Thoracic and Cardiovascular Surgeon最新文献

{"title":"Minimal Learning Curve for Minimally Invasive Aortic Valve Replacement.","authors":"Dror B Leviner, Tom Ronai, Dana Abraham, Hadar Eliad, Naama Schwartz, Erez Sharoni","doi":"10.1055/a-2337-1978","DOIUrl":"10.1055/a-2337-1978","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive aortic valve replacement (MiAVR) is an established technique for surgical aortic valve replacement (AVR). Although MiAVR was first described in 1993 and has shown good results compared with full sternotomy AVR (FSAVR) only a minority of patients undergo MiAVR. We recently started using MiAVR via an upper hemisternotomy. We aimed to examine the early results of our initial experience with this technique.</p><p><strong>Methods: </strong>We compared 55 MiAVR patients with a historical cohort of 142 isolated FSAVR patients (December 2016-December 2022). The primary outcome was in-hospital mortality. Secondary outcomes included cardiopulmonary bypass (CPB) and cross-clamp times, blood product intake, in-hospital morbidity, and length of intensive care unit and hospital stay.</p><p><strong>Results: </strong>There was no significant difference in preoperative characteristics, including age, laboratory values, and comorbidities. There was no significant difference between the groups regarding in-hospital mortality (FSAVR 3.52 vs. MiAVR 1.82%). There was no significant difference in CPB time (FSAVR 103.5 [interquartile range: 82-119.5] vs. MiAVR 107 min [92.5-120]), aortic cross-clamp time (FSAVR 81 [66-92] vs. MiAVR 90 min [73-99]), and valve size (FSAVR 23 [21-25] vs. MiAVR 23 [21-25]). The incidence of intraoperative blood products transfusion was significantly lower in the MiAVR group (10.91%) compared with the FSAVR group (25.35%, <i>p</i> = 0.03).</p><p><strong>Conclusion: </strong>Our findings further establish the possibility of reducing invasiveness of AVR without compromising patient safety and clinical outcomes. This is true even in the learning curve period and without requiring any significant change in the operative technique and dedicated equipment.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"296-303"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238228","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":"Staging of Early-Stage Lung Cancer without Routine PET in Candidates for Segmentectomy.","authors":"Alberto Lopez-Pastorini, Zehra Tatli, Antonia von Bargen, Dennis Faltenberg, Hendrik Beling, Aris Koryllos, Thomas Galetin, Erich Stoelben","doi":"10.1055/a-2405-2603","DOIUrl":"10.1055/a-2405-2603","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to investigate the accuracy of clinical staging without the routine use of positron emission tomography/computed tomography (PET/CT) in patients with cIA1 and cIA2 non-small-cell lung cancer (NSCLC) scheduled for segmentectomy.</p><p><strong>Methods: </strong>A total of 305 consecutive segmentectomies were retrospectively analyzed. Overall survival was calculated using the Kaplan-Meier method. Logistic regression was performed to investigate factors independently associated with pathologic upstaging.</p><p><strong>Results: </strong>The Union for International Cancer Control (UICC) upstaging was found in 86 patients (28%). Upstaged patients had longer operative times (146 ± 46 vs. 131 ± 44 minutes, <i>p</i> = 0.009), a higher number of lymph node resection (17 ± 10 vs. 13 ± 8, <i>p</i> = 0.001), and a higher rate of L1 involvement (34 vs. 16%, <i>p</i> < 0.001) than nonupstaged patients. N1 was found in 10 patients (3%) and N2 in 13 patients (4%). Nodal positive patients had longer operation times (154 ± 50 vs. 133 ± 44 minutes, <i>p</i> = 0.031) and higher rates of R1 (9 vs. 1%, <i>p</i> = 0.006) and L1 (39 vs. 20%, <i>p</i> < 0.026) than patients without nodal involvement. The 3- and 5-year overall survival rates for nonupstaged and upstaged patients were 85 and 67% and 67 and 54%, respectively (<i>p</i> = 0.040). In logistic regression, L1 involvement (odds ratio [OR]: 2.394, <i>p</i> = 0.005) and the number of dissected lymph nodes (OR: 1.037, <i>p</i> = 0.016) were independently associated with upstaging. Patients who received PET as part of clinical staging did not have a significantly lower nodal upstaging.</p><p><strong>Conclusion: </strong>Selective use of PET/CT based on the results of CT may be a viable option for patients with proven or suspected NSCLC up to 2 cm in size.