Interdisciplinary cardiovascular and thoracic surgery最新文献

{"title":"Major pathologic response predicts survival in resectable stage IIIA non-small cell lung cancer after neoadjuvant therapy.","authors":"Shihong Zhou, Ying Zhang, Ziheng Wu, Pinghui Xia, Tianyu He, Jinlin Cao, Wang Lv, Jian Hu","doi":"10.1093/icvts/ivae213","DOIUrl":"10.1093/icvts/ivae213","url":null,"abstract":"<p><strong>Objectives: </strong>Major pathologic response is more common in survival analyses than pathological complete response. Whether major pathologic response can predict survival of patients with resectable stage IIIA non-small cell lung cancer and whether neoadjuvant chemotherapy or immunochemotherapy affect the prognosis of patients remains questionable.</p><p><strong>Methods: </strong>Patients with resectable stage IIIA non-small cell lung cancer receiving neoadjuvant chemotherapy (≥2 cycles) with/without immunotherapy were enrolled and divided into two groups according to pathological response. Comparison between the two groups was through chi-square test. Univariate Cox regression analysis and log-rank test were made to identify predictive factors of overall survival and disease-free survival. Kaplan-Meier survival curves were constructed to evaluate the prognostic impact of these factors.</p><p><strong>Results: </strong>Totally, 38 patients were enrolled. Significant difference was observed in overall survival (P = 0.005) and disease-free survival (P = 0.007) between patients with/without major pathologic response. For patients failing to reach major pathologic response, those who underwent ≥2 cycles of neoadjuvant therapy exhibited improved outcomes in overall survival (P = 0.021) and disease-free survival (P = 0.046). Notably, within this subgroup, patients receiving ≥ 2 cycles of neoadjuvant immunochemotherapy showed a trend towards better overall survival (P = 0.076) and disease-free survival (P = 0.062).</p><p><strong>Conclusions: </strong>Major pathologic response can predict survival of patients with resectable stage IIIA non-small cell lung cancer. For patients potentially not achieving major pathologic response after two cycles of neoadjuvant therapy, extended cycles of feasible neoadjuvant therapy are advisable for survival benefits.</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/PMC11681939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840474","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 computed tomography-derived surgical margin assessment in an ex vivo sublobar lung resection model.","authors":"Shinsuke Kitazawa, Nicholas Bernards, Alexander Gregor, Yuki Sata, Yoshihisa Hiraishi, Hiroyuki Ogawa, Takamasa Koga, Tsukasa Ishiwata, Masato Aragaki, Fumi Yokote, Andrew Effat, Kate Kazlovich, Robert Weersink, Michael Cabanero, Yukio Sato, Kazuhiro Yasufuku","doi":"10.1093/icvts/ivae211","DOIUrl":"10.1093/icvts/ivae211","url":null,"abstract":"<p><strong>Objectives: </strong>Computed tomography (CT) imaging of a sublobar resection specimen may inform intraoperative surgical margin assessment. However, consistency with final pathological margins has not been previously evaluated. In this study, we investigated the concordance between surgical margin measurements by CT versus pathology measurements using an ex vivo sublobar lung resection model.</p><p><strong>Methods: </strong>Pig lung wedge samples containing agarose pseudotumours were harvested. CT images were acquired following specimen inflation. The specimen was bisected along the same plane observed by CT for accurate comparison with pathological surgical margin measurement. The bisected samples were then fixed in formalin before preparing haematoxylin & eosin slides. Surgical margin length at four distinct stages (CT, gross pre-formalin fixation, gross post-formalin fixation and pathology) were measured and compared.</p><p><strong>Results: </strong>A total of 50 lung specimens were analysed. After specimen processing, Surgical margin length decreased in 94% (47/50) and increased in 6% (3/50) of samples. Mean surgical margin lengths were as follows: CT 14.0 mm (range: 4.5-28.3 mm), gross pre-formalin fixation 13.0 mm (range: 4.0-25.0 mm), gross post-formalin fixation 12.1 mm (range: 2.5-26.0 mm) and pathology 10.9 mm (range: 1.0-23.4 mm). There was an average -23.8% (range: +11 to -82%) change in surgical margin length from CT to final pathology (P < 0.001).</p><p><strong>Conclusions: </strong>While CT-based surgical margin measurement is feasible, we observed an average 23.8% discordance when compared to final pathology measurement. Surgeons must be aware that the CT-derived surgical margin generally overestimates the pathology-derived surgical margin.