Journal of Cardiothoracic Surgery最新文献

{"title":"The prognostic value of pulmonary hypertension in intensive care unit patients from Beth Israel Deaconess Medical Center (BIDMC).","authors":"Huibiao Deng, Peng Wang, Minxing Liu","doi":"10.1186/s13019-024-03301-w","DOIUrl":"https://doi.org/10.1186/s13019-024-03301-w","url":null,"abstract":"<p><strong>Background: </strong>The impact of pulmonary hypertension (PH) on critically ill patients has not been fully understood. Our objective was to explore the possible relationship between PH and the outcomes in Intensive Care Unit (ICU) patients, and to determine risk factors of in-hospital mortality of ICU PH patients.</p><p><strong>Methods: </strong>The Medical Information Mart for Intensive Care (MIMIC)-IV database was used. Patient characteristics and clinical outcomes of ICU patients with or without PH were compared. The primary outcome was the in-hospital-mortality, and secondary outcome was 28-day mortality. Multivariate logistic regression analysis was conducted to determine independent risk factors of in-hospital mortality.</p><p><strong>Results: </strong>A total of 42,255 patients were included in the study, of which 1,210 patients had a diagnosis of PH and 4,262 patients died during the hospital stay. In-hospital mortality in the PH and non-PH groups were 15.1% and 9.9% respectively (P < 0.01). The length of stay in ICU and in hospital among ICU PH patients were longer than those without (P < 0.01), and PH group also showed higher 28-day mortality (P < 0.01). Multivariate logistic regression analysis indicated that PH was an independent risk factor for in-hospital mortality in critical ill patients [OR = 1.22, (95%CI: 1.02-1.46), P = 0.033]. Oxford Acute Severity of Illness (OASIS) [OR = 1.10, (95%CI: 1.08-1.12), P < 0.01] anion gap [OR = 1.07, (95%CI: 1.04-1.11), P < 0.01], and Charlson's score [OR = 1.09, (95%CI: 1.03-1.16), P < 0.01] were independent risk factors for in-hospital mortality among ICU PH patients.</p><p><strong>Conclusions: </strong>PH diangsoed in the ICU setting has unfavorable clinical outcomes. The Bigger the value of OASIS score, anion gap, Charlson's score were the predictors for in-hospital mortality in ICU patients with PH.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"29"},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining the cardiac surgical learning curve: a longitudinal cumulative analysis of a surgeon's experience and performance monitoring in the first decade of practice.","authors":"Shantel Chang, Ian Smith, Christopher Cole","doi":"10.1186/s13019-024-03236-2","DOIUrl":"https://doi.org/10.1186/s13019-024-03236-2","url":null,"abstract":"<p><strong>Background: </strong>Individual surgeons' learning curves are a crucial factor impacting patient outcomes. While many studies investigate procedure-specific learning curves, very few carried out a longitudinal analysis of individual cardiac surgeons over the course of their career. Given the evolving landscape of cardiac surgery with the introduction of transcatheter and robotic procedures, a contemporary evaluation of the cardiac surgical learning curve is justified and a method of personal performance monitoring is proposed in this study.</p><p><strong>Methods: </strong>A retrospective study of 1578 consecutive patients of a cardiac surgeon over ten years was undertaken. Risk adjustment was based on Euroscore. Cumulative risk adjusted morbidity (CRAM) charts of operative mortality, return to theatre and length of stay were constructed. Secondary endpoints included postoperative stroke and deep sternal wound infection. Change-point detection was applied to investigate temporal trends and identify when a significant change in outcome occurred. Multivariate analysis was performed to assess the influence of patient and system factors on operative mortality.</p><p><strong>Results: </strong>Patient average risk profile was highest in the later years of practice. Cardiopulmonary bypass time remained stable from 86.5 to 92 min across the decade. The frequency of redo operations increased from 4.07% in the first two years of practice to 9.29% in the last two years. The proportion of aortic surgery increased from 6.98 to 10.58% of total cases. There was a significantly reduced operative mortality signalled at case 1220 with the change point identified around case 970.</p><p><strong>Conclusion: </strong>This prompts training colleges to consider application of sequential performance monitoring in surgical training programs, to confirm the progress of trainees and identify early evolving patterns that suggest support is required or milestones are being achieved.