Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Ultra-Hybrid Repair: Open Thoracoabdominal Completion After Descending Stent Grafting","authors":"Matthew A. Thompson BS, BA ,&nbsp;Ashley M. Lowry MS, MEd ,&nbsp;Francis Caputo MD ,&nbsp;Douglas R. Johnston MD ,&nbsp;Christopher Smolock MD ,&nbsp;Patrick Vargo MD ,&nbsp;Eugene H. Blackstone MD ,&nbsp;Eric E. Roselli MD ,&nbsp;Collaborators in the Cleveland Clinic Aorta Center","doi":"10.1053/j.semtcvs.2022.10.004","DOIUrl":"10.1053/j.semtcvs.2022.10.004","url":null,"abstract":"<div><p><span>To characterize patient risk profiles and outcomes associated with staged ultra-hybrid repair of extensive aortic disease<span>, in which open thoracoabdominal completion was performed after thoracic stent grafting. From 1/2006 to 1/2021, 92 patients underwent open thoracoabdominal repair of chronic dissection (n=58, 63%), degenerative aneurysm (n=28, 30%), endoleak (n=4, 4.3%), or symptomatic acute type B dissection (n=2, 2.2%) after descending thoracic stent grafting (69, 75%), frozen elephant trunk (5, 5%), or both (18, 20%). The surgical graft was sewn to the distal endovascular device </span></span><em>in situ</em><span>, reducing the extent of the open procedure and eliminating the need for hypothermic circulatory arrest. Mean age was 58±13 years, 89 (97%) were hypertensive, 38 (43%) had chronic obstructive pulmonary disease<span><span>, 63 (72%) were smokers, 20 (24%) had a prior stroke, and 33 (36%) had a suspected or confirmed heritable aortic condition. Hospital mortality was 7.6% (n=7). Complications included dialysis (16, 20%), tracheostomy (8, 8.7%), stroke (5, 5.7%), and permanent paralysis (6, 6.9%). Survival at 1, 3, and 5 years was 80%, 71%, and 66%, respectively. Mortality was associated with higher </span>blood urea nitrogen and longer distance between the distal endograft edge and proximal patent visceral vessel (</span></span><em>P</em><span>=0.004 and .01, respectively). Patients with extensive aortic disease undergoing open aortic repair after thoracic stent grafting are often young with chronic dissection, multiple comorbidities, or a heritable aortic condition. Success of staged ultra-hybrid operations demonstrates open and endovascular repair strategies are complementary, even when performed in a high-risk patient population.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 137-147"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33512118","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":"Fate of the Right Ventricular Outflow Tract Following Valve-Sparing Repair of Tetralogy of Fallot","authors":"Omar Toubat PhD ,&nbsp;Winfield J. Wells MD ,&nbsp;Vaughn A. Starnes MD ,&nbsp;Subramanyan Ram Kumar MD, PhD","doi":"10.1053/j.semtcvs.2022.12.002","DOIUrl":"10.1053/j.semtcvs.2022.12.002","url":null,"abstract":"<div><p><span><span>Valve-sparing repair (VSR) of tetralogy of Fallot<span> (TOF) tends to result in higher residual right ventricular outflow tract (RVOT) gradients. We evaluated the progression and clinical implications of RVOT gradients following VSR of TOF. Demographic, clinical, and operative data were retrospectively collected from consecutive TOF patients who underwent VSR at our institution between 01/2010 and 06/2021. RVOT gradient, </span></span>pulmonary valve annulus (PVA) diameter and Boston Z-scores were recorded from serial </span>echocardiograms<span><span>. Data are presented as median and interquartile range or number and percentage. A total of 156 children (boys 92, 59%) underwent VSR at 6.5 (4.9-8.4) months of age and 6.6 kg (5.6- 7.7) weight. There was 1 (0.6%) operative mortality. The remaining 155 patients were followed for 69.4 months (4-106.2). RVOT gradient was 2.4m/s (1.7-2.9) at discharge. It transiently increased, then declined and stabilized during follow-up. PVA Z-score was -1.7 (-3.1 to 0.5) at discharge and ‘grew’ to -0.8 (-1.7 to 0.4) at last follow-up. Freedom from RVOT re-intervention was 97%, 94% and 91% at 1, 5 and 10-year follow-up. Among 67 (43%) patients with PVA Z-score &lt; -2, a similar RVOT gradient pattern was observed and freedom from RVOT re-intervention was 97%, 95% and 95% at 1, 5 and 8-year follow-up. Following VSR of TOF, RVOT gradients transiently increase and then fall as PVA </span>growth catches up<span>, resulting in durable intermediate outcomes. Patients with PVA Z-score &lt; -2 demonstrated a similar pattern of hemodynamics in the RVOT and excellent freedom from reintervention.