Interdisciplinary cardiovascular and thoracic surgery最新文献

{"title":"Long term outcome and prognostic factors after chest wall resection and reconstruction.","authors":"Alba M Fernandez Gonzalez, Jose R Matilla, Orsolya Anna Pipek, Laura Gonzalez Sanchez, Merjem Begic, Zsolt Megyesfalvi, Balazs Döme, Clemens Aigner","doi":"10.1093/icvts/ivaf126","DOIUrl":"https://doi.org/10.1093/icvts/ivaf126","url":null,"abstract":"<p><strong>Objectives: </strong>Our study aimed to evaluate factors influencing perioperative and long-term outcomes of patients undergoing curative-intent chest wall resection and reconstruction.</p><p><strong>Methods: </strong>A retrospective single-center analysis was conducted on all patients undergoing curative-intent chest wall resection and reconstruction from 2010 to 2023. Perioperative outcome was analyzed for the entire cohort. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method and log-rank test and multivariable Cox proportional hazards regression models with a particular focus on patients with lung cancer and chest wall involvement.</p><p><strong>Results: </strong>143 consecutive patients (median age 62 years, 44.1% females) were included 75% of patients received perioperative systemic therapy or radiation. Rib resection alone was performed in 69.9%, additional sternal resection in 16.1%, spine resection in 11.9% and clavicle resection in 2.1%. Additional resections included the lung (n = 75), diaphragm (n = 6), pericardium (n = 2), subclavian vein (n = 2), pulmonary artery (n = 1), and multiple structures (n = 22). Reconstruction was performed using synthetic protheses (n = 89), metallic (n = 6), or combinations of materials (n = 32). Median tumor diameter was 10 cm, 88% were malignant. Local recurrence rate was 9.5%. Median DFS (86 events) was 36 months, and median OS (62 events) 80 months. The 5-year-DFS and OS were 54.1% and 74.1%. In patients with lung cancer OS was significantly affected by age (p = 0.028), histology (p < 0.001), resection size >10 cm (p = 0.018), postoperative performance status (PS) (p < 0.001) and postoperative complications (p < 0.001) in multivariable analysis, DFS by postoperative PS (p < 0.001).</p><p><strong>Conclusions: </strong>Postoperative performance status is correlated with overall survival after chest wall resection.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183517","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":"Clinical assessment of cannula performance during adult minimally invasive valve surgery using predictive mathematical models.","authors":"Korneel Vandewiele, Filip De Somer, Michael Vandenheuvel, Pascal Verdonck, Thierry Bové","doi":"10.1093/icvts/ivaf127","DOIUrl":"https://doi.org/10.1093/icvts/ivaf127","url":null,"abstract":"<p><strong>Objectives: </strong>Peripheral cannula selection in minimally invasive cardiac surgery (MICS) is crucial, as venous drainage limitations during cardiopulmonary bypass (CPB can impair end-organ perfusion and overall outcomes. This study evaluates the in vivo venous drainage efficiency of different peripheral venous cannulas for adult MICS by applying dynamic similarity (DS) prediction formulas.</p><p><strong>Methods: </strong>This observational study included 75 adult MICS patients with use of single peripheral venous cannulation from January 2017 to June 2023. The analysis included cannulas Bio-Medicus Multi XL Life Support, Nextgen Bicaval, and Smart cannulas. Cannula performance was assessed by comparing predicted pressures with in vivo measurements.</p><p><strong>Results: </strong>A total of 278, 314, and 264 measurements were recorded for the Multi, Next, and Smart cannulas, respectively. No significant demographic differences were found between groups. Lin's concordance correlation coefficients for agreement between predicted and measured pressures were >0.95 for the Multi and Next cannulas but substantially lower for the Smart cannula (0.80). Bland-Altman analysis showed a mean bias of -1.09 mmHg for the Multi, -0.15 mmHg for the Next, and 3.68 mmHg for the Smart cannula, with the latter exceeding the ±12.5 mmHg limits of agreement.</p><p><strong>Conclusions: </strong>DS-based predictions revealed significant performance variability among peripheral venous cannula types. The in vivo performance was adequately predicted for the Multi and Next cannulas but not for the Smart cannula, underscoring the need for real-life evaluations and performance monitoring during CPB. Incorporating dynamic performance assessments into clinical decision-making might optimize venous drainage and patient outcomes.