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"23"},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult congenital aortic coarctation complicated by acute type a aortic intramural hematoma treated with a staged hybrid technique: a case report.","authors":"Haoyou Li, Min Wang, Haoyue Li, Wenfeng Zhang, Jiantao Wu, Zhaozhuo Niu, Lianjie Sun","doi":"10.1186/s13019-024-03204-w","DOIUrl":"https://doi.org/10.1186/s13019-024-03204-w","url":null,"abstract":"<p><strong>Background: </strong>Coarctation of the aorta (CoA) in adults is rare. usually combined with dilatation of the ascending aorta. Further disease progression complicated by hematoma or dissection of the ascending aorta is even more complicated and dangerous.</p><p><strong>Case presentation: </strong>A 58-year-old male patient with CoA complicated by acute type A aortic intramural hematoma (IMH), who was treated with a two-stage hybrid approach involving an urgent Bentall repair procedure and subsequent endovascular stenting. A 4-year follow-up showed a good prognosis for the patient.</p><p><strong>Conclusion: </strong>For patients with aortic coarctation combined with ascending aortic dissection/IMH, life-threatening proximal aortic lesions may be treated first. Secondary stent implantation can then be performed after stabilization to treat the congenital aortic coarctation.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"22"},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application value of central venous-arterial carbon dioxide partial pressure difference in postoperative cognitive dysfunction in patients with acute aortic dissection.","authors":"Lei Wang, Zhen Hong Wang, Duan Qi Zhu, Xin Yi Xie, Xin Chen, Xiao Liang Wang","doi":"10.1186/s13019-024-03300-x","DOIUrl":"https://doi.org/10.1186/s13019-024-03300-x","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the clinical application value of the central venous-arterial carbon dioxide partial pressure difference (Pv-aCO2) in postoperative cognitive dysfunction(POCD) in patients with acute aortic dissection.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the general data of 236 patients. Blood gas samples were collected from the arterial and venous lines at various time points during the surgery, including before and after the initiation of cardiopulmonary bypass (CPB), immediately after CPB initiation, before and after deep hypothermic circulatory arrest, 30 min after rewarming, and 5 min before weaning from CPB. The partial PV-aCO2 was calculated. Based on the average PV-aCO2 value, patients were divided into an observation group (PV-aCO2 > 6 mmHg, n = 112) and a control group (PV-aCO2 < 6 mmHg, n = 124). The perioperative data and Mini-Mental State Examination (MMSE) scores were compared between the two groups to assess the incidence and severity of POCD. Additionally, the expression levels of peripheral serum S100β in the two groups were compared 6 h postoperatively.</p><p><strong>Results: </strong>The incidence of POCD was higher in the observation group compared to the control group, while MMSE scores and serum S100β levels were lower in the observation group. Additionally, the observation group patients with POCD had lower MMSE scores and serum S100β levels compared to the control group patients. In addition, logistic regression analysis revealed that advanced age, serum S100β levels, female gender, CPB time, unilateral brain perfusion time, hyperlipidemia, diabetes, and smoking history were all independent risk factors for postoperative POCD (all P < 0.05).</p><p><strong>Conclusion: </strong>Pv-aCO2 can effectively reflect the intraoperative cerebral metabolic level in patients with acute aortic dissection and can serve as an intraoperative warning indicator for cognitive dysfunction. Its clinical recommendation for use is warranted.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"32"},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive analysis of telomere and aging-related signature for predicting prognosis and immunotherapy response in lung adenocarcinoma.","authors":"Zhe Ye, Yiwei Huang, Tingting Chen, Youyi Wu","doi":"10.1186/s13019-024-03337-y","DOIUrl":"https://doi.org/10.1186/s13019-024-03337-y","url":null,"abstract":"<p><strong>Background: </strong>Lung adenocarcinoma (LUAD) is a high-risk malignancy. Telomeres- (TRGs) and aging-related genes (ARGs) play an important role in cancer progression and prognosis. This study aimed to develop a novel prognostic model combined TRGs and ARGs signatures to predict the prognosis of patients with LUAD.</p><p><strong>Methods: </strong>LUAD patient's sample data and clinical data were obtained from public databases. The prognostic model was constructed and evaluated using the least absolute shrinkage and selection operator (LASSO), multivariate Cox analysis, time-dependent receiver operating characteristic (ROC), and Kaplan-Meier (K-M) analysis. Immune cell infiltration levels were assessed using single-sample gene set enrichment analysis (ssGSEA). Antitumor drugs with significant correlations between drug sensitivity and the expression of prognostic genes were identified using the CellMiner database. The distribution and expression levels of prognostic genes in immune cells were subsequently analyzed based on the TISCH database.