Interdisciplinary cardiovascular and thoracic surgery最新文献

{"title":"The role of Impella in the pre-procedural management of post-infarct ventricular septal defect: a systematic review.","authors":"Marco Gemelli, Daniele Ronco, Michele Di Mauro, Paolo Meani, Mariusz Kowalewski, Gary Schwartz, Rakesh C Arora, Glenn Whitman, Evgenij Potapov, Dominik Wiedemann, Daniel Zimpfer, Milan Milojevic, Gaik Nersesian, Leonardo Salazar, Sandro Gelsomino, Gino Gerosa, Roberto Lorusso","doi":"10.1093/icvts/ivae212","DOIUrl":"10.1093/icvts/ivae212","url":null,"abstract":"<p><strong>Objectives: </strong>Post-infarct ventricular septal defect is a rare but devastating complication. Delayed treatment offers better outcomes than emergency surgery, but when acute cardiogenic shock or unstable haemodynamics occur, temporary mechanical circulatory support may be needed to stabilize patients until treatment. The aim of our systematic review was to assess the outcomes of using Impella in this setting.</p><p><strong>Methods: </strong>A systematic search was performed in the Medline and EMBASE databases, and all the papers about the use of Impella in this setting were assessed. The study followed the PRISMA criteria.</p><p><strong>Results: </strong>A total of 20 papers encompassing 68 patients with an Impella implanted after the diagnosis of post-infarct ventricular septal defect and before its treatment were included. More than 95% were in cardiogenic shock when Impella was implanted, and half had another mechanical circulatory support device. Most of the patients (62%) had a posterior defect, and 72% underwent surgical or percutaneous repair. Total in-hospital mortality was 47%, and a total of 29 Impella-related complications were observed. Patients with surgical Impella had a numerically lower in-hospital mortality (35% vs. 58%) and a lower rate of complications compared to percutaneous device.</p><p><strong>Conclusions: </strong>Impella represents an effective device for diminishing low output syndrome, improving peripheral perfusion, and unloading both the ventricles. It can be used as an upgrade from another mechanical circulatory support or as an addition to extracorporeal membrane oxygenation to provide adequate left ventricular or biventricular support. Despite this, Impella-related complications can occur after its implantation and must be considered.</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/PMC11684336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824967","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":"Vein watershed analysis locational method versus computed tomography-guided percutaneous localization for detecting non-palpable peripheral pulmonary nodules: a real-world study of non-inferiority.","authors":"Chen Huang, Zi-Hao Chen, Li-Shan Peng, Jia-Tao Zhang, Jun-Tao Lin, Sheng Zhang, Jie Yang, Ben-Yuan Jiang, Xue-Ning Yang, Wen-Zhao Zhong, Qiang Nie","doi":"10.1093/icvts/ivae225","DOIUrl":"10.1093/icvts/ivae225","url":null,"abstract":"<p><strong>Objectives: </strong>In recent years, with the advancement of sublobar resection, a safe, painless method for locating peripheral pulmonary nodules was needed. Previously, an alternative method of arterial watershed localization was introduced to remedy the shortcomings of preoperative computed tomography (CT)-guided localization or other methods for locating pulmonary nodules, but its technical limitations were discovered during clinical applications. Therefore, we developed a technique to localize non-subpleural nodules using basin analysis of the target vein and validated its feasibility and safety.</p><p><strong>Methods: </strong>We performed a retrospective analysis of surgical cases of pulmonary nodules smaller than 2 cm in our centre. The vein watershed locational method (V-WALM) was compared with CT-guided percutaneous puncture localization wedge dissection in terms of success rate, the mean duration of the operation, mean volume of intraoperative bleeding and median postoperative stay, mean postoperative drainage and mean drainage tube indwelling time.</p><p><strong>Results: </strong>V-WALM and CT-guided localization were used for localized resection of pulmonary nodules in 50 patients. The localization success rates were 94.0% for V-WALM and 90.0% for CT-guided localization, respectively, with no statistical difference noted. In addition, no statistical difference in patient population distribution between the 2 groups was noted. The operating time was 95.5 ± 26.4 min for V-WALM and 94.3 ± 37.5 min for CT-guided localization, with no statistical difference. Neither were there statistical differences in intraoperative bleeding, postoperative drainage and drainage tube indwelling time. The lymph node sampling rate of V-WALM was 48.0%, which was much higher than the 24% noted in the CT-guided localization group.</p><p><strong>Conclusions: </strong>The results of this study demonstrate that V-WALM is a safe and feasible intraoperative localization method for peripheral lung nodules. It provides a high-precision, fast and minimally invasive approach to intraoperative localization.