Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Mid-Term Outcomes of Primary Arterial Switch Operation for Taussig-Bing Anomaly","authors":"Mingjun Gu MD,&nbsp;Jie Hu MD,&nbsp;Wei Dong MD,&nbsp;Wen Zhang MD,&nbsp;Qi Jiang MD,&nbsp;Renjie Hu MD,&nbsp;Yifan Zhu MD,&nbsp;Hongbin Zhu MD,&nbsp;Haibo Zhang MD, PhD","doi":"10.1053/j.semtcvs.2022.06.001","DOIUrl":"10.1053/j.semtcvs.2022.06.001","url":null,"abstract":"<div><p>To identify risk factors associated with mortality and reintervention on primary arterial switch operation<span><span> for Taussig-Bing anomaly in 225 cases over a 16-year period. From 2002 to 2017, 225 children with Taussig-Bing anomaly received a primary arterial switch operation at the Shanghai Children's Medical Center. Perioperative data and follow-up results were collected. Univariate and multivariable analysis was used to explore risk factors associated with early mortality. The competing risk analysis was used to identify risk factors related to reintervention. Early mortality was 12.9% (29/225) with a satisfactory long-term survival rate (10-year survival rate 85.0%). The median age at repair was 77 days (interquartile range, IQR, 48–139). The median duration of follow-up was 4.6 (range 0.1–18.3) years. 87 children (38.7%) received concomitant </span>aortic arch repair<span><span>. Prolonged cardiopulmonary bypass time (a-OR 1.18, 95% confidence interval [CI], 1.09–1.28, p &lt; 0.001) is found to be an independent risk factor for early death. Larger weight at repair tends to be a protective factor (a-OR 0.66, 95% CI, 0.425–1.02, p = 0.060) and intramural </span>coronary artery<span> (a-OR 4.81, 95% CI, 0.927–24.9, p = 0.062) tends to be a risk factor for early mortality. The cumulative incidence rate of overall reintervention was 18.9% (95% CI, 10.3%–27.4%) at 5 years and 32.3% (95% CI, 17,0%–47.6%) at 10 years. No independent risk factors were identified for long-term overall reintervention. Prolonged aortic-cross clamp time was an independent risk factor for long-term right-sided reintervention (adjusted hazard ratio [a-HR] 1.12, 95% CI 1.005–1.25, p = 0.041). Neo-aortic regurgitation was a concern with an incidence rate of moderate or greater neo-AR of 16.1 % (95% CI 7.6%–24.7%) at 10 years. Intramural coronary artery remains a surgical challenge in primary arterial switch operation for the Taussig-Bing anomaly. Larger weight at ASO tends to be a protective factor for early death. Reintervention is frequently necessary but can be performed with satisfactory results.</span></span></span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10006118","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":"Association of 3-Year All-Cause Mortality and Peak Wall Stresses of Ascending Thoracic Aortic Aneurysms in Veterans","authors":"Siavash Zamirpour BA ,&nbsp;Yue Xuan PhD ,&nbsp;Zhongjie Wang PhD ,&nbsp;Axel Gomez MD ,&nbsp;Michael D. Hope MD ,&nbsp;Joseph Leach MD, PhD ,&nbsp;Dimitrios Mitsouras PhD ,&nbsp;David A. Saloner PhD ,&nbsp;Julius M. Guccione PhD ,&nbsp;Liang Ge PhD ,&nbsp;Elaine E. Tseng MD","doi":"10.1053/j.semtcvs.2022.06.002","DOIUrl":"10.1053/j.semtcvs.2022.06.002","url":null,"abstract":"<div><p>Risk of aortic dissection in ascending thoracic aortic aneurysms is not sufficiently captured by size-based metrics. From a biomechanical perspective, dissection may be initiated when wall stress exceeds wall strength. Our objective was to assess the association between aneurysm peak wall stresses and 3-year all-cause mortality. Finite element analysis was performed in 273 veterans with chest computed tomography for surveillance of ascending thoracic aortic aneurysms. Three-dimensional geometries were reconstructed and models developed accounting for prestress geometries. A fiber-embedded hyperelastic material model was applied to obtain circumferential and longitudinal wall stresses under systolic pressure. Patients were followed up to 3 years following the scan to assess aneurysm repair and all-cause mortality. Fine-Gray subdistribution hazards were estimated for all-cause mortality based on age, aortic diameter, and peak wall stresses, treating aneurysm repair as a competing risk. When accounting for age, subdistribution hazard of mortality was not significantly increased by peak circumferential stresses (<em>p</em> = 0.30) but was significantly increased by peak longitudinal stresses (<em>p</em> = 0.008). Aortic diameter did not significantly increase subdistribution hazard of mortality in either model (circumferential model: <em>p</em> = 0.38; longitudinal model: <em>p =</em> 0.30). The effect of peak longitudinal stresses on subdistribution hazard of mortality was maximized at a binary threshold of 355kPa, which captured 34 of 212(16%) patients with diameter &lt;5 cm, 11 of 36(31%) at 5.0–5.4 cm, and 11 of 25(44%) at ≥5.5 cm. Aneurysm peak longitudinal stresses stratified by age and diameter were associated with increased hazard of 3-year all-cause mortality in a veteran cohort. Risk prediction may be enhanced by considering peak longitudinal stresses.