Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Robotic thoracic surgery using the single-port robotic system: Initial experience with more than 100 cases","authors":"Jun Hee Lee MD,&nbsp;Tae Hyun Park MD,&nbsp;Hyun Koo Kim MD, PhD","doi":"10.1016/j.jtcvs.2024.03.005","DOIUrl":"10.1016/j.jtcvs.2024.03.005","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to report the initial experiences of 115 patients who underwent robotic thoracic surgery<span> using the da Vinci single-port robotic surgical system (Intuitive Surgical).</span></div></div><div><h3>Methods</h3><div>Robotic thoracic surgery using the da Vinci single-port robotic surgical system was performed on 115 patients between November 2020 and June 2023. Patient characteristics, intraoperative outcomes, and postoperative outcomes were analyzed retrospectively.</div></div><div><h3>Results</h3><div><span>The type of surgeries included thymectomy<span>, mediastinal mass<span> excision, anatomical pulmonary resection (including </span></span></span>lobectomy<span><span><span><span> and segmentectomy), esophagectomy, and </span>enucleation of esophageal submucosal tumors in 41, 13, 54, 5, and 2 patients, respectively. The mean total operative time and chest tube duration for different procedures were as follows: thymectomy, 152.9. ± 6.7 minutes and 1.2 ± 0.5 days; mediastinal mass excision, 93.3 ± 26.5 minutes and 1.0 ± 0 days; anatomical pulmonary resection, 187.2 ± 55.8 minutes and 2.5 ± 1.5 days; esophagectomy, 485 ± 111.9 minutes and 12 ± 4.6 days; and enucleation of esophageal submucosal tumors, 170 ± 30 minutes and 5.5 ± 0.5 days, respectively. Conversion to a </span>thoracotomy<span> or sternotomy was not required. Conversion to video-assisted thoracic surgery occurred in 1 patient, and an additional port was applied in 2 patients. Two patients experienced </span></span>postoperative complications greater than grade IIIa.</span></div></div><div><h3>Conclusions</h3><div>Robotic thoracic surgery using the da Vinci single-port robotic surgical system is feasible and safe in various fields of thoracic surgery, including complex procedures such as anatomical pulmonary resection and esophagectomy. More complex thoracic surgeries can be performed with the continuous advancement and innovation of instruments in robotic systems.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 6","pages":"Pages 1513-1522.e2"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: The balance of flow in azygos continuation of the inferior vena cava","authors":"Igor E. Konstantinov MD, PhD, FRACS ,&nbsp;Tyson A. Fricke MBBS, PhD, FRACS","doi":"10.1016/j.jtcvs.2024.05.023","DOIUrl":"10.1016/j.jtcvs.2024.05.023","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 6","pages":"Pages 1740-1741"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: The Ross procedure is a durable solution for children with complex aortic valve disease","authors":"Aditya K. Kaza MD, MBA","doi":"10.1016/j.jtcvs.2024.08.027","DOIUrl":"10.1016/j.jtcvs.2024.08.027","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 6","pages":"Pages 1732-1733"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invest in the Future","authors":"","doi":"10.1016/S0022-5223(24)00997-8","DOIUrl":"10.1016/S0022-5223(24)00997-8","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 6","pages":"Page 1756"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: The severity of chronic obstructive pulmonary disease affects outcomes of thoracoabdominal aortic aneurysms repair—is GOLD the answer?","authors":"Ana Lopez-Marco PhD,&nbsp;Aung Y. Oo MD","doi":"10.1016/j.jtcvs.2023.10.039","DOIUrl":"10.1016/j.jtcvs.2023.10.039","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 6","pages":"Pages 1616-1617"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erector spinae plane blocks for opioid-sparing multimodal pain management after pediatric cardiac surgery","authors":"Nathalie Roy MD ,&nbsp;M. Fernanda Parra MD ,&nbsp;Morgan L. Brown MD, PhD ,&nbsp;Lynn A. Sleeper ScD ,&nbsp;Joe Kossowsky PhD ,&nbsp;Andreas M. Baumer MSc ,&nbsp;Sarah E. Blitz BS, BA ,&nbsp;Jocelyn M. Booth RN ,&nbsp;Connor E. Higgins BS ,&nbsp;Viviane G. Nasr MD, MPH ,&nbsp;Pedro J. del Nido MD ,&nbsp;Roland Brusseau MD","doi":"10.1016/j.jtcvs.2024.03.010","DOIUrl":"10.1016/j.jtcvs.2024.03.010","url":null,"abstract":"<div><h3>Objective</h3><div>Peripheral regional anesthesia<span> is proposed to enhance recovery. We sought to evaluate the efficacy of bilateral continuous erector spinae plane blocks (B-ESpB) for postoperative analgesia and the impact on recovery in children undergoing cardiac surgery.</span></div></div><div><h3>Methods</h3><div>Patients aged 2 through 17 years undergoing cardiac surgery in the enhanced recovery after cardiac surgery program were prospectively enrolled to receive B-ESpB at the end of the procedure, with continuous infusions via catheters postoperatively. Participants wore an activity monitor until discharge. B-ESpB patients were retrospectively matched with control patients in the enhanced recovery after cardiac surgery program. Outcomes of the matched clusters were compared using exact conditional logistic regression and generalized linear modeling.</div></div><div><h3>Results</h3><div>Forty patients receiving B-ESpB were matched to 78 controls. There were no major complications from the B-ESpB or infusions, and operating room time was longer by a median of 31 minutes. While blocks were infusing, patients with B-ESpB received fewer opioids in oral morphine equivalents than controls at 24 hours (0.60 ± 0.06 vs 0.78 ± 0.04 mg/kg; <em>P</em> = .02) and 48 hours (1.13 ± 0.08 vs 1.35 ± 0.06 mg/kg; <em>P</em> = .04), respectively. Both groups had low median pain scores per 12-hour period. There was no difference in early mobilization, length of stay, or complications.