Thoracic and Cardiovascular Surgeon最新文献

{"title":"Echocardiographic and Clinical Outcomes of Concomitant Secondary Chordal Cutting to Surgical Myectomy in Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-analysis.","authors":"Tijn Julian Pieter Heeringa, Romy R M J J Hegeman, Len van Houwelingen, Marieke Hoogewerf, David Stecher, Johannes C Kelder, Pim van der Harst, Martin J Swaans, Mostafa M Mokhles, Ilonca Vaartjes, Patrick Klein, Niels P van der Kaaij","doi":"10.1055/a-2434-7627","DOIUrl":"10.1055/a-2434-7627","url":null,"abstract":"<p><p>In patients who underwent surgical myectomy for hypertrophic obstructive cardiomyopathy (HOCM), additional mitral valve repair may offer additional benefits in terms of further reducing left ventricular outflow tract (LVOT) gradients, systolic anterior motion (SAM), and mitral regurgitation (MR). We performed a systematic review of the literature to evaluate the evidence of surgical myectomy with additional secondary chordal cutting in patients with HOCM. A systematic literature search in MEDLINE and EMBASE was performed until April 2024. The primary outcome studied was postoperative echocardiographic LVOT gradient. A random effects meta-analysis of means was performed for the primary outcome. The secondary outcomes studied were postoperative residual MR grade, 30-day new permanent pacemaker implantation, and in-hospital mortality. From 1,911 unique publications, a total of 6 articles fulfilled the inclusion criteria and comprised 471 patients with a pooled mean preoperative resting LVOT gradient of 84 mm Hg (95% confidence interval [CI]: 76-91). The postoperative pooled mean LVOT gradient was 11 mm Hg (95% CI: 10-12) with a low heterogeneity (<b><i>I</i></b> ² = 44%). The residual LVOT gradient exceeding 30 mm Hg was present in nine (1%) patients. MR grade 3 or 4 at hospital discharge was present in seven (1%) patients. The 30-day new permanent pacemaker implantation rate was 7% and the in-hospital mortality was 0.4%. This systematic review and meta-analysis demonstrate that combining surgical myectomy with secondary chordal cutting can be performed safely and effectively eliminate LVOT obstruction in HOCM patients. Further studies are needed to determine the additive effectiveness of additional secondary chordal cuttings.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"519-528"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376080","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":"Unilateral versus Bilateral T3 Ganglionectomy in Primary Palmar Hyperhidrosis Patients.","authors":"Beatrice Chia-Hui Shih, Duk Hwam Moon, Sungsoo Lee","doi":"10.1055/a-2699-8163","DOIUrl":"10.1055/a-2699-8163","url":null,"abstract":"<p><p>Primary palmar hyperhidrosis (PPH) causes excessive hand sweating, impacting daily activities and quality of life. Endoscopic thoracic sympathectomy (ETS), including ganglionectomy, is a common treatment, but the risk of compensatory hyperhidrosis (CH) remains a concern. This study compares unilateral versus bilateral T3 ganglionectomy, focusing on differences in CH occurrence and patient satisfaction.We retrospectively analyzed 118 patients who underwent either unilateral or bilateral T3 ganglionectomy for PPH at our institution from November 2023 to January 2025. Data on patient characteristics and surgical outcomes were extracted from electronic medical records. Patient satisfaction and incidence of CH were assessed at postoperative 3 months.Of the 118 patients with severe PPH, 77 underwent bilateral T3 ganglionectomy, and 41 received unilateral T3 ganglionectomy. No significant differences in baseline characteristics were observed between the groups. Postoperative satisfaction was higher in the unilateral group, with 93% reporting being \"very satisfied\" compared with 61% in the bilateral group (<i>p</i> < 0.001). The unilateral group also had fewer incidences of CH, with 80% reporting no CH, while 43% of the bilateral group experienced mild CH (<i>p</i> = 0.007). The most common areas affected by CH were the back, thighs, chest, abdomen, and hips. In the unilateral group, 7.5% showed improvement in contralateral sweating, with 22% necessitating contralateral ganglionectomy.This study is the first to compare the effectiveness and incidence of CH between unilateral and bilateral ETS for PPH. Our results show that 93% of unilateral ETS patients reported high satisfaction, compared with 61% in the bilateral group. Eighty percent of the unilateral group experienced no CH, while only 43% in the bilateral group reported mild CH. Statistically significant differences were observed in both satisfaction scores (<i>p</i> < 0.001) and CH occurrence (<i>p</i> = 0.007), suggesting unilateral ETS may provide better symptom relief with fewer adverse effects. Compared with prior studies, our cohort showed improved bilateral ETS outcomes, with only 48% developing CH. These findings indicate that unilateral ETS may be preferred for patients seeking higher satisfaction and reduced risk of CH, though further long-term studies are needed to confirm such results.