</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/PMC11758505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911275","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":"Impact of the distance of spread through air spaces in non-small cell lung cancer.","authors":"Asato Hashinokuchi, Takaki Akamine, Gouji Toyokawa, Kyoto Matsudo, Taichi Nagano, Fumihiko Kinoshita, Mikihiro Kohno, Takumi Tomonaga, Kenichi Kohashi, Mototsugu Shimokawa, Yoshinao Oda, Tomoyoshi Takenaka, Tomoharu Yoshizumi","doi":"10.1093/icvts/ivae181","DOIUrl":"10.1093/icvts/ivae181","url":null,"abstract":"<p><strong>Objectives: </strong>Spread through air spaces (STAS) is considered a poor prognostic factor in patients with resected non-small lung cell cancer; however, the clinical significance of STAS extent remains unclear. We hypothesized that the further the tumour cells spread from the tumour edge, the worse the prognosis becomes.</p><p><strong>Methods: </strong>This study retrospectively reviewed the data of 642 patients with completely resected pathological stage I-III non-small lung cell cancer between 2008 and 2018. The maximum spread distance (MSD) from the tumour edge to the farthest STAS was quantitatively evaluated, and STAS was categorized as limited (MSD ≤1000 μm) or extended (MSD >1000 μm), based on the median MSD. Recurrence-free survival (RFS) and overall survival (OS) were compared among patients stratified by STAS classification.</p><p><strong>Results: </strong>Patients were classified into STAS-negative (n = 382, 59.6%), limited STAS (n = 130, 20.2%) and extended STAS (n = 130, 20.2%) groups. Extended STAS was associated with a high maximum standardized uptake value, advanced pathological stage and vascular invasion compared with limited STAS. The extended STAS group demonstrated significantly shorter RFS and OS than both the limited STAS and STAS-negative groups (both P < 0.001 for RFS; P = 0.007 and P < 0.001 for OS, respectively). Multivariable analysis showed that extended STAS was an independent prognostic factor for both RFS and OS (P < 0.001, P < 0.001, respectively).</p><p><strong>Conclusions: </strong>The distance from tumour edge to STAS affects prognosis in patients with completely resected non-small lung cell cancer.</p><p><strong>Clinical registration number: </strong>IRB approval number: 2019-232.</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/PMC11669314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869666","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":"Impact of neoadjuvant therapy on angioplastic lobectomy: a retrospective study.","authors":"Tayeb Benkiran, Kheira Hireche, Sebastien Frey, Adeline Morisot, Aude Nguyen, Quentin Rudondy, Florent Alcaraz, Mauro Guarino, Charlotte Cohen, Abel Gomez-Caro, Jean-Phillippe Berthet","doi":"10.1093/icvts/ivae191","DOIUrl":"10.1093/icvts/ivae191","url":null,"abstract":"<p><strong>Objectives: </strong>The efficacy of neoadjuvant therapy (NT) prior to angioplastic lobectomy (AL) in non-small cell lung cancer is unclear. This study assessed its impact on morbidity, mortality and 5-year survival.</p><p><strong>Methods: </strong>We retrospectively analysed 114 patients who underwent AL at 2 tertiary centres from January 2000 to December 2020. Comparisons were made between patients who received NT and those who did not.</p><p><strong>Results: </strong>Among the patients, 78 (68.4%) underwent upfront surgery, and 36 (31.6%) received NT. There were no significant differences in postoperative complications (46.2% vs 31.6%, P = 0.42) or mortality rates (0% vs 3.8%, P = 0.55). Pathological upstaging differed significantly (37.2% vs 5.6%, P = 0.0008). Five-year survival rates were comparable (54% vs 38%, P = 0.3).</p><p><strong>Conclusions: </strong>Neoadjuvant therapy does not adversely affect morbidity, arterial repair complications or mortality in AL. There are no survival differences at 5 years. AL remains a safe option following NT.</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/PMC11669316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878775","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":"Benefit of minimally invasive extracorporeal circulation on minimally invasive aortic valve replacement through right lateral mini-thoracotomy using femoral cannulation: a propensity-matched analysis.","authors":"Yoshitsugu Nakamura, Taisuke Nakayama, Kusumi Niitsuma, Yuka Higuma, Masaki Ushijima, Miho Kuroda, Yuto Yasumoto, Yujiro Ito, Yujiro Hayashi, Ryo Tsuruta, Naoya Yamauchi, Akihiro Higashino, Fumiaki Shikata","doi":"10.1093/icvts/ivae224","DOIUrl":"10.1093/icvts/ivae224","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to evaluate the impact of minimally invasive extracorporeal circulation on blood transfusion and asymptomatic brain injury in comparison to conventional extracorporeal circulation in the context of minimally invasive aortic valve replacement through right lateral mini-thoracotomy surgery.</p><p><strong>Methods: </strong>This was a retrospective observational study. Patients who underwent isolated aortic valve replacement through right lateral mini-thoracotomy surgery were divided into two groups: the minimally invasive extracorporeal circulation group and the conventional extracorporeal circulation group. Propensity matching was employed for further analysis.