Seminars in Thoracic and Cardiovascular Surgery最新文献

{"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}

{"title":"Commentary: Switching Things Up is not Just for Transposition Anymore","authors":"Lauren Kane MD","doi":"10.1053/j.semtcvs.2022.06.010","DOIUrl":"10.1053/j.semtcvs.2022.06.010","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":"10383343","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":"Reoperations After Repair for Atrioventricular Septal Defects: >25 Years Experience at a Single Center","authors":"Jens Johansson Ramgren MD ,&nbsp;Shahab Nozohoor MD, PhD ,&nbsp;Igor Zindovic MD, PhD ,&nbsp;Ronny Gustafsson MD, PhD ,&nbsp;Nina Hakacova MD, PhD ,&nbsp;Johan Sjögren MD, PhD","doi":"10.1053/j.semtcvs.2022.06.008","DOIUrl":"10.1053/j.semtcvs.2022.06.008","url":null,"abstract":"<div><p><span><span>Our aim was to evaluate the total burden of reoperations<span> after previous repair for atrioventricular septal defects<span>, including long-term survival and identify risk factors for reoperation. All patients with surgical correction for atrioventricular septal defect (AVSD) 1993- 2020 underwent a follow-up in October 2020. Clinical data were obtained by retrospective review and evaluated with Kaplan-Meier and competing risk analysis. Of 477 patients who underwent initial repair, 53 patients (11.1%) underwent a total of 82 reoperations. The perioperative mortality at reoperation was 3.8% (2/53). There were no late deaths (0/51) during follow-up. </span></span></span>In patients<span> requiring reoperation for left atrioventricular valve regurgitation, a re-repair was performed in 90% (26/29) at first attempt. Estimated overall survival was 96.2 ± 2.6% (95% CI 91.2-100) in the Any reoperation group and 96.7 ± 0.9% (95% CI 94.9-98.5) in the No reoperation group at 20 years (</span></span><em>P</em> = 0.80). The cumulative incidence function of Any reoperation (with death as competing risk) was 13.0% (95% CI 9.4-16.5) at 20 years. Independent risk factors for Any reoperation included severe mitral regurgitation after primary repair (HR 40.7; 95% CI 14.9-111; <em>P</em><span> &lt; 0.001). The risk of perioperative mortality in AVSD patients undergoing reoperation was low in the present study. Long-term survival was very good and not significantly different when compared to patients who did not need reoperation. Re-repair for left atrioventricular valve regurgitation was possible in most cases and showed long-term durability. Our data suggest that reoperations after primary repair of AVSD have very good long-term outcomes when performed at a high-volume pediatric cardiac surgery center.</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":"10383346","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":"Non-small Cell Lung Cancer Surpassing the Elastic Layer Should Remain Classified as pT2a","authors":"Jing-Sheng Cai PhD ,&nbsp;Xiao-Meng Dou MD","doi":"10.1053/j.semtcvs.2022.04.009","DOIUrl":"10.1053/j.semtcvs.2022.04.009","url":null,"abstract":"<div><p>We aimed to evaluate the prognostic value of visceral pleural invasion on the survival of node-negative non-small cell lung cancer ≤3 cm using a large cohort. The Kaplan–Meier method was used to compare overall survival (OS); competing risk analysis<span> with Fine–Gray's test was used to compare cancer- specific survival between groups. The least absolute shrinkage and selection operator penalized Cox regression<span> model was used to identify prognostic factors. In total, 9725 eligible cases were included in this study, and they were separated into 3 groups: tumor invasion beneath the elastic layer (PL0), 8837 cases; tumor invasion surpassing the elastic layer (PL1), 505 cases; and tumor invasion to the visceral pleural surface (PL2), 383 cases. Visceral pleural invasion was more likely to occur in poorly differentiated and larger-sized tumors. Survival curves displayed that PL0 conferred better survival rates than PL1 and PL2, and PL1 achieved outcomes equivalent to those of PL2. Tumor size and histology subset analyses further corroborated this conclusion. Least absolute shrinkage and selection operator -penalized Cox regression analysis confirmed that PL status was an independent prognostic factor for both OS and cancer- specific survival. This study supported the notion that in node-negative non-small cell lung cancer ≤3 cm, PL1 patients should remain classified as pT2a, which could improve staging accuracy.</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":"10006102","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: Wishful or watchful waiting?","authors":"Akiko Tanaka MD, PhD,&nbsp;Anthony L. Estrera MD, FACS","doi":"10.1053/j.semtcvs.2022.06.014","DOIUrl":"10.1053/j.semtcvs.2022.06.014","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":"10383351","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":"Reverse Fragility Index in Negative Cardiac Procedural Randomized Controlled Trials","authors":"Nitish K. Dhingra BHSc,&nbsp;Allen Li BHSc,&nbsp;Grace Lee BHSc,&nbsp;Roger Kou BHSc,&nbsp;Derrick Y. Tam MD, PhD,&nbsp;Gianluigi Bisleri MD,&nbsp;Bobby Yanagawa MD, PhD","doi":"10.1053/j.semtcvs.2022.05.010","DOIUrl":"10.1053/j.semtcvs.2022.05.010","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":"10009272","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":"Aortic Pseudoaneurysm After Type A Aortic Dissection: Results of Conservative Management","authors":"German J. Chaud MD,&nbsp;Siamak Mohammadi MD,&nbsp;Manuel Roque Cervetti MD,&nbsp;Samantha Guimaron MD,&nbsp;Alexandre Sebestyen MD,&nbsp;François Dagenais MD,&nbsp;Eric Dumont MD","doi":"10.1053/j.semtcvs.2022.04.004","DOIUrl":"10.1053/j.semtcvs.2022.04.004","url":null,"abstract":"Aortic pseudoaneurysms after acute Type A aortic dissection (ATAAD) repair have been reported as high as 10 - 24 % and surgical treatment is usually recommended. The objective of this article is to examine the safety and efficacy of a conservative approach to aortic pseudoaneurysm and to compare this approach to standard surgical treatment. We retrospectively examined 39 patients who had an aortic pseudoaneurysm after ATAAD surgery in order to examine outcomes (baseline characteristics, presentation and freedom from aortic events and mortality). We initially identified 31 patients treated conservatively (CT). After close follow up, 5 of them were operated so 13 patients were treated surgically (ST) and analyzed at a long-term follow-up while 26 were in the conservative group. Mean follow - up of the whole cohort was 7.9 ± 5.9 years. The freedom from aortic-related mortality at 1, 5 and 10 years was 100 %, 83. 3 % and 72. 9 % for the ST group and 95. 8%, 77. 3 % and 77.3 % for the CT group (P= 0.35). A conservative approach to aortic pseudoaneurysms could be justified in asymptomatic patients. A close follow-up by a dedicated aortic clinic is mandatory so that patients are referred for surgery when necessary.","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":"10063785","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: Recurrence Rates of Esophageal Cancer and Geographic Considerations–An Underappreciated Intersection","authors":"Paul J. Speicher MD, MHS","doi":"10.1053/j.semtcvs.2022.05.009","DOIUrl":"10.1053/j.semtcvs.2022.05.009","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":"10009273","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}