Interdisciplinary cardiovascular and thoracic surgery最新文献

{"title":"Implantation of a sutureless aortic valve into the ring of a mechanical valve: an extreme solution for extreme cases.","authors":"Robič Boris, Rene Petrovič, Arta Krasniqi, Miha Antonič","doi":"10.1093/icvts/ivae207","DOIUrl":"10.1093/icvts/ivae207","url":null,"abstract":"<p><p>Reoperations due to dysfunction of artificial mechanical aortic valves represent a complex and high-risk surgical procedure, particularly for elderly patients. In this report, we present a case of an 81-year-old female patient where, due to structural degeneration of the mechanical valve, an emergency surgical procedure was indicated. After the removal of the valve leaflets, a sutureless aortic valve was implanted within the mechanical ring. In our case, we demonstrate that such an approach is a safe alternative for high-risk patients, who cannot undergo percutaneous procedures. By reducing the duration of cardiopulmonary bypass and aortic clamping, the surgical outcomes and complication rates can be significantly improved.</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/PMC11665631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824966","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":"Robotic-enhanced hybrid ablation for inappropriate sinus tachycardia: a world-first approach.","authors":"Zain Khalpey, Ujjawal Kumar, Alyssa Abraham, Yoaav Krauthammer","doi":"10.1093/icvts/ivae184","DOIUrl":"10.1093/icvts/ivae184","url":null,"abstract":"<p><p>We describe a world-first robotic ablation for inappropriate sinus tachycardia. A 26-year-old woman with refractory inappropriate sinus tachycardia underwent robotic-enhanced hybrid ablation, combining electrophysiological mapping with superior visualization and access compared to video-assisted thoracoscopic surgery (VATS) approaches. Ablations normalized the heart rate from 120 to 70 bpm. At one- and six-month follow-ups, she reported symptom resolution and improved quality of life. Holter monitoring confirmed no tachycardic episodes. This presents a promising alternative for patients who have exhausted conventional treatments, potentially revolutionizing inappropriate sinus tachycardia management.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11593499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633713","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":"Totally endoscopic coronary bypass: do we need a robot, a pump or both?","authors":"Hiroto Kitahara, Husam H Balkhy","doi":"10.1093/icvts/ivae186","DOIUrl":"10.1093/icvts/ivae186","url":null,"abstract":"","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640163","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":"Endoscopic-assisted, minimally invasive versus sternotomy total arterial multivessel bypass grafting.","authors":"De Qing Görtzen, Fleur Sampon, Naomi Timmermans, Joost Ter Woorst, Ferdi Akca","doi":"10.1093/icvts/ivae187","DOIUrl":"10.1093/icvts/ivae187","url":null,"abstract":"<p><strong>Objectives: </strong>This single-centre study compared the perioperative outcomes after total arterial multivessel revascularization through endoscopic-assisted, minimally invasive surgery compared to a conventional sternotomy approach.</p><p><strong>Methods: </strong>In this retrospective, propensity score-matched (PSM) cohort study, a total of 740 patients were analysed [endoscopic coronary artery bypass grafting (Endo-CAB), N = 92; Sternotomy, N = 648]. After PSM (1:2 ratio), 73 Endo-CAB and 137 sternotomy patients were compared with an equal number of distal anastomoses (Endo-CAB 2.3 versus Sternotomy 2.4 anastomoses per patient, P = 0.082). We used 'textbook outcome' as a patient-orientated outcome measure, defined as the absence of 30-day mortality, re-exploration for bleeding, postoperative ischaemia, cardiac tamponade, cerebrovascular events, wound infection, new onset arrhythmias, pneumonia, placement of chest drains and prolonged hospital stay (>7 days).</p><p><strong>Results: </strong>Patients undergoing Endo-CAB had significantly more often a textbook outcome compared to the sternotomy group (78.1% vs 59.1%, P = 0.009). Endo-CAB patients had shorter hospital stay (4.0 vs 6.0 days, P < 0.001), less postoperative blood loss (360 vs 490 ml, P < 0.001) and a significant reduction of new onset postoperative atrial fibrillation (5.5% vs 17.5%, P = 0.015). Other postoperative outcomes were comparable for both groups.