Thoracic and Cardiovascular Surgeon最新文献

{"title":"Characteristics and Ethnic Distribution of Aortic Aneurysms in a Caribbean Cohort.","authors":"Michael J Ramdass, Shivani T Persad, Patrick Harnarayan","doi":"10.1055/a-2128-5016","DOIUrl":"10.1055/a-2128-5016","url":null,"abstract":"<p><strong>Background: </strong> There is a paucity of data regarding relationships between patient demographics and aneurysm characteristics in the West Indies. With this in mind, a retrospective cross-sectional review was conducted analyzing the computed tomography aortogram reports/images of 273 aortic aneurysms.</p><p><strong>Methods: </strong> Data were collected and analyzed on ethnicity, size, type, morphology, presence and maximum size of thrombus and aneurysm location, demographics, and clinical presentation with correlations.</p><p><strong>Results: </strong> There were 273 patients with aortic aneurysms giving an incidence rate of 4.33 per 100,000 people per annum. Statistically significant associations were noted with age, gender, and ethnicity. All false aneurysms were male (<i>p</i> = 0.004). The average size of aortic aneurysms being 0.7 cm larger in males than females (<i>p</i> < 0.001). Females were more likely to present with rupture (<i>p</i> = 0.001). Thrombus was more likely in males, Black and mixed races, and in the 8th decade (<i>p</i> < 0.001). Mean age of presentation was the highest in East Indians at 78 than the other ethnicities (Chinese: 65, Black: 70, mixed: 71, White: 73).</p><p><strong>Conclusion: </strong> Aortic aneurysmal disease is increasing in Trinidad and the Caribbean. Infrarenal fusiform aneurysms are the most common types with many significant differences based on age, gender, and ethnicity in the Caribbean population.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"10-18"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9971170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Solitary Fibrous Tumor of the Pleura: Surgical Treatment and Recurrence.","authors":"Mary Bove, Giovanni Natale, Gaetana Messina, Matteo Tiracorrendo, Erino Angelo Rendina, Alfonso Fiorelli, Antonio D'Andrilli","doi":"10.1055/s-0043-1777260","DOIUrl":"10.1055/s-0043-1777260","url":null,"abstract":"<p><strong>Background: </strong> Solitary fibrous tumors of the pleura (SFTPs) are primary pleural tumors originating from the mesenchymal tissue. Surgical treatment was the first choice for management of SFTPs. There were no defined guidelines for the follow-up of these tumors and the postoperative therapy due to the rarity of these tumors.</p><p><strong>Methods: </strong> We conducted a retrospective, multicenter study from two high-volume centers in Italy. Data of patients diagnosed with pleural solitary fibrous tumors between January 2003 and October 2022 were prospectively recorded and retrospectively analyzed. The aim of this study was to identify predictive prognostic factors and the correlation between tumor characteristics and recurrence.</p><p><strong>Results: </strong> In all, 107 patients undergoing R0 surgical resection of pleural solitary fibrous tumor were included in the study. Patients were divided in two groups: benign and malignant. All the patients were treated with surgery with the aim to obtain R0 resection. Lung resection was necessary when the tumor adhered strongly to the lung parenchyma or infiltrated it. Twenty of the 107 patients had tumor recurrence. At a multivariate analysis, histological characteristics (high mitotic index) and maximum standardized uptake values (maxSUV) were related to recurrence. The mean disease-free survival (DFS) was 143.3 ± 6.1 months.</p><p><strong>Conclusion: </strong> In our experience, histological features of malignancy and maxSUV are significantly related to recurrence, which can occur even years after the first diagnosis. Surgical excision with negative surgical margins results in good long-term outcomes. After surgery, a long-term and strict follow-up should be done, in order to detect recurrence early. R0 of the recurrence is associated with long-term survival.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"78-85"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446293","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":"Trilateral versus Bilateral Antegrade Cerebral Perfusion in Frozen Elephant Trunk: A Propensity Score Analysis.","authors":"Razan Salem, Arnaud Van Linden, Jan Hlavicka, Afsaneh Karimian-Tabrizi, Ina Ischewski, Thomas Walther, Tomas Holubec","doi":"10.1055/a-2228-7189","DOIUrl":"10.1055/a-2228-7189","url":null,"abstract":"<p><strong>Objective: </strong> Spinal cord injury (SCI) with subsequent paraplegia and/or stroke after arch repair with frozen elephant trunk (FET) remain the most devastating complications. In this study, we aim to examine the impact of different cerebral perfusion strategies on the neurological outcome comparing bilateral antegrade cerebral perfusion (bACP) and trilateral antegrade cerebral perfusion (tACP).