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041282","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":"Is Total Arterial Grafting Superior to Multiarterial Grafting in Coronary Bypass?","authors":"Dror B Leviner, Tom Ronai, Ely Erez, Guy Witberg, Dana Abraham, Yaron Yishai, Nili Stein, John D Puskas, Erez Sharoni","doi":"10.1055/a-2700-7123","DOIUrl":"https://doi.org/10.1055/a-2700-7123","url":null,"abstract":"<p><p>Multiple arterial grafting (MAG) is associated with improved long-term outcomes. However, there are limited data on the benefit of total arterial revascularization (TAR).Retrospective study of adult patients with multivessel disease undergoing isolated coronary artery bypass grafting (CABG) in three centers between January 1, 2009, and December 31, 2023. Patients were grouped according to the revascularization strategy (TAR vs. MAG). The primary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE). The cumulative incidence of MACCE was plotted using Kaplan Meier (KM) curves. The hazard ratio (HR) for TAG versus MAG was calculated using multivariate Cox models.Our cohort included 2,791 patients. About 1,048 (37.55%) underwent TAR and 1,743 (62.45%) underwent MAG, of whom 2,434 (87.21%) were male. Mean age was 61.6 ± 9.8 years in the TAR and 62.1 ± 9.1 years in the MAG. Median follow-up time was 101 months. The cumulative incidence of the primary outcome was 48.57% in the TAR and 42.4% in the MAG group. After multivariable adjustment, TAR had an HR of 1.05, 95% CI (0.93-1.18) for the primary outcome (<i>p</i> = 0.25). The mortality rate was 28.72% in the TAR and 23.06% in the MAG group.TAR showed no benefit over MAG at midterm follow-up.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145178825","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 Novel Competency-Based Simulation Model for Thoracoscopic Lung Resection.","authors":"Ganwei Liu, Feng Yang, Zuli Zhou, Guanchao Jiang","doi":"10.1055/a-2702-2239","DOIUrl":"10.1055/a-2702-2239","url":null,"abstract":"<p><p>Simulation-based thoracic surgery training is increasingly incorporating physical models to enhance traditional learning methods. Conventional box trainers, though useful for basic skills, often lack anatomical accuracy and tactile feedback, limiting their relevance for complex procedures like thoracoscopic lung resection. High-fidelity 3D-printed lung models offer realistic anatomy and procedural flow, but their educational impact remains underexplored.Fifty-two surgical residents without prior thoracoscopic experience were randomly assigned to a high-fidelity lung model group or a conventional Fundamentals of Laparoscopic Surgery (FLS) box trainer group. All participants completed a baseline thoracic anatomy test and received standardized educational materials. The lung model group received structured simulation training on procedural anatomy and operative steps, while the FLS group practiced fundamental laparoscopic tasks. After training, participants repeated the anatomy test and performed a thoracoscopic lung wedge resection in a live animal model. Performance was assessed using the Objective Structured Assessment of Technical Skill (OSATS) and a 5-point confidence scale.A total of 52 surgical residents participated in the study, with 26 assigned to the high-fidelity lung model group and 26 to the FLS trainer group. Baseline anatomy scores were similar between groups (65.42  ±  6.10 vs. 66.12  ±  5.92; <i>p</i>  =  0.710). Posttraining, the lung model group showed greater gains in anatomy comprehension (87.60  ±  4.75 vs. 78.19  ±  5.54; <i>p</i>  <  0.001), higher OSATS scores (19.18  ±  2.43 vs. 15.41  ±  2.41; <i>p</i>  <  0.001), and increased confidence (3.13  ±  0.61 vs. 2.27  ±  0.68; <i>p</i>  =  0.002).High-fidelity 3D-printed lung models significantly enhance anatomical understanding, thoracoscopic skills, and confidence compared with conventional box trainers. These results support integrating anatomically accurate simulation into thoracic surgical education to improve both cognitive and psychomotor outcomes.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076013","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":"Computed Tomography Reduces Complications in Surgical Aortic Valve Replacement.","authors":"Liliane Zillner, Julian Heidtmann, Markus Mach, Richard Nolz, Christian Loewe, Alfred Kocher, Daniel Zimpfer, Martin Andreas","doi":"10.1055/a-2708-3100","DOIUrl":"https://doi.org/10.1055/a-2708-3100","url":null,"abstract":"<p><strong>Objective: </strong>To assess the efficacy of preoperative full aortic computed tomography (CT) to reduce complications during surgical aortic valve replacement (SAVR).