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10006117","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":"Patterns of Recurrence After Robot-Assisted Minimally Invasive Esophagectomy in Esophageal Squamous Cell Carcinoma","authors":"Yang Yang MD ,&nbsp;Hong Zhang MD ,&nbsp;Bin Li MD ,&nbsp;Jinchen Shao MD ,&nbsp;Zhichao Liu MD ,&nbsp;Rong Hua MD ,&nbsp;Zhigang Li MD","doi":"10.1053/j.semtcvs.2022.04.008","DOIUrl":"10.1053/j.semtcvs.2022.04.008","url":null,"abstract":"<div><p>Robot-assisted minimally invasive esophagectomy<span><span> (RAMIE) has been proven to be a feasible surgical approach for esophageal squamous cell carcinoma (ESCC). This study aimed to investigate the recurrence pattern and potential risk factors after RAMIE. Consecutive patients with ESCC who received RAMIE with McKeown technique at a single Esophageal Cancer Institute from November 2015 to September 2018 were retrospectively reviewed. Patients with available data, </span>radical resection<span><span> (R0), and a minimum 2-year follow-up period were eligible for the recurrence analysis. Risk factors of recurrence were examined by logistic regression analysis. R0 resection was achieved in 95.1% of patients (310/326). Of the 298 eligible patients with a median follow-up period of 30.6 months, recurrence was recognized in 95 patients (31.9%), with 4 (1.3%) local-only, 40 (13.4%) regional-only, 44 (14.8%) hematogenous-only and 7 (2.3%) combined recurrences. </span>Cervical lymph nodes<span> and lungs were the most frequent sites of regional and hematogenous recurrence, respectively. The median disease-free interval until recurrence was 12.1 (range 1.7–37.6) months and 83.2% of relapses occurred within 2 years after surgery. Multivariable analysis indicated that tumor in the upper esophagus, larger tumor length and positive lymph nodes as independent risk factors for recurrence. Hematogenous recurrence is the prevailing pattern after RAMIE for ESCC. For patients with advanced disease, neoadjuvant therapy is a key factor in reducing recurrence rather than surgical approaches.</span></span></span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10011307","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":"Novel Valve Choices for Pulmonary Valve Replacement","authors":"David Kalfa MD, PhD","doi":"10.1053/j.semtcvs.2021.11.018","DOIUrl":"10.1053/j.semtcvs.2021.11.018","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10008056","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":"Long-term Outcomes of Transatrial-Transpulmonary Repair of Tetralogy of Fallot With Anomalous Coronary Arteries","authors":"Xin Tao Ye MD ,&nbsp;Edward Buratto MBBS, PhD, FRACS ,&nbsp;Shuta Ishigami MD, PhD ,&nbsp;Robert G. Weintraub MBBS, FRACP ,&nbsp;Christian P. Brizard MD, MS ,&nbsp;Igor E. Konstantinov MD, PhD, FRACS","doi":"10.1053/j.semtcvs.2022.05.001","DOIUrl":"10.1053/j.semtcvs.2022.05.001","url":null,"abstract":"<div><p><span><span>Repair of tetralogy of Fallot<span> (TOF) can be complicated by the presence of an anomalous coronary artery<span> (ACA) crossing the right ventricular outflow tract (RVOT). This study sought to evaluate the late outcomes of a policy of transatrial-transpulmonary repair for this condition. The transatrial-transpulmonary approach was used in 864 consecutive TOF repairs between 1993 and 2018 at a single institution, of which 55 (6%) patients had an ACA. Nineteen (35%,19/55) patients underwent prior </span></span></span>palliation<span><span>. Late survival and freedom from reoperations were compared with the general cohort of 809 patients who underwent complete repair during the same period. Early mortality was 2% (1/55). Median follow-up was 15.6 years. Late mortality was 6% (3/54). Absence of a preoperative