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182179","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":"Effects of computed tomography-defined sarcopenia on patients undergoing transcatheter aortic valve implantation.","authors":"Hiroshi Kurazumi, Ryo Suzuki, Ryosuke Nawata, Kazumasa Matsunaga, Yousuke Miyazaki, Atsuo Yamashita, Takayuki Okamura, Akihito Mikamo, Motoaki Sano, Kimikazu Hamano","doi":"10.1093/icvts/ivaf083","DOIUrl":"https://doi.org/10.1093/icvts/ivaf083","url":null,"abstract":"<p><strong>Objectives: </strong>Stratifying patients with aortic stenosis is crucial for improving their lifetime management. Several studies analysed computed tomography (CT)-defined sarcopenia in patients undergoing transcatheter aortic valve implantation (TAVI). However, the criteria for CT-defined sarcopenia are heterogeneous among these studies. Mostly, they primarily evaluated short-term outcomes; research focusing on long-term outcomes, related to lifetime management in patients with aortic stenosis, is rare. We assessed the effects of CT-defined sarcopenia on the short- and long-term outcomes in patients undergoing TAVI using three different sarcopenia criteria, including two traditional criteria and a novel criterion.</p><p><strong>Methods: </strong>In this retrospective study, we enrolled 360 patients. Three different sarcopenia criteria (skeletal muscle index [SMI], psoas muscle area [PMA], and psoas muscle volume index [PVI]) were applied to assess safety and early and long-term clinical outcomes.</p><p><strong>Results: </strong>SMI-, PMA-, and PVI-sarcopenia were diagnosed in 244 (67.7%), 246 (68.3%), and 161 (44.7%) patients, respectively. However, PMA-sarcopenia was associated with poor long-term survival after TAVI. Furthermore, PVI-sarcopenia was associated with lower safety at 30 days and poor long-term survival. Using Cox regression hazard models, PVI-sarcopenia tended to be a risk factor of overall survival (hazards ratio: 1.49, p = 0.052).</p><p><strong>Conclusions: </strong>In patients undergoing TAVI, CT-defined sarcopenia using PVI-based criteria was a reliable predictor of poor outcomes. This finding might facilitate stratification of patients undergoing TAVI.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176087","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":"Surgical explanation of an infected aortic arch endograft: a two-stage approach.","authors":"Santi Trimarchi, Viviana Grassi, Nesar Hasami, Guido Gelpi","doi":"10.1093/icvts/ivaf123","DOIUrl":"https://doi.org/10.1093/icvts/ivaf123","url":null,"abstract":"<p><p>Thoracic Endovascular Aortic Repair has become the preferred treatment for various aortic pathologies due to its minimally invasive approach. While advancements, including branched devices, have expanded the scope of endovascular repair to the aortic arch and ascending aorta, they also present challenges, particularly in managing complications like infection. We report a rare case of an branched thoracic endograft explantation. It considered a 67-year-old male who presented with haemoptysis due to an infected branched endograft with an aorta-oesophageal fistula. The patient underwent a staged approach, including preoperative left common carotid artery to left subclavian artery bypass and explantation of the endograft under circulatory arrest. Reconstruction was achieved using a self-made bovine xenopericardial tube graft. Postoperative recovery was uneventful and the patient was discharged in good condition 23 days post-surgery.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176090","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":"Impact of the number of involved lymph node zones on survival in stage IIIA-N2 lung adeno and squamous cell carcinoma.","authors":"Raffaella Griffo, Hans Hoffmann, Seyer Safi, Florian Eichhorn, Laura V Klotz, Thomas Muley, Philip Baum, Marc Kriegsmann, Helge Bischoff, Hauke Winter, Martin E Eichhorn","doi":"10.1093/icvts/ivaf121","DOIUrl":"https://doi.org/10.1093/icvts/ivaf121","url":null,"abstract":"<p><strong>Objectives: </strong>The role of upfront surgery in treating stage IIIA-N2 non-small cell lung cancer remains controversial. This study aimed to evaluate the role of upfront surgery in selected patients with stage IIIA-N2 and assess the prognostic significance of the number of involved lymph node zones in relation to the N2-subclassification proposed by the International Association for the Study of Lung Cancer, comparing adenocarcinoma and squamous cell carcinoma.</p><p><strong>Methods: </strong>We retrospectively analysed patients with pIIIA-N2 adeno- or squamous cell carcinoma who underwent complete surgical resection with zone-based lymph node dissection. Survival was calculated using the Kaplan-Meier method and group differences were assessed via log-rank test and Cox regression analysis.