</p><p><strong>Conclusions: </strong>Total arterial Endo-CAB demonstrates excellent postoperative outcomes compared to a sternotomy approach for multivessel coronary artery disease. These findings provide a strong basis for further expanding the multivessel Endo-CAB programme.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633525","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":"Transcatheter aortic valve replacement failure: surgical valve explantation after more than a decade.","authors":"Go Yamashita, Shingo Hirao, Tatsuhiko Komiya","doi":"10.1093/icvts/ivae177","DOIUrl":"10.1093/icvts/ivae177","url":null,"abstract":"<p><p>Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement for severe aortic stenosis. However, the long-term outcomes and need for surgical reintervention following TAVR remain uncertain. This case report describes a 76-year-old woman who underwent surgical explantation of a SAPIEN-XT valve more than a decade after initial TAVR implantation due to late valve failure. The patient presented with severe aortic insufficiency and heart failure symptoms. Surgical intervention involved concomitant ascending aortic replacement, tricuspid annuloplasty and coronary artery bypass grafting. The TAVR valve was successfully explanted using careful blunt dissection to avoid annulus damage. Postoperative recovery was uneventful, with the patient discharged after 4 weeks. This case highlights the potential need for long-term surgical management of patients after TAVR and emphasizes the importance of surgical preparedness as TAVR indications expand. It also provides valuable insights for surgeons encountering similar cases of late TAVR failure requiring explantation.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514078","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":"Appraisal of partial anomalous pulmonary venous drainage through a lumped-parameter mathematical model: a new pathophysiological proof of concept.","authors":"Paolo Ferrero, Andrea Tonini, Giulio Valenti, Massimo Chessa, Luca Kuthi, Pier Paolo Bassareo, Luca Dede, Alfio Quarteroni","doi":"10.1093/icvts/ivae175","DOIUrl":"10.1093/icvts/ivae175","url":null,"abstract":"<p><strong>Objectives: </strong>Haemodynamic determinants of the ratio between pulmonary and systemic flow (Qp/Qs) in partial anomalous pulmonary venous return (PAPVR) are still not fully understood. Indeed, among patients with the same number of lung segments draining anomalously, a great variability is observed in terms of right ventricular overload. The aim of this study was to test the hypothesis that the anatomic site of drainage, affecting the total circuit impedance, independently influences the magnitude of shunt estimated by Qp/Qs. A zero-dimensional lumped parameter mathematical model was developed and validated on a sample of patients.</p><p><strong>Methods: </strong>We developed a zero-dimensional lumped parameter model, using time-varying elastances for heart chambers, RLC Windkessel circuits for the systemic and pulmonary circulations. Patients were categorized into vena cava (VC) type (including left drainage to anomalous vein) and right atrium (RA) type. The mathematical model is a system of ordinary differential equations that are numerically solved by means of the ode15s solver in the MATLAB environment.</p><p><strong>Results: </strong>The model showed an increase of Qp/Qs with the increase of the number of anomalous veins. With the same number of anomalous veins, Qp/Qs was lower in patients with anomalous drainage to the VC as compared with RA. The validation sample consisted of 49 patients (27, 55% females). As predicted by the model, patients with PAPVR with VC type displayed a lower invasive and cardiac magnetic resonance Qp/Qs as compared with drainage to RA: 1.4 (1.2-1.7) and 1.45 (1.25-1.6) versus 2 (1.75-2.1) and 1.9 (1.6-2), P < 0.05. After stratifying for number of lung territories, a lower Qp/Qs was measured in patients with VC PAPVR as compared with RA.</p><p><strong>Conclusions: </strong>In patients with PAPVR, the site of anomalous drainage modulates the Qp/Qs. According to the model, this effect is mediated by the post-capillary impedance of the circuit and significantly decreases with the increase of pulmonary vascular resistances.