Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Invited Review: Are the Floodgates Opening? New Indications for Transcatheter Aortic Valve Implantation for Asymptomatic Severe and Moderate Aortic Stenosis.","authors":"Gregory P Fontana, Asvin M Ganapathi","doi":"10.1053/j.semtcvs.2026.06.001","DOIUrl":"10.1053/j.semtcvs.2026.06.001","url":null,"abstract":"<p><p>Transcatheter aortic valve implantation (TAVI) has significantly expanded the access to aortic valve replacement in numerous populations as well as increased the overall volume of aortic valve replacement since its approval. Beyond its use for symptomatic, severe aortic stenosis, the emergence of new data regarding the importance of cardiac damage has led to exploration of the use of TAVI in patients with asymptomatic, severe aortic stenosis and those with moderate aortic stenosis. Data have demonstrated a potential benefit of TAVI in patients, with asymptomatic, severe aortic stenosis, particularly with respect to rehospitalization, however the data are less complete for patients with moderate aortic stenosis, which is the subject of multiple ongoing randomized trials. This review will provide a current overview of the data surrounding the use of TAVI in these 2 populations as well as explore the future directions of TAVI use in these patients.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551080","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":"A Systematic Review on the Impact of Postoperative Rehabilitation Programs in Thoracic Surgery Patients.","authors":"Nan Wang, Kexin Luan","doi":"10.1053/j.semtcvs.2026.05.004","DOIUrl":"10.1053/j.semtcvs.2026.05.004","url":null,"abstract":"<p><p>Post-operative challenges, including reduced respiratory function and slower overall recovery, are often associated with thoracic surgeries. Rehabilitation strategies have been important over the years for their potential to support patient recovery and improve post-surgical outcomes. Studies published up to March 2025 across the databases, including Google Scholar, PubMed, and ProQuest, were retrieved and analyzed for this systematic review. Out of the initially selected 29 studies systematically reviewed, 8 fulfilled the final inclusion criteria and were included in the analysis. Postoperative rehabilitation strategies such as physiotherapy-based programs, nurse-led initiatives, and technology-assisted interventions have been included in the systematic review and found to influence the recovery following thoracic surgery. Interventions like these improve pulmonary function, better pain management, enhanced functional capacity, reduced complication rates, and shorter recovery periods. The findings suggest that rehabilitative approaches may contribute to better postoperative outcomes. However, further clinical research is still needed to develop more standardized rehabilitation protocols.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319978","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":"Endoscopic vs Operative Management of Acute Esophageal Perforation: A 21-Year Experience at a High-Volume Referral Center.","authors":"Audrey Zhao, Alexis P Chidi, Harleen Sandhu, Rachel Lee, Robert Hetz, Juan Abreu, Phillip Rascoe, Anthony L Estrera, Akiko Tanaka","doi":"10.1053/j.semtcvs.2026.05.005","DOIUrl":"10.1053/j.semtcvs.2026.05.005","url":null,"abstract":"<p><p>Management of acute esophageal perforation varies significantly. Data are particularly limited regarding optimal management of patients with Boerhaave's syndrome (BS). We aimed to compare operative to endoscopic management for patients with acute esophageal injury at a high-volume tertiary referral center. This retrospective cohort study included adult patients presenting to a tertiary referral center with acute esophageal perforation from January 2002 to January 2023. Patients with esophageal cancer or prior esophagectomy were excluded. Our primary variable of interest was endoscopic (EM) versus operative management (OM) and our outcomes of interest included incidence of major postoperative morbidity and 30-day mortality. Additional covariates included demographic characteristics and preoperative clinical factors. Among 117 patients, 65 (56%) met criteria for BS, and 52 (44%) had other etiologies. Mean age was 57 ± 18 years, and 36 patients (31%) were female. Overall, 95 patients (81%) received OM. Twenty-two patients (19%) had EM with stenting; of these, 5 patients (23%) also had endoluminal vac therapy. Median ICU length of stay was 6 days (IQR 8), 30 patients (26%) required readmission, and 30-day mortality was 2.6% (3 patients, 1 with EM). Among patients with BS, 13 (20%) had EM and 52 (80%) had OM. Between BS patients managed endoscopically versus operatively, there were no significant differences in use of enteral feeding access, leaks, strictures, length of stay, readmission, or 30-day mortality (P > 0.05). At a high-volume center, endoscopic management with stenting and/or endoluminal therapy can be safely employed for well-selected patients, including those with BS.