</p><p><strong>Results: </strong>A total of 222 patients were analysed. The 5-year overall survival rate was 43%, with a median overall survival of 47.2 months. In the adenocarcinoma cohort, the N2b-subgroup was associated with a 1.7-fold increased risk of death, whereas adjuvant chemotherapy reduced the risk by 41%. In squamous cell carcinoma, neither adjuvant chemotherapy nor the N2b-subgroup were identified as prognostic factors for overall survival.</p><p><strong>Conclusions: </strong>The zone concept for intraoperatively assigning lymph nodes and the proposed N2-subgroups allowed a good stratification of long-term survival in patients with adenocarcinoma.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164008","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":"Intraoperative assessment and treatment of residual distal malperfusion improves outcomes in patients with acute Debakey I dissection.","authors":"Israa Abdellah, Jack Guiry, Thoralf M Sundt Iii, Matthew Eagleton, Eric Isselbacher, Jahan Mohebali, Sunita Srivastava, Jordan Bloom, Serguei Melnitchouk, Antonia Kreso, Motahar Hosseini, Arminder S Jassar","doi":"10.1093/icvts/ivaf117","DOIUrl":"https://doi.org/10.1093/icvts/ivaf117","url":null,"abstract":"<p><strong>Objectives: </strong>Type A Aortic Dissection(TAAD) with malperfusion carries high mortality and morbidity despite current surgical techniques; new approaches are needed to improve outcomes. This study evaluates the outcomes of patients undergoing intraoperative assessment and treatment of distal malperfusion during central aortic repair.</p><p><strong>Methods: </strong>A retrospective review of 551 TAAD patients from 2000-2023 identified 54 patients with clinical malperfusion of the mesenteric, renal, spinal cord, or iliofemoral based on clinical presentation, imaging, and biomarkers. Patients with radiological aortic branch involvement but without clinical symptoms were excluded. Patients were grouped into: Standard approach(n = 36), where central aortic repair was followed by postoperative ICU care, and Comprehensive approach(n = 18), where intraoperative evaluation for persistent malperfusion was conducted after termination of cardiopulmonary bypass, with immediate intervention if needed. The primary outcome was operative mortality. Secondary outcomes included resolution of malperfusion.</p><p><strong>Results: </strong>Of 54 patients, 41%(n = 22) had mesenteric, 46%(n = 25) renal, 11%(n = 6) spinal and 76%(n = 41) Iliofemoral malperfusion. The comprehensive approach was significantly associated with reduced odds of the composite outcome(OR : 0.17, 95% CI: 0.04-0.63, p = 0.008) and increased odds of resolving malperfusion(OR : 4.55, 95% CI : 1.26-16.44, p = 0.021). In the mesenteric subgroup(n = 22), odds of malperfusion resolution were markedly higher(OR : 19.30, 95% CI: 2.17-171.65, p = 0.008). However, no significant associations were found in the limb(OR : 3.17, p = 0.107) or renal subgroups(OR : 4.38, p = 0.164).</p><p><strong>Conclusions: </strong>Patients with TAAD undergoing immediate intraoperative evaluation to identify and treat distal malperfusion simultaneously with central aortic repair may benefit from lower rates of complications and bowel resection. Further studies with larger datasets are needed to validate this approach.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164010","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":"Mullerian cyst of the posterior mediastinum: utilizing indocyanine green for thoracic duct visualization during robotic-assisted resection.","authors":"William A Hardy, Jonathan Waxman","doi":"10.1093/icvts/ivaf122","DOIUrl":"https://doi.org/10.1093/icvts/ivaf122","url":null,"abstract":"<p><p>We describe a case of a 45-year-old female who underwent robot-assisted resection for a posterior mediastinal cyst abutting the thoracic duct. During this operation, near-infrared fluorescence lymphography with indocyanine green was successfully utilized for real-time intraoperative visualization of the thoracic duct. This technique should be considered when operating on structures near the thoracic duct to avoid and promptly detect iatrogenic injury.