Thoracic and Cardiovascular Surgeon最新文献

{"title":"Long-Term Performance of Bilateral Internal Thoracic Artery Grafts in Young Adults.","authors":"Dritan Useini, Brigitta Gahl, Marcus Franz, Ralf Degenhardt, Zulfugar Timur Taghiyev, Ingo Kutschka, Hassina Baraki","doi":"10.1055/a-2983-8877","DOIUrl":"https://doi.org/10.1055/a-2983-8877","url":null,"abstract":"<p><p>OBJECTIVE Coronary artery disease (CAD) in young adults is uncommon but associated with substantial long-term morbidity. Limited evidence exists regarding the long-term outcomes of bilateral internal thoracic artery (BITA) grafting in this population. This study evaluates perioperative and long-term outcomes of BITA revascularization in young adults undergoing coronary artery bypass grafting (CABG) and compares survival outcomes with those of the general population. METHODS A retrospective single-center observational study was conducted in 67 young patients (39 ± 3 years) who underwent BITA grafting for multivessel CAD. Perioperative outcomes, long-term overall survival, major adverse cardio-cerebral events (MACEs), and repeat revascularization were assessed. Long-term outcomes were evaluated using Kaplan-Meier analysis. Further survival analysis was conducted using an age- and sex-adjusted general population matched for age, sex, and calendar year. RESULTS BITA grafting was associated with very low perioperative morbidity. The median follow-up was 17 years, with an estimated overall survival at 20 years of 74% [0.74 (95% confidence interval [CI], 0.52-0.87)] and freedom from MACEs at 20 years of 70% [0.70 (95% CI, 0.49-0.84)]. Sternal wound complications were infrequent (1.5%). CONCLUSIONS BITA revascularization in young adults demonstrates excellent long-term survival, with survival comparable to that of the age- and sex-matched general population during the first 15 years after surgery, along with durable event-free outcomes, supporting its use as a durable revascularization strategy in this population.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224866","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":"Interstage Interval and Pulmonary Function in Two-Stage RATS for Bilateral Multiple Primary Lung Cancers.","authors":"Hao Xu, Meifeng Li, Linyou Zhang","doi":"10.1055/a-2965-7831","DOIUrl":"https://doi.org/10.1055/a-2965-7831","url":null,"abstract":"<p><strong>Background: </strong>The optimal interstage interval for bilateral multiple primary lung cancers (bMPLCs) remains undefined, particularly in the context of robot-assisted thoracic surgery (RATS).</p><p><strong>Methods: </strong>We retrospectively analyzed 24 patients with bMPLCs who underwent planned two-stage RATS at a single institution. Perioperative outcomes were compared between the first and second procedures. Pulmonary function preservation was assessed using the postoperative/preoperative forced expiratory volume in 1 second (FEV1) ratio. The association between interstage interval and FEV1 preservation was evaluated using Spearman correlation and restricted cubic spline (RCS) modeling.</p><p><strong>Results: </strong>Perioperative outcomes were comparable between the two procedures, with no mortality. A significant reduction in FEV1 was observed after the first surgery (<i>p</i> = 0.035). Interstage interval was positively correlated with FEV1 preservation (Spearman's <i>ρ</i> = 0.599, <i>p</i> = 0.002). RCS analysis demonstrated a nonlinear relationship, with a functional recovery threshold at approximately 190 days. Patients with an interval of ≥ 190 days showed significantly better FEV1 preservation than those with < 190 days (0.95 ± 0.12 vs. 0.80 ± 0.09, <i>p</i> = 0.008), and all maintained ≥ 80% of baseline FEV1 (<i>p</i> = 0.004).</p><p><strong>Conclusion: </strong>Two-stage RATS is safe and effective for bMPLCs. An interstage interval of approximately 6 months may optimize pulmonary function recovery, and parenchymal-sparing resection as the initial procedure may be advantageous. These findings suggest a nonlinear, threshold-dependent recovery pattern.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149428","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":"Minimally Invasive Thymectomy for Myasthenia Gravis: Feasibility and Functional Outcomes.","authors":"Nicolas Mwesigwa, Abdulla Al-Shamari, Samsul Islam, Tasnim Chowdhury, Ibrahim Ibrahim, Pablo Garcia-Reitboeck, Jeremy Smelt","doi":"10.1055/a-2969-6473","DOIUrl":"10.1055/a-2969-6473","url":null,"abstract":"<p><strong>Background: </strong>Thymectomy is established for myasthenia gravis (MG), but evidence from non-specialist general thoracic surgery units is limited. This study evaluates the feasibility and outcomes of thymectomy following an institutional transition from sternotomy to minimally invasive surgery, and assesses MG Composite and MG-ADL scores as longitudinal outcome measures.