JTCVS open最新文献

{"title":"Marfan and Loeys-Dietz aortic phenotype: A potential tool for diagnosis and management","authors":"Luigi Lovato MD ,&nbsp;Mariano Cefarelli MD, PhD ,&nbsp;Luca Di Marco MD, PhD ,&nbsp;Daniel Arcioni MD ,&nbsp;Giada Tortora MD, PhD ,&nbsp;Ada Dormi Mth D Biostatistical ,&nbsp;Nicolò Schicchi MD ,&nbsp;Elisabetta Mariucci MD, PhD ,&nbsp;Marco Di Eusanio MD, PhD ,&nbsp;Davide Pacini MD, PhD ,&nbsp;Rossella Fattori MD, PhD","doi":"10.1016/j.xjon.2024.03.015","DOIUrl":"10.1016/j.xjon.2024.03.015","url":null,"abstract":"<div><h3>Objective</h3><p>In heritable aortic diseases, different vascular involvement may occur with potential variable implications in aortic dilation/dissection risk. This study aimed to analyze the aortic anatomy of individuals with Marfan syndrome and Loeys-Dietz syndrome to identify possible morphological differences.</p></div><div><h3>Methods</h3><p>Computed tomography and magnetic resonance imaging of the thoracoabdominal aorta from the proximal supra-aortic vessels to the femoral bifurcation level of 114 patients with Marfan and Loeys-Dietz syndromes and 20 matched control subjects were examined. Aortic diameters, areas, length, and tortuosity were measured in different aortic segments using specific vessel analysis software.</p></div><div><h3>Results</h3><p>Patients with Marfan syndrome showed a higher prevalence of ascending aorta and aortic root dilation (<em>P</em> = .011), larger and longer aortic roots (<em>P</em> = .013) with pear-shaped phenotype, larger isthmus/descending aorta diameter ratio (<em>P</em> = .015), and larger suprarenal aorta and iliac arteries. Patients with Loeys-Dietz syndrome showed longer indexed segments and a significantly longer arch (<em>P</em> = .006) with type 2/3 arch prevalence (<em>P</em> = .097). Measurement ratios analysis provided cut-off values (aortic root to ascending aorta length/aortic root diameter, aortic root/sinotubular junction, aortic root/ascending aorta diameter) differentiating patients with Marfan syndrome from patients with Loeys-Dietz syndrome, even in the early stage of the disease.</p></div><div><h3>Conclusions</h3><p>Both syndromes show peculiar anatomic patterns at different aortic levels irrespective of aortic dilation and disease severity. These features may represent the expression of different genetic mutations on aortic development, with a potential impact on prognosis and possibly contributing to better management of the diseases. The systematic adoption of whole body imaging with magnetic resonance or computed tomography should always be considered, because they allow a complete vascular assessment with practical indicators of differential diagnosis.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 223-240"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000950/pdfft?md5=23e6f3501be154863946e302aabaf4a2&pid=1-s2.0-S2666273624000950-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792003","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 anatomic repair of recurrent aortic arch obstruction in children and adolescents","authors":"Michaela Kreuzer MD ,&nbsp;Eva Sames-Dolzer MD ,&nbsp;Melanie Klapper BSc ,&nbsp;Andreas Tulzer MD ,&nbsp;Roland Mair MD ,&nbsp;Fabian Seeber MD ,&nbsp;Gregor Gierlinger MD ,&nbsp;Dalibor Saric MD ,&nbsp;Rudolf Mair MD","doi":"10.1016/j.xjon.2024.04.007","DOIUrl":"10.1016/j.xjon.2024.04.007","url":null,"abstract":"<div><h3>Objective</h3><p>Surgery for recurrent aortic arch obstruction is highly challenging and publications are rare. The aim of this retrospective, single-center study was to evaluate mortality, complications, and reintervention rate after an anatomic repair.</p></div><div><h3>Methods</h3><p>Between 1999 and 2022, in total 946 operations on the aortic arch were performed at the Children's Heart Center Linz. In 39 cases, the indication was a recurrent or residual aortic arch obstruction or coarctation in a patient aged 18 years or younger. This is our study cohort. The aorta was reconstructed by a direct anastomosis/autograft in 20 patients, patch in 17 patients, and interposition graft in 2 adolescents. In 32 procedures, cardiopulmonary bypass with whole body perfusion was employed, in 4, antegrade cerebral perfusion was employed, in 2, a left heart bypass was employed, and in 1 no cardiopulmonary bypass was used.