</p><p><strong>Methods: </strong>A single-center retrospective study examined all SAVR procedures from 2013 to 2015, comparing outcomes between surgeries planned with CT and those without. The study assessed how CT imaging adapted surgical methods, including cannulation and the possibility of switching from SAVR to interventional therapy. The analysis primarily focused on the occurrence of in-hospital complications.</p><p><strong>Results: </strong>Out of 359 patients analyzed, those who received pre-surgical CT (n=305, complications = 53; 17%; EuroSCORE = 1.8)) had fewer in-hospital complications compared to the non-CT group (n=54, complications=17; 32%; EuroSCORE = 1.8), with a statistically significant difference (p=0.016). Patients in the CT group had a 15% absolute risk reduction and a number needed to treat (NNT) of 7 to avoid one in-hospital complication.</p><p><strong>Conclusions: </strong>CT is associated with reduced in-hospital complications in SAVR patients and could enhance patient outcomes when used in preoperative planning. This supports the recommendation for incorporating CT into routine preoperative assessment to enable personalized surgical strategies, potentially including a shift to transcatheter treatments when indicated. Keywords Aortic valve replacement, perioperative stroke, computed chest tomography, in-hospital complications, full aortic computed tomography.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138711","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":"Comments on \"Totally Thoracoscopic Ablation for Atrial Fibrillation: All-Box Clamping\".","authors":"Qi Tong, Ahmad Umar, Yongjun Qian","doi":"10.1055/a-2695-2624","DOIUrl":"https://doi.org/10.1055/a-2695-2624","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132003","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":"Bilateral Pneumothorax After Minimally Invasive Repair of Pectus Excavatum: Report of a Rare Life-Threatening Complication.","authors":"Marco Agamennone, Federica Lena, Francesco Donati, Maria Grazia Calevo, Vittorio Guerriero, Michele Torre","doi":"10.1055/a-2695-2498","DOIUrl":"https://doi.org/10.1055/a-2695-2498","url":null,"abstract":"<p><p>Minimally invasive repair of pectus excavatum (MIRPE) creates an iatrogenic communication between the pleural cavities, known as a \"buffalo chest.\" Patients with pectus excavatum are also at increased risk of spontaneous pneumothorax due to congenital apical blebs. When these two conditions coexist, the risk of bilateral spontaneous pneumothorax becomes potentially life-threatening. This study aims to evaluate the incidence and characteristics of spontaneous pneumothorax following MIRPE, with particular attention to the presence and role of congenital blebs.We retrospectively reviewed patients who underwent MIRPE between 2005 and 2024 to identify cases of spontaneous pneumothorax. Only cases occurring at least 1 month postoperatively and unrelated to intraoperative thoracoscopy were included. Patients were followed for at least 10 months. We analyzed laterality, clinical presentation, presence of blebs, treatment, and outcomes. A systematic literature review was also conducted to explore the relationship between buffalo chest, pneumothorax, and pectus excavatum.Among 795 patients, 7 developed spontaneous pneumothorax: 4 unilateral, 3 bilateral. In six cases, blebs were identified and treated with thoracoscopic bullectomy and pleurodesis. Two patients with bilateral pneumothorax experienced cardiac arrest: one recovered after emergency drainage; the other died in a peripheral hospital, where blebs were suspected but not confirmed. The literature review identified nine similar cases in five reports.Bilateral spontaneous pneumothorax after MIRPE can be a life-threatening emergency due to the buffalo chest. Patients and families should be informed of this rare but serious risk to enable early recognition and prompt treatment. Preoperative detection of apical blebs may help reduce this risk.