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"317-324"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112320","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":"Delayed Sternal Closure in Heart Surgery: Outcomes and Quality of Life.","authors":"Henrik Heuer, Zhiyang Song, Philipp Hegner, André Truong, Sigrid Wiesner, Armando Terrazas, Christopher Larisch, Hans-Christoph Aigner, Bernhard Floerchinger, Christof Schmid, Jing Li","doi":"10.1055/a-2607-6390","DOIUrl":"10.1055/a-2607-6390","url":null,"abstract":"<p><p>Delayed sternal closure (DSC) is a well-established strategy used to manage patients with hemodynamic instability and perioperative coagulopathy following cardiac surgery. The study aims to present our 15-year surgical experiences with DSC.Between 2007 and 2022, DSC was performed in 227 out of 14,210 patients (1.7%) who underwent cardiac surgery at our institution. Perioperative data, outcomes, and long-term survival were analyzed. Quality of life (QoL) was assessed utilizing the EuroQol-5D-5L questionnaire.Indications for DSC included low cardiac output syndrome (LCOS) (44.1%) and coagulopathy during the index procedure (32.2%), as well as postoperative tamponade (22.9%). In coronary artery bypass grafting, LCOS was the primary indication for DSC (72.7%), whereas in acute type A aortic dissection, coagulopathy was the leading indication (70.6%). For other procedures, DSC indications were more evenly distributed. The overall 30-day survival was 57.5%, with survival rates of 43.3% for LCOS, 72.0% for coagulopathy, and 65.4% for tamponade. Multivariate logistic regression identified body mass index, postoperative renal replacement therapy, aggravated heart failure, and intraoperative packed red blood cell transfusion as negatively associated with 30-day survival. The mean follow-up period was 6.58 ± 3.19 years. Younger patients and DSC patients upon bleeding related indications reported higher QoL in comparison to older patients and patients with LCOS. Longer follow-up interval correlated with higher QoL.The study emphasizes the significant impact of LCOS on outcomes in patients undergoing DSC. We provide QoL data demonstrating good rehabilitation potential upon survival of the acute phase.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080372","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 Subcostal Robot-Assisted Minimally Invasive Esophagectomy-How to Do It?","authors":"Edin Hadzijusufovic, Vladimir J Lozanovski, Luca Bellaio, Evangelos Tagkalos, Eren Uzun, Eva-Verena Griemert, Hauke Lang, Peter P Grimminger","doi":"10.1055/a-2587-6701","DOIUrl":"10.1055/a-2587-6701","url":null,"abstract":"<p><p>Minimally invasive robot-assisted esophagectomies have proven superior to traditional open surgery. While transhiatal and transthoracic approaches are common, subcostal access remains less frequent in minimally invasive esophageal surgery. Recent advancements in robotic systems, such as the da Vinci Single-Port (SP), now facilitate precise subcostal access. This innovation holds potential to reduce postoperative pain, enhance patient mobility, and broaden surgical options for patients with multiple health conditions. The Single-Port Subcostal Robot-Assisted Minimal Invasive Esophagectomy (SP SC RAMIE) utilizes an SP and laparoscopic approach, enabling effective mediastinal dissection and esophageal mobilization with radical lymphadenectomy. This novel technique shows promise, especially for frail patients with multiple comorbidities who stand to benefit greatly from expedited recovery pathways. Nonetheless, further exploration is necessary to fully assess its clinical effectiveness and reproducibility.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035781","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":"Normothermic Circulatory Arrest with Antegrade Cerebral Perfusion for Type A Aortic Dissection.","authors":"Laura Rings, Rasha Boulos, Vasileios Ntinopoulos, Achim Haeussler, Hector Rodriguez Cetina Biefer, Omer Dzemali","doi":"10.1055/a-2576-7627","DOIUrl":"https://doi.org/10.1055/a-2576-7627","url":null,"abstract":"<p><p>Deep hypothermic circulatory arrest is the standard approach for the surgical repair of acute type A aortic dissection. This study aimed to evaluate the feasibility and outcomes of normothermic circulatory arrest using antegrade cerebral perfusion as an alternative technique.A retrospective propensity score-matched analysis was conducted on patients undergoing surgery for acute type A aortic dissection between 2007 and 2023 at a single center. Outcomes were compared between patients who underwent normothermic (>35°C) versus mild hypothermic (28-34°C) circulatory arrest. The primary outcomes were 30-day mortality, new neurological deficits, and the intraoperative and postoperative parameters.After propensity score matching, 20 pairs were analyzed. The normothermic group (NTCA) had significantly shorter aortic cross-clamp times (47.5 vs. 66.5 minutes, <i>p</i> = 0.013) and trends toward shorter cardiopulmonary bypass times (68 vs. 95 minutes, <i>p</i> = 0.066), ICU stays (4.5 vs. 5 days, <i>p</i> = 0.4), and intubation times (6 vs. 8 hours, <i>p</i> = 0.4). There were no significant differences in new neurological deficits (<i>n</i> = 6 [NTCA] vs. 4, <i>p</i> = 0.7), delirium (<i>n</i> = 5 [NTCA] vs. 6, <i>p</i> = 0.6), or mortality (<i>n</i> = 1 [NTCA] vs. 3, <i>p</i> = 0.6) between the groups. The normothermic group required less prothrombin complex concentrate (<i>p</i> = 0.0012).In this pilot study, NTCA with antegrade cerebral perfusion appears feasible and safe for hemiarch repair in acute type A aortic dissection, with potential benefits of shorter operative times and improved coagulation profiles compared with mild hypothermia. Larger prospective studies are needed to confirm these findings.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050480","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":"Do the Frequency of Aortic Dissection Surgery and 30-day Survival Depend on the Day of the Week, Climate Parameters, or Moon Phase?","authors":"Andreas Boening, Marc Brühl, Christopher Büsch, Niklas Luther, Elena Xoplaki, Rawa Arif, Thilo Noack, Jochen Pöling, Martin Czerny, Jens Brickwedel, Sven Peterss, Tomas Holubec, Philipp Jawny","doi":"10.1055/a-2547-5604","DOIUrl":"10.1055/a-2547-5604","url":null,"abstract":"<p><p>The German Registry of Aortic Dissections Type A (GERAADA) is a large European registry documenting patients with type A aortic dissection who have undergone surgical repair. This analysis investigated a potential association between the incidence of type A dissections (AADA) and lunar cycles, day of the week, or weather conditions.Data from 2,388 patients were analyzed for two endpoints: incidence of AADA surgery per day (analyzed using a Poisson regression to account for overdispersed data) and early mortality after surgery (analyzed using a logistic mixed regression to account for center heterogeneity). In both models, the influence of weather conditions (season, temperature, temperature difference, radiation, and synoptic conditions), moon phase, and weekday of operation was examined.The occurrence of AADA surgery was similar between weekdays (Monday to Friday), but less frequent on weekends. The 30-day mortality odds ratio was higher for surgeries performed on weekends than on weekdays. Operations were more frequent in winter than in other seasons. The occurrence of surgery or early mortality after surgery was not associated with synoptic weather conditions. Mean daily temperature and global radiation were not found to be different between survivors and patients with early deaths. No significant association was found between the moon phase and the occurrence or the outcome of surgery.The occurrence of AADA surgery was higher during winter, with colder mean temperatures, and lower on weekends than on weekdays. Mortality after surgery on weekends was higher than after surgery on weekdays.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531885","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":"Concomitant LAA Closure during Cardiac Surgery-Update 2025.","authors":"Sören Schenk, Simon Pecha, Nicolas Doll, Heiko Burger, Michael Knaut","doi":"10.1055/a-2561-8547","DOIUrl":"https://doi.org/10.1055/a-2561-8547","url":null,"abstract":"<p><p>Atrial fibrillation is associated with an increased risk of embolic strokes and is present in about one-fourth of all patients undergoing cardiac surgery. Closure of the left atrial appendage (LAA) can effectively reduce the risk of neurological events and is now a class IB recommendation in the most recent ESC/EACTS AF guidelines. The working group \"Heart Rhythm Disorders\" of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) evaluates the current state of clinical research and recommends concomitant LAA closure in patients with preoperative atrial fibrillation as a routine part of heart surgeries.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039594","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":"Swan Song.","authors":"Markus K Heinemann","doi":"10.1055/a-2554-3049","DOIUrl":"https://doi.org/10.1055/a-2554-3049","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":"73 3","pages":"183-184"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765035","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":"Comparison of Pulmonary Outcome in Minimally Invasive (TCRAT) and Full Sternotomy CABG.","authors":"Christian Sellin, Ulrike Sand, Volodymyr Demianenko, Christoph Schmitt, Benedikt Schäfer, Robert Schier, Hilmar Doerge","doi":"10.1055/a-2378-8459","DOIUrl":"10.1055/a-2378-8459","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary complications are among the main causes of increased mortality, and morbidity, as well as prolonged intensive care unit (ICU) and hospital stay after cardiac surgery. Recently, a sternum-sparing concept of minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) was introduced. A higher risk of pulmonary injury could be anticipated due to the thoracic incision and the longer duration of surgery. Pulmonary complications in TCRAT were compared to standard coronary artery bypass grafting (CABG) via full median sternotomy (FS).