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284587","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":"Propensity Score-Matched Analysis Comparing Modified Konno Procedure and Transaortic Septal Myectomy in Children With Left Ventricular Outflow Tract Obstruction.","authors":"Qi Liu, Dingyi Yao, Shoujun Li, Keming Yang, Benqing Zhang","doi":"10.1053/j.semtcvs.2026.01.001","DOIUrl":"10.1053/j.semtcvs.2026.01.001","url":null,"abstract":"<p><p>The comparative clinical outcomes of the modified Konno procedure (MKP) and transaortic septal myectomy (TSM) for severe left ventricular outflow tract (LVOT) obstruction in children remain unclear. A total of 177 consecutive patients (age <14 years old) underwent surgical treatments, categorized by MKP or TSM technique (MKP n = 45, TSM n = 132). After propensity-score matching, 45 MKP patients were matched 1:1 with TSM patients. At discharge, the MKP group demonstrated a significantly lower LVOT peak gradient compared to the TSM group (median, 3.2 vs 11.6 mmHg, P = 0.011), which persisted at follow-up (median, 4.8 vs 11.6 mmHg, P = 0.01) in matched data. Although postoperative atrioventricular block was more frequent in the MKP group, no significant difference was observed in permanent pacemaker implantation rate between groups (P = 0.108). During follow-up (median, 1.08 years, 0.25-2.5), the incidence of recurrent LVOT obstruction was higher in the TSM group (17.8% vs 0%). Recurrent LVOT obstruction was associated with aortic annulus size (hazard ratio [HR] = 0.811; 95% confidence interval [CI], 0.675-0.974; P = 0.025) and preoperative LVOT peak gradient (HR = 1.030, 95% CI: 1.010-1.050, P = 0.003). The smaller aortic annulus size (<12.5 mm) or severe LVOT obstruction (>82.5 mmHg) significantly decreased the risk of survival free from recurrent LVOT obstruction (P = 0.01, P < 0.001). The MKP can provide better relief of LVOT obstruction than TSM in young children, particularly with a small aortic annulus or severe obstruction. MKP may not increase the risk of permanent pacemaker implantation and mortality.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228711","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":"Valved Sano Conduit During the Norwood Procedure: A Contemporary Review of Early Outcomes, Reintervention Burden, and Pulmonary Artery Growth.","authors":"Bahaaldin Alsoufi, Sitaram M Emani, David Kalfa","doi":"10.1053/j.semtcvs.2026.05.003","DOIUrl":"10.1053/j.semtcvs.2026.05.003","url":null,"abstract":"<p><p>The valved Sano (VS) right ventricle-to-pulmonary artery (RV-PA) shunt was developed to eliminate conduit regurgitation and thereby decrease volume load on the single right ventricle (RV) after the Norwood procedure. By reducing diastolic backflow, VS may limit tricuspid regurgitation and preserve RV function. Additional theoretical advantages include facilitated postoperative recovery and improved pulmonary artery (PA) growth. Despite compelling physiology, available evidence remains limited and largely retrospective. We describe the postoperative course of a low-weight neonate with hypoplastic left heart syndrome who underwent a Norwood procedure using a VS, and we review published literature addressing early outcomes, reintervention burden, late survival, and PA growth. Use of a VS can be associated with improved early physiologic recovery, lower postoperative lactate, faster diuresis and enteral advancement, and better early RV function. Short-term survival appears equivalent to the non-valved Sano. Interstage reinterventions remain frequent (40%-60% before stage II). Late survival beyond stage II is comparable to non-valved Sano. Femoral vein homograft-based conduits may promote greater PA growth and reduce the need for PA augmentation, but findings vary across centers. Valve competence commonly decays within 3-6 months, resulting in conduit regurgitation. VS conduits may facilitate early recovery and potentially favor PA growth when constructed with competent Femoral vein homograft segments, yet they have not demonstrated superior late survival or reduced reintervention burden. Larger multicenter studies are required to clarify optimal patient selection and long-term impact.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228720","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":"Post-Operative Hemothorax: Uniportal Video-Assisted Thoracic Surgery vs Thoracotomy-Analysis of Outcomes and Costs.","authors":"Antonio Giulio Napolitano, Claudia Bellettati, Adriana Nocera, Leonardo Petracca Ciavarella, Maria Teresa Congedo, Maria Letizia Vita, Filippo Lococo, Elisa Meacci, Stefano Margaritora, Dania Nachira","doi":"10.1053/j.semtcvs.2026.05.002","DOIUrl":"10.1053/j.semtcvs.2026.05.002","url":null,"abstract":"<p><p>Post-operative hemothorax (PH) is one of the most critical complications in thoracic surgery, which requires prompt treatment. The aim of the study is to review the consecutive series of patients with PH undergoing re-operation in Uniportal Video-Assisted Thoracic Surgery (U-VATS) or Thoracotomy, analyzing the outcomes and costs. Out of 1663 patients undergone Thoracic operations (pulmonary resections, esophagectomies, or pleural/chest wall lesions) between 2016 and 2024, 52 (3.12%) developed a PH and underwent surgical treatment. Data of patients were collected and retrospectively analyzed. Thirty-six patients were male (69.23%), with a mean age of 62.54 ± 16.46 years. Active bleeding was intraoperatively discovered in a total of 35 patients (67.30%). Most of the patients who developed PH had undergone a previous wedge resection (20, 38.46%) and in 15 cases (28.84%), the cause was pleural/parenchyma bleeding. Post-operative complications were significantly higher in the group of patients who underwent treatment of PH by thoracotomy (10 (34.48%) vs 2 (8.69%), P:0.028), and 14 patients (48.27%) required ICU admission(P:0.020). Patients with post-operative complications had a significantly longer hospital-stay (9.33 ± 5.02 vs 4.83 ± 2.09 days: <0.001). In general, post-operative hospital-stay was also longer in the thoracotomy group (7.07 ± 3.83 vs 4.35 ± 2.44 days, P:0.005). Total costs, including operating room expenses, hospital-stay, and ICU admission, were higher in the open group compared to U-VATS(6708.94 ± 2738.74 vs 5238.79 ± 2527.92€, P:0.052). Multivariable analysis identified the open approach as the only independent risk factor for complications (OR = 5.53, 95%CI [1.072-28.49], P:0.041). Open approach exposes to higher post-operative complications and costs, with longer hospital stay in case of reoperation for PH. U-VATS technique seems to be safe and effective and with lower costs, although the instruments are more expensive.