</p><p><strong>Results: </strong>This study identified eight characteristic genes that are significantly associated with LUAD prognosis and could serve as independent prognostic factors, with the low-risk group demonstrating a more favorable outcome. Additionally, a comprehensive nomogram was developed, showing a high degree of prognostic predictive value. The results from ssGSEA indicated that the low-risk group had higher immune cell infiltration. Ultimately, our findings revealed that the high-risk group exhibited heightened sensitivity to the Linsitinib, whereas the low-risk group demonstrated enhanced sensitivity to the OSI-027 drug.</p><p><strong>Conclusion: </strong>The risk score exhibited robust prognostic capabilities, offering novel insights for assessing immunotherapy. This will provide a new direction to achieve personalized and precise treatment of LUAD in the future.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"31"},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal membrane oxygenation for Chinese neonates with severe respiratory and cardiac failure.","authors":"Xiao-Juan Zhang, Ying-Yue Liu, Hui Wang, Xiao-Yang Hong","doi":"10.1186/s13019-024-03205-9","DOIUrl":"https://doi.org/10.1186/s13019-024-03205-9","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to outline the experience with extracorporeal membrane oxygenation (ECMO) for respiratory and cardiac failure in neonates in our institution and compare our results with those from other countries.</p><p><strong>Method: </strong>The clinical data of 28 neonates who required ECMO assistance were studied retrospectively.</p><p><strong>Results: </strong>A total of 28 neonates underwent support with veno-arterial ECMO, including 14 cardiac support and 14 respiratory support. The neonates with a median age of 5 days (1-28 days) and a median weight of 3.3 kg (2.4-4.2 kg). Of these neonates, 4 were female, and 24 were male. Among the neonates. For neonates requiring ECMO support for cardiac conditions, 9 survived, resulting in a 64% survival rate. In contrast, for those requiring ECMO support for respiratory conditions, 6 survived, indicating a 42% survival rate. The survivors exhibited a significant reduction in lactic acid levels within the first 24 h. In the 15 successful weaning neonates, four neonates died at the end of the study; one was for the cardiac function failure; two were for the respiratory failure; one was given up for Bipedal necrosis; the other 11 neonates were successful discharge. Notably, two neonates underwent ECMO ventilation in the prone position without experiencing any complications.</p><p><strong>Conclusion: </strong>The utilization of ECMO support in neonates experiencing severe respiratory and cardiac failure efficiently improves cardiopulmonary function and significantly reduces mortality rates among critically ill neonates. The neonates with a respiratory indication in our study have a lower survival rate than other reported in the literature. Monitoring the trend in lactate levels following ECMO support proves valuable in estimating the prognosis of affected children.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"30"},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cardioprotective effects of HTK solution and conventional blood cardioplegia in patients with atrial fibrillation undergoing valvular replacement and Cox maze III procedure.","authors":"BingMei Qiu, Lei Zhang, Dan Wu, Qian Li, Lei Sun, AnLi Wang, Zhilong Xi, HaiWei Wu, ChangTian Wang, ShanWu Feng","doi":"10.1186/s13019-024-03317-2","DOIUrl":"https://doi.org/10.1186/s13019-024-03317-2","url":null,"abstract":"<p><strong>Introduction: </strong>The study was to assess the myocardial protection effects of the histidine-tryptophan-ketoglutarate (HTK) solution and the 4:1 blood cardioplegia (BC) in patients with atrial fibrillation (AF) who were subjected to valvular replacement concomitant with the Cox maze III surgery.</p><p><strong>Methods: </strong>A cohort of 148 individuals afflicted with AF, who received valve replacement surgery in conjunction with the Cox maze III procedure at our clinic within the period extending from 2015 to 2023, were enrolled. Subsequent to adjustment by propensity score matching (PSM), the patients were categorized into two distinct groups: the HTK group and the BC group. The primary end points assessed inotropic support requirements, complications, troponin trend, mechanical ventilation time and the intensive care unit stay. Arrhythmias, aortic cross-clamp and cardiopulmonary bypass times, and other clinical perioperative variables were considered as secondary end points.