</p><p><strong>Results: </strong>Of 242 patients, the minimally invasive group and conventional group comprised 166 patients and 76 patients, respectively. In the matched cohort of 71 pairs, the two groups had similar preoperative characteristics. Extracorporeal circulation time was similar between the minimally invasive and conventional groups: 113 and 115 min, respectively, as was aortic clamp time: 86 and 82 min, respectively. Estimated amount of haemodilution was lower in the minimally invasive group (16.8 vs. 18.8%, P = 0.006). Blood transfusion frequency during surgery was less than half of conventional in the minimally invasive group (12.7 vs. 31.0%, P = 0.01). There were no deaths or stroke in either group during the hospital stay. Asymptomatic brain injury rate was the same for the two groups (35.2 vs. 35.2%, P = 1.00).</p><p><strong>Conclusions: </strong>Minimally invasive extracorporeal circulation was associated with fewer patients requiring transfusion than conventional extracorporeal circulation without an increase of asymptomatic brain injury in minimally invasive aortic valve replacement through right lateral mini-thoracotomy 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/PMC11729723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959904","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":"Development of a core outcome set of quality indicators for enhanced recovery after surgery in minimally invasive cardiac heart valve surgery by interprofessional Delphi consensus.","authors":"Susanne G R Klotz, Anke Begerow, Evaldas Girdauskas","doi":"10.1093/icvts/ivae218","DOIUrl":"10.1093/icvts/ivae218","url":null,"abstract":"<p><strong>Objectives: </strong>A core outcome set (COS) giving indicators of the quality of the process for minimally invasive valve surgery embedded into enhanced recovery after surgery (ERAS) protocols should be developed.</p><p><strong>Methods: </strong>Using web-based questionnaires, a Delphi process with three rounds was conducted from January to December 2022. Prior to the rounds, a systematic database search was performed identifying potential quality parameters. Experts for the panel were selected reflecting the interprofessional nature of the ERAS protocol. In the first round, participants could make suggestions of indicators in the pre-, intra- or postoperative and rehabilitative phase. These suggestions form together with the indicators of the literature a first indicator list. In the second round, participants could rate the relevance of the indicators resulting in a condensed indicator list. The third round was performed for further condensation based on importance ranking of the remaining indicators.</p><p><strong>Results: </strong>Three studies could be included in the systematic literature search providing a list of 22 indicators. Twenty-one experts participated in the Delphi survey. The experts named 315 indicators in the first round. After condensation in two further rounds, the final COS consisted of 24 indicators in the categories structure, process, outcome and complications.</p><p><strong>Conclusions: </strong>A consensual minimum set of quality measurements during pre-, intra- and postoperative and rehabilitation phase for patients with minimally invasive heart surgery is now available for enhancing the quality of clinical practice and facilitating comparisons across different ERAS programs.</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/PMC11706534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900815","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":"Is there any role for an atrial septal defect in off-loading a borderline left ventricle?","authors":"Amir-Reza Hosseinpour, Antonio González-Calle, Oliver Stümper, David J Barron","doi":"10.1093/icvts/ivae216","DOIUrl":"10.1093/icvts/ivae216","url":null,"abstract":"<p><p>A small atrial septal defect with right-to-left shunt is useful for off-loading a dysfunctional right ventricle postoperatively. However, an atrial septal defect with left-to-right shunt may not be as useful for a dysfunctional left ventricle. Experimental data are limited at present. Thus, we reconsider the related physiology to guide future approach.</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/PMC11706528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900886","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":"Single-stage surgical repair of a pre-coarctation aortic arch aneurysm and arteria lusoria.","authors":"Mouhammad Kanj, Ziad Mansour, Fadi Farhat","doi":"10.1093/icvts/ivae220","DOIUrl":"10.1093/icvts/ivae220","url":null,"abstract":"<p><p>Managing an adult patient with aortic coarctation and associated anomalies presents a significant surgical challenge. We present a case of an adult male with aortic coarctation, pre-coarctation distal arch 7-cm aneurysm involving the origin of the left subclavian artery, and aberrant (lusoria) right subclavian artery. He was managed with one surgical approach, consisting of right carotid-subclavian bypass, exclusion of the right subclavian artery, proximal descending aortic replacement and reinsertion of left subclavian artery, using partial cardiopulmonary bypass.