Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Postoperative Brain Attack: Current Perspectives and Future Directions.","authors":"Miriam Quinlan, Rakesh Arora, Sung Min Cho","doi":"10.1053/j.semtcvs.2025.02.007","DOIUrl":"10.1053/j.semtcvs.2025.02.007","url":null,"abstract":"<p><p>The incidence of stroke after cardiac surgery poses significant challenges. This expert review piece explores current knowledge, challenges, future directions, and offers insights into improving patient outcomes through optimal prevention, early recognition, and management strategies. By addressing the challenges and opportunities in this area, we can enhance patient care, reduce long-term disabilities, and improve the overall quality of life for affected individuals. This expert review aims to provide a comprehensive framework for managing postoperative stroke: mechanisms, risk factors, diagnosis, treatment, systems of care, and ethical considerations.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626524","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":"At the Heart of It All: Leadership in the Operating Room.","authors":"Alex M Wisniewski, Irving L Kron","doi":"10.1053/j.semtcvs.2025.02.005","DOIUrl":"10.1053/j.semtcvs.2025.02.005","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587497","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 Root Replacement: Should We Wait Until 5 cm?","authors":"Marc R Moon, Puja Kachroo","doi":"10.1053/j.semtcvs.2025.02.002","DOIUrl":"10.1053/j.semtcvs.2025.02.002","url":null,"abstract":"<p><p>Surgical replacement of the ascending aorta and root was first undertaken in the 1950s although methodologies were rudimentary compared to the current era. Advances in brain protection and surgical technique have made complex root procedures relatively low risk in experienced hands. The standard critieria for elective replacement of the root and ascending aorta has been 5.5 cm when there is no connective tissue etiology for the aneurysm. Recent literature has suggested that a more liberal criteria would may be appropriate in healthy patient at low risk, patients with high-risk features including strong family history of adverse aortic events, and in centers whose outcomes are such that the risk of surgery at lower aortic size is far less than the risk of progression of disease or significant adverse event. This manuscript critically evaluates recent literature to suggest in which patients and at what type of centers a more aggressive prophylactic approach should be entertained.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587496","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":"Hypotension and Perioperative Strokes in Cardiac Surgery: How Big Data Can Help Answer Big Questions.","authors":"Jose Rios-Monterrosa, Louise Y Sun","doi":"10.1053/j.semtcvs.2025.02.004","DOIUrl":"10.1053/j.semtcvs.2025.02.004","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574509","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 Surgical, Hybrid, and Transcatheter Approaches to the Dysfunctional Mitral Valve with Mitral Annular Calcification.","authors":"Omar Toubat, Max Shin, Michael A Catalano, Amit Iyengar, Pavan Atluri","doi":"10.1053/j.semtcvs.2025.01.008","DOIUrl":"10.1053/j.semtcvs.2025.01.008","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568518","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 Only Mitral Valve Repair Techniques That Everyone Ever Needs to Know.","authors":"Tarek Malas, Marc Gillinov","doi":"10.1053/j.semtcvs.2025.02.003","DOIUrl":"10.1053/j.semtcvs.2025.02.003","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568519","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":"Expert Opinion: What should Revascularization Trials that Inform the Guidelines Look Like?","authors":"Dawn S. Hui MD ,&nbsp;Victor Dayan MD ,&nbsp;David P. Taggart","doi":"10.1053/j.semtcvs.2024.08.005","DOIUrl":"10.1053/j.semtcvs.2024.08.005","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 1-5"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141494","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":"Minimally Invasive Coronary Artery Bypass Grafting is the Future: Pro","authors":"Marc Ruel MD, MPH ,&nbsp;Michael E. Halkos MD, MSc","doi":"10.1053/j.semtcvs.2024.09.003","DOIUrl":"10.1053/j.semtcvs.2024.09.003","url":null,"abstract":"<div><div>Coronary artery bypass grafting (CABG) remains one of the most commonly performed operations worldwide. However, most CABG operations performed today are as invasive —apart from saphenous vein harvesting— as they were 50 years ago. While heart valve operations have become less invasive, CABG faces formidable challenges in doing so. Valve surgery requires a single surgical exposure to the valve intervened on, but less invasive CABG necessitates multiple surgical exposures to harvest internal thoracic artery conduits, source their inflow plus that of other grafts, and expose each coronary target to be grafted —including anterior, lateral, posterior, and inferior vessels. In this article, we rationalize why we believe that conventional CABG remains unduly invasive, associated with morbidity and prolonged recovery, and why less invasive CABG in its many forms, which we describe, represents a safe, practical, diffusible, and less invasive alternative to sternotomy CABG. Centers of excellence in coronary artery surgery should dedicate resources and expertise to developing high-quality, safe, durable, and advanced forms of lesser invasive CABG.