Interdisciplinary cardiovascular and thoracic surgery最新文献

{"title":"Computational fluid dynamics to simulate stenotic lesions in coronary end-to-side anastomosis.","authors":"Kenichi Kamiya, Shinya Terada, Yukihiro Nagatani, Yuji Matsubayashi, Kohei Suzuki, Shohei Miyazaki, Hiroki Matsui, Syota Takano, Susumu Nakata, Yoshiaki Watanabe, Tomoaki Suzuki","doi":"10.1093/icvts/ivaf013","DOIUrl":"https://doi.org/10.1093/icvts/ivaf013","url":null,"abstract":"<p><strong>Objectives: </strong>End-to-side anastomosis is common in coronary artery bypass grafting, although restrictive suturing can narrow the anastomosis. We evaluated ex vivo end-to-side models by numerically simulating fluid dynamics to compare various degrees of stenotic anastomoses to predict haemodynamic effects.</p><p><strong>Methods: </strong>A carotid artery was grafted via an end-to-side anastomosis onto the left anterior descending artery of a porcine heart, with liquid silicone injected into the vessels. The end-to-side image was acquired via multidetector computed tomography for reference, and models of longitudinal shortening and bilateral narrowing were created with 25%, 50%, 75%, along with 90%, and 100% stenosis in the native coronary artery. Haemodynamics were analyzed using computational fluid dynamics simulations to calculate streamlines, wall shear stress, and oscillatory shear index.</p><p><strong>Results: </strong>In the reference model, the graft inflow impinged on the floor of the native artery, creating a recirculating vortex and a high oscillatory shear index region near the heel. As the graft flow angle increased with longitudinal stenosis, bilateral stenosis generated helical flow near the lateral wall of the native artery, worsening with increased stenosis. At 75% stenosis, both longitudinal shortening and bilateral narrowing caused abnormal flow separation, with low wall shear stress and high oscillatory regions forming distal to the toe of the anastomosis.</p><p><strong>Conclusions: </strong>Computational fluid dynamics modelling predicts that end-to-side anastomoses with 75% longitudinal or bilateral stenosis are at a risk of intimal hyperplasia causing graft failure, while anastomotic stenosis <50% indicates acceptable haemodynamics. Future studies should explore long-term clinical outcomes with suboptimal surgical anastomotic construction.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070023","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":"Long-term retention of the pedicled thymic flap after bronchial stump coverage.","authors":"Takahiro Karasaki, Sakashi Fujimori, Souichiro Suzuki, Shinichiro Kikunaga, Kazuki Ito, Yosuke Hamada, Shusei Mihara","doi":"10.1093/icvts/ivaf012","DOIUrl":"https://doi.org/10.1093/icvts/ivaf012","url":null,"abstract":"<p><p>This study aimed to assess the feasibility and retention rates of pedicled thymic flaps to enhance understanding of bronchial stump coverage. A retrospective analysis of 22 consecutive patients who underwent anatomical lung resection followed by bronchial stump coverage with pedicled thymic flaps between January 2017 and December 2022 was conducted. The procedure was performed using a minimally invasive 3-port video-assisted thoracoscopic surgery technique for all patients with no complications related to graft harvest or fixation. Postoperative retention of the engrafted flaps was evaluated in the 16 patients who underwent thin-slice computed tomography (CT) at least once after surgery. The majority of the postoperative CT examinations were performed for surveillance of lung cancer recurrence. The retention rates of pedicled thymic flaps were 100% at 60 days, 87% at 180 days, and 70% at one year post-surgery. Pedicled thymic flaps can be safely harvested using a minimally invasive approach, and the majority of engrafted flaps remain adjacent to the bronchial stump for more than one year. This technique may be a viable option for patients at high risk of a delayed bronchopulmonary fistula.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070028","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":"Closure of ventricular septal defect in children with trisomy 18: perioperative events and long-term survival.","authors":"Shintaro Nemoto, Kanta Kishi, Hayato Konishi, Akiyo Suzuki, Takahiro Katsumata, Noriyasu Ozaki, Yutaka Odanaka, Atsuko Ashida, Takamichi Uchiyama, Kenji Mine","doi":"10.1093/icvts/ivaf010","DOIUrl":"https://doi.org/10.1093/icvts/ivaf010","url":null,"abstract":"<p><strong>Objectives: </strong>This retrospective study aimed to investigate the feasibility of surgical closure of ventricular septal defect in children with trisomy 18 by assessing perioperative events and long-term survival.