</p><p><strong>Methods: </strong>A single-center retrospective cohort study of 58 consecutive patients who underwent MG thymectomy between 2018 and 2026. The primary outcome was favorable clinical status (complete stable remission or improvement) at 1 year. Secondary outcomes included complications, length of stay, medication reduction, and changes in MG Composite score. Between-group comparisons across surgical approaches are descriptive and exploratory only.</p><p><strong>Results: </strong>Surgical approaches were robotic-assisted thoracic surgery (RATS; <i>n</i> = 29; 50.0%), video-assisted thoracoscopic surgery (VATS; <i>n</i> = 22; 37.9%), and sternotomy (<i>n</i> = 7; 12.1%). Perioperative mortality was zero. Overall complication rate was 10.3%. A favorable outcome was achieved in 68.9% (95% CI: 57.3-81.9%). Sternotomy was associated with longer hospital stay (median 7 vs. 2-3 days; <i>p</i> = 0.02). Prednisolone and pyridostigmine were reduced or discontinued in 72.1 and 55.3% of preoperative users, respectively (both <i>p</i> < 0.001). MG Composite and MG-ADL scores improved progressively from 3 months onward.</p><p><strong>Conclusion: </strong>Thymectomy can be safely and effectively performed in a general thoracic surgery unit with appropriate specialist input, achieving outcomes comparable to regional referral centers. Apparently, transition to minimally invasive surgery did not compromise safety or efficacy while significantly reducing hospital stay. Future studies should collect MG Composite and MG-ADL scores prospectively as standardized outcome measures.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075794","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":"Beyond Length of Stay: Early Discharge after CABG.","authors":"Christos Voucharas, Athina Myrou, Angeliki Vouchara","doi":"10.1055/a-2970-6676","DOIUrl":"https://doi.org/10.1055/a-2970-6676","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128271","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":"Comment: Redo Coronary Artery Bypass Grafting: The Hidden Challenges of Propensity-Matched Comparisons.","authors":"Carl-Thaddäus Braun, Darko Radakovic, Marcus-Andre Deutsch","doi":"10.1055/a-2970-6709","DOIUrl":"https://doi.org/10.1055/a-2970-6709","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128415","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":"Association Between Postoperative NSAID and Chest Drainage Duration After VATS Pleurodesis.","authors":"Florent Leviel, Paul Tarpin, Florence De Dominicis, Geoni Merlusca, Alejandro Witte Pfizer, Julien Epailly, Olivier Georges, Osama Abou-Arab","doi":"10.1055/a-2965-7880","DOIUrl":"https://doi.org/10.1055/a-2965-7880","url":null,"abstract":"<p><strong>Background: </strong>Non-steroidal anti-inflammatory drugs (NSAIDs) are a cornerstone of multimodal postoperative analgesia. However, their use remains controversial in surgery for spontaneous pneumothorax because inflammation plays a key role in the development of pleural symphysis during pleurodesis. This retrospective study aimed to evaluate the impact of postoperative NSAID administration after thoracoscopic surgery for spontaneous pneumothorax on chest drainage duration.</p><p><strong>Methods: </strong>We conducted a monocentric retrospective observational study including patients who underwent video-assisted thoracoscopic surgery for spontaneous pneumothorax between January 1, 2015, and December 31, 2020. The primary endpoint was prolonged chest drainage, defined as drainage lasting ≥ 3 postoperative days. Secondary endpoints included early markers of pleural symphysis, postoperative analgesia, and postoperative complications.</p><p><strong>Results: </strong>A total of 558 patients were included, of whom 245 (44%) received postoperative NSAIDs and 313 (56%) did not. In multivariable logistic regression, NSAIDs administration was significantly associated with a reduced risk of prolonged chest drainage (OR 0.62; 95%CI: 0.44-0.89; <i>p</i> = 0.009). This association remained consistent after propensity score weighting (IPTW OR 0.66; 95%CI: 0.46-0.95) and sensitivity analyses. No significant differences were observed between the groups regarding postoperative complications or pleurodesis efficacy. The use of patient-controlled opioid analgesia was significantly lower in the NSAID group (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Postoperative NSAID administration was associated with a reduced incidence of prolonged chest drainage, without evidence of worse early postoperative outcomes. These findings do not support impaired short-term pleural symphysis, although definitive conclusions on long-term pleurodesis efficacy would require prospective studies with extended follow-up.