Seminars in Thoracic and Cardiovascular Surgery最新文献

{"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}

{"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}