</p><p><strong>Methods: </strong>From April 2008 to March 2024, 41 consecutive patients were referred to us for ventricular septal defect surgery. The defect was closed in 35 patients at the end (median age, 16 months; median body weight, 5.7 kg), 31 out of 37 patients after the preceding pulmonary artery banding according to our staged surgery policy, and 4 patients without the banding. Sixty-five significant non-cardiac lesions existed concurrently and 14 patients underwent tracheostomy before closure. The investigation was conducted by checking medical records and contacting the primary physician.</p><p><strong>Results: </strong>Four patients died during the inter-stage after banding to closure (10.8%). Two of them were awaiting closure. Concomitant surgeries, 15 right ventricular muscle resections, or 1 arch repair, were performed along with closure. Arrhythmia was the most common adverse event (51.4%). Three patients required extracorporeal membrane oxygenation support. Transient but severe hepatic injury occurred in 11 patients (31.4%). There were 2 hospital death (5.7%) due to severe respiratory insufficiency or fulminant sepsis. Five patients died after discharge, 3 pneumonia and 2 sudden death, resulting in a 5-year estimated survival of 79.5%. Three hepatoblastoma and 1 hepatoangioma developed, but complete remission was achieved in all patients.</p><p><strong>Conclusions: </strong>Although further studies are mandatory, surgical closure of ventricular septal defect may be an effective treatment option even for children with trisomy 18.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034805","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 aortic dissection in a patient with cervical aortic arch.","authors":"Akira Takeuchi, Hiroshi Tsuneyoshi, Hideyuki Katayama, Shuji Setozaki","doi":"10.1093/icvts/ivaf003","DOIUrl":"https://doi.org/10.1093/icvts/ivaf003","url":null,"abstract":"<p><p>Cervical aortic arch (CAA) is a rare malformation. Herein, we report a 58-year-old female patient diagnosed with left CAA with descending aortic aneurysm. Initially, the descending aorta replacement was planned via left rib-cross thoracotomy. However, because of intraoperative aortic dissection during mobilization, total arch replacement was performed via emergent median sternotomy first. The main body of the synthetic graft was then guided to the left thoracotomy view, and the peripheral anastomosis of the descending aorta was performed. The surgery was successfully completed. The surgical management of CAA remains unstandardized due to its rarity and complex abnormalities. As aortic wall thinning can easily lead to aortic dissection, careful manipulation is required during mobilization.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973660","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":"Hyperacute silicosis after bronchoscopy-induced melanoptysis in a lung transplant patient. A first report in literature.","authors":"Angel Saenz, Jorge Dreyse, Joel Melo, Andrés Giglio","doi":"10.1093/icvts/ivaf004","DOIUrl":"https://doi.org/10.1093/icvts/ivaf004","url":null,"abstract":"<p><p>Silicosis, a fibrotic lung disease caused by crystalline silica inhalation, presents unique challenges in lung transplantation. This case reports an unprecedented complication in a lung transplant recipient with chronic silicosis. A man in his 60 s, post left single-lung transplantation for silica-induced pneumoconiosis, developed acute respiratory deterioration following routine bronchoscopy. Melanoptysis, followed by imaging showing extensive inflammatory involvement in the transplanted lung, required intubation and prone positioning. This case highlights the potential for residual silicotic material to trigger acute post-transplant complications. It underscores the importance of comprehensive pretransplant evaluation of occupational exposures and heightened awareness of silica-related complications in post-transplant care. The report emphasizes gaps in understanding long-term outcomes and optimal management strategies for lung transplant recipients with silicosis.