Thoracic and Cardiovascular Surgeon最新文献

{"title":"Risk Factors for Stage 3 Acute Kidney Injury after Acute Stanford Type A Aortic Dissection Repair.","authors":"Yaling Cui, Haisheng Chen, Chunxi Zhang, Bin Li, Zhigen Li","doi":"10.1055/a-2923-5881","DOIUrl":"10.1055/a-2923-5881","url":null,"abstract":"<p><strong>Background: </strong>This study explored the risk factors for developing severe acute kidney injury (AKI, stage 3) after acute type A aortic dissection (ATAAD) surgery.</p><p><strong>Methods: </strong>In total, 163 patients with ATAAD who underwent Bentall or ascending aortic replacement combined with total arch replacement and elephant trunk repair at our center between January 2017 and December 2022 were retrospectively analyzed. Postoperative stage 3 AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. Multivariate logistic regression analyses were performed to identify independent risk factors for postoperative stage 3 AKI.</p><p><strong>Results: </strong>Stage 3 AKI occurred in 35 patients (21.5%), who demonstrated a significantly higher in-hospital mortality than the stage 0 to 2 AKI group (risk ratio = 4.88, χ² = 11.557; <i>p</i> = 0.001). Preoperative serum creatinine (sCr), preoperative estimated glomerular filtration rate, chronic kidney disease history, long-term smoking history, surgical method, cardiopulmonary bypass time, aortic cross-clamp time, postoperative low cardiac output, and postoperative stroke were significantly associated with stage 3 AKI (<i>p</i> < 0.05). Multivariate logistic regression analysis identified preoperative sCr (odds ratio [OR] = 1.023, 95% confidence interval [CI]: 1.013-1.034; <i>p</i> = 0.000), surgical method (OR = 0.089, 95% CI: 0.025-0.319; <i>p</i> = 0.000), and postoperative low cardiac output (OR = 15.214, 95% CI: 1.765-131.135; <i>p</i> = 0.013) as independent risk factors for AKI3. Preoperative sCr could effectively predict postoperative AKI3 (area under the curve = 0.747; cutoff value: 123.5 μmol/L; sensitivity: 63%; specificity: 83%).</p><p><strong>Conclusion: </strong>Postoperative AKI3 was significantly associated with in-hospital mortality after ATAAD surgery. Preoperative sCr, surgical method, and postoperative low cardiac output are independent risk factors for postoperative AKI3. Patients with preoperative sCr >123.5 µmol/L should be closely monitored for increased risk.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607802","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":"Redo Coronary Artery Bypass Grafting: The Hidden Challenges of Propensity-Matched Comparisons.","authors":"Khaled Ebrahim Al Ebrahim","doi":"10.1055/a-2933-1982","DOIUrl":"10.1055/a-2933-1982","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726909","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":"Enhanced Trocar Design Optimizes Robotic-Assisted Lung Resection.","authors":"Shuenn-Wen Kuo, Jang-Ming Lee, Pei-Ming Huang","doi":"10.1055/a-2924-6258","DOIUrl":"10.1055/a-2924-6258","url":null,"abstract":"<p><p>This study aims to assess the initial experience with a downsized bevel-cut trocar to enhance lung resection in robot-assisted thoracoscopic surgery (RATS). In addition, we provide a mathematical model to support the scientific rationale and functional advantages of this design.We analyzed the impact of trocar cannula diameter using software and conducted a retrospective review of patients who underwent lung resection using a modified bevel-cut trocar for uniportal or biportal RATS between July 2024 and February 2025. Perioperative and postoperative outcomes, including incision length, surgery duration, complications, and hospital stay, were compared with those of conventional trocar RATS.A total of 34 patients underwent RATS anatomical lung resection, including 12 with modified bevel-cut trocars and 22 with conventional trocars. Baseline demographic and clinical characteristics were comparable between groups. The modified trocar group had shorter utility incision lengths than the conventional trocar group (overall <i>p</i> < 0.001). Mean incision length was 3.75 cm (range, 3.0-4.5) versus 6.0 cm for uniportal RATS and 3.0 cm versus 4.6 cm (range, 4.0-6.0) for biportal RATS. In exploratory approach-specific comparisons, operative time was shorter in the modified trocar group for both uniportal and biportal RATS (<i>p</i> = 0.007 and <i>p</i> = 0.039, respectively), whereas this finding should be interpreted cautiously because of the small subgroup sizes and non-randomized approach selection. No conversion, major postoperative complication, or mortality occurred.The modified bevel-cut trocar offers a safer and more practical solution for performing uniportal or biportal RATS.