</p></div><div><h3>Results</h3><p>Median (Q1, Q3) age at operation was 253 days (100, 2198 days), weight 7.5 kg (4.5, 17.8 kg). Median cardiopulmonary bypass time was 177 minutes (115, 219 minutes), crossclamp time 73 minutes (49, 102 minutes). Three infants died during the hospital stay: 1 with Williams syndrome, 1 with hypoplastic left heart syndrome, and 1 with heterotaxia. There was no death due to an arch complication. The main complications were 1 neurologic injury after postoperative resuscitation (Williams syndrome) and 1 permanent recurrent laryngeal nerve paralysis. During the follow-up period of median 8.1 years (2.6, 12 years) 1 re-reintervention on the aortic arch was necessary.</p></div><div><h3>Conclusions</h3><p>Sophisticated reoperations on the aortic arch could be performed safely. In children, the growth potential of all segments of the aorta could be sustainably preserved by avoiding interposition or extra-anatomic bypass grafts.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 215-222"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001098/pdfft?md5=349a1529717a397cad498ff4d211b527&pid=1-s2.0-S2666273624001098-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778474","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 cardiothoracic surgery interest group starter kit for medical students from the Thoracic Surgery Medical Student Association","authors":"Andrew D. Vogel MS ,&nbsp;Ahmet Bilgili BS ,&nbsp;Betemariam Sharew BA ,&nbsp;Allen Kuncheria BS ,&nbsp;Kenny Nguyen BS ,&nbsp;John A. Treffalls BS ,&nbsp;Zachary Brennan DO ,&nbsp;Dominic Emerson MD ,&nbsp;Tyler J. Wallen DO ,&nbsp;Ibrahim Sultan MD ,&nbsp;Jeffery P. Jacobs MD","doi":"10.1016/j.xjon.2024.03.003","DOIUrl":"10.1016/j.xjon.2024.03.003","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 378-382"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000615/pdfft?md5=4a2c2c35c2ac86c8e01f455726c20021&pid=1-s2.0-S2666273624000615-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140275918","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 surgical armamentarium for correcting systolic anterior motion with re-repair rather than replacement","authors":"Whitney Fu MD,&nbsp;Catherine Wagner MD,&nbsp;Gurnoordeep Pawar BS,&nbsp;Nicolas Ceniza BS,&nbsp;Matthew A. Romano MD,&nbsp;Gorav Ailawadi MD, MBA,&nbsp;Steven F. Bolling MD,&nbsp;Michigan Mitral Research Group","doi":"10.1016/j.xjon.2024.03.010","DOIUrl":"10.1016/j.xjon.2024.03.010","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 91-93"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000895/pdfft?md5=bbcc623140b42fd29d34a5dd050e3e65&pid=1-s2.0-S2666273624000895-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403439","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: Suit yourself: Tailoring treatment to malperfusion in acute type A aortic dissection","authors":"James A. Brown MD, MS ,&nbsp;Ibrahim Sultan MD","doi":"10.1016/j.xjon.2024.04.016","DOIUrl":"10.1016/j.xjon.2024.04.016","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 45-46"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001190/pdfft?md5=c30cccc7fcfbf9937b002df2371c1d5b&pid=1-s2.0-S2666273624001190-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140760275","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: How to define oversizing or undersizing of frozen elephant trunk","authors":"Yuichiro Kitada MD ,&nbsp;Homare Okamura MD, PhD","doi":"10.1016/j.xjon.2024.04.001","DOIUrl":"10.1016/j.xjon.2024.04.001","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Page 40"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000962/pdfft?md5=d26a9d1cfe6491cae8a9c3f35e20f058&pid=1-s2.0-S2666273624000962-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770306","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":"Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and