refer to the time series plot of operation times (Figure 1 [1]) and the corresponding CUSUM plot (Figure 2 [1]) from their paper [1]. The CUSUM plot of the sum of the successive differences of the operating times from their average (Figure 2 [1]) was broken into 3 phases, i.e. the initial learning, the increased competence and the experienced phases. As pointed out by Woodall et al. [2], however, this type of plot is subject to over- interpretation. It has neither a conceptual nor a mathematical justification.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9329823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40535670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}