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

{"title":"Complex endovascular arch repair using fenestrated and branched devices: a single-centre experience.","authors":"Martina Bastianon, Jan Stana, Nikolaos Konstantinou, David Khangoli, Sven Peterss, Maximilian Pichlmaier, Nikolaos Tsilimparis","doi":"10.1093/ejcts/ezaf208","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf208","url":null,"abstract":"<p><strong>Objectives: </strong>Endovascular arch repair is a reasonable alternative for patients at high risk for open surgery. Despite a reduction in procedural invasiveness, complications remain, particularly in elderly and urgent cases. This study aimed to evaluate our institutional experience at a high-volume aortic center.</p><p><strong>Methods: </strong>Retrospective, single-center study of endovascular arch repair, along with subgroup analyses for urgent settings, octogenarian patients and graft design. Primary outcomes were technical success, 30-day mortality and morbidity. During follow-up, survival estimation, cumulative incidence of reintervention, endoleak and target vessels instability were evaluated.</p><p><strong>Results: </strong>The study included 74 patients (mean age 72 ± 9 years) treated, between September 2018 and April 2024, with custom-made fenestrated/branched endograft. Technical success was achieved in 93.2% of the patients. Thirty-day mortality in elective setting was 5.4%, and 44.4% in urgent repairs. Major stroke occurred in 6.8% of patients. Urgent repairs showed higher rates of technical failure (22.2 vs 1.8% P < 0.01), 30-day mortality (44.4 vs 5.4%; P < 0.001) and major strokes compared to elective repairs (22.2 vs 1.8%; P < 0.01). Octogenarians had significantly higher 30-day mortality but no difference in major adverse events compared to younger patients (P < 0.01). Branched endografts had higher rates of type Ia endoleaks and reinterventions than fenestrated endografts. At 24 months, the estimated rates were as follows: survival 79% (standard error-SE 0.09), cumulative incidence of reintervention 24% (SE 0.074), endoleak 9% (SE 0.037) and target vessel instability 9% (SE 0.04).</p><p><strong>Conclusions: </strong>Endovascular arch repair is feasible and yields satisfactory outcomes in high-risk populations, particularly in elective settings. Urgent and elderly patients remain challenging, underscoring the importance of careful patient selection.</p>","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":"144532797","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":"Mechanical bowel preparation versus no bowel preparation for oesophageal cancer surgery: a multicentre, randomized, parallel, open-labelled trial.","authors":"Yuan Yu, Rui Liang, Yibo Xue, Dongfang Li, Shuxin Li, Siqiu Xia, Jie Sun, Ji Luo, Hongna Chen, Jianjun Qin, Yin Li, Zhen Wang","doi":"10.1093/ejcts/ezaf182","DOIUrl":"10.1093/ejcts/ezaf182","url":null,"abstract":"<p><strong>Objectives: </strong>To compare post-operation influence between mechanical bowel preparation (MBP) and no MBP (NBP) before surgery for patients with oesophageal cancer.</p><p><strong>Methods: </strong>In this multicentre, parallel, open-labelled trial, eligible patients who were prepared to undergo oesophagectomy in 3 hospitals in China were randomly assigned (1:1) to an MBP or NBP group. Patients allocated to the MBP group prepared their bowel by drinking 3-4 l of polyethylene glycol dissolved in water the day before surgery. Patients in the NBP group did not receive MBP. The primary outcome was the incidence of major complications during or within 30 days after surgery.</p><p><strong>Results: </strong>Between 20 September 2022 and 30 April 2023, 652 patients were recruited (326 patients were randomized to MBP and 326 patients were randomized to NBP), with 612 patients included in the final analyses (311 patients for MBP and 301 patients for NBP). Risk difference (RD) was -2.6% between the 2 groups (29.9% in NBP vs 32.5% in MBP), and the relative risk (RR) was 0.92 [97.5% confidence interval (CI) 0.727-1.165]. The upper limit of the 1-sided 97.5% CI for RD was 4.73%, and the upper limit for RR was 1.165, both lower than the predefined non-inferiority margins (Δ = 10% for RD; threshold = 1.308 for RR). No significant differences of CCI were observed; CCI was similar between the 2 groups (15.6 in MBP vs 15.1 in NBP). Ten items in EORTC QLQ-C30 were better in the MBP group than in the NBP group in the 7 days after the operation (P < 0.05). No statistical differences were found in the EORTC OES-18 results between the 2 groups.