Interdisciplinary cardiovascular and thoracic surgery最新文献

{"title":"Totally endoscopic aortic valve replacement with concomitant septal myectomy.","authors":"Sahri Kim, Jae Suk Yoo","doi":"10.1093/icvts/ivaf030","DOIUrl":"10.1093/icvts/ivaf030","url":null,"abstract":"<p><p>Left ventricular outflow tract obstruction may become apparent after successful aortic valve replacement for severe aortic stenosis, necessitating both aortic valve replacement and septal myectomy. Despite significant advancements in minimally invasive surgery, the current literature on concurrent minimally invasive cardiac procedures is limited due to the varying optimal exposures required for each procedure. In this context, we present a case of aortic valve replacement with concomitant septal myectomy using a minimally invasive, totally endoscopic approach.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451166","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 outcome after repair of interrupted aortic arch in a single centre†.","authors":"Michaela Kreuzer, Eva Sames-Dolzer, Andreas Tulzer, Melanie Klapper, Roland Mair, Gregor Gierlinger, Fabian Seeber, Rudolf Mair","doi":"10.1093/icvts/ivaf026","DOIUrl":"10.1093/icvts/ivaf026","url":null,"abstract":"<p><strong>Objectives: </strong>Mortality in patients with interrupted aortic arch (IAA) rates among the highest in congenital heart surgery. Various techniques for aortic arch repair are described; reintervention rates remain substantial. This retrospective single-centre study aimed to evaluate the long-term outcome in a biventricular series with a preferably performed direct anastomosis and one-stage repair.</p><p><strong>Methods: </strong>At the Children's Heart Center Linz, 58 biventricular patients with IAA were operated between 1999 and 2023. Median age at operation was 10 [7; 15] days and weight was 3.3 [3; 3.7] kg. In the 24 children with ventricular septal defects (VSDs) only, the arch was repaired by a direct anastomosis. Thirty-four had complex concomitant heart defects, and the arch reconstruction was performed by direct anastomosis (20), direct anastomosis + patch (10), reverse subclavian flap + patch (3) and aortic autograft + patch (1).</p><p><strong>Results: </strong>Median cardiopulmonary bypass time was 222 [159; 315] min, and aortic cross-clamp time was 94 [75; 143] min. Two patients died during the hospital stay (4%), two patients after discharge (4%), and four (7%) required an arch reintervention during a follow-up period of median 9.3 [6.2; 17.2] years. There was no death or arch reintervention in the VSD group.</p><p><strong>Conclusions: </strong>All-cause mortality in biventricular patients with IAA was 7%, and the arch reintervention rate was 8%. Direct aortic anastomosis in patients with VSD can only be performed with excellent outcomes, with no deaths or arch reinterventions being observed after a follow-up up to 24 years.</p><p><strong>Clinical registration number: </strong>EK Nr 1268/2021, Ethics committee of the Medical Faculty at Johannes Kepler University Linz.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400898","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":"Contemporary outcomes of open thoraco-abdominal aortic repair: a single-centre experience.","authors":"N A Hasami, M Smulders, M W A Verkroost, W W L Li, N Saouti, F J H Nauta, G S C Geuzebroek, R H Heijmen","doi":"10.1093/icvts/ivaf019","DOIUrl":"10.1093/icvts/ivaf019","url":null,"abstract":"<p><strong>Objectives: </strong>Untreated cases of thoraco-abdominal aortic aneurysms pose significant challenges, often leading to severe morbidity and high mortality. While promising, endovascular treatment is not suitable in all cases, particularly younger patients and those with collagen disorders. This study reports on the contemporary outcomes of open thoraco-abdominal aortic aneurysm repair at our academic medical centre from 2015 to 2023.</p><p><strong>Methods: </strong>All patients with thoraco-abdominal aortic aneurysm (Crawford-Safi Types I-V), including elective and non-elective cases, who underwent open surgical repair between January 2015 and December 2023 were included. Patient characteristics, intraoperative variables and postoperative outcomes were prospectively recorded and analysed retrospectively. The primary end point was operative mortality; secondary end points included rates for spinal cord injury, stroke, tracheostomy, need for dialysis and a comparison of outcomes between elective and non-elective cases.