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607735","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":"Partial Upper Sternotomy versus Right Thoracotomy with Central Cannulation for Surgical Aortic Valve Replacement.","authors":"Laura Rings, Rasha E Boulos, Stak Dushaj, Igor Tudorache, Petar Risteski, Hector Rodriguez Cetina Biefer, Omer Dzemali","doi":"10.1055/a-2922-5500","DOIUrl":"https://doi.org/10.1055/a-2922-5500","url":null,"abstract":"<p><strong>Objectives: </strong>This study compared surgical aortic valve replacement (SAVR) via partial upper sternotomy (PUS) and right anterolateral thoracotomy (RALT) with central aortic cannulation regarding intraoperative perfusion parameters, transfusion requirements, and early postoperative outcomes.</p><p><strong>Methods: </strong>We retrospectively analyzed 380 patients who underwent isolated SAVR via PUS or RALT. Propensity score matching yielded 107 matched pairs. All patients underwent central aortic and peripheral venous cannulation.</p><p><strong>Results: </strong>Cardiopulmonary bypass, aortic cross-clamp, and total operative times were longer in the RALT group, whereas reperfusion time was shorter (all <i>p</i> < 0.001). Transfusion requirements for packed red blood cells, fresh-frozen plasma, and platelet concentrates did not differ between groups. Cell salvage volume was generally lower in the RALT group after matching. Intubation times were comparable between groups. Intensive care unit (ICU) length of stay and total postoperative hospital stay were shorter in the RALT group (<i>p</i> < 0.001 and <i>p</i> = 0.008, respectively). Peak catecholamine requirements were lower in the RALT group (<i>p</i> = 0.005). Rates of permanent pacemaker implantation and pulmonary, wound, and urinary tract infections did not differ. In-hospital mortality was 0.9% in the PUS group; no deaths occurred in the RALT group.</p><p><strong>Conclusion: </strong>Both approaches achieved low in-hospital mortality and comparable complication rates. Despite longer operative times, RALT was associated with shorter ICU and hospital stays and lower vasopressor requirements. RALT with central aortic cannulation is a safe and feasible alternative to PUS for minimally invasive aortic valve surgery.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702209","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":"Adjunct Coronary Endarterectomy in CABG: Risk Stratification and Midterm Outcomes.","authors":"Ahmed Hasan, Mohamed Gad, Yasser Mubarak","doi":"10.1055/a-2923-5942","DOIUrl":"10.1055/a-2923-5942","url":null,"abstract":"<p><strong>Background: </strong>Complete revascularization in diffuse coronary artery disease (CAD) is challenging when target vessels are small and circumferentially diseased. Coronary endarterectomy (CE) can enable reconstruction where a standard distal anastomosis is not feasible, but its impact remains debated. This study aimed to evaluate the impact of concomitant CE with coronary artery bypass grafting (CABG) on midterm outcomes and explore the potential risk factors for adverse events.</p><p><strong>Methods: </strong>A single-center, retrospective cohort (2017-2022) of patients who underwent CABG with or without CE (<i>n</i> = 406; CE <i>n</i> = 97, CABG-only <i>n</i> = 309). The prespecified primary endpoint was major adverse cardiovascular events (all-cause mortality or myocardial infarction [MI]) assessed in-hospital/30 days and up to 72 months. CE-subgroup risk modelling used Firth penalized logistic regression. Effects were summarized as odds ratios (95% confidence intervals [CIs]); time-to-event analyses used Kaplan-Meier.</p><p><strong>Results: </strong>Early perioperative MI and in-hospital mortality did not differ significantly between groups. Over 72 months, overall survival was similar (log-rank <i>p</i> = 0.289). Within the CE cohort, midterm MI (1.0%) and stroke (2.1%) were infrequent. In multivariable CE-subgroup modelling, renal impairment, female sex, peripheral vascular disease (PVD), and age ≥65 were independently associated with complications.