Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Drinking Pudding Through a Straw: Large-Bore versus Pigtail Catheters for Pleural Drainage","authors":"Andrew Hawkins MD, Linda W. Martin MD, MPH, FACS","doi":"10.1053/j.semtcvs.2025.05.007","DOIUrl":"10.1053/j.semtcvs.2025.05.007","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"38 1","pages":"Pages 80-83"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250412","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":"Recent Articles in AATS Journals","authors":"","doi":"10.1053/j.semtcvs.2026.03.001","DOIUrl":"10.1053/j.semtcvs.2026.03.001","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"38 1","pages":"Pages e1-e3"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147685807","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 MD ,&nbsp;Puja Kachroo MD","doi":"10.1053/j.semtcvs.2025.02.002","DOIUrl":"10.1053/j.semtcvs.2025.02.002","url":null,"abstract":"<div><div>Surgical replacement of the ascending aorta<span> 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.</span></div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"38 1","pages":"Pages 5-10"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","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":"The Role of Surgery for Local Consolidative Therapy in the Management of Oligometastatic Disease","authors":"Rajika Jindani ,&nbsp;Kyle G. Mitchell ,&nbsp;Mara B. Antonoff","doi":"10.1053/j.semtcvs.2025.05.003","DOIUrl":"10.1053/j.semtcvs.2025.05.003","url":null,"abstract":"<div><div>Oligometastatic non-small cell lung cancer (NSCLC) constitutes a distinct form of disease with limited metastatic burden, which may benefit in terms of disease control and overall survival<span> from local consolidative therapy (LCT). Pulmonary resection<span> has emerged as a valuable component of LCT, demonstrating improvements in progression-free and overall survival for appropriately selected patients. This review examines the evolving role of surgery in the management of oligometastatic NSCLC, emphasizing survival benefits, biological rationale, surgical complexities, disparities in care, and ongoing trials. Emerging research integrating biomarkers, novel pharmacotherapy, and advanced surgical techniques offers new opportunities to refine patient selection and improve outcomes. Addressing barriers and advancing multidisciplinary approaches will be critical to fully realize the benefits of surgery in this context.</span></span></div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"38 1","pages":"Pages 71-79"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121099","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":"Outcomes of Redo Aortic Arch Repair Post Type A Dissection in the Modern Era","authors":"Suguru Ohira MD, PhD ,&nbsp;Sooyun Caroline Tavolacci MD, MSCR ,&nbsp;Corazon de la Pena MD ,&nbsp;David Spielvogel MD","doi":"10.1053/j.semtcvs.2025.03.006","DOIUrl":"10.1053/j.semtcvs.2025.03.006","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"38 1","pages":"Pages 13-20"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039786","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":"Reoperative Arch Replacement: Outcomes and Technical Considerations","authors":"Eilon Ram MD,&nbsp;Christopher Lau MD,&nbsp;Danica Germain PA-C,&nbsp;Ivancarmine Gambardella MD,&nbsp;Giovanni Jr. Soletti MD,&nbsp;Mario Gaudino MD,&nbsp;Leonard N. Girardi MD","doi":"10.1053/j.semtcvs.2025.07.001","DOIUrl":"10.1053/j.semtcvs.2025.07.001","url":null,"abstract":"<div><div>Reoperative total arch replacement (TAR) following prior cardiovascular surgery presents significant technical challenges and is associated with higher risk profiles. With increasing numbers of patients undergoing reoperation as a result of successful outcomes from primary procedures, we sought to compare the clinical outcomes of reoperative TAR with those of first-time TAR. We reviewed 474 patients who underwent TAR at our institution from 1997 to 2024. Of these, 171 patients (36%) had previously undergone cardiovascular surgery, while the remaining 303 (64%) were undergoing TAR for the first time. Demographic, procedural, and outcome data were collected and analyzed. Comparisons between the reoperative and primary groups were made, and multivariable regression was used to identify covariates associated with major postoperative adverse events (MAEs). Patients in the reoperative group were younger on average (61.5 ± 13.5 vs 70.7 ± 10.9 years, <em>P</em> &lt; 0.001), but presented with a higher burden of comorbidities, including ischemic heart disease (15.8% vs 7.3%, <em>P</em> = 0.006), prior strokes (38.6% vs 15.5%, <em>P</em> &lt; 0.001), and renal impairment (24.6% vs 12.5%, <em>P</em> = 0.001). Operative times were significantly longer for reop TAR, with extended circulatory arrest (48.4 ± 12.8 vs 36 ± 10.8 minutes, <em>P</em> &lt; 0.001), cardiac ischemia (118.2 ± 44.2 vs 99 ± 32.1 minutes, <em>P</em> &lt; 0.001), and cardiopulmonary bypass duration (180.7 ± 38.2 vs 146.7 ± 26.3 minutes, <em>P</em> &lt; 0.001). The reoperative group had higher operative mortality (4.1% vs 0.3%, <em>P</em> = 0.007) and a 2.3-fold increased risk of MAEs (OR 2.27, 95% CI 1.01–5.1, <em>P</em> = 0.046). Reoperative TAR is associated with increased operative risk, longer procedural times, and higher rates of operative complications compared to first-time TAR. Despite these challenges, successful outcomes can be achieved with thorough preoperative planning and attention to key technical details.