</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/PMC11771764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959906","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":"Feasibility of 4D-flow CMR for haemodynamic characterization in hypertrophic cardiomyopathy after septal myectomy with and without anterior mitral valve leaflet extension.","authors":"Sulayman El Mathari, Pim van Ooij, Renske Merton, Eric Schrauben, Luuk Hopman, Aart Nederveen, Marco Götte, Jolanda Kluin","doi":"10.1093/icvts/ivae210","DOIUrl":"10.1093/icvts/ivae210","url":null,"abstract":"<p><strong>Objectives: </strong>The common surgical treatment in patients with obstructive hypertrophic cardiomyopathy is septal myectomy. This involves resection of a segment of the myocardial septum and can be performed with and without concomitant anterior mitral valve leaflet extension (AMVLE). While both approaches have satisfying clinical outcomes, there is a lack of data regarding the added value of concomitant AMVLE. In particular, their impact on postoperative haemodynamics remains unexplored. Therefore, we conducted a study to assess the feasibility of utilizing four-dimensional-flow cardiac magnetic resonance imaging (4D-flow cardiac magnetic resonance imaging (CMR)) to investigate postoperative haemodynamic differences among both surgical approaches.</p><p><strong>Methods: </strong>In this feasibility study, nine subjects underwent 4D-flow CMR evaluation, including three patients who underwent isolated myectomy, three patients with myectomy + AMVLE and three healthy controls. Primary end-points were aortic wall shear stress, left ventricular outflow tract (LVOT) peak velocity and peak kinetic energy in the LVOT and ascending aorta.</p><p><strong>Results: </strong>Results showed that patients who underwent myectomy with concomitant AMVLE exhibited (i) lower aortic wall shear stress (-21.2%), (ii) lower LVOT peak velocity (-6.3%), (iii) higher kinetic energy in the LVOT (+10.8%) and (iv) lower kinetic energy in the ascending aorta (-28.8%) compared to patients who underwent isolated myectomy.</p><p><strong>Conclusions: </strong>Patients undergoing additional AMVLE exhibited a better trend towards the haemodynamic reference values from healthy controls compared to patients undergoing isolated myectomy. Our findings underscore the feasibility of 4D-flow CMR to assess postoperative haemodynamic differences in hypertrophic cardiomyopathy patients undergoing different surgical approaches. This highlights the potential of 4D-flow CMR to compare surgical strategies based on postoperative haemodynamics.</p><p><strong>Clinical registration number: </strong>Dutch National Medical Ethics Committee, registration number 2022.0078.</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":"142840473","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":"Suspected heparin-induced thrombocytopaenia in pulmonary thromboendarterectomy: retrospective cohort.","authors":"Guillaume Guimbretière, Clément Dubost, Justin Issard, Virginie Louvain-Quintard, Xavier Jais, Samuel Dolidon, François Stephan, Daniela-Iolanda Ion, Olaf Mercier, Elie Fadel","doi":"10.1093/icvts/ivaf001","DOIUrl":"10.1093/icvts/ivaf001","url":null,"abstract":"<p><strong>Objectives: </strong>Heparin is given for anticoagulation during and after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. Our objective was to add to the limited data available on the incidence, management and outcomes of suspected heparin-induced thrombocytopaenia after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.</p><p><strong>Methods: </strong>This retrospective single-centre study included consecutive patients with suspected heparin-induced thrombocytopaenia after pulmonary thromboendarterectomy done in 2005-2018. Confirmed heparin-induced thrombocytopaenia was defined as positive findings from both the antibody test and the platelet aggregation test. Patients with versus without confirmed heparin-induced thrombocytopaenia were compared, as well as patients with versus without heparin replacement therapy within the group with unconfirmed heparin-induced thrombocytopaenia. The platelet counts over time were compared to those in controls without suspected heparin-induced thrombocytopaenia.</p><p><strong>Results: </strong>Heparin-induced thrombocytopaenia was suspected in 86 (6.3%) of 1360 patients and confirmed in 16 (16/86, 19%), all of whom received heparin replacement therapy and survived to intensive care unit discharge. Of the remaining 70 patients, 28 (40%) received heparin replacement therapy and less often experienced bleeding compared to the other 42 (3.6% vs 21.4%, P = 0.043). Intensive care unit mortality was 17/70 (24.3%) and was lower in the subgroup given heparin replacement therapy (10.7% vs 33.3%; P = 0.046). Confirmed heparin-induced thrombocytopaenia was associated with a sharp platelet-count drop on Day 5. In unconfirmed suspected heparin-induced thrombocytopaenia, the early platelet-count decline was similar to that in the controls without suspected heparin-induced thrombocytopaenia, but the baseline count was lower.</p><p><strong>Conclusions: </strong>Clinical features suggesting heparin-induced thrombocytopaenia after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension were associated with excess mortality. Relay heparin replacement therapy was associated with lower mortality and fewer bleeding events.</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/PMC11754861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017511","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}