Interdisciplinary cardiovascular and thoracic surgery最新文献

{"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}

{"title":"The European Board of Cardiovascular Perfusion statement on organ perfusion.","authors":"Gerdy Debeuckelaere, Adrian Bauer, Andreas Lemmers, Filip De Somer","doi":"10.1093/icvts/ivaf007","DOIUrl":"10.1093/icvts/ivaf007","url":null,"abstract":"","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":"40 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11802468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366891","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":"Surgery for acute type A aortic dissection.","authors":"Tirone E David","doi":"10.1093/icvts/ivaf028","DOIUrl":"10.1093/icvts/ivaf028","url":null,"abstract":"","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/PMC11846668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412007","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":"Hyperacute silicosis after bronchoscopy-induced melanoptysis in a lung transplant patient. A first report in literature.","authors":"Angel Saenz, Jorge Dreyse, Joel Melo, Andres Giglio","doi":"10.1093/icvts/ivaf004","DOIUrl":"10.1093/icvts/ivaf004","url":null,"abstract":"<p><p>Silicosis, a fibrotic lung disease caused by crystalline silica inhalation, presents unique challenges in lung transplantation. This case reports an unprecedented complication in a lung transplant recipient with chronic silicosis. A man in his 60s, post left single-lung transplantation for silica-induced pneumoconiosis, developed acute respiratory deterioration following routine bronchoscopy. Melanoptysis, followed by imaging showing extensive inflammatory involvement in the transplanted lung, required intubation and prone positioning. This case highlights the potential for residual silicotic material to trigger acute post-transplant complications. It underscores the importance of comprehensive pretransplant evaluation of occupational exposures and heightened awareness of silica-related complications in post-transplant care. The report emphasizes gaps in understanding long-term outcomes and optimal management strategies for lung transplant recipients with silicosis.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11802471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959907","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":"How cardiac output is controlled in a Fontan circulation: an update.","authors":"Marc Gewillig, Thomas Salaets, Alexander Van de Bruaene, Jef Van den Eynde, Stephen C Brown","doi":"10.1093/icvts/ivae183","DOIUrl":"10.1093/icvts/ivae183","url":null,"abstract":"<p><p>After creating a Fontan circuit, control of the circulation is shifted upstream from the ventricle to the newly created Fontan portal system. The goal of this review was to illustrate that the customary laws of biventricular cardiac output no longer apply and explain why standardized cardiac failure treatment regimens have little or no effect on a failing Fontan patient. A Fontan circulation is, in effect, a circulation in series regulated by the basic rules of any hydrodynamic circuit. We developed a formula that elucidates how flow through the critical bottleneck, and therefore through the whole circuit, is controlled. The critical bottleneck in a hydrodynamic model is the prime determinant of overall flow; other (less critical) bottlenecks may control local upstream congestion, but not overall flow. Once relieved, control of flow shifts to the next most significant bottleneck. The available options for improving flow in a hydrodynamic model are identical to those applicable to any dam: tackle the obstruction (the most impactful approach), push harder upstream (the easiest action) or pull/suck further downstream of the bottleneck (the least efficient strategy). In the early stages, the Fontan neo-portal circulation plays a pivotal role in the pathophysiology. The ventricle has little effect and has an impact only at a late stage. The Fontan formula in the present article stands as a valuable tool, aiding physicians in comprehending the pathophysiological and hydrodynamic intricacies of the Fontan circuit within the context of everyday clinical practice.</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/PMC11814490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191318","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 for non-peripheral and peripheral small-sized non-small-cell lung cancer.","authors":"Zhen Yang, Jie Dai, Yao Wang, Fujun Yang, Zhaoxun Li, Yimu Wu, Dongliang Bian, Fenghuan Sun, Gening Jiang","doi":"10.1093/icvts/ivaf018","DOIUrl":"10.1093/icvts/ivaf018","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the oncological outcomes of segmentectomy for non-peripheral versus peripheral small-sized non-small-cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>This retrospective observational study included patients with clinical stage IA1-A2 NSCLC who underwent segmentectomy. Patients were separated based on tumour distance index (DI, which was calculated as the ratio of the distance from the entrance of the segmental bronchus to the proximal tumour margin to the distance to the lobar pleura along the same line): non-peripheral group (DI ≤ 2/3) and peripheral group (DI > 2/3). Disease-free survival (DFS) and overall survival were compared with log-rank tests.</p><p><strong>Results: </strong>850 patients were included, comprising 274 in the non-peripheral group and 576 in the peripheral group. Recurrence occurred in 68 patients (24 in the peripheral group and 44 in the non-peripheral group), and 56 patients died (22 in the peripheral group and 34 in the non-peripheral group). Log-rank tests showed no statistical differences in 5-year DFS (92.2% vs 91.2%) and 5-year overall survival (96.3% vs 93.6%) between the two groups, but higher margin recurrence occurred in the non-peripheral group. Multivariable analysis revealed that age, tumour diameter, consolidation-to-tumour ratios, pathological subtype and pathologic stage were independent risk factors for DFS. Subgroup analysis indicated that patients with a non-peripheral solid NSCLC had a worse 5-year DFS (62.1% vs 76.3%) and a higher margin recurrence rate (13.2% vs 2.0%).</p><p><strong>Conclusions: </strong>Segmentectomy for small-sized non-peripheral NSCLC could gain a comparable outcome to the peripheral, but worse DFS and higher margin recurrence occurred in the non-peripheral solid NSCLC.</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/PMC11879287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366887","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}