Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"New Directions in Coronary Revascularization for Refractory Angina: Gene Therapy and the Lizard Heart","authors":"Ahmed H. Aly MD, PhD,&nbsp;Nahush A. Mokadam MD","doi":"10.1053/j.semtcvs.2024.11.009","DOIUrl":"10.1053/j.semtcvs.2024.11.009","url":null,"abstract":"<div><div>Refractory angina is a debilitating disease with limited therapeutic options that is primarily caused by microvascular dysfunction and desertification. Toward addressing this unmet need, microvascular revascularization therapy has progressively evolved from the lizard heart–inspired transmyocardial revascularization to precisely inducing vascular endothelial growth factor with gene therapy. Gene therapy with adenoviral vehicles or naked modified ribonucleic acid is safe and shows early signs of clinical promise but has not yet been proven effective due to gaps in optimization.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 28-33"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822676","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":"Internal Thoracic Arteries Injuries During Harvesting: Mitigation and Management","authors":"Jules J. Bakhos MD, MSc,&nbsp;Gabriele M. Iacona MD,&nbsp;Marijan Koprivanac MD,&nbsp;Michael Z. Tong MD,&nbsp;Shinya Unai MD,&nbsp;Edward G. Soltesz MD,&nbsp;Haytham Elgharably MD,&nbsp;Faisal G. Bakaeen MD","doi":"10.1053/j.semtcvs.2024.08.006","DOIUrl":"10.1053/j.semtcvs.2024.08.006","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 22-27"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298978","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":"Techniques and Results of Multiple Arterial Bypass Grafting: Towards More “Curative” Coronary Revascularizations","authors":"J. Scott Rankin MD ,&nbsp;J. Hunter Mehaffey MD ,&nbsp;Danny Chu MD ,&nbsp;Richard Ramsingh MD ,&nbsp;Abhishek Sharma MD ,&nbsp;Vinay Badhwar MD ,&nbsp;Faisal G. Bakaeen MD","doi":"10.1053/j.semtcvs.2024.09.002","DOIUrl":"10.1053/j.semtcvs.2024.09.002","url":null,"abstract":"<div><div>Surgical coronary bypass has evolved continually, and most analyses currently favor performing coronary grafts with autologous living arterial conduits to obtain better long-term patencies and clinical outcomes. With bilateral internal mammary artery grafts and both radial arteries, 4 excellent arterial conduits exist for creating “all-arterial” revascularization in the majority of multivessel disease patients, including those with valve disorders. Using contemporary surgical techniques, it is possible to obtain greater than 95% overall early graft patencies that translate into better late outcomes, including improved survival, freedom from myocardial infarction, fewer percutaneous coronary interventions, and redo coronary bypass procedures. The overall goal is to revascularize the 2 most important coronary systems with internal mammary artery grafts, and the rest with radial arteries, depending on the anatomy, experience, and choice of the surgeon. Using highly validated management strategies, early postoperative complications, including the incidence of sternal infections, are extremely uncommon, and in many practices, multi-arterial grafts currently are used in the majority of multivessel patients, including those with concomitant valve disease. Because patencies and outcomes are significantly better than with saphenous vein bypass or percutaneous coronary interventions, referring physicians frequently favor multi-arterial bypass procedures as the primary therapy for patients with prognostically serious multivessel disease. Thus, coronary bypass using predominantly autologous arterial conduits should play an increasingly important role in the future management of severe coronary atherosclerosis.