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959907","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 surgical case of right atrial wall perforation caused by an invasive angiosarcoma.","authors":"Yuichiro Yokoyama, Takeshi Emmoto, Yumiko Abe, Mitsunori Abe","doi":"10.1093/icvts/ivae222","DOIUrl":"https://doi.org/10.1093/icvts/ivae222","url":null,"abstract":"<p><p>Cardiac angiosarcoma is a rare, diagnostically elusive disease with a poor prognosis. Herein, we describe the case of a 61-year-old man who presented with cardiac tamponade caused by perforation of the right atrial wall resulting from an invasive angiosarcoma. The tumour, which had spread throughout the entire right atrial free wall, was resected under cardiopulmonary bypass. Subsequent reconstruction of the right atrial wall involved the use of both autologous and bovine pericardial patches. Cardiac wall rupture due to invasive cardiac angiosarcoma is an extremely rare complication, with only a few cases reported. Therefore, we also review the relevant literature herein.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959908","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":"One-year patency of a novel biorestorative polymeric coronary artery bypass conduit.","authors":"Isaac George, Paulo Neves, Martijn Cox, Adrian Ebner","doi":"10.1093/icvts/ivaf006","DOIUrl":"10.1093/icvts/ivaf006","url":null,"abstract":"<p><p>Coronary artery bypass graft (CABG) surgery remains the gold standard in the treatment of complex coronary artery disease. Saphenous vein grafts (SVG) are commonly used for the non-left anterior descending artery. However, SVG failure rates in CABG surgery have been reported to be as high as 30% at 1 year and ∼50% at 10 years. Despite suboptimal performance, ∼80% of all CABG surgery includes SVG graft use. Therefore, an off-the-shelf, small-diameter vascular conduit with good patency rates remains a large unmet clinical need. XABG (Xeltis BV, Eindhoven, The Netherlands), a novel supramolecular electrospun biorestorative polymeric conduit with an embedded nitinol microskeleton, is under clinical development to fulfill this unmet need. This case report aims to demonstrate the safety and feasibility of this conduit in a routine CABG operation with implantation in a 70-year-old male patient with three-vessel disease. The XABG conduit remained patent with TIMI 3 flow at 6 months, and patency was confirmed by cardiac computed tomography at 12 months.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973657","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":"Are current follow-up intervals justified in patients with non-emergent aortic surgeries?","authors":"Joseph Kletzer, Tim Berger, Stoyan Kondov, Thomas Bleile, Aleksandar Dimov, Victoria Werdecker, Martin Czerny, Bartosz Rylski, Maximilian Kreibich","doi":"10.1093/icvts/ivae226","DOIUrl":"10.1093/icvts/ivae226","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence for different surveillance protocols following aortic treatment is still lacking. The aim of this study was to analyse the clinical relevance of a first follow-up visit after 6 months.</p><p><strong>Methods: </strong>Between January 2018 and December 2019, 464 patients treated for non-emergent aortic pathologies were retrospectively analysed. The incidence of aortic events during follow-up (ie, death, reintervention, endoleaks, anastomotic/new aneurysms and diameter progression over time) was investigated. A discrete-time non-homogeneous Markov Chain Model was used to analyse the data and to arrive at the number of skipped 6-month follow-up visits needed to harm a patient.</p><p><strong>Results: </strong>After 6 months, 2 (1.77%) patients had died, 15 (15.31%) patients suffered from aortic events and a total of 4 (3.67%) patients had undergone reintervention after endovascular surgery, compared to 0 deaths, 2 (0.59%) patients with aortic events and 5 (1.48%) reinterventions after open surgery. In our Markov Chain Model, after 6 months, 4.75% of patients showed aortic events, received a reintervention or died. Sixty patients would need to skip their 6-month follow-up visit for one indication for reintervention to go unnoticed. Only 24 would need to skip it for one complication to go by unnoticed. This number is 55 after open surgery and 9 after endovascular surgery.