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081728","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":"Embolisation of Contraceptive Implants to the Pulmonary Arterial System: A Series of Three Cases from a Tertiary Thoracic Surgery Unit.","authors":"Theo Hughes, Leo Gundle, Micayla Pather, Sara Khademi, Sophia Chan, Shuya Chen, Rebecca Weedle, Andrea Bille, Leanne Ashrafian, John Pilling","doi":"10.1055/a-2687-1182","DOIUrl":"10.1055/a-2687-1182","url":null,"abstract":"<p><p>Contraceptive implants are widely used for long-acting reversible contraception (LARC) due to their high efficacy and convenience. However, complications including migration and, rarely, embolisation to the pulmonary arterial system have been reported. This case series presents three cases of contraceptive implant embolisation to the pulmonary arterial system, managed at a tertiary thoracic surgery unit between 2021 and 2024. Different surgical management was performed in all three cases influenced by factors including: length of time since possible embolisation, implant location, and suspected degree of endothelialisation. The cases highlight challenges in surgical management of embolized contraceptive implants, focusing on arteriotomy and anatomical resection approaches. The importance of prompt diagnosis, multidisciplinary decision-making, and necessity for further research to establish guidelines for the management of embolized contraceptive implants is exemplified. Suppliers should be aware of this rare complication and consider methods to prevent its occurrence.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970124","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 Effects of Unilateral Cerebral Perfusion Under Mild Hypothermia.","authors":"Nikolozi Vashakmadze, Otto Dapunt, Mamuka Bokuchava, Nodar Pkhakadze, Nana Ghlonti, Tengiz Purtskhvanidze, Valeri Kuzmenko","doi":"10.1055/a-2686-4606","DOIUrl":"https://doi.org/10.1055/a-2686-4606","url":null,"abstract":"<p><p>DeBakey type I aortic dissection requires circulatory arrest during arch reconstruction, putting the brain at risk. In resource-limited centers, deep hypothermia can exacerbate coagulopathy and lead to increased bleeding. This study compares outcomes between mild and moderate hypothermia under unilateral cerebral perfusion (UCP).Retrospective analysis of 60 patients who underwent modified Bentall procedures with hemiarch replacement under UCP between 2014 and 2024. Patients were divided into two groups: mild hypothermia (mH, 32°C; <i>n</i> = 40) and moderate hypothermia (MH, 24°C; <i>n</i> = 20). Exclusion criteria included bilateral cerebral perfusion, additional procedures (e.g., total arch replacement, bypass surgery), preexisting neurological or renal conditions, and incomplete datasets. Neurological events, blood loss, transfusion requirements, acute kidney injury (AKI), and mortality were assessed.Neurological outcomes (permanent neurological dysfunction and transient neurological dysfunction) were comparable in both groups (20% each). The mH group had significantly lower blood loss (787 vs. 1,183 mL), reduced red blood cell transfusion (200 vs. 828 mL), and less fresh frozen plasma use (259.5 vs. 882 mL). The mH group also had lower rates of AKI (15 vs. 30%), rethoracotomy (10 vs. 22.5%), and infections (10 vs. 20%). Mortality was 20% (mH) versus 35% (MH).Mild hypothermia under UCP provides cerebral protection comparable to moderate hypothermia while reducing coagulopathy, transfusion needs, and complications-particularly relevant for centers in resource-limited countries.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006604","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":"Fissureless Non-arterial Dissection Videothoracoscopic Lobectomy for Lower Lobes.","authors":"Murat Kara, Salih Duman, Ilker Kolbas, Arda Sarigul, Seyhmus Cuhatutar, Berker Ozkan","doi":"10.1055/a-2687-1095","DOIUrl":"https://doi.org/10.1055/a-2687-1095","url":null,"abstract":"<p><p>Two primary techniques, namely, the conventional transfissural and the fissureless approaches, have been defined for videothoracoscopic lobectomy. We hypothesized that a videothoracoscopic fissureless, non-arterial dissection (NAD) technique-using new generation staplers-for lower lobe resections may reduce operative time and lower the intra- and postoperative complication rates.We had 69 consecutive patients assigned to a fissureless NAD or a conventional lobectomy for lower lobes. In the fissureless NAD technique, the pulmonary artery, together with the adjacent lung parenchyma along the fissure line, was divided as the last anatomical structure using staplers with tri-height cartridges. We analyzed the feasibility and safety of the fissureless NAD technique.A total of 29 (42%) patients underwent NAD lobectomy. The mean operative time was significantly shorter in the NAD group (<i>p</i> = 0.003). No patient had intraoperative complication, and three (10.3%) patients (<i>p</i> = 0.212) had postoperative complication in the NAD group. The mean time of chest tube removal (<i>p</i> = 0.031) and the length of hospital stay (<i>p</i> = 0.008) were significantly shorter in the NAD group.The fissureless NAD videothoracoscopic lobectomy is a safe and feasible technique for lower lobectomies. This technique significantly reduces the operative time with potential benefit of earlier patient discharge.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993302","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}