</p><p><strong>Conclusions: </strong>This study confirms that in preoperative preparation for oesophageal cancer surgery, the non-inferiority of NBP is established both by the RD and the RR. These results collectively support the safety of omitting MBP and provide robust evidence for simplifying preoperative protocols.</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":"144236735","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":"Aortic valve surgery in adolescents and young adults: analysis of early operative data from the European Congenital Heart Surgeons Association database†.","authors":"Alvise Guariento, Claudia Cattapan, Ilias P Doulamis, Zdzislaw Tobota, Bohdan Maruszewski, Mark S Bleiweis, Jeffrey P Jacobs, George E Sarris, Vladimiro Vida","doi":"10.1093/ejcts/ezaf101","DOIUrl":"10.1093/ejcts/ezaf101","url":null,"abstract":"<p><strong>Objectives: </strong>Aortic valve surgery is a crucial treatment for congenital and acquired aortic disease in adolescents and young adults. This study evaluated outcomes in this group by analysing data from the European Congenital Heart Surgeons Association Congenital Cardiac Database (ECCDB).</p><p><strong>Methods: </strong>A retrospective review included patients aged 10-18 years from the ECCDB who underwent aortic valve surgery between 2013 and 2022. The primary outcome was operative mortality, defined as death within 30 days or during hospitalization. Secondary outcomes included reoperations and postoperative complications. Risk factors for mortality were identified using multivariable logistic regression analysis, and surgical trends were evaluated.</p><p><strong>Results: </strong>A total of 2129 patients were included, with the majority undergoing valve replacement, followed by valve repair and the Ross procedure. Patients receiving valve replacement were typically older and larger. Over the decade, there was an increase in the use of the Ross procedure. Reoperations were more frequent in the repair group, while postoperative complications were more common in the replacement group. The overall mortality rate was 1.5%. Independent risk factors for mortality included longer cardiopulmonary bypass (CPB) times (odds ratio 1.1, P < 0.001) and annulus enlargement (odds ratio 3.8, P = 0.02). CPB durations exceeding 240 min increased the risk of death. The Ross procedure, particularly in isolated cases without annulus enlargement, was associated with a low mortality rate of 0.4%.</p><p><strong>Conclusions: </strong>Aortic valve surgery in adolescents and young adults is complex, with outcomes influenced by CPB time and annulus enlargement. The Ross procedure shows excellent results despite its technical demands.</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/PMC12208064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500276","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":"Reply to Nezic.","authors":"Marco Gemelli, Thanakorn Rojanathagoon, Eltayeb Mohamed Ahmed, Cha Rajakaruna","doi":"10.1093/ejcts/ezaf185","DOIUrl":"10.1093/ejcts/ezaf185","url":null,"abstract":"","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":"144510316","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":"Sex differences in outcomes after rheumatic and degenerative mitral surgery: a long-term follow-up analysis on 3012 patients.","authors":"Soo Jin Park, Kitae Kim, Hong Rae Kim, Ho Jin Kim, Jae Suk Yoo, Sung-Ho Jung, Cheol Hyun Chung, Joon Bum Kim","doi":"10.1093/ejcts/ezaf172","DOIUrl":"10.1093/ejcts/ezaf172","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the long-term outcomes of mitral valve (MV) disease depending on sex and its differences within the MV aetiology in patients undergoing MV surgery.