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075769","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":"Left Atrial Diameter Index Predicts Cerebrovascular Events after Postoperative Atrial Fibrillation following Coronary Artery Bypass Grafting.","authors":"Arda Can Doğan, Ali Rıza Demir, Alkım Ateşli Yazıcı, Batuhan Yazıcı, Ali Kemal Kalkan","doi":"10.1055/a-2747-7537","DOIUrl":"10.1055/a-2747-7537","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative atrial fibrillation (POAF) is a frequent complication after coronary artery bypass grafting (CABG) and is linked to increased short- and long-term stroke risk. This study evaluated the prognostic value of the left atrial diameter index (LADI) for predicting cerebrovascular events (CVE) in patients undergoing isolated CABG who developed POAF, had no prior atrial fibrillation (AF), and were discharged in sinus rhythm.</p><p><strong>Materials and methods: </strong>Among 2,094 patients undergoing isolated CABG between June 2015 and June 2022, 392 consecutive patients with POAF and discharge in sinus rhythm met inclusion criteria. LADI was calculated preoperatively, and an optimal cutoff (21.2 mm/m²) was determined via receiver operating characteristic curve and Youden index. Patients were classified as low (≤21.2 mm/m²) or high (>21.2 mm/m²) LADI. The association between LADI and CVE was assessed over a mean follow-up of 42.4 ± 20.0 months using Cox proportional hazards modeling.</p><p><strong>Results: </strong>Thirty patients (7.7%) experienced a CVE, including eight in-hospital cases (2.0%). CVE incidence was higher in the high LADI group compared with the low LADI group (19.8 vs. 2.8%). Multivariable analysis identified older age, hypertension, congestive heart failure, and high LADI as independent CVE predictors. Kaplan-Meier analysis confirmed significantly higher CVE rates in the high LADI group (log-rank, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>In patients developing POAF after isolated CABG, LADI is a simple, easily obtainable parameter that independently predicts long-term CVE risk and may aid in postoperative risk stratification.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145522856","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":"Listening to the Body after Aortic Dissection: A Participatory Sound-Based Co-Creation Project.","authors":"Nimrat Grewal","doi":"10.1055/a-2960-9495","DOIUrl":"https://doi.org/10.1055/a-2960-9495","url":null,"abstract":"<p><strong>Purpose: </strong>Survival after acute aortic dissection (AD) has improved substantially, shifting attention to long-term recovery. Although reduced quality of life and psychological distress are documented, less is known about how survivors experience their bodies after a life-threatening event. We developed After the Storm, a participatory sound-based cocreation project, and examined experiences of bodily awareness, vigilance, sound, and silence emerging during codesign.</p><p><strong>Methods: </strong>This qualitative study was embedded within the codesign phase of After the Storm. Twenty-three survivors of acute AD participated across two cocreation sessions (an initial group of 14 and a second After the Storm session of 9). Data generated throughout the process, recruitment responses, follow-up correspondence, workshop discussions, reflective conversations, listening exercises, and field notes, were analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>Participants described recovery as extending beyond physical healing, involving a fundamental change in their relationship with their bodies. Five interconnected themes emerged: (1) a body that can no longer be taken for granted, (2) living in vigilance, (3) the invisible burden of recovery, (4) sound, silence, and recognition, and (5) rebuilding life after the storm. Participants reported heightened awareness of bodily sensations, persistent attentiveness to physical signals, and difficulty communicating recovery to others. Many felt strong recognition in the focus on listening, sound, and silence, capturing aspects of recovery difficult to articulate clinically.</p><p><strong>Conclusion: </strong>Recovery after AD involves dimensions of bodily awareness, vigilance, and meaning-making not fully reflected in existing clinical frameworks. A participatory sound-based codesign process offered a novel space in which these experiences could be explored, shared, and recognized, suggesting arts-based approaches may capture aspects of survivorship that conventional patient-reported outcomes miss.