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11543523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514077","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":"Treatment of concomitant persistent chylothorax and superior vena cava syndrome through innominate vein-right atrial bypass.","authors":"Emrah Şişli, Arzu Funda Tarhan, Eylem Kıral, Gürkan Bozan","doi":"10.1093/icvts/ivae176","DOIUrl":"10.1093/icvts/ivae176","url":null,"abstract":"<p><p>Persistent chylothorax is a major challenge in paediatric patients. We present a case of a 6.5 kg, 1-year-old boy with superior vena cava syndrome and persistent chylothorax who underwent successful surgery without cardiopulmonary bypass. His medical history included multiple comorbidities such as myeloproliferative disease, short bowel syndrome and central vein catheterizations. The patient also had innominate vein thrombosis, progressing to superior vena cava, and was on anticoagulants. Despite dietary changes and somatostatin, his high-output chylous pleural effusion persisted. He was treated with innominate vein-to-right atrial bypass using a 6-mm Dacron graft. Postoperatively, there was a significant reduction in effusion and accelerated recovery. Somatostatin failure was likely due to mechanical obstruction of the thoracic duct.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523787","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":"Defining the causes for Fontan circulatory failure in total cavopulmonary connection patients.","authors":"Joeri Van Puyvelde, Filip Rega, Werner Budts, Alexander Van De Bruaene, Bjorn Cools, Marc Gewillig, Benedicte Eyskens, Ruth Heying, Thomas Salaets, Bart Meyns","doi":"10.1093/icvts/ivae188","DOIUrl":"10.1093/icvts/ivae188","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to identify the causes of failure in Fontan patients with a total cavopulmonary connection.</p><p><strong>Methods: </strong>We conducted a comprehensive review of all patients who underwent a total cavopulmonary connection procedure at our centre between 1988 and 2023, aiming to identify and analyse the factors contributing to Fontan failure (defined as mortality, heart transplantation, Fontan takedown, protein-losing enteropathy, plastic bronchitis or New York Heart Association Functional Classification class III or IV).</p><p><strong>Results: </strong>The study included 217 patients (median age at time of Fontan completion 3.7 years) with a median follow-up of 12.7 years (interquartile range 7.2-17.7). Systolic ventricular function decreased significantly over time in patients with right ventricular dominant morphology (P = 0.002), while systolic ventricular function remained stable in patients with left ventricular dominant morphology. Fontan failure occurred in 24 patients, with estimated freedom from Fontan failure rates of 97.7% [95% confidence interval (CI), 95-99] at 1 year, 93.9% (95% CI, 89-97) at 15 years and 77.2% (95% CI, 65-86) at 20 years of follow-up. Systolic ventricular dysfunction was the most common cause of failure (29%), followed by atrioventricular valve regurgitation (16.7%), a high pulmonary vascular resistance (16.7%), restrictive pathophysiology (16.7%) and obstruction (12.5%). Patients with right ventricular dominance developed most often systolic ventricular dysfunction, while patients with left ventricular dominant morphology developed most often restrictive pathophysiology or a high pulmonary vascular resistance.</p><p><strong>Conclusions: </strong>Approximately 10% of patients experienced Fontan failure within 15 years postoperatively. Patients with right ventricular dominance experienced progressive decline due to systolic dysfunction, while those with left ventricular dominance exhibited failure due to restrictive pathophysiology or high pulmonary vascular resistance.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11601976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683522","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":"The prognostic significance of modified frailty index-5 in patients undergoing pneumonectomy for lung cancer.","authors":"Muhammet Sayan, Bengisu Artiran, Funda Ozturk, Mahir Fattahov, Irmak Akarsu, Muhammet Tarik Aslan, Gunel Ahmadova, Aysegul Kurtoglu, Ismail Cuneyt Kurul, Ali Celik","doi":"10.1093/icvts/ivae179","DOIUrl":"10.1093/icvts/ivae179","url":null,"abstract":"<p><strong>Objectives: </strong>In some centrally located lung cancers, complete excision of the mass cannot be achieved with parenchymal-sparing procedures and pneumonectomy may be required. The mortality and morbidity rates of pneumonectomy were reported to be considerably high. Here, we investigated the effectivity of modified frailty index-5 (MFI-5) in patients undergoing pneumonectomy for non-small cell lung cancer.