</p><p><strong>Methods: </strong>We reviewed 3012 patients undergoing isolated MV surgery with or without tricuspid valve (TV) surgery/ablation between January 2000 and December 2022. The primary end-points were all-cause mortality and a composite valve-related adverse events including heart failure, stroke, reoperation and infective endocarditis. Multivariate analysis with interaction terms identified independent risk factors, with median follow-up of 8.3 years (total 30 180.6 patient-years).</p><p><strong>Results: </strong>Among the 3012 patients (54.8 ± 12.7 years), 1671 were females (55.5%). Rheumatic and degenerative MV diseases comprised 54.1% and 45.9%, respectively, with higher rates of rheumatic disease in females (69.7% vs 34.7%). Compared to males, females were older with higher prevalence of atrial fibrillation, TV insufficiency and advanced heart failure symptoms, consequently undergoing more MV replacements and concomitant procedures. Females showed higher rates of composite adverse outcomes (hazard ratio [HR], 1.25; 95% confidence intervals [CIs], 1.07-1.46; P = 0.006). Significant interaction was observed between sex and aetiology, with females showing higher mortality (HR 1.51; 95% CIs, 1.12-2.04; P = 0.007) and composite outcomes (HR 1.48; 95% CIs 1.15-1.91; P = 0.002) in degenerative disease (P for interaction = 0.021 and 0.016, respectively). Multivariate Cox regression demonstrated female sex as an independent risk factor for composite valve-related adverse outcomes (adjusted HR, 1.46; 95% CIs, 1.04-2.04; P = 0.028).</p><p><strong>Conclusions: </strong>Significant sex-based differences exist in MV disease patient characteristics and surgical outcomes, with females experiencing worse results, particularly in degenerative disease. Female sex was an independent risk factor for composite valve-related adverse outcomes after MV surgery. These differences suggest the need for sex-specific diagnostic criteria to reduce the disparities in patients with MV disease.</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":"144500279","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":"Outcome after day- and nighttime surgery for acute type A aortic dissection.","authors":"Till Joscha Demal, Tim Knochenhauer, Jessica Weimann, Tatu Juvonen, Timo Mäkikallio, Antonio Fiore, Andrea Perrotti, Matteo Pettinari, Sven Peterss, Joscha Buech, Caroline Radner, Angelo M Dell'Aquila, Konrad Wisniewski, Marek Pol, Petr Kacer, Francesco Onorati, Alessandra Francica, Igor Vendramin, Daniela Piani, Mauro Rinaldi, Luisa Ferrante, Eduard Quintana, Robert Pruna-Guillen, Javier Rodriguez Lega, Angel G Pinto, Metesh Acharya, Mark Field, Manoj Kuduvalli, Francesco Nappi, Sebastien Gerelli, Dario Di Perna, Giuseppe Gatti, Enzo Mazzaro, Stefano Rosato, Paola D'Errigo, Giovanni Mariscalco, Zein El-Dean, Christian Detter, Hermann Reichenspurner, Gianluca Polvani, Fausto Biancari, Lenard Conradi","doi":"10.1093/ejcts/ezaf192","DOIUrl":"10.1093/ejcts/ezaf192","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to investigate the differences in early and late outcomes after daytime compared to nighttime surgery for type A aortic dissection.</p><p><strong>Methods: </strong>From 2005 to 2021, patients undergoing surgery for type A aortic dissection at 18 European centres participating in the European registry of type A aortic dissection were included in this study. Based on the time of procedure, patients were allocated into groups (8 a.m. to 8 p.m. vs 8 p.m. to 8 a.m.). After propensity-score matching, short- and long-term all-cause mortality and reoperation rate as well as secondary end-points including myocardial infarction, neurological outcome and renal failure were compared.</p><p><strong>Results: </strong>A total of 3902 patients were included in this study. After propensity-score matching, outcomes of 1475 pairs of patients were compared. No differences were found regarding rates of surgical techniques. Daytime surgery was associated with an increased rate of global brain injury [daytime 5.4% (n = 80) vs nighttime 3.6% (n = 53); P = 0.021]. No significant differences were found in the rates of myocardial infarction, renal failure or neurological outcome other than global brain ischaemia. Significantly higher 1-year mortality (24.8% vs 21.7%, P = 0.049) and 10-year mortality (48.7% vs 45.1%, P = 0.022) was demonstrated in the daytime group. No significant differences in the rates of reoperation at 10 years were found.