</p><p><strong>Methods: </strong>Records of 151 consecutive TCRAT (from September 2021 to November 2022) and 229 consecutive FS patients (from January 2017 to December 2018) patients, who underwent elective or urgent CABG, were analyzed. Preoperative baseline characteristics (age, sex, body mass index, diabetes, hypertension, chronic obstructive pulmonary disease, smoking status, left ventricular ejection fraction, pulmonary hypertonus, and EuroScore II) were comparable between groups.</p><p><strong>Results: </strong>Differences between examined groups examined were found for the pulmonary parameters: Horowitz index 6 hours after operation (TCRAT 270 ± 72 vs. FS 293 ± 73, <i>p</i> < 0.05), pneumothorax (TCRAT 0% vs. FS 2.6%, <i>p</i> < 0.05), bronchoscopies (TCRAT 5.9% vs. FS 1.7%, <i>p</i> < 0.05), and pleural effusion (TCRAT 8.6% vs. FS 3.5%, <i>p</i> < 0.05). Moreover, there were differences between groups with regard to mean ICU stay (TCRAT 2.4 ± 3.0 days vs. FS 1.8 ± 1.8 days, <i>p</i> < 0.05), stroke (TCRAT 0% vs. FS 1.3%, <i>p</i> < 0.05), and hospital stay (TCRAT 10.9 ± 8.5 days vs. FS 13.2 ± 9.3 days, <i>p</i> < 0.05). There were no differences regarding atelectasis, reintubations, tracheostomies, ventilation time, and mortality.</p><p><strong>Conclusion: </strong>Pulmonary complications in terms of pleural effusions were more common with TCRAT, however, without substantial impact on clinical outcome.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"185-190"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879462","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":"Impella 5.5 Support for Delayed Surgical Ventricular Septal Defect Repair-A Paradigm Shift?","authors":"Kaveh Eghbalzadeh, Clara Großmann, Ihor Krasivskyi, Ilija Djordjevic, Elmar W Kuhn, Christian Origel Romero, Farhad Bakhtiary, Navid Mader, Antje Christin Deppe, Thorsten C W Wahlers","doi":"10.1055/s-0044-1788982","DOIUrl":"10.1055/s-0044-1788982","url":null,"abstract":"<p><strong>Background: </strong>Ventricular septal defects (VSDs) remain a rare but life-threatening complication of myocardial infarction. Although the incidence has decreased due to better treatment options, the mortality rate remains high. The timing of VSD repair remains critical to outcome. The use of mechanical circulatory support is rarely described in the literature, although it may help to delay repair to allow tissue stabilization. While Impella is currently considered contraindicated due to the potential worsening of the right-to-left shunt and possible systemic embolization of necrotic debris, there is no comprehensive evidence for this. Therefore, we aimed to analyze whether the use of Impella 5.5 as a first choice for patients undergoing VSD repair should be considered for discussion.</p><p><strong>Methods: </strong>This retrospective study analyses four consecutive patients who underwent delayed ventricular septal repair after prior implantation of Impella 5.5 (Abiomed Inc., Danvers, Massachusetts, United States).</p><p><strong>Results: </strong>A total of 75% of patients (<i>n</i> = 3) presented with acute right heart failure prior to implantation with a mean systolic pulmonary artery pressure of 64 ± 3.0 mmHg. Implantation was performed under local anesthesia in three cases. The mean time to surgery was 9.8 ± 3.1 days. All patients remained on the Impella 5.5 device postoperatively. Weaning from Impella 5.5 was successful in 75% (<i>n</i> = 3). The mean length of stay in the intensive care unit was 22.3 ± 7.5 days.</p><p><strong>Conclusion: </strong>Preoperative implantation of the Impella 5.5 device is a safe and feasible option for patients undergoing VSD repair. Outcomes may be improved by performing Impella implantation under local anesthesia and continuing Impella support after VSD repair. However, it is important to note that these patients represent a high-risk cohort and the mortality rate remains high.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"224-229"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971914","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}