</p><p><strong>Results: </strong>190 patients (146 elective/44 non-elective) were included, with a mean age of 63.8 years (standard deviation 11.5), and 58% were male. Operative mortality was 7.9%, with 7.5% in elective cases and 9.1% in non-elective cases. Stroke with persisting symptoms at discharge occurred in 5.8% of patients, and tracheostomy was required in 3.7%. Spinal cord injury symptoms were observed in 7.4%, with persistent paraparesis in 2.1% and paraplegia in 1.6% at discharge. Acute kidney injury occurred in 38.4% of patients, with 6.9% requiring dialysis and 3.7% continuing dialysis at discharge.</p><p><strong>Conclusions: </strong>Open thoraco-abdominal aortic aneurysm surgery, supported by a multidisciplinary team approach and strict perioperative protocols, remains effective in managing this complex patient population, demonstrating low rates of mortality and severe complications.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191312","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":"Segmentectomy versus lobectomy in younger patients with early-stage non-small cell lung cancer.","authors":"Atsushi Kamigaichi, Takahiro Mimae, Norifumi Tsubokawa, Yoshihiro Miyata, Yujin Kudo, Takuya Nagashima, Hiroyuki Ito, Norihiko Ikeda, Morihito Okada","doi":"10.1093/icvts/ivaf024","DOIUrl":"10.1093/icvts/ivaf024","url":null,"abstract":"<p><strong>Objectives: </strong>Despite clinical trials supporting the efficacy of segmentectomy for early-stage non-small cell lung cancer (NSCLC), a previous report indicated its limited efficacy in younger patients, raising concerns about its indication.</p><p><strong>Methods: </strong>Patients aged <70 years with radiologically solid-dominant clinical stage IA NSCLC ≤2 cm who underwent lobectomy or segmentectomy at three institutions between 2010 and 2017 were enrolled. Propensity scores were estimated to adjust for confounding variables (age, sex, smoking history, tumour location, size, ground-glass opacity, maximum standardized uptake value and histological type). To elucidate the prognostic impact of surgical indications in the late postoperative phase, restricted mean survival time (RMST) from 0 to 5 and 8 years was also determined.</p><p><strong>Results: </strong>Overall, 388 patients with a median age of 63 years were enrolled. Overall survival (OS) (hazard ratio [HR], 0.447; 95% confidence interval [CI], 0.152-1.316) and recurrence-free survival (RFS) (HR, 0.638; 95% CI, 0.335-1.216) did not differ significantly between the segmentectomy (n = 114) and lobectomy groups (n = 274). In the propensity score matching of 100 pairs, OS (HR, 0.577; 95% CI, 0.162-2.056) and RFS (HR, 0.945; 95% CI, 0.408-2.191) were comparable between the segmentectomy and lobectomy groups. Regarding OS in the segmentectomy and lobectomy groups, the 5- and 8-year RMST were 4.95 years versus 4.92 years (difference: 0.02 years; 95% CI, -0.09-0.13; P = 0.699) and 7.82 years versus 7.69 years (difference: 0.12 years; 95% CI, -0.17-0.42; P = 0.420), respectively.</p><p><strong>Conclusions: </strong>Segmentectomy is a viable option for younger patients with early-stage NSCLC, suggesting that indications for segmentectomy need not vary by age.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383989","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":"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":"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 three-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 at least once after surgery. The majority of the postoperative computed tomography 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 1 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 1 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":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070028","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":"Innovative balloon-inflatable venous cannula for enhanced cardiopulmonary bypass in minimally invasive cardiac surgery.","authors":"Faizus Sazzad, Ki Han Kim, Irwan Shah Bin Mohd Moideen, Abdulrahman El Gohary, John C Stevens, Theo Kofidis","doi":"10.1093/icvts/ivaf017","DOIUrl":"10.1093/icvts/ivaf017","url":null,"abstract":"<p><strong>Objectives: </strong>Minimally invasive cardiac surgery (MICS) struggles with effective caval isolation and cannulation for cardiopulmonary bypass (CPB). We aimed to develop a novel MICS venous cannula, eliminating external manipulations. The goal of this study is to thoroughly evaluate both the safety and the efficacy of a newly developed venous cannula.</p><p><strong>Methods: </strong>The study presents the Aulus venous cannula for MICS, designed with internal balloons to block caval blood flow. Preclinical bench tests with a cardiac biosimulator and large animal studies per ISO10993-2016, evaluated performance and safety.