stroke","authors":"Mariusz Kowalewski MD, PhD ,&nbsp;Michał Święczkowski MD ,&nbsp;Łukasz Kuźma MD, PhD ,&nbsp;Bart Maesen MD, PhD ,&nbsp;Emil Julian Dąbrowski MD ,&nbsp;Matteo Matteucci MD ,&nbsp;Jakub Batko MD, PhD ,&nbsp;Radosław Litwinowicz MD, PhD ,&nbsp;Adam Kowalówka MD, PhD ,&nbsp;Wojciech Wańha MD, PhD ,&nbsp;Federica Jiritano MD, PhD ,&nbsp;Giuseppe Maria Raffa MD, PhD ,&nbsp;Pietro Giorgio Malvindi MD, PhD ,&nbsp;Luigi Pannone MD ,&nbsp;Paolo Meani MD, PhD ,&nbsp;Roberto Lorusso MD, PhD ,&nbsp;Richard Whitlock MD, PhD ,&nbsp;Mark La Meir MD, PhD ,&nbsp;Carlo de Asmundis MD, PhD ,&nbsp;James Cox MD, PhD ,&nbsp;Piotr Suwalski MD, PhD","doi":"10.1016/j.xjon.2024.02.022","DOIUrl":"10.1016/j.xjon.2024.02.022","url":null,"abstract":"<div><h3>Objective</h3><p>Left atrial appendage closure (LAAC) concomitant to heart surgery in patients with underlying atrial fibrillation (AF) has gained attention because of long-term reduction of thromboembolic complications. As of mortality benefits in the setting of non-AF, data from both observational studies and randomized controlled trials are conflicting.</p></div><div><h3>Methods</h3><p>On-line databases were screened for studies comparing LAAC versus no LAAC concomitant to other heart surgery. End points assessed were all-cause mortality and stroke at early and longest-available follow-up. Subgroup analyses stratified on preoperative AF were performed. Risk ratios (RR) with 95% CIs served as primary statistics.</p></div><div><h3>Results</h3><p>Electronic search yielded 25 studies (N = 660 [158 patients]). There was no difference between LAAC and no LAAC in terms of early mortality. In the overall population analysis, LAAC reduced long-term mortality (RR, 0.86; 95% CI, 0.74-1.00; <em>P</em> = .05; <em>I</em>² = 88%), reduced early stroke risk by 19% (RR, 0.81; 95% CI, 0.72-0.93; <em>P</em> = .002; <em>I</em>² = 57%), and reduced late stroke risk by 13% (RR, 0.87; 95% CI, 0.84-0.90; <em>P</em> &lt; .001; <em>I</em>² = 58%). Subgroup analysis showed lower mortality (RR, 0.85; 95% CI, 0.72-1.01; <em>P</em> = .06; <em>I</em>² = 91%), short-, and long-term stroke risk reduction only in patients with preoperative AF (RR, 0.81; 95% CI, 0.71-0.93; <em>P</em> = .003; <em>I</em>² = 71% and RR, 0.87; 95% CI, 0.84-0.91; <em>P</em> &lt; .001; <em>I</em>² = 70%, respectively). No benefit of LAAC in patients without AF was found.</p></div><div><h3>Conclusions</h3><p>Concomitant LAAC was associated with reduced stroke rates at early and long-term and possibly reduced all-cause mortality at the long-term follow-up but the benefits were limited to patients with preoperative AF. There is not enough evidence to support routine concomitant LAAC in non-AF settings.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 131-163"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000585/pdfft?md5=c21d11a31c91a61dd45c5196fcb5b057&pid=1-s2.0-S2666273624000585-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140267941","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 strategies and outcomes following acute type A aortic dissection repair in patients with bicuspid and tricuspid aortic valves: A meta-analysis","authors":"Tomonari Shimoda MD ,&nbsp;Yujiro Yokoyama MD ,&nbsp;Hisato Takagi MD, PhD ,&nbsp;Toshiki Kuno MD, PhD ,&nbsp;Shinichi Fukuhara MD","doi":"10.1016/j.xjon.2024.02.020","DOIUrl":"10.1016/j.xjon.2024.02.020","url":null,"abstract":"<div><h3>Background</h3><p>There is no consensus regarding the strategies for repairing acute type A aortic dissection (ATAAD) in patients with bicuspid aortic valve (BAV). This meta-analysis aimed to compare the treatment strategies and outcomes of ATAAD repair between patients with BAV and those with tricuspid aortic valve (TAV).</p></div><div><h3>Methods</h3><p>A systematic review of databases were performed from inception through March 2023. The primary outcome of interest was all-cause mortality, with a minimum follow-up of 1 year. The secondary outcomes of interest included ratios of performed procedures and rate of distal aortic reoperation. Data were extracted, and pooled analysis was performed using a random-effects model.