Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Predictors of Recurrence Following Sublobar Resection for Clinical T1N0M0 Non-Small Cell Lung Cancer.","authors":"Lauren Drake, Benny Weksler","doi":"10.1053/j.semtcvs.2025.05.002","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.05.002","url":null,"abstract":"<p><strong>Background: </strong>Recurrence is a significant concern after sublobar resection for clinical T1N0M0 lung cancer. Identifying modifiable risk factors is essential for improving oncologic outcomes.</p><p><strong>Objective: </strong>This review examines recurrence risk factors following sublobar resection, focusing on disease stage, tumor characteristics, and surgeon-related factors.</p><p><strong>Methods: </strong>Data from randomized trials and retrospective studies were analyzed to assess the impact of tumor biology, stage, surgical margins, and lymph node dissection on recurrence.</p><p><strong>Results: </strong>Recurrence is influenced by tumor stage, biology, and surgical technique. While tumor characteristics and stage are non-modifiable, inadequate surgical margins and incomplete nodal dissection significantly increase recurrence risk. A margin of ≥1 cm or equal to the tumor diameter is associated with lower recurrence rates. Systematic nodal dissection enhances staging accuracy and informs adjuvant therapy. Although sublobar resection is non-inferior to lobectomy in select cases, inadequate margins and suboptimal nodal assessment elevate recurrence risk.</p><p><strong>Conclusion: </strong>Surgical margins and lymph node dissection are the most critical modifiable risk factors for recurrence. To optimize long-term survival, adequate margins and systematic nodal evaluation should be prioritized. Further research is needed to assess the role of completion lobectomy or adjuvant therapy, particularly in patients with multiple high-risk features.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: The CAS lung allocation system - the good, the bad, and the ugly.","authors":"Faiza M Khan, Ramiro Fernandez","doi":"10.1053/j.semtcvs.2025.05.001","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.05.001","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial Bridge in Children: Do we care about it?","authors":"Arvind Kumar Bishnoi, Michael Ma","doi":"10.1053/j.semtcvs.2025.04.007","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.04.007","url":null,"abstract":"<p><strong>Objective: </strong>Myocardial bridges are congenital anomalies known to cause adverse events in adults. However, this anomaly is less often considered a differential diagnosis in the evaluation of children with chest pain. Anomalous aortic origin of a coronary artery (AAOCA) is being identified with increasing frequency, and myocardial bridges have been found intraoperatively. Myocardial bridges, being congenital, have the potential to affect children.</p><p><strong>Methods: </strong>This was a retrospective review of 38 patients who underwent surgical unroofing of myocardial bridges in isolation or as part of AAOCA repair at a single institution. We share our diagnostic approach and surgical strategy for this disease.</p><p><strong>Results: </strong>14 patients underwent surgical unroofing for isolated myocardial bridges and 21 as an additional procedure at the time of coronary unroofing or reimplantation for AAOCA. Three patients underwent AAOCA surgery, and recurrent angina prompted evaluation for a myocardial bridge.</p><p><strong>Conclusions: </strong>Myocardial bridges are common and can be symptomatic in children. It should be considered as a differential diagnosis in children presenting with undiagnosed chest pain. It is easy to identify with current investigative modalities, and surgical treatment is effective in hemodynamically significant lesions.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Surgery for Local Consolidative Therapy in the Management of Oligometastatic Disease.","authors":"Rajika Jindani, Kyle G Mitchell, Mara B Antonoff","doi":"10.1053/j.semtcvs.2025.05.003","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.05.003","url":null,"abstract":"<p><p>Oligometastatic non-small cell lung cancer (NSCLC) constitutes a distinct form of disease with limited metastatic burden, which may benefit in terms of disease control and overall survival from local consolidative therapy (LCT). Pulmonary resection has emerged as a valuable component of LCT, demonstrating improvements in progression-free and overall survival for appropriately selected patients. This review examines the evolving role of surgery in the management of oligometastatic NSCLC, emphasizing survival benefits, biological rationale, surgical complexities, disparities in care, and ongoing trials. Emerging research integrating biomarkers, novel pharmacotherapy, and advanced surgical techniques offers new opportunities to refine patient selection and improve outcomes. Addressing barriers and advancing multidisciplinary approaches will be critical to fully realize the benefits of surgery in this context.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Prevention and Management of Postoperative Delirium in Cardiac Surgery Patients.","authors":"Syed M Ali Hassan, Shubh K Patel, Miriam S Badross, Nitish K Dhingra, Raj Verma, Meena Verma, Ryuta Seguchi, Bobby Yanagawa, Jessica Spence, C David Mazer, Ahmad Alli, Subodh Verma, Rakesh C Arora","doi":"10.1053/j.semtcvs.2025.04.008","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.04.008","url":null,"abstract":"<p><strong>Objective: </strong>This review examines the prevention and management of postoperative delirium in cardiac surgery patients, a frequent complication linked with significant mortality, morbidity, prolonged hospitalization, and cognitive decline. The aim was to consolidate current evidence on postoperative delirium pathophysiology, risk factors, diagnostic approaches, and pharmacologic and non-pharmacologic interventions.</p><p><strong>Methods: </strong>A PubMed/MEDLINE database review was conducted through October 2024, identifying studies that evaluated the relationship between cardiac surgery and the occurrence of postoperative delirium.</p><p><strong>Results: </strong>The pathogenesis of postoperative delirium is complex, involving neuroinflammation, neurotransmitter imbalance, and endothelial dysfunction, compounded by baseline vulnerabilities and perioperative stressors. Early screening using tools like the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) aids in timely detection. Prevention emphasizes non-pharmacologic interventions, such as the Hospital Elder Life Program and the ABCDEF bundle, alongside pharmacologic strategies to minimize high-risk sedatives. Emerging technologies, including intraoperative neurophysiologic monitoring modalities and machine learning models, enhance postoperative delirium risk assessment and enable targeted interventions.</p><p><strong>Conclusion: </strong>Effective postoperative delirium management in cardiac surgery requires a balanced approach incorporating non-pharmacologic and pharmacologic methods. Integration of evidence-based practices and innovative technologies into routine care holds promise for improving patient outcomes. Ongoing research is essential to optimize postoperative delirium management and standardize practices in high-risk populations.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventional Strategies for Full Hybrid/Norwood, the Double Intention, Double Intervention (DIDI) Approach.","authors":"Dietmar Schranz, Hakan Akintuerk, Michael Huebler, Jelena Pabst von Ohain, Anoosh Esmaeili, Nora Lang, Rainer Kozlik-Feldmann, Gunter Kerst","doi":"10.1053/j.semtcvs.2025.03.013","DOIUrl":"10.1053/j.semtcvs.2025.03.013","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approach to Intramural Hematoma in South Korea.","authors":"Joon Chul Jung, Kay-Hyun Park","doi":"10.1053/j.semtcvs.2025.04.006","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.04.006","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Debate: Implications for the Continuous Allocation System for Organ Distribution in the United States: Challenges and Controversies - CON.","authors":"Caitlin T Demarest, Anil J Trindade","doi":"10.1053/j.semtcvs.2025.04.004","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.04.004","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Looking to the Right Ventricle After Heart Transplantation: Invited Expert Opinion.","authors":"Lise N Tchouta, Lucy Nam, David A D'Alessandro","doi":"10.1053/j.semtcvs.2025.04.005","DOIUrl":"10.1053/j.semtcvs.2025.04.005","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: The Root of the Argument Is Are We Even Arguing About the Root?","authors":"Anna K Gergen, Thomas Brett Reece","doi":"10.1053/j.semtcvs.2025.03.008","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.03.008","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}