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220056","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":"Palliative Care Throughout the Entire Perioperative Pathway in Cardiovascular Surgery.","authors":"Moritz Blum, Felix Schoenrath, Johann Ahn, Kathrin Bockbreder, Sascha Ott, Katharina Schmitt, Susanne Jöbges, Laura Gelfman, Volkmar Falk","doi":"10.1053/j.semtcvs.2026.04.003","DOIUrl":"10.1053/j.semtcvs.2026.04.003","url":null,"abstract":"<p><p>Cardiovascular surgery has substantially improved survival and quality of life for patients with cardiovascular disease, yet contemporary surgical populations are increasingly older, multimorbid, and affected by advanced disease, rendering procedures and perioperative care more complex. Patients often experience severe physical symptoms, psychological distress, and difficult decisions, which in cases of complications also include escalation, limitation, or withdrawal of life-sustaining treatment. In this article, we argue that palliative care offers a framework to address these complex needs throughout the entire cardiovascular surgery pathway, rather than only at the end of life. Preoperatively, structured shared decision-making, goals-of-care discussions, and advance care planning can help align surgical strategies with patients' values and prepare patients and families for potential complications. Postoperatively, routine assessment and management of physical symptoms, psychological distress, social needs, and spiritual concerns could prevent and alleviate suffering during the hospitalization. In the setting of serious complications, interdisciplinary team support, regular family meetings, and professional communication can support decision-making and reduce distress for patients, families, and clinicians. Most palliative care needs can be addressed by surgical and intensive care teams as primary palliative care, while specialty palliative care should be involved for complex symptoms, decisional conflict, or challenging psychosocial or existential distress. Further research, education, and guideline development are needed to change professional culture and establish palliative care as a routine, complementary component of cardiovascular surgical care.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212680","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: Telescopic Sleeve – Don’t Lose Focus on the Fundamentals","authors":"Ryan A.J. Campagna MD MEd,&nbsp;Paul L. Feingold MD MHS","doi":"10.1053/j.semtcvs.2025.10.004","DOIUrl":"10.1053/j.semtcvs.2025.10.004","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"38 2","pages":"Pages 139-140"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432800","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":"Identification of Segmental Parenchymal Resection Margins: Left S9, 10 How I Do It","authors":"Subin Lee MD, Resident ,&nbsp;Benjamin Medina MD, Assistant Professor of Surgery ,&nbsp;Ashley McCormack MD ,&nbsp;Richard Lazzaro MD","doi":"10.1053/j.semtcvs.2025.05.009","DOIUrl":"10.1053/j.semtcvs.2025.05.009","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"38 2","pages":"Pages 141-144"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310561","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":"Optimal Inotropic Support Strategy in Low Cardiac Output Syndrome","authors":"Travis J. Miles MD ,&nbsp;Kyle W. Blackburn BS ,&nbsp;Marc R. Moon MD ,&nbsp;Subhasis Chatterjee MD","doi":"10.1053/j.semtcvs.2025.04.002","DOIUrl":"10.1053/j.semtcvs.2025.04.002","url":null,"abstract":"<div><div><span><span>Low cardiac output syndrome (LCOS), a form of </span>cardiogenic shock<span> that occurs after cardiac surgery, is associated with an elevated risk of morbidity and mortality. Generally, LCOS is managed medically with inotropes and vasopressors to optimize </span></span>hemodynamics<span><span><span><span>. However, randomized data comparing the efficacy of individual inotropes in treating LCOS are limited. Consequently, there is little consensus regarding the optimal inotrope strategy, and practice patterns vary widely. This review synthesizes current evidence on pharmacologic, non-mechanical </span>circulatory support strategies for managing LCOS, advocating for a personalized approach tailored to the individual patient’s hemodynamic profile and </span>inotropic requirements. Currently available </span>vasoactive agents are discussed, and guidance is provided on their use across specific clinical contexts to support individualized treatment.</span></div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"38 2","pages":"Pages 93-101"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057749","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}