</p><p><strong>Conclusions: </strong>This study demonstrates that surgery for type A aortic dissection performed during nighttime is not associated with adverse outcomes compared to daytime surgery, suggesting that nighttime procedures can be safely performed without compromising short- or long-term outcomes.</p><p><strong>Clinical trial registration number: </strong>European Registry of Type A Aortic Dissection (ERTAAD) (Identifier: NCT04831073. URL: https://clinicaltrials.gov/study/NCT04831073).</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":"144510315","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":"Pain Catastrophizing Scale as a predictor for acute postoperative pain following video-assisted thoracoscopic surgery lobectomy.","authors":"Lasse Visby, Simone Engdahl, Erik Lilja Secher, Hasse Møller-Sørensen, Henrik Kehlet, René Horsleben Petersen","doi":"10.1093/ejcts/ezaf174","DOIUrl":"10.1093/ejcts/ezaf174","url":null,"abstract":"<p><strong>Objectives: </strong>Postoperative pain after thoracic surgery remains a significant challenge, underscoring the need to identify patients at risk of severe pain. While prior research across various surgical types highlights the Pain Catastrophizing Scale (PCS) as a key psychological predictor of acute postoperative pain, evidence specific to thoracic surgery is limited. This study aimed to investigate the association between PCS and postoperative pain in patients undergoing multiportal video-assisted thoracoscopic surgery (VATS) lobectomy.</p><p><strong>Methods: </strong>We conducted a prospective observational study including consecutive patients scheduled for VATS lobectomy. Patients completed the PCS-questionnaire preoperatively and pain scores (Numeric Rating Scale) were collected twice daily for the first 2 postoperative days under 4 conditions: resting, coughing, using a positive expiratory pressure (PEP) device and 5-meter walk-test.</p><p><strong>Results: </strong>In total, 100 patients were included. Median age was 72 [interquartile range (IQR): 64, 76] years, and 57% of patients were female. Median PCS score for all patients was 11 (IQR: 319). The minimum observed PCS score was 0, and the maximum was 43. Twenty-two (24.7%) of the patients presented with a PCS score ≥ 20 and were considered high-pain responders. High-pain responders reported significantly higher pain scores during coughing (6.00 vs 5.00, P = 0.02) and 5-meter-walk test (3.42 vs 1.75, P = 0.034) and were more likely to experience moderate-severe pain (95.5% vs 71.6%, P = 0.02) during the first 2 postoperative days. Linear regression confirmed that higher PCS scores were significantly associated with increased pain across most conditions, particularly coughing and 5-meter-walk-test.</p><p><strong>Conclusions: </strong>Higher PCS scores were associated with increased risk of acute postoperative pain following VATS lobectomy. The PCS is a simple, rapid and reliable predictor of acute postoperative pain.</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":"144121988","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":"Platelet drug response assay in patients undergoing off-pump coronary artery bypass grafting.","authors":"Chan Hyeong Kim, Yoonjin Kang, Ji Seong Kim, Suk Ho Sohn, Jae Woong Choi, Ho Young Hwang","doi":"10.1093/ejcts/ezaf183","DOIUrl":"10.1093/ejcts/ezaf183","url":null,"abstract":"<p><strong>Objectives: </strong>We observed antiplatelet drug response before and after off-pump coronary artery bypass grafting (OPCAB) and elucidated the clinical usefulness of the platelet drug response assay (PDRA).</p><p><strong>Methods: </strong>This retrospective observational study was conducted by including patients who underwent isolated OPCAB at our institution between December 2021 and December 2023. PDRA was performed using a turbidimetric whole-blood assay according to measure aspirin reaction unit (ARU, threshold value for responsiveness = 550) and P2Y12 reaction unit (PRU, threshold = 208). The primary end-point of this study was the change in PDRA values for aspirin and clopidogrel before and after OPCAB. The secondary end-point was early clinical outcomes and perioperative bleeding according to preoperative aspirin responsiveness.