diagnosis of ACA was not a risk factor for worse outcomes in terms of late re-interventions, </span>acute coronary syndrome, residual RVOT gradient, and late mortality. Survival was 91% (95% confidence interval [CI]: 77–96%) at 20 years and was comparable to the general TOF cohort (95%, 95% CI: 90–98%, </span></span><em>P</em> = 0.12). Actuarial freedom from any re-intervention was 46% (95% CI: 27–62%) at 20 years, which was also comparable to the general cohort (31%, 95% CI: 20–42%, <em>P</em><span> = 0.19). The presence of an ACA does not appear to affect late survival or re-intervention rates in patients undergoing transatrial-transpulmonary repair of TOF.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10362086","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: Scoops and Goose Necks: Long Term Challenges Following Atrioventricular Septal Defect Repair","authors":"Aditya Sengupta MD ,&nbsp;Meena Nathan MD, MPH","doi":"10.1053/j.semtcvs.2022.07.004","DOIUrl":"10.1053/j.semtcvs.2022.07.004","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10011319","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: Predicting a Changing Future","authors":"Michael J. Reardon MD","doi":"10.1053/j.semtcvs.2022.04.001","DOIUrl":"10.1053/j.semtcvs.2022.04.001","url":null,"abstract":"of disease waves that varied within each institution and each wave both from the changing nature of the disease but also from knowledge gained from previous waves and better preparation using this knowledge. If we spread these differences across the nation, we can see the formidable challenge the authors took on. The issue of recovery time is more difficult as additional unexpected factors have arisen. We have lost OR nurses, ICU nurses and research personnel at a high rate and replacing them has proven extraordinarily difficult. How the “great resignation” will ultimately impact recovery time is difficult to say.","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8993699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10063782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Aesthetic Outcome of the Nuss Procedure in Patients with Pectus Excavatum","authors":"Nadine A. Coorens MSc ,&nbsp;Jean H.T. Daemen MD ,&nbsp;Cornelis H. Slump MSc, PhD ,&nbsp;Nicky Janssen MD ,&nbsp;Yanina Jansen MD, PhD ,&nbsp;Jos G. Maessen MD, PhD ,&nbsp;Yvonne L.J. Vissers MD, PhD ,&nbsp;Karel W.E. Hulsewé MD, PhD ,&nbsp;Erik R. de Loos MD, PhD","doi":"10.1053/j.semtcvs.2022.06.007","DOIUrl":"10.1053/j.semtcvs.2022.06.007","url":null,"abstract":"<div><p>Patients suffering from pectus excavatum<span> often experience psychosocial distress due to perceived anomalies in their physical appearance. The ability to visually inform patients about their expected aesthetic outcome after surgical correction is still lacking. This study aims to develop an automatic, patient-specific model to predict aesthetic outcome after the Nuss procedure. Patients prospectively received preoperative and postoperative 3-dimensional optical surface scanning of their chest during the Nuss procedure. A prediction model was composed based on nonlinear least squares<span> data-fitting, regression methods and a 2-dimensional Gaussian function with adjustable amplitude, variance, rotation, skewness, and kurtosis components. Morphological features of pectus excavatum were extracted from preoperative images using a previously developed surface analysis tool to generate a patient-specific model. Prediction accuracy was evaluated through cross-validation, utilizing the mean root squared deviation and maximum positive and negative deviations as performance measures. The prediction model was evaluated on 30 (90% male) prospectively imaged patients. The model achieved an average root mean squared deviation of 6.3 ± 2.0 mm, with average maximum positive and negative deviations of 12.7 ± 6.1 and –10.2 ± 5.7 mm, respectively, between the predicted and actual postoperative aesthetic result. Our developed 2-dimensional Gaussian model based on 3-dimensional optical surface images is a clinically promising tool to predict postsurgical aesthetic outcome in patients with pectus excavatum. Prediction of the aesthetic outcome after the Nuss procedure potentially improves information provision and expectation management among patients. Further research should assess whether increasing the sample size may reduce deviations and improve performance.