</p><p><strong>Results: </strong>No substantive disparities were observed concerning mortality rates, arrhythmias, neurological events, or renal complications. The duration of cardiopulmonary bypass and the aortic cross-clamp time did not demonstrate any marked variations between both groups, with p-values of 0.71 and 0.05, respectively. The time required for weaning from mechanical ventilation and the length of postoperative hospitalization were notably less in the group receiving HTK solution (p < 0.001 and p = 0.03, respectively). While inotropic support need was higher in the BC group (p = 0.02). Conversely, the dosage and frequency of perfusions were considerably increased in the BC group (p < 0.001 for each parameter). Within subgroups stratified by longer than 150 min of aortic cross-clamping duration, those in the BC cohort had significantly elevated peaks of cardiac troponin I (cTnI) (p = 0.01), whereas individuals in the HTK group experienced less mechanical ventilation time (p = 0.002) and shorter durations of intensive care unit admission (p < 0.001). The LVEF value in the HTK group was higher compared to that in the BC group in the 3-month follow-up data (p = 0.02).</p><p><strong>Conclusions: </strong>Both the HTK and 4:1 blood cardioplegia could be used safely in patients with AF who were subject to valvular replacement and Cox maze III procedure. However, the utilization of HTK conferred a greater advantage in diminishing the duration of mechanical ventilation weaning and the duration of postoperative hospitalization. HTK may be a better myocardial protection in patients with long cross-clamp time. The follow-up data indicated that HTK might be superior to 4:1 blood cardioplegia in the short-medium term cardiac function.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"25"},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracoscopic resection of primary mediastinal liposarcoma: a case report and literature review.","authors":"Yanhui Yang, Ji Li, Sipeng Cheng, Jinyuan Mei, Xin Cheng, Min Jing, Yi Wang","doi":"10.1186/s13019-024-03245-1","DOIUrl":"https://doi.org/10.1186/s13019-024-03245-1","url":null,"abstract":"<p><strong>Background: </strong>Primary mediastinal liposarcomas (PLMs) are extremely rare. Patients typically present with symptoms caused by tumor size, as the mass can compress surrounding tissues and organs. Here, we report a case of a large primary mediastinal liposarcoma that was successfully resected thoracoscopically. By reviewing the available literature on mediastinal liposarcomas and sharing perioperative insights, we aim to provide guidance on the diagnosis and surgical management of large mediastinal liposarcomas.</p><p><strong>Case presentation: </strong>A 38-year-old male presented to our hospital with complaints of dysphagia after meals. Chest computed tomography (CT) revealed a large space-occupying lesion in the posterior upper mediastinum, and gastroscopy identified esophageal compression without evidence of new growth. The patient underwent thoracoscopic resection, resulting in significant improvement of his dysphagia postoperatively. He experienced no postoperative complications and was discharged one week following surgery.</p><p><strong>Conclusion: </strong>The incidence of PLM is very low. Due to the proximity of vital structures such as the vena cava, esophagus, trachea, and subclavian artery, surgical resection presents elevated risks and complexity. While minimally invasive thoracoscopic techniques offer both safety and efficacy, careful preservation of surrounding organs is essential during the procedure.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"21"},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Totally endoscopic mitral valve repair with novel technique of left atrial exposure: five years experience from a single center.","authors":"Thanh Dat Pham, Thanh Huyen Tran, Ngoc Thanh Le, Cong Huu Nguyen","doi":"10.1186/s13019-024-03250-4","DOIUrl":"https://doi.org/10.1186/s13019-024-03250-4","url":null,"abstract":"<p><strong>Background: </strong>.Endoscopic mitral valve repair has progressively been adopted as the standard approach for treating isolated mitral regurgitation across numerous renowned cardiac surgery centers worldwide. Our innovative method for mitral valve exposure has been previously described. This study evaluates the outcomes of totally endoscopic mitral valve repair using this advanced technique over a five-year period at a single center.