</p><p><strong>Conclusions: </strong>After elective endovascular or open aortic surgery without immediate in-hospital postoperative aortic events, the first follow-up visit after 6 months is important. Extending the first interval to longer time periods might lead to a considerable increase in missed aortic events. The cost and radiation exposure of frequent follow-ups must be balanced against the benefits of early preventative aortic interventions, warranting further research.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900773","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":"Arterial thoracic outlet syndrome caused by a cervical rib: a combined thoracoscopic and supraclavicular approach for 'en bloc'-resection.","authors":"Jon Andri Lutz, Emmanouil Psathas, Benoît Rouiller, Luis Filipe Azenha","doi":"10.1093/icvts/ivae217","DOIUrl":"10.1093/icvts/ivae217","url":null,"abstract":"<p><p>A cervical rib is the cause of ∼5% of thoracic outlet syndromes (TOS). We report the case of a patient with arterial TOS due to the presence of a cervical rib, managed by combined thoracoscopic and supraclavicular approach. An 18-year-old female patient presented with symptoms of arterial TOS. Magnetic resonance imaging and computed tomography angiography scans showed a tortuous subclavian artery due to a fused cervical and 1st rib. Three-port thoracoscopy was performed, which allowed to mobilize the ventral part of the 1st rib. Supraclavicular access allowed mobilization as well as central division of the ribs. After removal of the ribs, the subclavian artery presented a normal calibre and aspect. In recent years, there has been a trend towards minimally invasive approach to TOS, either by thoracoscopy or by robotic-assisted surgery. The advantages of this approach are the 'enbloc'-resection of both ribs and the possibility to evaluate the subclavian artery during the same procedure and perform repair if necessary.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900791","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":"Examining the learning curves in robotic cardiac surgery wet lab simulation training.","authors":"Gennady V Atroshchenko, Emiliano Navarra, Matthew Valdis, Elena Sandoval, Nasseh Hashemi, Stepan Cerny, Daniel Pereda, Meindert Palmen, Flemming Bjerrum, Niels Henrik Bruun, Martin G Tolsgaard","doi":"10.1093/icvts/ivae227","DOIUrl":"10.1093/icvts/ivae227","url":null,"abstract":"<p><strong>Background: </strong>Simulation-based training has gained distinction in cardiothoracic surgery as robotic-assisted cardiac procedures evolve. Despite the increasing use of wet lab simulators, the effectiveness of these training methods and skill acquisition rates remain poorly understood.</p><p><strong>Objectives: </strong>This study aimed to compare learning curves and assess the robotic cardiac surgical skill acquisition rate for cardiac and noncardiac surgeons who had no robotic experience in a wet lab simulation setting.</p><p><strong>Methods: </strong>In this prospective cohort study, participants practiced 3 robotic tasks in a porcine model: left atriotomy closure, internal thoracic artery harvesting and mitral annular suturing. Participants were novice robotic cardiac and noncardiac surgeons alongside experienced robotic cardiac surgeons who established performance benchmarks. Performance was evaluated using the time-based score and modified global evaluative assessment of robotic skills (mGEARS).</p><p><strong>Results: </strong>The participants were 15 novice surgeons (7 cardiac; 8 noncardiac) and 4 experienced robotic surgeons. Most novices reached mastery in 52 (±22) min for atrial closure, 32 (±18) for internal thoracic artery harvesting and 34 (±12) for mitral stitches, with no significant differences between the cardiac and noncardiac surgeons. However, for mGEARS, noncardiac novices faced more challenges in internal thoracic artery harvesting. The Thurstone learning curve model indicated no significant difference in the learning rates between the groups.</p><p><strong>Conclusions: </strong>Wet lab simulation facilitates the rapid acquisition of robotic cardiac surgical skills to expert levels, irrespective of surgeons' experience in open cardiac surgery. These findings support the use of wet lab simulators for standardized, competency-based training in robotic cardiac surgery.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959905","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}