European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery最新文献

{"title":"Outcomes of conservative treatment for thoracic vascular graft infections.","authors":"Mathias Van Hemelrijck, Juri Sromicki, Petar Risteski, Rasha Boulos, Ronny R Buechel, Michelle Frank, Barbara Hasse, Héctor Rodríguez Cetina Biefer, Omer Dzemali","doi":"10.1093/ejcts/ezaf171","DOIUrl":"10.1093/ejcts/ezaf171","url":null,"abstract":"<p><strong>Objectives: </strong>Thoracic vascular graft infections are devastating complications after aortic surgery, entailing high mortality. The gold standard treatment combines excisional surgery and antimicrobial therapy, but patients deemed inoperable might benefit from a conservative approach. Outcomes of patients treated only with antimicrobial agents without reoperative surgery are scanty. We aim to describe patients' characteristics and outcomes using an antibiotic-only strategy without thorough debridement.</p><p><strong>Methods: </strong>Retrospectively collected data from a prospective cohort in a tertiary centre. Descriptive analysis for baseline characteristics and Kaplan-Meier estimates for survival were performed.</p><p><strong>Results: </strong>From November 2012 to December 2022, 66 patients were identified with aortic root, ascending aortic and aortic arch graft infections. Of these, 44 received an antibiotic-only strategy or in combination with selective debridement after achieving multidisciplinary consensus. Median follow-up was 4.8 years [interquartile range (IQR) 1.7-6.1], and cumulative survival was 82.9% (CI 95%, 69.7-96.1). Streptococcus spp were the most common isolated microorganisms.</p><p><strong>Conclusions: </strong>In selected cases, a conservative approach with antibiotics only or in combination with selective debridement showed acceptable results at follow-up, suggesting a valuable therapy option for this cohort of patients.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative and long-term survival outcomes following resection of stage IV non-small-cell lung cancer: a multi-centre experience†.","authors":"Raphael Werner, Michael A Eisenberg, Zamaan Hooda, Shanique Ries, Theodorus Papasotiropoulos, Nina Steinmann, Isabelle Opitz, Mara B Antonoff","doi":"10.1093/ejcts/ezaf156","DOIUrl":"10.1093/ejcts/ezaf156","url":null,"abstract":"<p><strong>Objectives: </strong>Recent investigations have demonstrated the feasibility of surgery as local consolidative therapy for treating metastatic non-small-cell lung cancer (NSCLC). However, long-term benefits and associated operative risks for these potentially more challenging operations remain unclear. We aimed to explore perioperative and long-term outcomes following pulmonary resection for stage IV NSCLC.</p><p><strong>Methods: </strong>We identified patients from 2 institutions (1 European, 1 North American) with metastatic NSCLC from 1996 to 2023 who underwent pulmonary resection for NSCLC treatment. Gathered data included demographic, clinicopathologic and perioperative variables, as well as oncologic and survival outcomes. Survival outcomes were evaluated using the Kaplan-Meier method and multivariate logistic regression.</p><p><strong>Results: </strong>We included 179 patients, with 53.1% (95) being women. The median age at surgery was 58.8 (51.8-66.5) years. Median number of metastatic sites was 1.0 (1.0-2.0), with brain (59, 45.4%) being most commonly involved. Multivariable analysis failed to identify any independent predictors of postoperative complications. Only 64 (35.8%) patients developed recurrence at a median follow-up of 30.3 months (14.1-70.5). Locoregional and distant recurrences occurred at a median of 15.3 (11.0-25.1) and 15.4 (10.7-23.7) months, respectively, which was associated with shortened overall survival (37.4 vs 87.5 months; P = 0.049). Median overall survival and progression-free survival were 77.9 (56.5-114.7) and 36.6 months (25.1-49.4), respectively. Mortality predictors included increased age [odds ratio (OR) 1.07; 95% confidence interval (CI) 1.03-1.12; P = 0.002) and greater-than-lobar resection (OR 2.63; 95% CI 1.88-24.0, P = 0.040).</p><p><strong>Conclusions: </strong>In appropriately selected patients, pulmonary resection for stage IV NSCLC is safe, and results in excellent perioperative and long-term survival benefits.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitral valve surgery after failed transcatheter intervention for mitral regurgitation: surgical techniques, challenges and outcomes.","authors":"Mateo Marin-Cuartas, Syed Zaid, Jörg Kempfert, Michael A Borger, Serdar Akansel, Thilo Noack, David Holzhey, Tsuyoshi Kaneko, Isaac George, Gorav Ailawadi, Robert L Smith, Arnar Geirrson, Ahmed El-Eshmawi, Dimosthenis Pandis, Suzanne de Waha, Nikolaos Bonaros, Fabien Praz, Maurizio Taramasso, Michele De Bonis, Lenard Conradi, Christian Hagl, Nicolas Doll, Mahmoud Wehbe, Alexey Dashkevich, Manuela de la Cuesta, Jagdip Kang, Zara Dietze, Philipp Kiefer, Gilbert H L Tang","doi":"10.1093/ejcts/ezaf179","DOIUrl":"10.1093/ejcts/ezaf179","url":null,"abstract":"<p><strong>Objectives: </strong>This review article aims to examine the surgical approach to patients with failed mitral transcatheter edge-to-edge repair (M-TEER), focusing on operative challenges, decision-making and contemporary outcome data. Technical considerations, including device removal and the management of complex mitral valve (MV) anatomy, are discussed.