</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/PMC11706792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824965","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":"Preoperative interatrial block is associated with postoperative atrial fibrillation after cardiac surgery.","authors":"Spela Leiler, Andre Bauer, Wolfgang Hitzl, Rok Bernik, Valentin Guenzler, Matthias Angerer, Theodor Fischlein, Jurij Matija Kalisnik","doi":"10.1093/icvts/ivae178","DOIUrl":"https://doi.org/10.1093/icvts/ivae178","url":null,"abstract":"<p><strong>Objectives: </strong>Atrial fibrillation is common complication after heart surgery potentially leading to chronic atrial fibrillation, heart failure, and mortality. The aim of this study was to explore the relationship between preoperative interatrial block and the occurrence of postoperative atrial fibrillation.</p><p><strong>Methods: </strong>Perioperative 12-channel ECGs of patients in sinus rhythm, scheduled for heart surgery including bypass and/or valve surgery were analysed. Patients with pre-existing atrial fibrillation, amiodarone therapy, atrioventricular block II or III, or pacemaker were excluded from the study. Clinical parameters in patients with vs without atrial fibrillation were compared. To evaluate the association between interatrial block and postoperative atrial fibrillation univariable and multivariable regression analysis was performed.</p><p><strong>Results: </strong>Out of 2374 patients, 1350 were amenable to analysis. Postoperative atrial fibrillation was documented in 505 (37.4%). In multivariable regression analysis prediction models with and without interatrial block were established. Step-wise regression analysis identified interatrial block (2.64[2.02; 3.46], p < 0.001), age (1.11[1.03; 1.20], p = 0.007), EuroScore II (1.05[1.03; 1.07], p < 0.001), pulmonary hypertension (1.91[1.24; 2.97], p = 0.006), history of cardiogenic shock (2.05[1.11; 3.87], p = 0.032), statins (1.66[1.21; 2.27], p = 0.002), COPD (2.11[1.25; 3.65], p = 0.009), and cardiopulmonary bypass time (1.78[1.04; 3.05], p = 0.047) as independent predictors for postoperative atrial fibrillation.</p><p><strong>Conclusions: </strong>Preoperative interatrial block was associated with higher incidence of postoperative atrial fibrillation. Inclusion of ECG-derived preoperative conduction disturbances can enhance risk stratification of postoperative atrial fibrillation after heart surgery.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808660","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":"Comparing unilateral and bilateral cerebral perfusion during total arch replacement for acute type A aortic dissection.","authors":"Yumeng Ji, Juntao Qiu, Kai Zhang, Huiyuan Qin, Jian Song, Chenyu Zhou, Shiqi Gao, Bin Hou, Fangfang Cao, Ji Wang, Cuntao Yu, Wei Gao","doi":"10.1093/icvts/ivae205","DOIUrl":"https://doi.org/10.1093/icvts/ivae205","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the effects of unilateral versus bilateral antegrade cerebral perfusion (u-ACP vs b-ACP) on postoperative complications and mid-term follow-up results in Asian patients with acute type A aortic dissection (ATAAD) undergoing total arch replacement (TAR) + the frozen elephant trunk (FET).</p><p><strong>Methods: </strong>Clinical baseline data and postoperative complications of 702 ATAAD patients undergoing TAR+ FET at China Cardiovascular Centre Fuwai Hospital between January 2019 and December 2022 were collected. Patients were categorized into two groups based on antegrade cerebral perfusion: unilateral (n = 402) and bilateral (n = 300). Propensity scores were matched for 217 pairs of patients. Mid-term and perioperative surgical complications were analyzed, and baseline characteristics between the two groups were assessed.</p><p><strong>Results: </strong>The matched cohort revealed comparable 30-day mortality rates between u-ACP and b-ACP: 4.15% and 3.23%, respectively (p = 0.61). Rates of postoperative permanent neurologic dysfunction (PND) were similar across groups (2.76% for u-ACP and 3.23% for b-ACP, p = 0.76). However, u-ACP exhibited a higher incidence of postoperative transient neurologic deficit (TND) at 14.29% compared to 6.91% with b-ACP (p = 0.01). Logistic regression models identified u-ACP and cardiopulmonary bypass (CPB) time as independent risk factors for TND. Mid-term survival rates were comparable between the two groups (5-year survival: 90.29% vs 93.67%, p = 0.133).