</p></div><div><h3>Results</h3><p>Eight observational studies including a total of 3701 patients (BAV, n = 349; TAV, n = 3352) were selected for a meta-analysis. Concerning proximal aortic procedures, BAV patients exhibited a higher incidence of necessary root replacement (odds ratio [OR], 6.53; 95% confidence interval [CI], 3.84 to 11.09; <em>P</em> &lt; .01). Regarding distal aortic procedures, extended arch replacement was performed less frequently in BAV patients (OR, 0.69; 95% CI, 0.49 to 0.99; <em>P</em> = .04), whereas hemiarch procedure rates were comparable in the 2 groups. All-cause mortality was lower in the BAV group (hazard ratio, 0.68; 95% CI, 0.50 to 0.92; <em>P</em> = .01). Distal aortic reoperation rates were comparable in the 2 groups.</p></div><div><h3>Conclusions</h3><p>This study highlights distinct procedural patterns in ATAAD patients with BAV and TAV. Despite differing baseline characteristics, BAV patients exhibited superior survival compared to TAV patients, with comparable distal aortic reoperation rates. These findings may be useful for decision making regarding limited versus extended aortic arch repair.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 9-30"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266627362400055X/pdfft?md5=335b6bf1280c8c974a01e9c4e042a3e4&pid=1-s2.0-S266627362400055X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140275835","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 outcomes of heart transplantation in adults with congenital heart disease: The impact of single-ventricle versus biventricular physiology","authors":"Alice V. Vinogradsky BA ,&nbsp;Stephanie N. Nguyen MD ,&nbsp;Krushang Patel MD ,&nbsp;Matthew Regan MS ,&nbsp;Kelly M. Axsom MD ,&nbsp;Matthew J. Lewis MD ,&nbsp;Gabriel Sayer MD ,&nbsp;Nir Uriel MD, MSc ,&nbsp;Yoshifumi Naka MD, PhD ,&nbsp;Andrew B. Goldstone MD, PhD ,&nbsp;Koji Takeda MD, PhD","doi":"10.1016/j.xjon.2024.04.006","DOIUrl":"10.1016/j.xjon.2024.04.006","url":null,"abstract":"<div><h3>Objective</h3><p>Congenital heart disease is a risk factor for mortality after orthotopic heart transplantation; however, the impact of preoperative circulation type and primary congenital heart disease diagnosis remains poorly delineated.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed patients with adult congenital heart disease aged 16 years or more who underwent orthotopic heart transplantation at our institution between 2008 and 2022. Patients were categorized as having single-ventricle or biventricular circulation. The primary end point was 5-year post-transplant survival.</p></div><div><h3>Results</h3><p>Sixty-one patients with adult congenital heart disease (single-ventricle: n = 26 [42.6%], biventricular: n = 35 [57.4%]) underwent orthotopic heart transplantation at 33.7 [interquartile range, 19.1-48.7] years. The most common congenital heart disease diagnosis was hypoplastic left heart syndrome (n = 11, 42.3%) in the single-ventricle group and congenitally corrected transposition of the great arteries (n = 7, 20.0%) in the biventricular group. Twenty-four patients previously underwent Fontan palliation. At transplant, patients in the single-ventricle group were younger (18.5 [interquartile range, 17.6-32.3] years vs 45.0 [interquartile range, 33.0-52.2] years, <em>P &lt; .</em>001) and more likely to have biopsy-proven cirrhosis (46.2% vs 14.3%<em>, P = .</em>01) and protein-losing enteropathy (42.3% vs 2.9%<em>, P &lt; .</em>001). Patients in the single-ventricle group also had longer bypass times (223.4 ± 65.3 minutes vs 187.4 ± 59.5 minutes<em>, P = .</em>03) and longer durations of mechanical ventilatory support (3.5 [interquartile range, 2.0-6.0] days vs 1.0 [interquartile range, 1.0-2.0] days<em>, P &lt; .</em>001). Operative mortality was comparable (11.5% vs 8.6%, <em>P</em> = 1). Median follow-up was 6.0 [interquartile range, 2.4-10.0] years. Five-year survival was worse in the single-ventricle group (66.0% ± 10.0% vs 91.3% ± 4.8%<em>, P = .