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 12-21"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401662","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 Importance of Pulmonary Nodule Features in the Selection of Treatment for the High-Risk Patient with Stage I Non-Small Cell Lung Cancer","authors":"Arjun Pennathur MD, Co-Chair Writing Committee ,&nbsp;Michael Lanuti MD ,&nbsp;Robert E. Merritt MD ,&nbsp;Andrea Wolf MD, MPH ,&nbsp;Homa Keshavarz PhD ,&nbsp;Billy W. Loo Jr, MD, PhD ,&nbsp;Robert D. Suh MD ,&nbsp;Raymond H. Mak MD ,&nbsp;Alessandro Brunelli MD ,&nbsp;Gerard J. Criner MD ,&nbsp;Peter J. Mazzone MD ,&nbsp;Garrett Walsh MD ,&nbsp;Michael Liptay MD ,&nbsp;Q. Eileen Wafford MSt, MLIS ,&nbsp;Sudish Murthy MD, PhD ,&nbsp;M. Blair Marshall MD ,&nbsp;Betty Tong MD ,&nbsp;Brian Pettiford MD ,&nbsp;Gaetano Rocco MD ,&nbsp;James Luketich MD ,&nbsp;Scott J. Swanson MD, Co-Chair Writing Committee","doi":"10.1053/j.semtcvs.2024.10.003","DOIUrl":"10.1053/j.semtcvs.2024.10.003","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 75-81"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814739","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 Radial Artery is the Second Best Conduit after the Left Internal Thoracic Artery","authors":"James Tatoulis MB BS, MS, MD, FRACS, FRCST, FCSANZ","doi":"10.1053/j.semtcvs.2024.07.002","DOIUrl":"10.1053/j.semtcvs.2024.07.002","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 58-66"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510838","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 Image-Guided Thermal Ablation for Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer","authors":"Michael Lanuti MD ,&nbsp;Robert D. Suh MD ,&nbsp;Gerard J. Criner MD ,&nbsp;Peter J. Mazzone MD ,&nbsp;M. Blair Marshall MD ,&nbsp;Betty Tong MD ,&nbsp;Robert E. Merritt MD ,&nbsp;Andrea Wolf MD, MPH ,&nbsp;Homa Keshavarz PhD ,&nbsp;Billy W. Loo Jr, MD, PhD ,&nbsp;Raymond H. Mak MD ,&nbsp;Alessandro Brunelli MD ,&nbsp;Garrett Walsh MD ,&nbsp;Michael Liptay MD ,&nbsp;Q. Eileen Wafford MSt, MLIS ,&nbsp;Sudish Murthy MD, PhD ,&nbsp;Brian Pettiford MD ,&nbsp;Gaetano Rocco MD ,&nbsp;James Luketich MD ,&nbsp;Matthew J. Schuchert MD ,&nbsp;Arjun Pennathur MD, Co-Chair Writing Committee","doi":"10.1053/j.semtcvs.2024.11.001","DOIUrl":"10.1053/j.semtcvs.2024.11.001","url":null,"abstract":"<div><div>Image-guided thermal ablation (IGTA) applied to pulmonary pathology is an alternative to surgery in high-risk patients with stage I non-small cell lung cancer (NSCLC). Its application to lung neoplasm was first introduced in 2001 and has been implemented to treat metastatic disease to the lung or in select medically inoperable patients with peripheral stage I NSCLC. IGTA may also be an alternative to treat stage I NSCLC in non-operable patients with interstitial lung disease in whom a radiation modality is deemed too high risk. There are 3 methods of delivery: radiofrequency ablation (RFA), microwave ablation and cryoablation. Observational series and some prospective trials have shown safety and efficacy across all three modalities. Despite accumulating experience, there are no large randomized clinical trials comparing the outcomes of lung IGTA to alternative locoregional therapies (eg, stereotactic body radiotherapy or sublobar pulmonary resection) for the treatment of stage I NSCLC. Because IGTA is a local therapy, a higher risk of locoregional recurrence is inherently understood as compared with anatomic resection. In the literature, primary tumor control after RFA ranges from 47 to 90% and is dependent on tumor size and proximity to bronchovascular structures. Local failure ranges from 10 to 47%, and tumors ≥3 cm have the highest rate of local recurrence. The most prevalent side effects are pneumothorax and reactive pleural effusion; hemorrhage is uncommon. Of note, observational series show no significant loss of lung function after IGTA. This expert review contextualizes limitations, complications and outcomes of IGTA in patients with stage I NSCLC.