</p><p><strong>Methods: </strong> Between 2009 and 2021, 88 patients underwent total arch replacement using a hybrid prosthesis in FET technique for acute (40.4%) and chronic (59.6%) aortic pathologies. After excluding 14 patients who underwent FET with unilateral ACP the remaining 74 patients were divided into two groups. Propensity score matching was performed based on pre- and perioperative patient characteristics resulting in 22 patients in each group. The primary endpoint was a combination of major cerebral event and SCI. Secondary end point was all-cause mortality.</p><p><strong>Results: </strong> Major cerebral events occurred in 9% of the patients in bACP versus 13.6% in tACP group (<i>p</i> = 0.63). No postoperative SCI was observed in patients with bACP and only one patient suffered SCI with tACP (<i>p</i> = 0.31). There was no significant difference in 30-day mortality between the two groups (22.7% in bACP vs. 13.6% in tACP; <i>p</i> = 0.43).</p><p><strong>Conclusion: </strong> In patients undergoing total aortic arch repair using FET technique, both perfusion strategies (bilateral and trilateral ACP) are safe and effective. The rates of neurological complications as well as mortalities are acceptably low in both groups. Further studies with larger patient cohorts are warranted.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"25-32"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138802884","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 New Predisposing Factor for Postoperative Atrial Fibrillation: Tube Insertion Site.","authors":"Zinar Apaydın, Barış Timur, Batuhan Yazıcı, Kübra Gözaçık, Anıl Akbaş, Timuçin Aksu, Taner İyigün","doi":"10.1055/a-2474-2827","DOIUrl":"10.1055/a-2474-2827","url":null,"abstract":"<p><strong>Background: </strong> The aim of this study is to compare the insertion sites of drainage tubes placed in the left thorax after elective coronary artery bypass grafting (CABG) surgeries.</p><p><strong>Materials and methods: </strong> Patients were divided into two groups based on the site of tube insertion into the left hemithorax: those with a tube inserted from the subxiphoid region and those with a tube inserted from the left intercostal region. Comparative analyses between these two groups and factor analyses contributing to the outcome were performed.</p><p><strong>Results: </strong> There were no significant differences observed in terms of age, gender, height, and weight among patients undergoing coronary artery bypass surgery based on the site of drain placement. Twelve patients (5.2%) required re-drainage procedures, with five (41.7%) for pneumothorax and seven (58.3%) for pleural effusion. Atelectasis was absent in 144 patients (62.1%) while present in 88 patients (37.9%). The frequency of atrial fibrillation (AF) was significantly higher in the group with intercostal drains. Additionally, pain scale scores were significantly higher in patients with intercostal drains. Path analysis revealed that the visual pain scale value played a full mediating role in the effect of the drain site on AF.</p><p><strong>Conclusion: </strong> The statistically significant occurrence of pain and higher rates of postoperative AF in patients with intercostal tube placement are noteworthy. We believe that in patients undergoing elective coronary artery bypass surgery, the drain placed in the left hemithorax should be inserted from the subxiphoid region, if there are no contraindications.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669310","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 High-intensity Statin on Atrial Fibrillation after Off-Pump Coronary Artery Bypass.","authors":"Yeiwon Lee, Yoonjin Kang, Ji Seong Kim, Sue Hyun Kim, Suk Ho Sohn, Ho Young Hwang","doi":"10.1055/a-2447-0020","DOIUrl":"10.1055/a-2447-0020","url":null,"abstract":"<p><strong>Background: </strong> There is uncertainty regarding the impact of high-intensity statins on postoperative outcomes in patients undergoing surgical myocardial revascularization. This study was conducted to evaluate the impact of high-intensity statin treatment on the occurrence rate of new-onset postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass grafting (OPCAB).</p><p><strong>Methods: </strong> Six hundred and thirteen patients (66.8 ± 9.8 years, male:female = 476:137) who underwent isolated OPCAB were retrospectively enrolled. Hypertension (<i>n</i> = 409, 66.7%), diabetes mellitus (<i>n</i> = 343, 59.6%), and chronic kidney disease (<i>n</i> = 138, 22.5%) were common comorbidities. Statins and beta-blockers were administered to all patients until the day of surgery and resumed within 6 hours after surgery. Risk factors associated with POAF were analyzed, including the use of high-intensity statins (atorvastatin 40-80 mg or rosuvastatin 20 mg), as well as baseline characteristics and preoperative risk factors.