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 34-42"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378384","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":"Systematic Review of Stereotactic Ablative Radiotherapy (SABR)/Stereotactic Body Radiation Therapy (SBRT) for Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer","authors":"Andrea Wolf MD, MPH ,&nbsp;Billy W. Loo Jr, MD, PhD ,&nbsp;Raymond H. Mak MD ,&nbsp;Michael Liptay MD ,&nbsp;Brian Pettiford MD ,&nbsp;Gaetano Rocco MD ,&nbsp;Michael Lanuti MD ,&nbsp;Robert E. Merritt MD ,&nbsp;Homa Keshavarz PhD ,&nbsp;Robert D. Suh MD ,&nbsp;Alessandro Brunelli MD ,&nbsp;Gerard J. Criner MD ,&nbsp;Peter J. Mazzone MD ,&nbsp;Garrett Walsh MD ,&nbsp;Q. Eileen Wafford MSt, MLIS ,&nbsp;Sudish Murthy MD, PhD ,&nbsp;M. Blair Marshall MD ,&nbsp;Betty Tong MD ,&nbsp;James Luketich MD ,&nbsp;Matthew J. Schuchert MD ,&nbsp;Scott J. Swanson MD, Co-Chair Writing Committee","doi":"10.1053/j.semtcvs.2024.10.005","DOIUrl":"10.1053/j.semtcvs.2024.10.005","url":null,"abstract":"<div><div>Stereotactic ablative radiotherapy (SABR) has emerged as an alternative, non-surgical treatment for high-risk patients with stage I non-small cell lung cancer (NSCLC) with increased use over time. The American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) assembled an expert panel and conducted a systematic review of the literature evaluating the results of SABR, which is also referred to as stereotactic body radiation therapy (SBRT) or stereotactic radiosurgery (SRS), prior to developing treatment recommendations for high-risk patients with stage I NSCLC based on expert consensus. Publications detailing the findings of 16 prospective studies of SABR and 14 retrospective studies of SABR for the management of early-stage lung cancer in 54,697 patients were identified by systematic review of the literature with further review by members of our expert panel. Medical inoperability (93–95%) was the primary reason for utilizing SABR. The median rate of histologically confirmed cancer in treated patients was 67% (range 57–86%). In retrospective studies and prospective studies, the most common dosing regimens were 48–54<!--> <!-->Gy in 3–5 fractions and 44–66<!--> <!-->Gy in 3–5 fractions respectively. The median follow-up after SABR was 30 months (range 15–50). The complications, oncological results and quality of life after SABR in high-risk patients with early-stage NSCLC are summarized in this Expert Review article. Further prospective randomized trials are needed and are currently underway to compare outcomes after SABR with outcomes after sublobar resection to fully evaluate treatment options applicable this high-risk group of patients.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 89-98"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824836","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":"CABG Should Be a Subspecialty","authors":"Bob Kiaii MD ,&nbsp;Bradley Taylor MD","doi":"10.1053/j.semtcvs.2024.12.003","DOIUrl":"10.1053/j.semtcvs.2024.12.003","url":null,"abstract":"<div><div>Subspecialization in surgery is increasingly common and for great reasons. Over the past 20 years, there has been evidence in support of the link between subspecialization in the disciplines of orthopedic surgery, general, thoracic surgery, neurosurgery, and in interventional cardiology and better patient outcomes and technical advances in their respective fields. In addition, studies suggest that increased hospital and surgeon volume throughout surgery may lead to improved surgical outcomes. The degree of specialization has been shown to reduce operative mortality in a variety of procedures and highlights that the level of sophistication and fund of knowledge required within each area is so great that no one surgeon can “do it all” and do it well. Cardiac surgery has become more subspecialized; however, many still view coronary artery surgery as a generalist procedure. There is debate as to the relative contribution of hospital volume, surgeon volume, or degree of specialization on perioperative mortality following isolated coronary artery bypass grafting. In this paper, we will discuss the current data supporting the need for specialization in coronary surgery and present arguments in favor of further specialization in this field.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 6-11"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904034","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}