</p><p><strong>Methods: </strong>Data of patients who underwent pneumonectomy for non-small cell lung cancer between January 2018 and December 2023 were reviewed retrospectively. The MFI-5 score was determined by preoperative diabetes mellitus, hypertension, chronic obstructive pulmonary diseases, congestive heart failure and functional status. The effectiveness of the MFI-5 score for the presence of postoperative major complications and 30-day mortality was investigated by multivariate logistic regression analysis. A P-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 107 patients who met the inclusion criteria were included in the study. Eight (7.5%) of patients were female, and the mean age was 61.4 ± 8.7. The MFI-5 score was 0 in 48 patients (44.9%), 1 in 27 patients (25.2%) and 2 in 20 patients (18.7%). Postoperative 30-day mortality was detected in 4 patients (3.7%), and the major complications occurred in 42 patients (39.3%). In multivariate analysis, an MFI-5 score of 2 or higher (P = 0.008, OR: 4.9) was statistically significant for complications, whereas age, gender, side of the operation, <2 MFI-5 score, tumor diameter, type of surgery and lymph node metastasis status were not statistically significant (P > 0.05).</p><p><strong>Conclusions: </strong>The MFI-5 score is a significant indicator for predicting major postoperative events in patients who underwent pneumonectomy for non-small cell lung cancer.</p><p><strong>Clinical registration number: </strong>2024-323, approved by Gazi University Local Ethics Committee.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549316","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, safety and quality of complex mitral valve repair in the early phase of a robotic surgery programme.","authors":"Kei Kobayashi, Yizhan Guo, Thomas E Rubino, Luis E Ramirez, Stephen D Waterford, Ibrahim Sultan, Victor D Morell, Johannes Bonatti","doi":"10.1093/icvts/ivae182","DOIUrl":"10.1093/icvts/ivae182","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the feasibility, safety and quality of robotic-assisted mitral valve repair in complex versus non-complex cases during the early phase of a programme.</p><p><strong>Methods: </strong>Since the programme launch in September 2021 until February 2024, 100 patients underwent robotic-assisted mitral valve repair. Of them, 21 patients had complex repairs, while 79 had non-complex repairs. The median age was 58 years for complex cases and 61 years for non-complex cases (P = 0.36).</p><p><strong>Results: </strong>Bileaflet prolapse was significantly more prevalent in the complex group (52.4% vs 12.7%, P < 0.001). Neochord placement (61.9% vs 13.9%, P < 0.001) and commissuroplasty (28.6% vs 5.1%, P = 0.005) were more frequent in the complex group. The complex group had longer cardiopulmonary bypass times (161 vs 141 min, P < 0.001), aortic cross-clamp times (123 vs 102 min, P < 0.001) and leaflet repair times (43 vs 24 min, P < 0.001). Second pump runs were required more often for complex cases (23.8% vs 3.8%, P = 0.01). All patients left the operating room with residual mitral regurgitation of mild or less. Fewer complex patients were extubated in the operating room (42.9% vs 70.9%, P = 0.02), yet hospital stay was similar (4 vs 4 days, P = 0.56). There were no significant differences in postoperative adverse events. There were no differences in mitral regurgitation of mild or less 4 weeks post-surgery (95.2% vs 98.7%, P = 0.47).</p><p><strong>Conclusions: </strong>Complex mitral valve repair can be safely and effectively performed with robotic assistance, even in the early phase of a programme. Despite longer operative and ventilation times in the complex group, hospital stay and postoperative adverse events remained similar.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669427","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}