</p><p><strong>Conclusions: </strong>Both u-ACP and b-ACP are effective brain protection techniques for ATAAD patients undergoing total arch replacement. The use of b-ACP significantly reduces the incidence of TND.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831023","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":"Risk of neurologic events after surgery for mitral valve insufficiency and concomitant Cox-maze IV procedure for atrial fibrillation. A nationwide register-based study.","authors":"Anders Albåge, Farkas Vanky, Gabriella Boano, Anders Holmgren, Lena Jidéus, Birgitta Johansson, Göran Kennebäck, Shahab Nozohoor, Henrik Scherstén, Johan Sjögren, Anders Wickbom, Torbjörn Ivert","doi":"10.1093/icvts/ivae189","DOIUrl":"10.1093/icvts/ivae189","url":null,"abstract":"<p><strong>Objectives: </strong>Analysis of the long-term risks of ischaemic stroke and cerebral bleeding in patients with atrial fibrillation after mitral valve surgery and concomitant Cox-maze IV procedure.</p><p><strong>Methods: </strong>In total, 397 patients with symptomatic degenerative mitral valve insuffciency and atrial fibrillation, underwent mitral valve surgery and Cox-maze IV in Sweden between 2009 and 2017. In this retrospective nationwide analysis, patients were followed in national patient registers until 30 September 2022.</p><p><strong>Results: </strong>There were 4 deaths within 30 days (1.0%). Mean follow-up was 8.7 (0.1-13.4) years. Survival without ischaemic stroke or cerebral haemorrhage at 5 and 10 years were 90% and 74%, respectively. Nineteen patients experienced an ischaemic stroke, of which 4 were fatal. Five of 34 patients (14.7%) with a history of stroke preoperatively experienced ischaemic stroke during follow-up. The linearized rate of ischaemic stroke per patient-year was 0.6% and was similar regardless of left atrial appendage closure during surgery or whether a mechanical valve was inserted. The observed ischaemic stroke rate was lower than the predicted rate for all CHA2DS2-VASc score groups. Fourteen patients suffered cerebral bleeding, of which 3 were fatal. Patients who experienced cerebral bleeding were older and had higher mechanical valve implantation rate than those without cerebral bleeding.</p><p><strong>Conclusions: </strong>Surgery for mitral valve insufficiency and concomitant Cox-maze IV can be performed with low perioperative risk. There is a low continuing risk of stroke long-term postoperatively that correlates with a higher CHA2DS2-VASc score. Patients with preoperative stroke are at increased risk of postoperative stroke despite atrial fibrillation surgery.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669448","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":"Repair of aortic coarctation in neonates less than two kilograms.","authors":"Qiang Chen, Thomas Fleming, Massimo Caputo, Serban Stoica, Andrew Tometzki, Andrew Parry","doi":"10.1093/icvts/ivae185","DOIUrl":"10.1093/icvts/ivae185","url":null,"abstract":"<p><strong>Objectives: </strong>A significant number of low-birth-weight neonates are born with aortic coarctation. Previous studies of early operation on these patients have shown a high hospital mortality and recurrence at 1 year. We reviewed our data to ascertain whether modern approaches allow better outcomes for these children.</p><p><strong>Methods: </strong>Fourteen patients weighing <2 kg with isolated coarctation between January 2005 and December 2015 were studied by retrospective chart review to ensure >5 years follow-up. All patients underwent extended end-to-side surgical repair. In-hospital and medium-term follow-up data were collected. Data are expressed as median (range).</p><p><strong>Results: </strong>Weight at the time of surgery was 1.8 (1.5-1.9) kg. There were no deaths, in-hospital or during follow-up. In-hospital stay was 11 (4-47) days. At follow-up of 141 (80-207) months echocardiographic velocity across the repair was 1.6 (0.9-3.8) m/s. Two patients required balloon dilatations for recoarctation including 1 with William's syndrome who required balloon coarctoplasty followed by stenting. This patient had grossly abnormal vessels at the time of initial surgery with aortic wall thickness >3 mm. There were no central neurological complications. Other complications included vocal cord dysfunction in 1, development of chylothorax requiring prolonged chest drainage in 2, pneumothorax following chest drain removal in 1 and wound dehiscence in 1 patient.