</p><p><strong>Methods: </strong>We performed a comprehensive literature review and gathered the experience from high-volume centres in the surgical management of failed M-TEER.</p><p><strong>Results: </strong>MV surgery after failed M-TEER is a complex but increasingly necessary procedure as the use of M-TEER grows. It occurs in up to 6% of patients, with a median age of 70-76 years at the moment of failure and a median time to failure of <6 months. MV surgery following M-TEER is associated with high mortality and morbidity, with a reported 30-day mortality ranging from 10% to 40% and 1-year survival below 60%. Functional device failure, structural device failure, MV disease progression and infective endocarditis are frequent mechanisms of M-TEER failure. Surgical MV repair is the preferred management strategy; however, due to the technical and anatomical complexity, MV replacement is performed much more frequently (MV repair rates <10%).</p><p><strong>Conclusions: </strong>MV surgery after failed M-TEER poses technical challenges due to the presence of altered anatomy, the need for concomitant procedures and the patient's comorbidities. While surgical intervention carries increased risks, it remains the definitive treatment for failed M-TEER, offering durable relief from MR. Due to the technical complexities associated with these procedures, strong consideration should be given to transferring patients requiring MV surgery after failed M-TEER to high-volume MV centres.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A shard in the heart: images of a broken balloon expandable transcatheter prosthesis.","authors":"Laura Besola, Federico Giorgi, Andrea Colli","doi":"10.1093/ejcts/ezaf197","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf197","url":null,"abstract":"","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":"67 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter management of left-sided valvular heart disease following heart transplantation.","authors":"Hristian Hinkov, Luise Roehrich, Chong Bin Lee, Christoph Klein, Marian Kukucka, Nicolas Merke, Volkmar Falk, Henryk Dreger, Christoph Knosalla, Felix Schoenrath, Axel Unbehaun","doi":"10.1093/ejcts/ezaf191","DOIUrl":"10.1093/ejcts/ezaf191","url":null,"abstract":"<p><strong>Objectives: </strong>Aortic stenosis (AS) and mitral regurgitation (MR) are rare in heart transplant (HTx) recipients, but their incidence increases with extended post-transplant survival. This study assesses the safety, efficacy and outcomes of transcatheter interventions in this high-risk population.</p><p><strong>Methods: </strong>An institutional series of HTx patients undergoing a transcatheter aortic valve implant (TAVI) or mitral transcatheter edge-to-edge repair (M-TEER) from March 2015 through April 2024 was analysed retrospectively. Both elective cases and patients in cardiac decompensation/cardiogenic shock were included. There were no exclusion criteria. Primary outcomes were echocardiographic allograft function and Valve Academic Research Consortium 3 (VARC-3)/Mitral Valve Academic Research Consortium (MVARC) success and safety composite end points. Secondary outcomes included symptom change, complications and survival.</p><p><strong>Results: </strong>A total of 15 consecutive patients were included in the analysis. Nine patients underwent TAVI and 6 had M-TEER. The median age was 56 years, with a median of 17 years from HTx to valve intervention. A total of 46.7% (7/15) of the procedures were considered urgent/emergency. Improvements were noted in the left ventricular ejection fraction, systolic pulmonary artery pressure and tissue Doppler peak contraction velocity. The VARC-3/MVARC technical success was 100%; device success for TAVI was 93.3% and 83.3% for M-TEER. VARC-3 early safety was 66.7% for TAVI, and MVARC procedural success was 83.3% for M-TEER; 86.7% showed improved functional status. Median survival was 800 days.</p><p><strong>Conclusions: </strong>TAVI and M-TEER were feasible and efficient in improving echocardiographic allograft function. Elective procedures were associated with a median survival of over 2 years. Survival outcomes varied based on procedure urgency. Close monitoring of AS/MR seems crucial in HTx patients, with timely intervention prior to decompensation/shock. Further multicentre studies are needed to establish management guidelines for AS/MR in HTx recipients.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal anastomotic new entry tears predict long-term outcomes after hemi-arch repair for DeBakey I aortic dissection†.","authors":"Prabhvir S Marway, Carlos A Campello Jorge, Rana-Armaghan Ahmad, Nicasius Tjahjadi, Himanshu J Patel, Bo Yang, Nicholas S Burris","doi":"10.1093/ejcts/ezaf170","DOIUrl":"10.1093/ejcts/ezaf170","url":null,"abstract":"<p><strong>Objectives: </strong>Aortic arch tears, including distal anastomosis new entry tears and residual arch tears, have been associated with adverse outcomes (false lumen growth, distal reoperation) after hemi-arch repair for DeBakey Type I aortic dissection. However, no study has compared distal anastomosis new entry tears and RATs as independent entities despite their distinct aetiologies and preventative strategies which may inform surgical management.