</span></span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10383344","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 Effect of COVID-19 on Cardiac Surgical Volume and its Associated Costs","authors":"Edgar Aranda-Michel PhD ,&nbsp;Derek Serna-Gallegos MD ,&nbsp;George Arnaoutakis MD ,&nbsp;Arman Kilic MD ,&nbsp;James A Brown MD ,&nbsp;Yancheng Dai BS ,&nbsp;Courtenay Dunn-Lewis PhD ,&nbsp;Ibrahim Sultan MD","doi":"10.1053/j.semtcvs.2022.01.009","DOIUrl":"10.1053/j.semtcvs.2022.01.009","url":null,"abstract":"<div><p>The COVID-19 pandemic significantly affected health care and in particular surgical volume. However, no data surrounding lost hospital revenue due to decreased cardiac surgical volume have been reported. The National Inpatient Sample database was used with decreases in cardiac surgery at a single center to generate a national estimate of decreased cardiac operative volume. Hospital charges and provided charge to cost ratios were used to create estimates of lost hospital revenue, adjusted for 2020 dollars. The COVID period was defined as January to May of 2020. A Gompertz function was used to model cardiac volume growth to pre-COVID levels. Single center cardiac case demographics were internally compared during January to May for 2019 and 2020 to create an estimate of volume reduction due to COVID. The maximum decrease in cardiac surgical volume was 28.3%. Cumulative case volume and hospital revenue loss during the COVID months as well as the recovery period totaled over 35 thousand cases and 2.5 billion dollars. Institutionally, patients during COVID months were younger, more frequently undergoing a CABG procedure, and had a longer length of stay. The pandemic caused a significant decrease in cardiac surgical volume and a subsequent decrease in hospital revenue. This data can be used to address the accumulated surgical backlog and programmatic changes for future occurrences.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8976579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10361604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specialization in Acute Type A Aortic Dissection Repair: The Outcomes and Challenges","authors":"Elizabeth L. Norton MD, MS ,&nbsp;Linda Farhat MS ,&nbsp;Xiaoting Wu PhD ,&nbsp;Karen M. Kim MD ,&nbsp;Shinichi Fukuhara MD ,&nbsp;Himanshu J. Patel MD ,&nbsp;George Michael Deeb MD ,&nbsp;Bo Yang MD, PhD","doi":"10.1053/j.semtcvs.2022.05.005","DOIUrl":"10.1053/j.semtcvs.2022.05.005","url":null,"abstract":"<div><p><span>With increasing specialization within the field of cardiac surgery and a positive relationship between case volume and surgical outcomes in many areas, the concept of dedicated aortic surgeons performing acute type A aortic dissection<span> (ATAAD) repair was investigated. From 1996 to 2014, 436 patients underwent open surgical repair of an ATAAD and were subsequently divided based on surgeon subspecialization, aortic-surgeon (AS, n = 401) vs non-aortic-surgeon (NAS, n = 35). Each aortic surgeon performed an average of 13 ATAAD repair operations per year. Preoperative comorbidities were similar between groups. Intraoperatively, the AS group had 36% aortic root replacement vs 23% in the NAS group, </span></span><em>P</em> = 0.12, and 36% zone 1/2/3 arch replacement vs 26% in the NAS group, <em>P</em><span> = 0.20). Postoperatively, the AS group had significantly better outcomes, including intraoperative mortality (1.2% vs 5.7%), 30-day mortality (6.5% vs 17%), and composite outcomes (23% vs 46%). Multivariable logistic regression showed NAS was a risk factor for 30-day mortality with an odds ratio (OR) of 4.4 (</span><em>P</em> = 0.03), as were COPD (OR = 4.0, <em>P</em><span> = 0.046) and cardiogenic shock (OR = 13.4, </span><em>P</em> &lt; 0.0001). The 10-year survival was 66% in the AS group vs 46% in the NAS group, <em>P</em><span> = 0.02. NAS (HR = 2.2), Age (hazard ratio (HR) = 1.05), COPD (HR = 1.96), acute stroke (HR = 3.0), and New York Heart Association class III or IV (HR = 1.75) were significant risk factors for long-term mortality. Managing ATAAD by subspecialized aortic surgeons resulted in improved short- and long-term outcomes. Our specialty could consider ATAAD repair by high-volume aortic surgeons for better patient outcomes.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10361609","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}