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040598","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":"Impact of Upper Lobe Resection and Potassium on Atrial Fibrillation After Lung Surgery.","authors":"Taner Şahin","doi":"10.1055/a-2951-2202","DOIUrl":"10.1055/a-2951-2202","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the relationship between postoperative atrial fibrillation (POAF) following lung resection and surgical factors, particularly the extent and location of resection, alongside preoperative electrolyte levels. We also sought to develop and internally validate a composite risk model for identifying high-risk patients.</p><p><strong>Methods: </strong>In this single-center retrospective cohort study, 422 patients who underwent lung resection (sublobar, lobar, or major resection) between December 2024 and April 2025 were analyzed. Patients with preexisting atrial substrate, heart failure, or left atrial dilatation (≥ 40 mm) were excluded. Independent predictors were identified using multivariable logistic regression. To further address potential confounding, inverse probability of treatment weighting (IPTW) analysis was performed.</p><p><strong>Results: </strong>POAF developed in 66 patients (15.6%). In multivariable analysis, lower preoperative potassium levels (odds ratio [OR]: 0.40; 95% confidence interval [CI]: 0.21-0.79; <i>p</i> = 0.008), major resection (OR: 4.10; 95% CI: 1.98-8.49; <i>p</i> < 0.001), and upper lobe resection (OR: 4.23; 95% CI: 2.22-8.05; <i>p</i> < 0.001) were independent predictors of POAF. In the IPTW-adjusted analysis, upper lobe resection remained significantly associated with POAF (OR: 2.08; 95% CI: 1.16-3.75; <i>p</i> = 0.013). The composite model demonstrated moderate discrimination (area under the curve: 0.716; 95% CI: 0.641-0.777), which remained stable after bootstrap validation. POAF was associated with longer intensive care unit stay and higher in-hospital mortality (16.7 vs. 1.4%, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>POAF after lung resection is a predictable complication associated with the extent of surgery, upper lobe involvement, and preoperative potassium levels. These findings highlight the importance of closer rhythm surveillance and perioperative electrolyte optimization in high-risk patients.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888287","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":"Early Discharge after Isolated CABG does not Increase 30-Day Readmission.","authors":"Kudret Atakan Tekin, Ahmet Can Topçu, Fatih Yiğit, Fatma İrem Öztürk, Taylan Adademir, Kaan Kırali","doi":"10.1055/a-2955-5342","DOIUrl":"10.1055/a-2955-5342","url":null,"abstract":"<p><strong>Background: </strong>We aimed to evaluate the relationship between early discharge and 30-day readmission after isolated coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>This retrospective study included all consecutive adults undergoing isolated CABG in a single tertiary institution between May 2023 and December 2024. Patients with concomitant cardiac procedures, in-hospital mortality, or prolonged hospitalization (> 14 days) were excluded. Patients were categorized into early (≤ 5 days) and late (> 5 days) discharge groups. The primary outcome was 30-day all-cause unplanned readmission. The secondary outcome was 30-day all-cause emergency room presentation.</p><p><strong>Results: </strong>The final cohort consisted of 1,470 patients. The 30-day unplanned readmission rate was significantly lower in the early-discharge group compared with the late-discharge group (6.7% vs. 12.0%, <i>p</i> = 0.001). In univariable analysis, advanced age, increased length of hospital stay, cardiopulmonary bypass (CPB) time, mechanical ventilation duration, postoperative atrial fibrillation, and need for surgical reexploration were significantly associated with an increased risk of hospital readmission. In multivariable analysis, early discharge was not an independent predictor of 30-day readmission (odds ratio [OR]: 0.714, 95% confidence interval [CI]: 0.470-1.085, <i>p</i> = 0.114). Multivariable analysis identified increased CPB time (OR: 1.008, 95% CI: 1.003-1.013, <i>p</i> = 0.003) and surgical reexploration (OR: 2.479, 95% CI: 1.283-4.788, <i>p</i> = 0.007) as independent predictors of 30-day readmission.</p><p><strong>Conclusion: </strong>In selected low-risk patients with an uncomplicated postoperative course, early discharge after isolated CABG was not independently associated with increased 30-day readmission. Longer CPB time and surgical reexploration were independently associated with readmission.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920794","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}