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"38 1","pages":"Pages 41-49"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650958","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 State of the Art in Acquired Tracheoesophageal Fistula Management.","authors":"Konstantina Spetsotaki, Sandra Guzzella, Rolf Schuepbach, Andre Mueller, Carolin Steinack, Christian Alexander Gutschow, Isabelle Opitz","doi":"10.1053/j.semtcvs.2025.11.004","DOIUrl":"10.1053/j.semtcvs.2025.11.004","url":null,"abstract":"<p><p>Tracheoesophageal fistula (TEF) is a challenging, complex condition with a wide spectrum of underlying causes and clinical manifestations. TEF management requires a deep understanding of anatomical characteristics, underlying conditions, and a multidisciplinary approach to optimize the diagnostic pathways and treatment allocations. The management of benign and malignant TEF has shown progress in its effective treatment; however, surgical techniques remain a challenge and are often complemented by innovative stent deployment strategies. Concurrently, new techniques are being added to the treatment landscape; however, the evidence remains largely limited to case reports. Nevertheless, despite the substantial advancements in the management of TEF, there remains a lack of consensus or established guidelines for this condition in the adult population, and the treatment approach remains highly individualized. The aim of this article is to summarize the current treatment strategies for this complex disease.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953668","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":"Why Magnetic Resonance Imaging Is Invaluable for the Evaluation of Thymic Masses.","authors":"Maria Clara N Lorca, Michael Lanuti, Jeanne B Ackman","doi":"10.1053/j.semtcvs.2025.11.002","DOIUrl":"https://doi.org/10.1053/j.semtcvs.2025.11.002","url":null,"abstract":"<p><p>The widespread and ever-expanding use of computed tomography for disease, trauma, cardiac imaging, and lung cancer screening has led to increased incidental detection of indeterminate thymic nodules and masses on CT. Chest MRI provides increased diagnostic specificity and delineation of disease extent and should therefore both reduce unnecessary thymectomy and improve clinical management of thymic masses.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946632","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":"Shall We Step Outside the Cage? Non-Intercostal Approaches to Pulmonary Lobectomy.","authors":"Luciano Bulgarelli Maqueda, Maxime Têtu, Omar Abdulaziz M Alkathiri, Ohud Fahad Alreshidi, Pedro Guimarães Rocha Lima, Joseph Seitlinger, Stéphane Renaud, Pasquale Ferraro, Moishe Liberman","doi":"10.1053/j.semtcvs.2025.11.001","DOIUrl":"10.1053/j.semtcvs.2025.11.001","url":null,"abstract":"<p><p>Pulmonary lobectomy via a minimally invasive surgery (MIS) approach represents the current standard of care in early-stage non-small cell lung cancer. However, MIS has mostly relied on intercostal incisions, with the inherent risk of intercostal nerve injury. As a result, several non-intercostal approaches were developed. However, published data on the subject remain scarce. We aim to review existing non-intercostal MIS lobectomy techniques to specifically assess their feasibility and safety. Systematic review from 2010-2025. The outcomes for feasibility and safety were conversion rate and 30-day mortality, respectively. A total of 17 studies were included in the qualitative synthesis. From a combined total of 2376 patients included in the study, 66% (n = 1570) underwent a non-intercostal lobectomy. Among these, 83.5% (n = 1312) were performed via a subxiphoid approach, 15% (n = 236) via subcostal incisions. Among the studies that reported on outcomes, conversion rate and mortality were reported, respectively, as 4.3% (n = 53/1228) and 0.4% (n = 1/259) for subxiphoid approach, 1.4% (n = 2/140) and 0.7% (n = 1/140) for subcostal incisions. There has been growing interest in various non-intercostal approaches to pulmonary lobectomy over the past decade. Notably, recent studies suggest a shift toward higher-quality research and a transition from subxiphoid video-assisted to subcostal robotic-assisted thoracic surgery techniques. Among these, Outside the Cage (OTC) RATS robotic-assisted thoracic surgery emerges as the only fully non-intercostal reproducible robotic approach. Despite encouraging early data, further efforts are required to rigorously evaluate potential benefits. Nonetheless, the evidence to date suggests that it could be both feasible and safe to step \"outside the cage.\"</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893157","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":"Thymic Surgery for Neoplasm: Perspectives on the Optimal Approach.","authors":"Matthew Skovgard, Bernard Park","doi":"10.1053/j.semtcvs.2025.11.003","DOIUrl":"10.1053/j.semtcvs.2025.11.003","url":null,"abstract":"<p><p>Thymic epithelial tumors require tailored surgical strategies to optimize outcomes. This review synthesizes current evidence on surgical approaches, emphasizing the critical roles of tumor stage, anatomy, and multidisciplinary planning. For early-stage thymic epithelial tumors (Stage I/II), minimally invasive techniques (video-assisted thoracic surgery, robotic-assisted) demonstrate equivalent oncologic outcomes to open surgery, with reduced morbidity, shorter hospitalization, and faster recovery. Recent propensity-matched studies highlight robotic thymectomy's advantages, including lower blood loss and complication rates, though operative times may be longer. Locally advanced tumors (Stage IIIA-B) demand meticulous R0 resection, often necessitating open approaches for complex resections involving pericardium, phrenic nerves, or great vessels. Induction therapy shows promise in converting borderline resectable tumors and improving R0 rates. For Stage IVA disease, surgery within multimodal regimens may enhance survival, though benefits depend on pleural burden and histology, underscoring the need for individualized management. Emerging debates focus on refining resection extent. Lymphadenectomy gains traction for thymic carcinomas and advanced thymomas due to nodal metastasis risks, while partial thymectomy for early-stage tumors remains controversial, requiring randomized trials to balance oncologic efficacy against long-term immunologic consequences. Thymic surgery continues to evolve, prioritizing R0 resection while integrating minimally invasive advancements and multimodal therapies. Centralized, high-volume centers and international collaboration remain pivotal to addressing these rare malignancies. Future research must clarify lymphadenectomy's role, validate partial thymectomy, and optimize induction strategies through prospective trials.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851203","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}