</p><p><strong>Results: </strong>PDRAs were performed before and after surgery for aspirin and clopidogrel in 255 and 219 patients, respectively. The mean ARU was higher in the postoperative period than in the preoperative period [474.8 ARU (SD 71.9) vs 441.0 ARU (SD 72.4), P < 0.001], although the proportions of aspirin responders were not significant (85.9% vs 88.2%, P = 0.50). No significant change was observed in the ratio of the platelet function suppression by clopidogrel or in the mean PRU; however, the proportion of clopidogrel responders was significantly lower in the postoperative period (58.9% vs 47.9%, P = 0.019).</p><p><strong>Conclusions: </strong>The absolute ARU value increases and the proportion of clopidogrel responders decreases in the early postoperative period after OPCAB. By contrast, changes in the proportion of aspirin responders and the absolute PRU value are not statistically significant.</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":"144228380","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":"Dislocated thrombus aspiration with computer-assisted vacuum thrombectomy during endovascular aortic repair: a bailout procedure.","authors":"Giacomo Murana, Francesco Buia, Costanza Fiaschini, Davide Pacini","doi":"10.1093/ejcts/ezaf184","DOIUrl":"10.1093/ejcts/ezaf184","url":null,"abstract":"<p><p>A 70-year-old woman was treated with thoracic endovascular aortic repair for an enlarging descending thoracic aortic aneurysm. Intraprocedural angiography after stentgraft positioning revealed superior mesenteric and right renal artery occlusion due to parietal thrombus displacement. This unusual complication was promptly treated with thrombus aspiration, which avoided visceral ischaemia by utilizing a minimally invasive technique. Treatment success was confirmed with intraprocedural angiography and computerized tomography a few days postoperatively.</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":"144288052","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":"Minimally invasive, transapical dual-lumened cannula for short-term left ventricular support in a clinically relevant large animal model†.","authors":"Marcell Székely, László Székely, Mónika C Dénes, Tamás Radovits, Béla Merkely, István Hartyánszky","doi":"10.1093/ejcts/ezaf173","DOIUrl":"10.1093/ejcts/ezaf173","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiogenic shock is still a major clinical challenge, despite the available devices. We developed a minimally invasive, transapical dual-lumened cannula, which can provide antegrade circulatory support and unloading for the left ventricle (LV). After using 3D printing technology, we wanted to test whether our prototypes are haemodynamically competent and implantable in an experimental large porcine model as a proof of concept study.</p><p><strong>Methods: </strong>We implanted our cannula prototypes to 7 healthy porcines via median sternotomy (n = 6) and via minimally invasive access (n = 1), transapically, under fluoroscopic control, off-pump. The cannulas were connected to a heart-lung machine, and we went from 2.5, to 3.5, 4, 4.5, 5 and 5.5 l/min flow with 15-15 min intervals on each flow to ensure LV support. Different metabolic and haemodynamic parameters were continuously monitored.</p><p><strong>Results: </strong>Implantation time was 14 ± 5 min. The cardiac output of the right ventricle elevated with the LV and roller pump performance from baseline of 4.81 ± 2.09 to 6.17 ± 1.02 l/min at 5.5 l/min pump flow. Mean arterial pressure and central venous pressure changed from 68.9 ± 9.4 and 9.2 ± 2.4 mmHg, to 72.8 ± 11.3 and 9.8 ± 3 mmHg, respectively. Serum lactic acid and other metabolic parameters were not changed significantly.</p><p><strong>Conclusions: </strong>We have successfully proved in a large animal study that our prototypes are implantable and can provide up to 5.5 l/min cardiac output. They could assist, then fully replace the function of the LV using a roller pump during our study. Further investigations are planned in the future using centrifugal pumps for longer-term support.</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/PMC12209791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121986","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}