</p><p><strong>Conclusion: </strong>Selective CE with CABG yielded comparable early and midterm outcomes to CABG-only, with low midterm complication rates. Risk was concentrated among women, patients with renal impairment or PVD, and those aged ≥65 years, supporting heightened perioperative vigilance and tailored follow-up in these subgroups.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607763","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":"Postoperative Recurrence of ROS1-Rearranged Lung Adenocarcinoma: A Case Series.","authors":"Ryo Miyata, Ryota Sumitomo, Ryo Nakanobo, Masatsugu Hamaji","doi":"10.1055/a-2768-2882","DOIUrl":"10.1055/a-2768-2882","url":null,"abstract":"<p><strong>Abstract: </strong>Postoperative recurrence of c-ros oncogene 1 (<i>ROS1</i>)-rearranged non-small cell lung cancer is rarely reported, and the role of tyrosine kinase inhibitors (TKIs) remains unclear. We retrospectively reviewed four patients with completely resected <i>ROS1</i>-positive lung adenocarcinoma who developed recurrence, three receiving crizotinib. The median disease-free interval was 33.4 months, and the median overall survival from postoperative recurrence and initial surgery was 40.7 and 71.2 months, respectively. Brain metastases were the most common initial recurrence site (75%). Crizotinib showed limited efficacy with a median progression-free survival of 3.5 months. These findings highlight indolent disease behavior but limited TKI benefit, supporting the need for adjuvant trials.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"430-432"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744206","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 Geometry of Survival: Left Ventricular Mass Index's Prognostic Value in Coronary Surgery.","authors":"Barış Timur, Rezan Aksoy, Zihni Mert Duman, Recep Çalışkan, Kandemir Baş, Cem Aydoğdu, Cevdet Ugur Kocogullari","doi":"10.1055/a-2637-0964","DOIUrl":"10.1055/a-2637-0964","url":null,"abstract":"<p><strong>Background: </strong>This study explores the impact of left ventricular mass and geometry on the prognosis of patients undergoing coronary artery bypass grafting. Left ventricular hypertrophy is a known risk factor for cardiovascular complications, yet its role in surgical outcomes remains underexplored.</p><p><strong>Methods: </strong>A retrospective cohort of 494 elective coronary artery bypass grafting patients treated between 2013 and 2018 was analyzed. Left ventricular mass was calculated using the Devereux formula, and patients were divided into normal and increased left ventricular mass index groups. Mortality rates, postoperative complications, and echocardiographic parameters were evaluated.</p><p><strong>Results: </strong>Patients with increased left ventricular mass exhibited significantly higher 5-year mortality rates (27.2 vs. 11.5%, <i>p</i> < 0.001), postoperative atrial fibrillation (24.8 vs. 16.0%, <i>p</i> = 0.018), and carotid stenosis (21.8 vs. 12.5%, <i>p</i> = 0.006). Elevated preoperative biomarkers, including creatinine and C-reactive protein, were observed in this group, with sustained impairment in postoperative kidney function. However, no significant differences in 30-day, 1-year, or 3-year mortality rates were detected.</p><p><strong>Conclusion: </strong>Left ventricular mass and geometry independently predict long-term outcomes in coronary artery bypass grafting patients. Targeted strategies to mitigate left ventricular remodeling may enhance postoperative outcomes. Future research should focus on therapeutic interventions to reverse adverse left ventricular changes and optimize patient survival and quality of life.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"349-354"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144544973","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":"Effectiveness of Gentamicin-Collagen Sponges in Preventing Sternal Wound Infections.","authors":"Roi Glam, Tom Ronai, Maged Makhoul, Tom Friedman, Mahli Raad, Zvi Adler, Oved Cohen, Benjamin Medalion, Gil Bolotin","doi":"10.1055/a-2635-3239","DOIUrl":"10.1055/a-2635-3239","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate whether the combined use of gentamicin-collagen sponges and topical vancomycin reduces the incidence of sternal wound infections (SWIs) in patients at high risk for infection following cardiac surgery.