</p><p><strong>Results: </strong> High-intensity statins were used in 158 patients (25.8%). POAF occurred in 184 patients (30.0%). The use of high-intensity statins was not correlated with preoperative levels of low-density lipoprotein (<i>p</i> = 0.446) or high-sensitivity C-reactive protein (<i>p</i> = 0.478). Multivariate logistic regression analysis revealed that the use of high-intensity statins was significantly associated with a reduced occurrence of POAF (<i>p</i> = 0.022, odds ratio [95% confidence interval] = 0.592 [0.378-0.926]). Age, acute coronary syndrome, insulin-dependent diabetes mellitus, and chronic kidney disease were also significantly associated with POAF.</p><p><strong>Conclusion: </strong> Preoperative administration of high-intensity statins was associated with a 41% reduction in the occurrence rate of POAF in patients who underwent OPCAB.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508539","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":"Coal Holes.","authors":"Markus K Heinemann","doi":"10.1055/s-0044-1793951","DOIUrl":"https://doi.org/10.1055/s-0044-1793951","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":"72 8","pages":"577-578"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732708","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":"Retention Rate of Free Pericardial Fat Grafts after Bronchial Stump Coverage.","authors":"Takahiro Karasaki, Sakashi Fujimori, Souichiro Suzuki, Shinichiro Kikunaga","doi":"10.1055/a-2335-9986","DOIUrl":"10.1055/a-2335-9986","url":null,"abstract":"<p><p>The postoperative course of the graft tissue after bronchial stump coverage remains unclear. We retrospectively analyzed 44 patients who underwent anatomical lung resection followed by bronchial stump coverage using free pericardial fat grafts. All patients underwent minimally invasive video-assisted thoracoscopic surgery. Computed tomography scans showed a graft retention rate of 100% on 60 days after surgery, 61% on 180 days, and plateauing at around 20% after 1 year. Free pericardial fat grafts, harvested minimally invasively, demonstrated a promising retention rate after surgery, making them a suitable option for patients with a high risk of bronchopleural fistula.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"646-650"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180746","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":"Single-Port da Vinci Robot-Assisted Cervical Esophagectomy: How to Do It.","authors":"Edin Hadzijusufovic, Vladimir J Lozanovski, Eva-Verena Griemert, Luca Bellaio, Hauke Lang, Peter P Grimminger","doi":"10.1055/a-2405-2708","DOIUrl":"10.1055/a-2405-2708","url":null,"abstract":"<p><p>Minimally invasive esophagectomies, including robot-assisted procedures, have demonstrated superiority over traditional open surgery. Despite the prevalence of transhiatal and transthoracic approaches, cervical access is less common in minimally invasive esophageal surgery. Advancements in robotic systems, such as the da Vinci Single Port (SP), enable controlled transcervical extrapleural mediastinoscopic access, potentially reducing pulmonary complications and extending surgical options to patients with comorbidities. The da Vinci SP robot-assisted cervical esophagectomy (SP-RACE) employs an SP and laparoscopic approach, demonstrating feasibility with comparable lymphadenectomy and recurrent nerve palsy rates to transthoracic methods. This technique, performed for the first time in Europe at the University Hospital Mainz, involves a transcervical SP phase that allows for effective mediastinal dissection and esophageal mobilization. Despite technical challenges due to limited space, robotic systems enhance controlled access and eliminate arm collision. The da Vinci SP platform's advantages include improved triangulation, fewer interferences, and better control of instruments in confined spaces. This novel approach shows promise for patients with high esophageal tumors and those unsuitable for transthoracic surgery, warranting further investigation into its clinical utility and reproducibility.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"654-658"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11597184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and Late Results after Surgical Mitral Valve Repair: A High-Volume Center Experience.","authors":"Julia Götte, Armin Zittermann, Marcus-Andre Deutsch, Rene Schramm, Sabine Bleiziffer, Andre Renner, Jan F Gummert","doi":"10.1055/a-2266-7677","DOIUrl":"10.1055/a-2266-7677","url":null,"abstract":"<p><strong>Background: </strong> Surgical mitral valve repair is the gold standard treatment of severe primary mitral regurgitation (MR). In the light of rapidly evolving percutaneous technologies, current surgical outcome data are essential to support heart-team-based decision-making.