</em>03), as was freedom from major rejection (58.3% ± 10.2% vs 84.0% ± 6.6%<em>, P = .</em>02). In univariable analysis, hypoplastic left heart syndrome and Fontan circulation were risk factors for post-transplant mortality (hypoplastic left heart syndrome: hazard ratio, 5.0<em>, P &lt; .</em>001; Fontan: hazard ratio, 3.5, <em>P = .</em>03).</p></div><div><h3>Conclusions</h3><p>Adult patients with congenital heart disease undergoing heart transplant with single-ventricle physiology experienced a more complicated post-transplant course, with worse long-term survival and freedom from rejection. Multicenter studies are required to guide orthotopic heart transplantation decision-making in this complex cohort.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 257-274"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001086/pdfft?md5=c1ab72bdf11563cf3c7b3eda601d2e4d&pid=1-s2.0-S2666273624001086-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140785907","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":"Outcomes of single- versus multi-port video-assisted thoracoscopic surgery: Data from a multicenter randomized controlled trial of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer","authors":"Eric Lim MD ,&nbsp;Rosie A. Harris MSc ,&nbsp;Tim Batchelor Bsc (Hons), MBChB, FRCS ,&nbsp;Gianluca Casali MEDGB ,&nbsp;Rakesh Krishnadas MD ,&nbsp;Sofina Begum MD ,&nbsp;Simon Jordan MD ,&nbsp;Joel Dunning MD ,&nbsp;Ian Paul MD ,&nbsp;Michael Shackcloth MD ,&nbsp;Sarah Feeney RN ,&nbsp;Vladimir Anikin MD ,&nbsp;Niall Mcgonigle MD ,&nbsp;Hazem Fallouh MD ,&nbsp;Luis Hernandez MD ,&nbsp;Franscesco Di Chiara MD ,&nbsp;Dionisios Stavroulias MD ,&nbsp;Mahmoud Loubani MD ,&nbsp;Syed Qadri MD ,&nbsp;Vipin Zamvar MD ,&nbsp;Chris A. Rogers PhD","doi":"10.1016/j.xjon.2024.02.025","DOIUrl":"https://doi.org/10.1016/j.xjon.2024.02.025","url":null,"abstract":"<div><h3>Objectives</h3><p>Surgery through a single port may be less painful because access is supplied by 1 intercostal nerve or more painful because multiple instruments are used in 1 port. We analyzed data collected from the video-assisted thoracoscopic surgery group of a randomized controlled trial to compare differences in pain up to 1 year.</p></div><div><h3>Methods</h3><p>Groups were compared in a prespecified exploratory analysis using direct (regression) and indirect comparison (difference with respect to thoracotomy). In-hospital visual analogue scale pain scores were used, and analgesic ratios were calculated. After discharge, pain was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaires-Core 30 scores up to 1 year.</p></div><div><h3>Results</h3><p>From July 2015 to February 2019, we randomized 503 participants. After excluding 50 participants who did not receive lobectomy, surgery was performed using a single port in 42 participants (predominately by a single surgeon), multiple ports in 166 participants, and thoracotomy in 245 participants. No differences were observed in-hospital between single- and multiple-port video-assisted thoracoscopic surgery when modeled using a direct comparison, mean difference of −0.24 (95% CI, −1.06 to 0.58) or indirect comparison, mean difference of −0.33 (−1.16 to 0.51). Mean analgesic ratio (single/multiple port) was 0.75 (0.64 to 0.87) for direct comparison and 0.90 (0.64 to 1.25) for indirect comparison. After discharge, pain for single-port video-assisted thoracoscopic surgery was lower than for multiple-port video-assisted thoracoscopic surgery (first 3 months), and corresponding physical function was higher up to 12 months.</p></div><div><h3>Conclusions</h3><p>There were no consistent differences for in-hospital pain when lobectomy was undertaken using 1 or multiple ports. However, better pain scores and physical function were observed for single-port surgery after discharge.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 296-308"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000949/pdfft?md5=a26bc67800c5e8425b43fb22f19f6484&pid=1-s2.0-S2666273624000949-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141325252","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}