European Journal of Cardio-Thoracic Surgery最新文献

Objectives: The growing elderly population contributes to an increasing prevalence of severe degenerative native aortic valve (AV) or mitral valve (MV) disease in combination with bio-prosthetic valve failure of prior implanted (aortic or mitral) bio-prostheses, as well as concomitant failure of both aortic and mitral bio-prosthetic valves. A combined surgical AV and MV replacement carries a markedly higher risk, especially in the redo setting. Transcatheter double valve implantation (TDVI) is emerging as a promising alternative that may mitigate the risks of redo surgery. The evidence for TDVI is very limited. This study aims to address the current gap in the literature by analysing a large institutional series of single-stage TDVI.

Methods: Single-centre retrospective analysis of all patients (n = 13) undergoing simultaneous transcatheter aortic valve implantation (TAVI) and transcatheter mitral valve implantation (TMVI) from October 2018 until April 2024. Primary end-points were Valve Academic Research Consortium-3 (VARC-3) and Mitral Valve Academic Research Consortium (MVARC) technical success, 30-day device success and early safety (MVARC procedural success). Secondary end-points included echocardiographic TDVI performance, adverse events, symptom change and survival.

Results: The median age of patients was 77 years, with 7/13 (53.8%) females. Median EuroSCORE II was 16.9%. All patients presented with structural valve degeneration (SVD) with severe haemodynamic valve detoriation according to the VARC-3 definition. Procedural outcomes showed 100% technical success. There was absence of 30-day mortality (0%). 30-day device success and early safety/MVARC procedural success were 100%. No major adverse events occurred. After TDVI, the median NYHA functional class improved from III to II.

Conclusions: TDVI appears to be a safe and effective alternative to surgical redo double valve replacement for selected patients. Our findings support the feasibility of TDVI with excellent early outcomes. Further prospective multicentre studies with larger cohorts are needed to validate the long-term effects and to establish TDVI as a guideline consideration.

Objectives: Tracheobronchoplasty is an operation to treat excessive central airway collapse by stabilizing the posterior tracheal membrane. In 2020, our institution transitioned from the traditional open approach to the robotic-assisted tracheobronchoplasty in select patients. This retrospective cohort study compares postoperative complications and short-term outcomes for patients undergoing open versus robotic tracheobronchoplasty at a high-volume complex airway center.

Methods: A retrospective review of all patients who underwent open tracheobronchoplasty (2018-2020) and robotic tracheobronchoplasty (2020-2023) was conducted.

Results: During the study period, 43 and 69 patients underwent robotic and open tracheobronchoplasty, respectively. Robotic tracheobronchoplasty had longer median operative times than open (8.4 vs 6.2 hours; p = <0.01). Both median ICU length of stay (1.0 vs 3.0 days, p = <0.01) and hospital length of stay (5.0 vs 7.0 days, p = <0.01) were shorter after robotic tracheobronchoplasty. There were no significant differences in major or minor complications, total Clavien-Dindo Score, estimated blood loss, discharge to home, and 30-day readmission. The robotic group had two reoperations during the index hospitalization and three conversions to open. There were no mortalities in either group. Short-term (3-month) functional and quality of life outcomes were equivalent between groups.

Conclusions: In selected patients with severe and symptomatic excessive central airway collapse, robotic tracheobronchoplasty is a safe and feasible alternative to the traditional open approach. Patients undergoing robotic tracheobronchoplasty have shorter ICU and total hospital stays with equivalent complication rates. As the robotic approach becomes more prevalent, further comparative outcomes are necessary with longer follow-up to ensure durability of the robotic-assisted repair.

Objectives: Our aim was to investigate the incidence and risk factors for prolonged air leak in patients undergoing minimally invasive single-port pulmonary segmentectomy.

Methods: A retrospective analysis of all patients undergoing uniportal segmentectomy in our department from March 2015 to September 2023 was performed. Univariable, multivariable logistic regression analyses and machine learning were used to investigate risk factors for prolonged air leak (>5 days).

Results: 575 segmentectomies were performed using uniportal video-assisted thoracoscopic surgery. 333 patients (57.9%) were men and the mean age was 64.8 years.Prolonged air leak occurred in 88 patients (15.3%). Length of stay and duration of chest drainage were 8.6 (SD 4.86) and 10.6 (SD 8.12) days in the subgroup with prolonged air leak, compared to 3.6 (SD 2.25) and 2.0 (SD 1.3) days in the subgroup without air leak (p < 0.0001). Multivariable analysis revealed that upper lobe location, lower BMI, an additional wedge resection on another segment and hypertension were associated with increased risk of PAL.Machine learning was used to develop models that predicted the occurrence of prolonged air leak with an accuracy of 70%. The first model detected the following parameters as significant: resection of segment 2, diabetes, inhalers, and squamous cell carcinoma. The second model recognized DLCO (%), pack-years, FEV1 (%) and surgery time respectively.

Conclusions: Low BMI, DLCO% or FEV1% values, increased pack-years, inhalers, diabetes, hypertension, histology of primary lung cancer, longer surgery time, an additional wedge resection, segment 2 removal and upper lobe surgery were identified as risk factors for prolonged air leak.

Objectives: This study investigated the longitudinal changes in ventricular function and atrioventricular valve function to clarify the timing and the mechanisms of failing Fontan.

Methods: Patients who underwent total cavopulmonary connection between 1994 and 2023 were reviewed, and longitudinal echocardiographic examinations of ventricular function and atrioventricular valve regurgitation were analysed.

Results: A total of 650 patients were included. The most frequent primary diagnosis was hypoplastic left heart syndrome in 175 patients. Dominant right ventricle was observed in 337 patients (51.8%). The median age at total cavopulmonary connection was 2.3 (1.8-3.3) years. Failing Fontan was observed in 78 patients (12%) during the median follow-up of 6.2 years. Among them, dominant right ventricle was observed in 51 patients (65.4%). Patients with protein-losing enteropathy or plastic bronchitis (n = 37) developed Fontan failure early (median 2.6 years post-total cavopulmonary connection). Still, patients maintained ventricular function (93.1% normal at 5 years) and atrioventricular valve competence (no case of moderate/severe regurgitation at 5 years) over time. Patients who developed failing Fontan associated with progression of heart failure (n = 41) had later onset (median 8.3 years post-total cavopulmonary connection) but indicated progressive ventricular dysfunction (68.3% normal at 5 years, 53.8% normal at 10 years) and atrioventricular valve regurgitation (12.3% moderate/severe at 5 years, 15.3% moderate/severe at 10 years).

Conclusions: Patients with failing Fontan indicated different serial ventricular and atrioventricular valve function profiles. Ventricular function was preserved in failing Fontan patients with protein-losing enteropathy or plastic bronchitis, whereas progressive ventricular dysfunction was observed in failing Fontan patients with heart failure.