</p><p><strong>Methods: </strong> This retrospective, high-volume, single-center study analyzed in 1779 patients with primary MR early morbidity and mortality, postoperative valve function, and long-term survival after mitral valve (MV) repair. Surgeries were performed between 2009 and 2022. Surgical approaches included full sternotomy (FS) and right-sided minithoracotomy (minimally invasive cardiac [MIC] surgery).</p><p><strong>Results: </strong> Of the surgeries (mean age: 59.9 [standard deviation:11.4] years; 71.5% males), 85.6% (<i>n</i> = 1,527) were minithoracotomies. Concomitant procedures were performed in 849 patients (47.7%), including tricuspid valve and/or atrial septal defect repair, cryoablation, and atrial appendage closure. The majority of patients did not need erythrocyte concentrates. Mediastinitis and rethoracotomy for bleeding rates were 0.1 and 4.3%, respectively. Reoperation before discharge for failed repair was necessary in 12 patients (0.7%). Freedom from more than moderate MR was > 99%. Thirty-day mortality was 0.2% and did not differ significantly between groups (<i>p</i> = 0.37). Median follow-up was 48.2 months with a completeness of 95.9%. Long-term survival was similar between groups (<i>p</i> = 0.21). In the FS and MIC groups, 1-, 5-, and 10-year survival rates were 98.8 and 98.8%, 92.9 and 94.4%, and 87.4 and 83.1%, respectively.</p><p><strong>Conclusion: </strong> MV surgery, both minimally invasive and via sternotomy, is associated with high repair rates, excellent perioperative outcomes, and long-term survival. Data underscore the effectiveness of surgical repair in managing MR, even in the era of advancing interventional techniques.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"624-630"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724095","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":"New Insights into Mortality-Related Risk Factors in Infective Endocarditis: Results from the Brandenburg State Endocarditis Register.","authors":"Roya Ostovar, Filip Schroeter, Frarzane Seifi Zinab, Dirk Fritzsche, Hans-Heinrich Minden, Nirmeen Lasheen, Martin Hartrumpf, Oliver Ritter, Gesine Dörr, Johannes Maximilian Albes","doi":"10.1055/a-2199-2344","DOIUrl":"10.1055/a-2199-2344","url":null,"abstract":"<p><strong>Objective: </strong> Endocarditis as a potentially life-threatening disease with high complication and mortality rates. In recent years, an increase in the incident of endocarditis has been reported throughout Europe. In the aging society, successful treatment is complex and challenging owing to the high rate of multimorbidity.</p><p><strong>Methods: </strong> We initiated a statewide prospective multicenter endocarditis registry in 2020. Perioperative risk factors, comorbidities, microbiological, laboratory and imaging diagnostics, complications, and mortality including 1-year follow-up were collected. The present midterm analysis includes factors influencing mortality in the first 313 patients.</p><p><strong>Result: </strong> In-hospital mortality and 1-year mortality were 28.4 and 40.9%, respectively. Preoperative risk factors include age (<i>p</i> < 0.001), EuroSCORE II (<i>p</i> < 0.001), coronary artery disease (<i>p</i> = 0.022), pacemaker probe infection (<i>p</i> = 0.033), preoperative left ventricular ejection fraction (LVEF), systemic inflammatory response syndrome (SIRS), pulmonary edema, heart failure, septic emboli, acute renal failure, impaired coagulation, hypalbuminemia (<i>p</i> < 0.001), and N-terminal prohormone of brain natriuretic peptide (NTproBNP) (<i>p</i> = 0.001). The presence of peri-annular abscess, perforation, and shunt were associated with increased mortality (<i>p</i> = 0.004, 0.001, and 0.004, respectively). In addition, cardiopulmonary bypass time influenced mortality (<i>p</i> = 0.002). The main postoperative causes of death were multi-organ failure, renal failure, vasoplegia, and low-output syndrome (<i>p</i> < 0.001). Previous endocarditis was 7.7%, while 35.5% were prosthetic valve recipients and 33.6% were redo surgeries.</p><p><strong>Conclusion: </strong> Our first registry data show the complexity of endocarditis patients and the challenging treatment. Some risk factors can be treated preoperatively. For instance, hypalbuminemia and the duration of the procedure can be controlled with adequate albumin substitution and carefully planned procedures restricted to the essential requirements, that is, hybrid approaches with consecutive interventions.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"587-594"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54231055","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}