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 82-88"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814737","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":"Treatment Selection for the High-Risk Patient with Stage I Non-Small Cell Lung Cancer: Sublobar Resection, Stereotactic Ablative Radiotherapy or Image-Guided Thermal Ablation?","authors":"Arjun Pennathur MD, Co-Chair Writing Committee ,&nbsp;Michael Lanuti MD ,&nbsp;Robert E. Merritt MD ,&nbsp;Andrea Wolf MD, MPH ,&nbsp;Homa Keshavarz PhD ,&nbsp;Billy W. Loo Jr, MD, PhD ,&nbsp;Robert D. Suh MD ,&nbsp;Raymond H. Mak MD ,&nbsp;Alessandro Brunelli MD ,&nbsp;Gerard J. Criner MD ,&nbsp;Peter J. Mazzone MD ,&nbsp;Garrett Walsh MD ,&nbsp;Michael Liptay MD ,&nbsp;Q. Eileen Wafford MSt, MLIS ,&nbsp;Sudish Murthy MD, PhD ,&nbsp;M. Blair Marshall MD ,&nbsp;Betty Tong MD ,&nbsp;Brian Pettiford MD ,&nbsp;Gaetano Rocco MD ,&nbsp;James Luketich MD ,&nbsp;Scott J. Swanson MD, Co-Chair Writing Committee","doi":"10.1053/j.semtcvs.2024.10.004","DOIUrl":"10.1053/j.semtcvs.2024.10.004","url":null,"abstract":"<div><div>A significant proportion of patients with stage I non–small cell lung cancer (NSCLC) are considered at high risk for complications or mortality after lobectomy. The American Association for Thoracic Surgery (AATS) previously published an expert consensus document detailing important considerations in determining who is at high risk. The current objective was to evaluate treatment options and important factors to consider during treatment selection for these high-risk patients. After systematic review of the literature, treatment options for high-risk patients with stage I NSCLC were reviewed by an AATS expert panel. Expert consensus statements and vignettes pertaining to treatment selection were then developed using discussion and a modified Delphi method. The expert panel identified sublobar resection, stereotactic ablative radiotherapy (SABR), and image-guided thermal ablation (IGTA) as modalities applicable in the treatment of high-risk patients with stage I NSCLC. The panel also identified lung-nodule-related factors that are important to consider in treatment selection. Using this information, the panel formulated 14 consensus statements and 5 vignettes illustrating clinical scenarios. This article summarizes important factors to consider in treatment selection using these modalities, which are applicable in high-risk patients with stage I NSCLC. The choice of which modality (sublobar resection, SABR, or IGTA) is optimal in high-risk patients with stage I NSCLC is complex, but a surgical approach is generally favored when deemed safe. SABR and IGTA are reasonable options in select patients. SABR is more commonly used than IGTA and is likely the next-best choice. A multi-disciplinary review of patient and tumor characteristics is essential for achieving an optimal decision. The clinical treatment decision should also take patient perspectives, preferences, and quality of life into consideration.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 114-121"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814742","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":"Off-Pump Coronary Artery Bypass Grafting is Overutilized","authors":"Allen A. Razavi MD,&nbsp;Jad Malas MD,&nbsp;Aminah Salam MD,&nbsp;Dominic A. Emerson MD,&nbsp;Michael E. Bowdish MD, MS","doi":"10.1053/j.semtcvs.2024.12.001","DOIUrl":"10.1053/j.semtcvs.2024.12.001","url":null,"abstract":"<div><div>Off-pump coronary artery bypass grafting (CABG), developed to avoid the potential complications of cardiopulmonary bypass, remains a subject of debate. Studies have demonstrated that off-pump CABG is associated with higher rates of incomplete revascularization, inferior graft patency, and increased reintervention rates compared to on-pump CABG, leading to worse outcomes. The theoretical neuroprotective and renal-protective benefits associated with off-pump CABG have not been definitively proven, with stroke and renal failure rates similar to those of on-pump CABG in both short- and long-term follow-up. Off-pump CABG presents technical challenges, contributing to a steep learning curve, and its effectiveness is dependent on surgeon and center experience. Lower-volume centers and surgeons performing off-pump CABG have shown increased rates of mortality and reintervention. Despite the potential cost savings by avoiding cardiopulmonary bypass, the need for repeat interventions and associated complications can lead to higher long-term healthcare costs. This paper advocates for a more selective use of off-pump CABG while maintaining on-pump CABG as the standard approach for patients with coronary artery disease.