</p><p><strong>Conclusions: </strong>Neonates below 2 kg can undergo coarctation repair safely with low incidence of recurrence. Waiting for growth in this cohort of patients may not therefore be justified.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":"39 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808769","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 H. Daungsupawong et al.","authors":"Uladzimir Andrushchuk, Artsem Niavyhlas, Vitali Adzintsou, Mikalai Shchatsinka","doi":"10.1093/icvts/ivae200","DOIUrl":"10.1093/icvts/ivae200","url":null,"abstract":"","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":"39 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814955","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":"Value of observational studies in the outcome evaluation of transcatheter and surgical aortic valve replacement.","authors":"Fausto Biancari, Timo Mäkikallio, Paola D'Errigo, Gianluca Polvani","doi":"10.1093/icvts/ivae198","DOIUrl":"10.1093/icvts/ivae198","url":null,"abstract":"","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752494","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":"Prophylactic ablation during cardiac surgery in patients without atrial fibrillation: a systematic review and meta-analysis of randomized trials.","authors":"Mika'il Visanji, Emilie P Belley-Côté, Ashok Pandey, Yael Amit, Graham R McClure, Jack Young, Kevin J Um, Alireza Oraii, Jeff S Healey, Richard P Whitlock, William F McIntyre","doi":"10.1093/icvts/ivae195","DOIUrl":"10.1093/icvts/ivae195","url":null,"abstract":"<p><strong>Objectives: </strong>Atrial fibrillation is the most common complication of cardiac surgery and occurs frequently in patients without a history of the arrhythmia. We conducted a systematic review and meta-analysis of randomized controlled trials to assess whether prophylactic ablation during cardiac surgery in patients without a history of atrial fibrillation prevents atrial fibrillation.</p><p><strong>Methods: </strong>We searched CENTRAL, MEDLINE and Embase from inception to August 2024. We included randomized trials of adults without a history of atrial fibrillation undergoing cardiac surgery. The intervention of interest was ablation during surgery. We pooled data using random-effects models. The primary outcome was new-onset early postoperative atrial fibrillation within 30 days following surgery. The key secondary outcome was incident clinical atrial fibrillation at follow-up (minimum 6 months). We assessed risk of bias using the Cochrane Collaboration's risk of bias tool v.2 and evidence quality using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).</p><p><strong>Results: </strong>We included 7 trials (n = 687). The intervention was pulmonary vein isolation in 6 trials and ganglion plexi ablation in 1. Patients who received prophylactic ablation were less likely to have early postoperative atrial fibrillation (21% vs 37%, risk ratio [RR] 0.5, 95% confidence interval 0.3-0.8, I2 = 64%) and incident clinical atrial fibrillation at longest follow-up (range 6 months-2 years; 3% vs 10%, RR 0.3, 95% confidence interval 0.2-0.7, I2 = 0%). The quality of evidence was low.</p><p><strong>Conclusions: </strong>Prophylactic ablation during cardiac surgery may prevent atrial fibrillation in patients without a history of the arrhythmia. A definitive randomized trial is needed to confirm effects and safety.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735212","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":"A successful post-surgical treatment of cardiogenic shock using Impella via brachiocephalic artery.","authors":"Ai Sakai, Kenji Iino, Yoshitaka Yamamoto, Hirofumi Takemura","doi":"10.1093/icvts/ivae202","DOIUrl":"https://doi.org/10.1093/icvts/ivae202","url":null,"abstract":"<p><p>Patients with low-flow, low-gradient severe aortic stenosis and ischaemic cardiomyopathy are at risk for postcardiotomy cardiogenic shock and have a poor prognosis. Although Impella has emerged as a bridge therapy, traditional approaches for Impella insertion are infeasible in patients with peripheral vascular diseases. We successfully managed postcardiotomy cardiogenic shock in a patient with low-flow, low-gradient severe aortic stenosis and ischaemic cardiomyopathy and limited vascular access by introducing Impella via the brachiocephalic artery. Impella may enable the surgical treatment of high-risk patients.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":"39 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824968","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}