</p><p><strong>Methods: </strong>A single-center, retrospective study compared two groups of high-risk cardiac surgery patients from June 2018 to September 2021. High-risk patients, identified through departmental consensus, had multiple SWI risk factors. The study group (278 patients) received gentamicin-collagen sponges plus topical vancomycin, whereas the control group (309 patients) received only topical vancomycin. The primary outcome was SWI incidence.</p><p><strong>Results: </strong>The incidence of SWI was significantly lower in the study group, with 2.8% (8/278) compared with 9% (28/309) in the control group (<i>p</i> = 0.002). After adjusting for known risk factors, the odds of infection in the control group were 4.64 times higher (95% confidence interval [CI]: 1.63-13.21) than in the study group. The rate of deep sternal wound infections (DSWI) was 1.8% in the study group versus 4.2% in the control group (<i>p</i> = 0.09), with adjusted odds of DSWI being 4.1 times higher in the control group (95% CI: 0.99-16.86). Although the <i>p</i>-value was borderline (<i>p</i> = 0.05), no significant differences in mortality rates were observed between the two groups.</p><p><strong>Conclusion: </strong>The use of gentamicin-collagen sponges as part of a prophylactic regimen significantly reduces the incidence of SWI in high-risk cardiac surgery patients, suggesting its potential benefit as an adjunctive treatment in preventing postoperative infections.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"397-403"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310429","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":"Variables Associated with Treatment Failure after Negative Pressure Wound Therapy in Poststernotomy Mediastinitis: A Case-Control Study.","authors":"Christoph Schimmer, Christina Heinowski, Khaled Hamouda, Patrick Meybohm, Nodir Madrahimov, Gloria Färber, Dejan Radakovic","doi":"10.1055/a-2733-4361","DOIUrl":"10.1055/a-2733-4361","url":null,"abstract":"<p><strong>Background: </strong>This study investigated factors leading to treatment failure after negative pressure wound therapy (NPWT) in poststernotomy mediastinitis (PSM) patients.</p><p><strong>Methods: </strong>A single-center retrospective case-control study in 198 cardiac surgery patients with PSM and consecutive NPWT were retrospectively divided into two groups. Group I consisted of patients whose NPWT was successful (<i>n</i> = 117/198; 59.1%), while in Group II treatment, failure occurred (<i>n</i> = 81/198; 40.9%). The primary endpoint was treatment failure, defined as recurrence of wound infection requiring surgical treatment within 30 days after secondary wound closure.</p><p><strong>Results: </strong>Body mass index (BMI) >30 kg/m² (<i>p</i> = 0.04; odds ratio [OR] 1.07), diabetes mellitus (DM; <i>p</i> = 0.03; OR 1.94), and the number of sponge changes (<i>p</i> = 0.01; OR 1.57) showed an association with the occurrence of NPWT failure. During the study period, 10/198 (19.8%) patients died after secondary wound healing. In group I, 1/117 (0.9%) patient died versus group II with 9/81 (12.7%) patients. About 70% patients died from septic multiple organ failure.</p><p><strong>Conclusion: </strong>This study confirms that variables associated with treatment failure after NPWT in PSM are BMI >30 kg/m², diabetes mellitus (DM), and the \"number of sponge changes,\" respectively. However, this does not mean that sponge changes increase the risk; rather, sponge changes are associated with more resistant germs, incomplete wound healing, and more aggressive infection. This implies that management should be in the hands of cardiac surgeons with extensive experience in septic surgery and at centers with expertise in order to minimize the duration of NPWT and thus the number of sponge changes.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"404-409"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410205","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 Bypass in Obese Patients: Beyond Cosmesis.","authors":"Christos Voucharas, Angeliki Vouchara, Evangelia Tsigkraki","doi":"10.1055/a-2707-0772","DOIUrl":"10.1055/a-2707-0772","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"361"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226009","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}