</span></span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 242-249"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10061142","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":"Prognostic Impact of Very Small Ground-Glass Opacity Component in Stage IA Solid Predominant Non-small Cell Lung Cancer","authors":"Aritoshi Hattori MD ,&nbsp;Takeshi Matsunaga MD ,&nbsp;Mariko Fukui MD ,&nbsp;Kazuhiro Suzuki MD ,&nbsp;Kazuya Takamochi MD ,&nbsp;Kenji Suzuki MD","doi":"10.1053/j.semtcvs.2022.09.006","DOIUrl":"10.1053/j.semtcvs.2022.09.006","url":null,"abstract":"<div><p><span>We evaluated the prognostic role of the presence of a very small ground glass opacity<span> (GGO) component in stage IA solid-predominant non-small cell lung cancer (NSCLC). We evaluated surgically resected 1471 patients diagnosed with stage IA solid-predominant NSCLC. They were classified into 3 groups; that is, GGO group (0.5&lt;CTR&lt;0.9), Very small GGO group (0.9≤CTR&lt;1.0), and the Solid group (CTR = 1.0). The prognostic influence of a very small GGO component was evaluated using the Cox proportional hazards model. Overall survival (OS) was estimated using the Kaplan-Meier method with a log-rank test. In total, 523 GGO groups, 91 Very small GGO groups, and 857 Solid groups were identified. The median CTR of the Very small GGO group was 0.92 ± 0.02 (range, 0.90–0.97). Both the pathological characteristics and survival outcome was similar between GGO group and Very small GGO group (5 year-OS, 91.7% Vs 89.8%, </span></span><em>P</em> = 0.374). However, several pathological findings including nodal involvement (8% Vs 20%, <em>P</em> = 0.004), lymphatic (12% Vs 27%, <em>P</em> = 0.003) or vascular (18% Vs 37%, <em>P</em> &lt; 0.001) invasion or spread through alveolar space (9% Vs 23%, <em>P</em> = 0.004) were significantly different in comparison between Very small GGO and Solid group. Accordingly, the 5-year OS significantly differed between the groups (89.8% Vs 72.5%, <em>P</em> &lt; 0.001), which was also demonstrated in the propensity score-matched cohort (89.4% Vs 79.2%; <em>P</em> = 0.019). Prognostic impact of a very small GGO component is relevant in stage IA solid-predominant NSCLC. In the future, it is necessary to confirm these data using larger multi-institutional datasets that are more appropriately powered.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 251-260"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40386501","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":"Cardioprotective Effects of Glucose-Insulin-Potassium Infusion in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis","authors":"Andres Hagerman MD ,&nbsp;Raoul Schorer MD ,&nbsp;Alessandro Putzu MD ,&nbsp;Gleicy Keli-Barcelos MD, PhD ,&nbsp;Marc Licker MD","doi":"10.1053/j.semtcvs.2022.11.002","DOIUrl":"10.1053/j.semtcvs.2022.11.002","url":null,"abstract":"<div><p>The infusion of glucose-insulin-potassium (GIK) has yielded conflicting results in terms of cardioprotective effects. We conducted a meta-analysis to examine the impact of perioperative GIK infusion in early outcome after cardiac surgery. Randomized controlled trials (RCTs) were eligible if they examined the efficacy of GIK infusion in adults undergoing cardiac surgery. The main study endpoint was postoperative myocardial infarction (MI) and secondary outcomes were hemodynamics, any complications and hospital resources utilization. Subgroup analyses explored the impact of the type of surgery, GIK composition and timing of administration. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were calculated with a random-effects model. Fifty-three studies (n=6129) met the inclusion criteria. Perioperative GIK infusion was effective in reducing MI (k=32 OR 0.66[0.48, 0.89] <em>P</em>=0.0069), acute kidney injury (k=7 OR 0.57[0.4, 0.82] <em>P</em>=0.0023) and hospital length of stay (k=19 MD -0.89[-1.63, -0.16] days <em>P</em>=0.0175). Postoperatively, the GIK-treated group presented higher cardiac index (k=14 MD 0.43[0.29, 0.57] L/min <em>P</em>&lt;0.0001) and lesser hyperglycemia (k=20 MD -30[-47, -13] mg/dL <em>P</em>=0.0005) than in the usual care group. The GIK-associated protection for MI was effective when insulin infusion rate exceeded 2 mUI/kg/min and after coronary artery bypass surgery. Certainty of evidence was low given imprecision of the effect estimate, heterogeneity in outcome definition and risk of bias. Perioperative GIK infusion is associated with improved early outcome and reduced hospital resource utilization after cardiac surgery. Supporting evidence is heterogenous and further research is needed to standardize the optimal timing and composition of GIK solutions.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 167-181"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1043067922002623/pdfft?md5=57e71c6e09516cef281a90c26872c501&pid=1-s2.0-S1043067922002623-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40456167","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":"Commentary: A Tale of Two Operations","authors":"Omar M. Sharaf BS ,&nbsp;Gilbert R. Upchurch MD ,&nbsp;Thomas M. Beaver MD, MPH","doi":"10.1053/j.semtcvs.2022.10.006","DOIUrl":"10.1053/j.semtcvs.2022.10.006","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 148-149"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673676","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":"Reply: A Paradigm Shift is Starting Point","authors":"Edgar Aranda-Michel PhD ,&nbsp;Lena Trager BA ,&nbsp;Jason Han MD ,&nbsp;Ibrahim Sultan MD","doi":"10.1053/j.semtcvs.2022.09.001","DOIUrl":"10.1053/j.semtcvs.2022.09.001","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Page 215"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33458873","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: How Soon is Now?","authors":"Hellmuth R. Muller Moran MD ,&nbsp;Rakesh C. Arora MD, PhD, FRCSC","doi":"10.1053/j.semtcvs.2023.03.004","DOIUrl":"10.1053/j.semtcvs.2023.03.004","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 209-210"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9350878","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":"Identifying Actionable Targets to Improve Patient Satisfaction After Cardiac Surgery","authors":"Ko Bando MD, PhD","doi":"10.1053/j.semtcvs.2022.09.005","DOIUrl":"10.1053/j.semtcvs.2022.09.005","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 211-212"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40376124","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":"Identifying Patients Vulnerable to Inadequate Pain Resolution After Cardiac Surgery","authors":"Ian Kelly BS ,&nbsp;Kara Fields MS ,&nbsp;Pankaj Sarin MD ,&nbsp;Amanda Pang BS ,&nbsp;Martin I. Sigurdsson MD, PhD ,&nbsp;Stanton K. Shernan MD ,&nbsp;Amanda A. Fox MD, MPH ,&nbsp;Simon C. Body MBChB, MPH ,&nbsp;Jochen D. Muehlschlegel MD, MMSc, MBA","doi":"10.1053/j.semtcvs.2022.08.010","DOIUrl":"10.1053/j.semtcvs.2022.08.010","url":null,"abstract":"<div><p><span><span>Acute postoperative pain<span> (APOP) is often evaluated through granular parameters, though monitoring postoperative pain using trends may better describe pain state. We investigated acute postoperative pain trajectories in cardiac surgical patients to identify subpopulations of pain resolution and elucidate predictors of problematic pain courses. We examined retrospective data from 2810 cardiac surgical patients at a single center. The k-means algorithm for longitudinal data was used to generate clusters of pain trajectories over the first 5 postoperative days. Patient characteristics were examined for association with cluster membership using ordinal and multinomial </span></span>logistic regression<span>. We identified 3 subgroups of pain resolution