</p><p><strong>Results: </strong>The heparin-coated Aulus cannula had a post-sterilization comparable density of ∼0.200 μg/cm2. In ex vivo tests, using porcine heart models, the cannula enabled full caval occlusion, with endoscopic views confirming precise positioning. The pressure drop remained below the haemolytic threshold of 100 mmHg, indicated lower values compared to BioMedicus. A non-Good Laboratory Practice (GLP) large animal study included eight ovine models, divided into short- and long-term follow-up groups. Clinical pathology values were consistent CPB procedures, and histopathology indicated favourable tolerance despite short-term vessel injuries and long-term stenosis with fibrosis.</p><p><strong>Conclusions: </strong>The Aulus cannula showed effective anticoagulant activity, strong integrity, and good tolerance in vitro and in vivo, highlighting its clinical potential.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191397","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":"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":"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":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973660","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 modified heart team protocol facilitated the revascularization decision-making quality in complex coronary artery disease.","authors":"Hanping Ma, Shen Lin, Xi Li, Yang Wang, Weixian Yang, Kefei Dou, Sheng Liu, Zhe Zheng","doi":"10.1093/icvts/ivaf023","DOIUrl":"10.1093/icvts/ivaf023","url":null,"abstract":"<p><strong>Objectives: </strong>A lack of standardization in heart team implementation potentially leads to suboptimal decision-making quality, and we previously established a modified heart team protocol to improve the decision-making quality. The present trial was to validate the effect of the modified heart team implementation protocol on improving the decision-making quality versus the conventional protocol in complex coronary artery disease (CAD).</p><p><strong>Methods: </strong>Eligible interventional cardiologists, cardiac surgeons and non-interventional cardiologists were randomly allocated to the intervention or control arm and established 12 heart teams in each arm. The 12 heart teams in each arm were randomly divided into 6 pairs, and 480 historic cases with complex CAD into 6 sets of 80 cases. In each arm, each set of 80 cases was discussed independently by one pair of heart teams, with each case finally receiving two heart team decisions ('pairwise decisions'). The intervention arm conducted heart team decision-making according to the previously established protocol and the control arm based on guideline recommendations. The primary outcome was the overall percent agreement of the inter-team pairwise decisions. Decision-making appropriateness was further analysed.</p><p><strong>Results: </strong>A total of 36 cardiac surgeons, 36 interventional cardiologists and 12 non-interventional cardiologists from 26 centres were enrolled. The overall percent agreement was significantly higher in the intervention arm than the control arm (72.1% vs 65.8%, P = 0.04; kappa 0.51 vs 0.37). Both team-level (19.4% vs 33.0%; P < 0.001) and specialist-level (interventional cardiologists, 19.8% vs 37.7%, P < 0.001; cardiac surgeons, 19.8% vs 28.7%, P < 0.001) inappropriateness rate of decision-making was significantly lower in the intervention arm than the control arm.</p><p><strong>Conclusions: </strong>The modified heart team implementation protocol improved the decision-making quality and appropriateness compared with the guideline-based protocol.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392457","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":"Intracranial thrombus migration and perioperative cerebral injury in acute type A aortic dissection.","authors":"Hiroshi Nagamine, Hiroshi Nagano, Mitsuru Asano","doi":"10.1093/icvts/ivaf032","DOIUrl":"10.1093/icvts/ivaf032","url":null,"abstract":"<p><p>In this report, we present a case of intracranial thrombus migration that contributed to the postoperative exacerbation of neurological injury in a 69-year-old man with acute type A aortic dissection complicated by cerebral malperfusion. Our findings underscore perioperative thrombus migration as a potentially under-recognized factor influencing inconsistent surgical outcomes. A comprehensive perioperative evaluation, including a detailed assessment of intracranial arteries, is imperative.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470078","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":"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, Shota Takano, Susumu Nakata, Yoshiyuki Watanabe, Tomoaki Suzuki","doi":"10.1093/icvts/ivaf013","DOIUrl":"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 analysed 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><p><strong>Clinical registration number: </strong>Not applicable.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070023","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}