Marie De Vos MD , Bart Meyns MD, PhD , Rozenn Anne Quarck MSc, PhD , Catharina Belge MD, PhD , Laurent Godinas MD, PhD , Steffen Rex MD, PhD , Dirk Vlasselaers MD, PhD , Marion Delcroix MD, PhD , Tom Verbelen MD, PhD
{"title":"通过倒 T 型上半身切口进行肺动脉内膜切除术","authors":"Marie De Vos MD , Bart Meyns MD, PhD , Rozenn Anne Quarck MSc, PhD , Catharina Belge MD, PhD , Laurent Godinas MD, PhD , Steffen Rex MD, PhD , Dirk Vlasselaers MD, PhD , Marion Delcroix MD, PhD , Tom Verbelen MD, PhD","doi":"10.1016/j.xjtc.2024.09.021","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to explore the feasibility of an inverted-T upper hemisternotomy approach for pulmonary endarterectomy (PEA) and report the results after 17 cases.</div></div><div><h3>Methods</h3><div>PEA was conducted through a 7-cm skin incision using an inverted-T upper hemisternotomy across the third intercostal spaces. Cardiopulmonary bypass (CPB) was established through central arterial and percutaneous femoral dual-staged venous cannulation. Perioperative and hemodynamic data were compared with 17 previous conventional PEAs performed by the same surgeon.</div></div><div><h3>Results</h3><div>From July 2022 to September 2023, 22 PEAs were performed, 17 through inverted-T upper hemisternotomy. Contraindications were an inferior caval vein filter, concomitant coronary revascularization or mitral valve surgery, pulmonary artery intimal sarcoma, and an emergency. Compared with 17 preceding conventional PEAs, there was no significant difference in demographics or in CPB time (274 [256-301] vs 264 [250-274] minutes, <em>P</em> = .1629), deep hypothermic circulatory arrest time (56 [45-65] vs 54 [50-58] minutes, <em>P</em> = .9587), preoperative pulmonary vascular resistance (4.12 [3.10-4.79] vs 4.49 [3.25-6.24] Wood units, <em>P</em> = .5890), 6-month postoperative pulmonary vascular resistance (1.90 [1.40-2.56] vs 1.83 [1.44-2.20] Wood units, <em>P</em> = .6374), or hospital stay (10 [8-12] vs 11 [9-14] days, <em>P</em> = .3327). Intravenous opioid use (0.29 [0.21-0.83] vs 2.99 [1.31-4.33] mg, <em>P</em> < 1.10<sup>−4</sup>) was significantly lower.</div></div><div><h3>Conclusions</h3><div>PEA using an inverted-T upper hemisternotomy approach is feasible and safe and obtains similar hemodynamic results compared with a full sternotomy approach without prolonging CPB and deep hypothermic circulatory arrest times. It offers bilateral treatment via a single incision and has few contraindications.</div></div>","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"28 ","pages":"Pages 65-72"},"PeriodicalIF":1.7000,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pulmonary endarterectomy through inverted-T upper hemisternotomy\",\"authors\":\"Marie De Vos MD , Bart Meyns MD, PhD , Rozenn Anne Quarck MSc, PhD , Catharina Belge MD, PhD , Laurent Godinas MD, PhD , Steffen Rex MD, PhD , Dirk Vlasselaers MD, PhD , Marion Delcroix MD, PhD , Tom Verbelen MD, PhD\",\"doi\":\"10.1016/j.xjtc.2024.09.021\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>We aimed to explore the feasibility of an inverted-T upper hemisternotomy approach for pulmonary endarterectomy (PEA) and report the results after 17 cases.</div></div><div><h3>Methods</h3><div>PEA was conducted through a 7-cm skin incision using an inverted-T upper hemisternotomy across the third intercostal spaces. Cardiopulmonary bypass (CPB) was established through central arterial and percutaneous femoral dual-staged venous cannulation. Perioperative and hemodynamic data were compared with 17 previous conventional PEAs performed by the same surgeon.