after cardiac surgery: 37.7% with good resolution, 44.2% with moderate resolution, and 18.2% exhibiting poor resolution. Type I diabetes (2.04 [1.00–4.16], </span></span><em>p</em> = 0.05), preoperative opioid use (1.65 [1.23–2.22], <em>p</em><span> = 0.001), and illicit drug use (1.89 [1.26–2.83], </span><em>p</em> = 0.002) elevated risk of membership into worse pain trajectory clusters. Female gender (1.72 [1.30–2.27], <em>p</em> &lt; 0.001), depression (1.60 [1.03–2.50], <em>p</em> = 0.04) and chronic pain (3.28 [1.79–5.99], <em>p</em> &lt; 0.001) increased risk of membership in the worst pain resolution cluster. This study defined 3 APOP resolution subgroups based on pain score trend after cardiac surgery and identified factors that predisposed patients to worse resolution. Patients with moderate or poor pain trajectory consumed more opioids and received them for longer before discharge. Future studies are warranted to determine if altering postoperative pain monitoring and management improve postoperative course of patients at risk of moderate or poor pain resolution.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 182-194"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33456399","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":"Palliated Hypoplastic Left Heart Syndrome Patients Experience Superior Waitlist and Comparable Post-Heart Transplant Survival to Non-Single Ventricle Congenital Heart Disease Patients","authors":"Jason W. Greenberg MD,&nbsp;Muhammad Aanish Raees MBBS,&nbsp;Alia Dani MD, MPH,&nbsp;Haleh C. Heydarian MD,&nbsp;Clifford Chin MD,&nbsp;Farhan Zafar MD, MS,&nbsp;David G. Lehenbauer MD,&nbsp;David L.S. Morales MD","doi":"10.1053/j.semtcvs.2022.08.019","DOIUrl":"10.1053/j.semtcvs.2022.08.019","url":null,"abstract":"<div><p><span><span>Congenital heart disease (CHD) is a well-established risk factor for inferior waitlist and post-heart </span>transplant survival<span><span><span> in children. Differences in outcomes between CHD subgroups are understudied. The present study compared outcomes for palliated hypoplastic left heart syndrome (HLHS) patients to other non-single ventricle CHD (non-SVCHD) and non-CHD patients. United Network for Organ Sharing was used to identify children (age &lt; 18) listed for </span>heart transplant in the United States between 2016 and 2021. CHD sub-diagnoses were only available for United Network for Organ Sharing status 1a after 2015, thereby defining the cohort. Waitlist outcomes were studied using competing-risk time-to-event analysis for transplantation, mortality/decompensation, and alive-on-waitlist. Multivariable Cox </span>proportional hazards regression analyses were used to identify factors associated with inferior post-transplant survival. Patients included: palliated-HLHS (</span></span><em>n =</em> 477), non-SVCHD (<em>n =</em> 686), and non-CHD (<em>n =</em> 1261). At listing, Palliated-HLHS patients were older than non-SVCHD (median 2-year [IQR 0-8] vs median 0-year [0-3], respectively) and younger than non-CHD (median 7-year [0-14]) (<em>P &lt;</em> 0.001 vs both), and were more likely to be white (<em>P &lt;</em> 0.01 vs both). Upon time-to-event analysis, rates of waitlist mortality/decompensation rates were greater among non-SVCHD than palliated-HLHS. Post-transplant survival was comparable between palliated-HLHS and non-SVCHD (<em>P =</em> 0.920) but worse compared to non-CHD (<em>P &lt;</em> 0.001). Both palliated-HLHS (HR 2.40 [95% CI 1.68-3.42]) and non-SVSCHD (2.04 [1.39-2.99]) were independently associated with post-transplant mortality. Palliated-HLHS patients with heart failure experience significantly worse post-transplant outcomes than non-CHD but, compared to other CHD patients, experience superior waitlist and comparable post-transplant survival. While a high-risk cohort, HLHS patients can achieve gratifying waitlist and post-transplant survival.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 230-241"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9536420","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}