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164096","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":"Microplastic in perfusion: the hidden risk and how to address it.","authors":"Friedhelm Beyersdorf","doi":"10.1093/icvts/ivaf116","DOIUrl":"https://doi.org/10.1093/icvts/ivaf116","url":null,"abstract":"","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133331","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":"Socioeconomic deprivation is associated with worse in-hospital survival after isolated coronary artery bypass grafting in the United Kingdom.","authors":"Jeremy Chan, Pradeep Narayan, Jacie Jiaqi Law, Tim Dong, Gianni D Angelini","doi":"10.1093/icvts/ivaf119","DOIUrl":"https://doi.org/10.1093/icvts/ivaf119","url":null,"abstract":"<p><strong>Objectives: </strong>Previous studies have identified a correlation between socioeconomic deprivation and poorer outcomes following cardiac surgery in the US, where healthcare is predominantly delivered through private system. However, the influence of socioeconomic deprivation in countries with universal healthcare systems, such as the UK has been less extensively investigated.Therefore, we used the Index of Multiple Deprivation (IMD) to evaluate the impact of socioeconomic status on early clinical outcomes following coronary artery bypass grafting (CABG) in the UK.</p><p><strong>Methods: </strong>All patients who underwent elective/urgent isolated CABG between 2008-2019 in the UK were included. The IMD, along with other peri-operative characteristics, were incorporated into a regression model to determine factors associated with in-hospital mortality.</p><p><strong>Results: </strong>The analysis included 182,911 patients (median age: 67.3 years, 82.13% male). Patients were categorised into 5 groups based on IMD, 1:most deprived - 5 the least: 1=30,564,2=, 30,815, 3=59,161, 4=31,891, and 5=30,480. Patients from the most socioeconomically deprived areas exhibited markedly higher rates of comorbidities and risk factors such as diabetes and had a higher rate of urgent surgical intervention. There is a small increase in In-hospital mortality when socioeconomic status declined, with rates of 1.30%,1.30%,1.24%,1.14%, and 1.15% for group 1-5, respectively. Socioeconomic deprivation, particularly in income and education, was associated with an increase in in-hospital survival.</p><p><strong>Conclusion: </strong>Socioeconomic deprivation, particularly in income and education, is associated with higher burdens of comorbidity and a small decrease in-hospital survival after CABG in the UK. This suggests that these factors may play a critical role in clinical outcomes even in a universal healthcare system.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121633","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":"Comparison of outcomes following the Fontan procedure between patients with previous ductus stent and aortopulmonary shunt.","authors":"Dimitrij Grozdanov, Muneaki Matsubara, Takuya Osawa, Jonas Palm, Thibault Schaeffer, Carolin Niedermaier, Nicole Piber, Paul Philipp Heinisch, Stanimir Georgiev, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono","doi":"10.1093/icvts/ivaf118","DOIUrl":"https://doi.org/10.1093/icvts/ivaf118","url":null,"abstract":"<p><strong>Objective: </strong>In this study, we aimed to compare the outcome after the Fontan procedure in patients after an initial ductus stenting or a surgical aortopulmonary shunt.</p><p><strong>Methods: </strong>We reviewed infants with single ventricle and ductal-dependent pulmonary blood flow who underwent ductus stenting or an aortopulmonary shunt between 2009 and 2022, and subsequently underwent the staged Fontan procedure.</p><p><strong>Results: </strong>A total of 93 patients were included (39 ductus stenting and 54 aortopulmonary shunts). Before the Fontan procedure, pulmonary artery pressure (9 vs. 9 mmHg, p = 0.376) and pulmonary artery index (184 vs. 183 mm2/m2, p = 0.988) were similar between the groups. However, the incidence of venovenous collaterals was higher in patients after ductus stenting than those after aortopulmonary shunt (35.9 vs. 16.7%, p = 0.034). Median age (1.9 vs. 1.8 years, p = 0.493) and weight at the Fontan procedure (12 vs. 11kg, p = 0.596) were similar between the groups. There was no in-hospital mortality in each group. The length of the intensive care unit stay (median 5 vs. 5 days, p = 0.542) and hospital stay (median 17 vs. 14 days, p = 0.767) were similar between the groups. During the median follow-up of 2.5 years, one late death was observed in the DS group. Freedom from reintervention (66.6 vs. 82.0%, p = 0.095) and from adverse events (78.6 vs. 92.2%, p = 0.488) at 5 years were similar between the groups.</p><p><strong>Conclusions: </strong>This pilot study demonstrated comparable outcomes following the Fontan procedures between patients with single ventricle and ductal-dependent pulmonary blood flow after initial ductus stenting and those after initial aortopulmonary shunt.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121629","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}