</div></div><div><h3>Results</h3><div>From July 2022 to September 2023, 22 PEAs were performed, 17 through inverted-T upper hemisternotomy. Contraindications were an inferior caval vein filter, concomitant coronary revascularization or mitral valve surgery, pulmonary artery intimal sarcoma, and an emergency. Compared with 17 preceding conventional PEAs, there was no significant difference in demographics or in CPB time (274 [256-301] vs 264 [250-274] minutes, <em>P</em> = .1629), deep hypothermic circulatory arrest time (56 [45-65] vs 54 [50-58] minutes, <em>P</em> = .9587), preoperative pulmonary vascular resistance (4.12 [3.10-4.79] vs 4.49 [3.25-6.24] Wood units, <em>P</em> = .5890), 6-month postoperative pulmonary vascular resistance (1.90 [1.40-2.56] vs 1.83 [1.44-2.20] Wood units, <em>P</em> = .6374), or hospital stay (10 [8-12] vs 11 [9-14] days, <em>P</em> = .3327). Intravenous opioid use (0.29 [0.21-0.83] vs 2.99 [1.31-4.33] mg, <em>P</em> < 1.10<sup>−4</sup>) was significantly lower.</div></div><div><h3>Conclusions</h3><div>PEA using an inverted-T upper hemisternotomy approach is feasible and safe and obtains similar hemodynamic results compared with a full sternotomy approach without prolonging CPB and deep hypothermic circulatory arrest times. It offers bilateral treatment via a single incision and has few contraindications.</div></div>\",\"PeriodicalId\":53413,\"journal\":{\"name\":\"JTCVS Techniques\",\"volume\":\"28 \",\"pages\":\"Pages 65-72\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2024-10-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JTCVS Techniques\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666250724004309\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS Techniques","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666250724004309","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
目的我们旨在探索倒 T 型上半身切口肺动脉内膜切除术（PEA）的可行性，并报告 17 例病例的治疗结果。心肺旁路（CPB）是通过中心动脉和经皮股静脉双级插管建立的。围手术期和血流动力学数据与之前由同一外科医生实施的17例常规PEA进行了比较。结果从2022年7月到2023年9月，共实施了22例PEA，其中17例通过倒T形上半腔切开术。禁忌症包括下腔静脉滤器、同时进行冠状动脉再通术或二尖瓣手术、肺动脉内膜肉瘤和急诊。与之前的17例常规PEA相比，在人口统计学、CPB时间（274 [256-301] vs 264 [250-274] 分钟，P = .1629）、深低温循环停止时间（56 [45-65] vs 54 [50-58]分钟，P = .9587）、术前肺血管阻力（4.12 [3.10-4.79] vs 4.49 [3.25-6.24] Wood 单位，P = .5890）、术后 6 个月肺血管阻力（1.90 [1.40-2.56] vs 1.83 [1.44-2.20] Wood 单位，P = .6374）或住院时间（10 [8-12] vs 11 [9-14] 天，P = .3327）。结论 采用倒 T 上半身切口法进行全身抽吸术是可行和安全的，与全胸骨切开术相比，能获得相似的血流动力学结果，且不会延长 CPB 和深低温循环停止时间。它通过单切口提供双侧治疗，禁忌症很少。
Pulmonary endarterectomy through inverted-T upper hemisternotomy
Objective
We aimed to explore the feasibility of an inverted-T upper hemisternotomy approach for pulmonary endarterectomy (PEA) and report the results after 17 cases.
Methods
PEA was conducted through a 7-cm skin incision using an inverted-T upper hemisternotomy across the third intercostal spaces. Cardiopulmonary bypass (CPB) was established through central arterial and percutaneous femoral dual-staged venous cannulation. Perioperative and hemodynamic data were compared with 17 previous conventional PEAs performed by the same surgeon.
Results
From July 2022 to September 2023, 22 PEAs were performed, 17 through inverted-T upper hemisternotomy. Contraindications were an inferior caval vein filter, concomitant coronary revascularization or mitral valve surgery, pulmonary artery intimal sarcoma, and an emergency. Compared with 17 preceding conventional PEAs, there was no significant difference in demographics or in CPB time (274 [256-301] vs 264 [250-274] minutes, P = .1629), deep hypothermic circulatory arrest time (56 [45-65] vs 54 [50-58] minutes, P = .9587), preoperative pulmonary vascular resistance (4.12 [3.10-4.79] vs 4.49 [3.25-6.24] Wood units, P = .5890), 6-month postoperative pulmonary vascular resistance (1.90 [1.40-2.56] vs 1.83 [1.44-2.20] Wood units, P = .6374), or hospital stay (10 [8-12] vs 11 [9-14] days, P = .3327). Intravenous opioid use (0.29 [0.21-0.83] vs 2.99 [1.31-4.33] mg, P < 1.10−4) was significantly lower.
Conclusions
PEA using an inverted-T upper hemisternotomy approach is feasible and safe and obtains similar hemodynamic results compared with a full sternotomy approach without prolonging CPB and deep hypothermic circulatory arrest times. It offers bilateral treatment via a single incision and has few contraindications.
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