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 43-47"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899509","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":"Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer","authors":"Arjun Pennathur MD, Co-Chair Writing Committee ,&nbsp;Michael Lanuti MD ,&nbsp;Robert E. Merritt MD ,&nbsp;Andrea Wolf MD, MPH ,&nbsp;Homa Keshavarz PhD ,&nbsp;Billy W. Loo Jr, MD, PhD ,&nbsp;Robert D. Suh MD ,&nbsp;Raymond H. Mak MD ,&nbsp;Alessandro Brunelli MD ,&nbsp;Gerard J. Criner MD ,&nbsp;Peter J. Mazzone MD ,&nbsp;Garrett Walsh MD ,&nbsp;Michael Liptay MD ,&nbsp;Q. Eileen Wafford MSt, MLIS ,&nbsp;Sudish Murthy MD, PhD ,&nbsp;M. Blair Marshall MD ,&nbsp;Betty Tong MD ,&nbsp;Brian Pettiford MD ,&nbsp;Gaetano Rocco MD ,&nbsp;James Luketich MD ,&nbsp;Scott J. Swanson MD, Co-Chair Writing Committee","doi":"10.1053/j.semtcvs.2024.10.002","DOIUrl":"10.1053/j.semtcvs.2024.10.002","url":null,"abstract":"<div><h3>Objectives</h3><div>A significant proportion of patients with stage I non–small cell lung cancer (NSCLC) are considered at high risk for complications or mortality after lobectomy. The American Association for Thoracic Surgery (AATS) previously published important considerations in determining which patients are considered high risk. The current objective was to evaluate treatment options and important factors to consider during treatment selection for these high-risk patients.</div></div><div><h3>Methods</h3><div>The AATS Clinical Practice Standards Committee assembled an expert panel to review treatment options for high-risk patients with stage I NSCLC. After a systematic search of the literature identification of lung-nodule-related factors to consider in treatment selection, the panel developed expert consensus statements and vignettes using a modified Delphi method. A 75% consensus was required for approval.</div></div><div><h3>Results</h3><div>The expert panel identified sublobar resection, image-guided thermal ablation (IGTA), and stereotactic ablative radiotherapy (SABR), which is also known as stereotactic body radiation therapy (SBRT) or stereotactic radiosurgery (SRS), as modalities applicable in the treatment of high-risk patients with stage I NSCLC. Fourteen statements and 5 vignettes illustrating clinical scenarios were formulated, revised, and ultimately approved.</div></div><div><h3>Conclusion</h3><div>The choice of which modality (sublobar resection, SABR, or IGTA) is optimal in high-risk patients with stage I NSCLC is complex, but a surgical approach is generally favored when deemed safe. SABR and IGTA are reasonable options in select patients, with SABR being the likely next choice in nonsurgical patients. If possible, obtaining a biopsy is very important prior non-surgical treatment. A multi-disciplinary review of patient and tumor characteristics is essential for achieving an optimal decision. The clinical treatment decision should also take patient perspectives, preferences, and quality of life into consideration.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 67-74"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822657","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":"Integrating Quality Metrics with Enhanced Recovery Pathways in Coronary Artery Bypass Grafting","authors":"Katherine G. Phillips MD,&nbsp;Aubrey Galloway MD,&nbsp;Eugene A. Grossi MD,&nbsp;Daniel Swistel MD,&nbsp;Deane E. Smith III MD,&nbsp;Ralph Mosca MD,&nbsp;Elias Zias MD","doi":"10.1053/j.semtcvs.2025.01.002","DOIUrl":"10.1053/j.semtcvs.2025.01.002","url":null,"abstract":"<div><div>Quality improvement and enhanced recovery initiatives for coronarybypass surgery have reduced complications, shortened hospital stay and recovery times, and improved patient outcomes. Beyond the Society of Thoracic Surgery’s (STS) quality metrics, many other operative measures, such as completeness of revascularization, and patient care measures add quality and value for patients undergoing coronary artery bypass surgery; and Enhanced Recovery after Surgery (ERAS) protocols have improved patient experience and recovery, leading to better outcomes and significant healthcare savings.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 48-57"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076005","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}