</div></div><div><h3>Conclusions</h3><div>B-ESpBs are safe in children undergoing cardiac surgery. When performed as part of a multimodal pain strategy in an enhanced recovery after cardiac surgery program, pediatric patients with B-ESpB experience good pain control and require fewer opioids in the first 48 hours.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 6","pages":"Pages 1742-1750.e9"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-dose warfarin with a novel mechanical aortic valve: Interim registry results at 5-year follow-up","authors":"Marc W. Gerdisch MD ,&nbsp;Robert Carl Hagberg MD ,&nbsp;Michael J. Perchinsky MD ,&nbsp;Mark Joseph MD ,&nbsp;Aung Y. Oo MD ,&nbsp;Mahmoud Loubani MD ,&nbsp;Geoffrey M. Tsang MD ,&nbsp;Joseph Zacharias MD ,&nbsp;Mohanakrishnan Sathyamoorthy MD","doi":"10.1016/j.jtcvs.2024.04.017","DOIUrl":"10.1016/j.jtcvs.2024.04.017","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate whether warfarin targeted at an international normalized ratio of 1.8 (range, 1.5-2.0) after On-X mechanical aortic valve implant is safe for all patients.</div></div><div><h3>Methods</h3><div>This prospective, observational clinical registry assessed adverse event rates in adult patients receiving low-dose warfarin (target international normalized ratio, 1.8; range, 1.5-2.0) plus daily aspirin (75-100 mg) during a 5-year period after On-X aortic valve implant. The primary end point is the combined rate of major bleeding, valve thrombosis, and thromboembolism overall and in 4 subgroups. The comparator is the Prospective Randomized On-X Anticoagulation Trial control group patients on standard-dose warfarin (international normalized ratio, 2.0-3.0) plus aspirin 81 milligrams daily.</div></div><div><h3>Results</h3><div>A total of 510 patients were recruited at 23 centers in the United States, United Kingdom, and Canada between November 2015 and January 2022. This interim analysis includes 229 patients scheduled to complete 5-year follow-up by August 16, 2023. The linearized occurrence rate (in percent per patient-year) of the primary composite end point of major bleeding, valve thrombosis, and thromboembolism is 1.83% compared with 5.39% (95% confidence interval, 4.12%-6.93%) in the comparator group. Results are consistent in clinic-monitored and home-monitored patients and in those at high risk for thromboembolism. Major bleeding and total bleeding were reduced by 87% and 71%, respectively, versus the comparator group, without an increase in thromboembolic events.</div></div><div><h3>Conclusions</h3><div>Interim results support the continued safety of the On-X aortic mechanical valve with a target international normalized ratio of 1.8 plus low-dose aspirin through 5 years after implant, with or without home monitoring.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 6","pages":"Pages 1645-1655.e6"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of a transaortic approach to midventricular and apical septal myectomy","authors":"Jean-Luc A. Maigrot BS ,&nbsp;Aaron J. Weiss MD, PhD ,&nbsp;Andrea M. Steely MD ,&nbsp;Austin Firth MS ,&nbsp;David Moros MD ,&nbsp;Eugene H. Blackstone MD ,&nbsp;Nicholas G. Smedira MD, MBA","doi":"10.1016/j.jtcvs.2024.04.016","DOIUrl":"10.1016/j.jtcvs.2024.04.016","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to evaluate the safety and efficacy of a transaortic approach to midventricular and apical septal myectomy in patients with hypertrophic cardiomyopathy with left ventricular outflow tract or midventricular obstruction.</div></div><div><h3>Methods</h3><div>From January 2018 to August 2023, 940 patients underwent transaortic septal myectomy at the Cleveland Clinic, of whom 682 (73%) had midventricular or apical resection. Patients who underwent isolated basal myectomies were excluded. Templated operative reports designated septal regions resected as basal (opposition to mitral valve up to the leaflet tips), midventricular (leaflet tips to just beyond the papillary muscle heads), and apical (apical third of the ventricle). Myocardial resection specimen weights, intraventricular gradients, and clinical outcomes were assessed.</div></div><div><h3>Results</h3><div>Of the 682 patients, 582 (85%) had basal plus midventricular resection and 78 (11%) had basal, midventricular, and apical resection. Mean preoperative intraventricular gradient was 102 ± 41 mm Hg. Median resection weight was 10 g (15th, 85th percentiles: 7, 15), and mean postoperative intraventricular gradient was 16 ± 10 mm Hg, with 625 (96%) patients achieving gradients 36 mm Hg or less. There were no iatrogenic mitral or aortic valve injuries. Permanent pacemaker placement was required in 38 patients (5.6%), of whom 8 (1.2%) had normal preoperative conduction. Operative mortality occurred in 1 patient (0.1%) after an intraoperative ventricular septal defect.</div></div><div><h3>Conclusions</h3><div>Most patients undergoing septal myectomy for relief of obstruction required resection beyond the basal septum. With specialized instrumentation, detailed imaging and knowledge of variable septal anatomy, resecting midventricular and apical septal muscle can be safely and effectively achieved through a transaortic approach.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 6","pages":"Pages 1666-1674.e1"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information for readers","authors":"","doi":"10.1016/S0022-5223(24)00943-7","DOIUrl":"10.1016/S0022-5223(24)00943-7","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 6","pages":"Page A17"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracic Articles in AATS Journals","authors":"","doi":"10.1016/S0022-5223(24)00976-0","DOIUrl":"10.1016/S0022-5223(24)00976-0","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"168 6","pages":"Page e207"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}