</p><p><strong>Methods: </strong>. A retrospective review was conducted on 122 patients who underwent totally endoscopic mitral valve repair between May 2018 and December 2023. Clinical and echocardiographic data were meticulously collected and analyzed. The surgical procedure was performed completely endoscopic via a 3-4 cm right mini-thoracotomy, with peripheral cardiopulmonary bypass. A specialized technique utilizing retraction sutures for mitral valve exposure was employed. Primary outcomes included the results of the endoscopic techniques, mitral valve repair outcomes, perioperative complications, and short-term mortality. Long-term outcomes, including survival, freedom from reoperation, and recurrent mitral regurgitation, were assessed using Kaplan-Meier analysis.</p><p><strong>Results: </strong>. Mitral valve exposure was successfully achieved in all cases. The mean age of the patients was 54.5 ± 14.2 years, and their mean log EuroSCORE II was 1.53 ± 1.30. The repair rate was 96%, with anterior leaflet repair in 13%, posterior leaflet repair in 69%, and bileaflet repair in 14%. Mean aortic cross-clamp time and cardiopulmonary bypass time were 117 ± 39 min and 181 ± 48 min, respectively. The early mortality rate was 1.6%. Three patients (2.5%) experienced intraoperative conversion to sternotomy and 6 patients (4.9%) underwent a reoperation. There were 2 cases of stroke (1.6%) and 2 cases of unilateral pulmonary edema (1.6%). The minimum follow-up duration for a patient was 6 months, extending up to 72 months, with a mean follow-up duration of 28.6 ± 15.1 months. Kaplan-Meier analysis demonstrated a 96.7 ± 1.6% survival rate at 5 years, with 98.4 ± 1.2% freedom from reoperation, and 86.1 ± 3.1% freedom from recurrent mitral regurgitation.</p><p><strong>Conclusions: </strong>. Totally endoscopic mitral valve repair utilizing the novel technique of left atrial exposure is feasible and can be safely performed with low mortality and morbidity. This approach achieves a high rate of mitral repair and demonstrates favorable long-term outcomes.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"28"},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A laboratory feasibility study using a computer algorithm for anastomosis segmentation of epicardial ultrasonography images from distal coronary artery bypass anastomoses.","authors":"Alex Skovsbo Jørgensen, Martin Siemienski Andersen, Lasse Riis Østergaard, Samuel Emil Schmidt, Dorte Nøhr, Jan Jesper Andreasen","doi":"10.1186/s13019-024-03187-8","DOIUrl":"https://doi.org/10.1186/s13019-024-03187-8","url":null,"abstract":"<p><strong>Background: </strong>The outcome of coronary artery bypass grafting (CABG) depends on several factors, including the quality of the distal anastomoses to the coronary arteries. Early graft failure may be caused by, e.g., technical suture failures, and such failures may be detected using intraoperative quality assessment. High-intensity epicardial ultrasonography (ECUS) allows anatomical visualization of the anastomoses during surgery, but currently, the images must be assessed manually. Here, we aim to describe an automatic quality assessment of distal coronary anastomoses using in-house software for vessel area and diameter extraction.</p><p><strong>Methods: </strong>A postoperative, laboratory, investigational feasibility study comparing computer readings of longitudinal and transverse ultrasonographic images of distal coronary artery anastomoses with manual readings was performed, including ECUS images from 30 patients undergoing elective, isolated on-pump CABG. Vessel and anastomosis segmentation performance metrics from images obtained intraoperatively were compared to assess agreement between the manual and automatic segmentation methods. Scatter plots, the Dice coefficient and correlation analyses were used as measures of similarity between the two readings. p < 0.05 was considered significant.</p><p><strong>Results: </strong>The number of dimensions of anastomotic vessel structures that are relevant for stenosis quantification and the Dice coefficient were 0.888 between the automatic and manual segmentations. The correlation coefficient between the manual and automatic stenotic rates was 0.674.</p><p><strong>Conclusions: </strong>An anastomosis segmentation software for automatic and objective extraction of the anatomical dimensions of relevant distal coronary anastomotic structures from ECUS images obtained during CABG was developed. The framework allows for quantifying stenotic in the anastomotic structures and has the potential to assist surgeons during quality assessment of coronary anastomoses when the described segmentation of vessels and anastomoses is available for real-time epicardial ultrasonography use during surgery.</p><p><strong>Trial registration: </strong>The study was registered on September 29, 2016, before enrolment of the first participant (ClinicalTrials.gov ID: NCT02919124).</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"34"},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949351","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}