</p><p><strong>Methods: </strong>Retrospective cohort study of adult patients with hemi-arch repair for DeBakey Type I aortic dissection at a tertiary referral centre (1996-2021). We included patients who survived beyond their initial hospitalization with good-quality post-operative CT angiograms. Distal anastomosis new entry tears and residual arch tears metrics were collected from the first good-quality post-operative CT. Maximal aortic diameters (distal to graft) were collected from pre- and post-hemi-arch repair CT angiograms. Presence and imaging characteristics of distal anastomosis new entry tears and RATs were examined for prediction of false lumen growth and distal aortic intervention.</p><p><strong>Results: </strong>We included 272 patients, and 24.5% (69) had distal anastomosis new entry tears, which on multivariable analysis was associated with a post-operative descending diameter change of +6.2 mm (95% confidence interval [CI]: 4.5, 7.9) and greater risk of distal intervention, hazard ratio 3.24 (95% CI: 1.57, 6.68); residual arch tears were not significantly associated, hazard ratio 0.72 (95% CI: 0.28, 1.83). Distal anastomosis new entry tears located on the greater curvature versus lesser curvature (58% vs 42%, P = 0.044) were more likely to lead to reoperation (45% vs 17%, P = 0.033).</p><p><strong>Conclusions: </strong>Distal anastomosis new entry tears, not residual arch tears, correlate strongly with negative descending aorta remodelling and distal intervention after hemi-arch repair for DeBakey I aortic dissection. Therefore, additional strategies are warranted to prevent distal anastomosis new entry tears, a result of anastomotic technical challenge, during operative repair.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored preoperative assessment in neonatal cardiac surgery: a European Congenital Heart Surgeons Association study†.","authors":"Claudia Cattapan, Alvise Guariento, Jeffrey P Jacobs, Mark S Bleiweis, Zdzislaw Tobota, Bohdan Maruszewski, Steven J Staffa, David Zurakowski, George E Sarris, Vladimiro Vida","doi":"10.1093/ejcts/ezaf178","DOIUrl":"10.1093/ejcts/ezaf178","url":null,"abstract":"<p><strong>Objectives: </strong>Current preoperative counselling in neonatal cardiac surgery is mainly focused on the primary procedure. However, other factors must be considered when evaluating the surgical risk of a neonate. We aimed to develop a risk adjustment model to personalize preoperative counselling using data from the European Congenital Heart Surgeons Association Congenital Database (ECHSA-CD).</p><p><strong>Methods: </strong>A retrospective, multicentre analysis of the ECHSA-CD dataset was conducted, including 20 687 neonates undergoing cardiac surgery between 2013 and 2022. A risk adjustment model was developed on a training set (70%) and validated on a separate cohort (30%).</p><p><strong>Results: </strong>A model incorporating age, weight, STAT mortality category and need for cardiopulmonary bypass (CPB) demonstrated good predictive performance. Lower age (≤10 days), lower weight (<2.5 kg), higher STAT category and need for CPB were associated with increased risk of operative mortality. The model's area under the receiver operating characteristic curve was 0.701 in the training set and 0.700 in the validation set, indicating good discrimination. Additionally, the Brier quadratic probability score was 0.08 in both datasets, indicating good calibration.</p><p><strong>Conclusions: </strong>This study underscores the importance of patient characteristics in predicting outcomes in neonatal cardiac surgery. The developed risk adjustment model can be used as a tool in preoperative counselling, decision-making and risk stratification for neonates undergoing cardiac surgery. By providing a more accurate estimate of operative mortality, this model can help families make more informed decisions about their child's care and improve the overall quality of care for neonates with congenital heart defects.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to: Data insights for quality improvement: the latest EUROMACS report.","authors":"","doi":"10.1093/ejcts/ezaf181","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf181","url":null,"abstract":"","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":"67 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to: 2024 EACTS Guidelines on perioperative medication in adult cardiac surgery.","authors":"","doi":"10.1093/ejcts/ezaf169","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf169","url":null,"abstract":"","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":"67 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to: Full circumferential human tracheal replacement: a systematic review.","authors":"","doi":"10.1093/ejcts/ezaf085","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf085","url":null,"abstract":"","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":"67 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}