European Journal of Cardio-Thoracic Surgery最新文献

Objectives: This study aimed to evaluate the prognostic impact of permanent pacemaker (PPM) implantation within the first year after mitral valve (MV) surgery combined with the Cox-maze procedure, focusing on long-term outcomes, including overall mortality, infective endocarditis (IE) and ischaemic stroke.

Methods: We conducted a retrospective cohort study using data from the National Health Insurance Service (NHIS) in South Korea, identifying 10 127 patients who underwent MV surgery with the Cox-maze procedure between 2005 and 2020. Patients were classified into the PPM and non-PPM groups based on PPM implantation within 1 year postoperatively. The primary outcome was overall mortality, and secondary outcomes included risk factors for overall mortality, IE and ischaemic stroke. Multivariable Cox proportional hazards regression and Fine-Gray competing risk models were utilized for statistical analysis.

Results: Of the total cohort, 178 patients (1.76%) underwent PPM implantation. The overall mortality during the follow-up period was 20.5%, with no significant difference between the PPM and non-PPM groups. PPM implantation was not a significant risk factor for overall mortality (hazard ratio [HR], 0.825; 95% confidence interval [CI] 0.598-1.140; P = 0.244) or ischaemic stroke. However, PPM implantation was associated with a significantly increased risk of IE (HR, 2.015; 95% CI 1.179-3.442; P = 0.010).

Conclusions: PPM implantation within the first year after MV surgery with the Cox-maze procedure does not significantly impact long-term mortality or ischaemic stroke risk but is associated with an increased risk of IE. The Cox-maze procedure remains advisable for patients with atrial fibrillation undergoing MV surgery.

Objectives: Extracorporeal membrane oxygenation (ECMO) can act as a bridge to recovery in both pre- and postoperative patients with transposition of the great arteries (TGA). However, literature on its use in these patients is scarce.

Methods: Retrospective single-centre cohort study encompassing all TGA patients who received ECMO between January 2009 and March 2024.

Results: Twenty-two neonates received ECMO during the study period, with an overall median age and weight at time of ECMO cannulation of 6.5 (1.8-10) days and 3.7 (3.3-4.0) kg, respectively. Twelve neonates received ECMO prior to the arterial switch operation because of severe persistent pulmonary hypertension (83%), respiratory failure due to severe pulmonary atelectasis (8%) or hypoxia after pulmonary arterial banding procedure (8%). Postoperative ECMO was used in 11 patients; of these, 1 (9%) had also received ECMO preoperatively. Postoperative indications for the remaining patients included failure to wean from cardiopulmonary bypass (50%), low cardiac output in Intensive Care Unit (20%), or after cardiopulmonary arrest (30%). Overall, median ECMO duration for all TGA patients was 75 (45-171) h, with a survival rate of 59% to hospital discharge. Among the preoperative ECMO patients, 5 patients (42%) died (4 preoperatively, 1 postoperatively performed while on ECMO). In the postoperative ECMO group, survival rate was 60%.

Conclusions: In this single-centre retrospective study, TGA neonates received ECMO preoperatively primarily for severe pulmonary hypertension and postoperatively for failure to wean from cardiopulmonary bypass. This study showed a 58% and 60% survival to hospital discharge in ECMO patients supported preoperatively and those supported postoperatively, respectively.

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.

Objectives: The study's aim was to investigate the outcomes and risk factors for mortality in patients undergoing surgery for acute type A aortic dissection receiving concomitant venoarterial extracorporeal membrane oxygenation (ECMO) support.

Methods: Patients from 5 European centre who underwent surgery for acute type A aortic dissection and received perioperative venoarterial ECMO support were included. A multivariable binary logistic regression analysis was performed to identify risk factors for 30-day mortality. A receiver operating characteristic curve and restricted cubic splines were designed to investigate the association between pre-ECMO lactate peak and survival.

Results: The final cohort comprised 117 patients. Mean time on ECMO support was 3 days (interquartile range 1-7). In 36 patients (31%), successful ECMO weaning was achieved. Thirty-day mortality was 72%, leading cause for early mortality was multiorgan failure (39%). In total, 20% of patients were discharged from hospital. Pre-ECMO lactate peak [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.005-1.032], presence of preoperative shock (OR 9.47, 95% CI 1.749-98.257) and need for total arch replacement (OR 6.628, 95% CI 1.492-33.373) were identified as associates for 30-day mortality. For pre-ECMO lactate peak, the area under the curve showed an acceptable value of 0.73 and restricted cubic splines showed a significant correlation to survival (P = 0.004) with an increased risk above a lactate level of 85 mg/dl.

Conclusions: Venoarterial ECMO support may not be futile but should be well balanced against the high-risk profile in this patient cohort. The pre-ECMO lactate peak is an independent risk factor and a valid predictor of 30-day mortality.

Objectives: Previous analyses of the volume-outcome relationship have focused on short-term outcomes such as early mortality. The current study aims to update a novel statistical methodology, facilitating the evaluation of the relation between procedural volume and time-to-event outcomes such as long-term survival, using surgery for acute type A aortic dissection as an illustrative example.

Methods: This study employed an existing dataset of type A dissection outcomes, retrieved from literature. Studies were included when reporting on annual case load and long-term survival, which served as the primary outcome of interest. Individual patient data were reconstructed from the included studies, and a hazard ratio was determined per study in relation to overall survival, after which the calculated hazard ratios were incorporated in a restricted cubic-spline model, facilitating the application of the elbow method.

Results: Fifty-two studies were included (n = 14 878 patients), with a median follow-up of 5 years. One-, 3-, 5- and 10-year survival of the overall cohort were 82% [95% confidence interval (CI) 82-83%], 79% (95% CI 78-80%), 74% (95% CI 74-75%) and 60% (95% CI 59-62%), respectively. A significant non-linear volume-outcome relation for long-term survival was observed in both the unadjusted and adjusted analyses (P = 0.030 and P = 0.002), with an optimal annual case load of 32 cases/year (95% CI 31-33).

Conclusions: Based on the available data, these findings imply that the annual case volume to achieve optimal long-term survival is located near a procedural volume of 32 cases/year. After accrual of more annual procedures, long-term survival may no longer significantly improve any further.

Objectives: Single lung transplant (SLT) is an acceptable treatment modality for certain patients with end stage lung disease. SLT occurs when two appropriate donor lungs are split between recipients ("split singles") or when one donor lung is adequate for transplant and the other lung is declined ("isolated single"). There is a paucity of literature investigating the outcomes in patients who received an isolated SLT. This study analyzes the characteristics and survival outcomes of isolated SLT recipients.

Methods: The transplant database at our institution was queried for all lung transplants between 2010 and 2021. The primary outcome of survival was assessed using Kaplan-Meier curves and Cox regression modeling. Secondary outcomes were assessed using Cox regression and Fisher's exact test.

Results: Of 759 lung transplant recipients, 164 patients underwent a split SLT and 271 patients underwent an isolated SLT. There was no significant difference when comparing most demographic characteristics between isolated SLT and split SLT patients. Isolated SLT recipients had similar overall mortality when compared to split SLT recipients (HR 0.97, CI 0.72-1.33, p = 0.87). There was no difference in post-operative need for extracorporeal membrane oxygenation (p = 0.209), duration of postoperative ventilation (p = 0.408) and length of hospitalization (p = 0.443).

Conclusions: Our analysis demonstrating similar overall survival between recipients of isolated SLT and split SLT shows that a well-selected isolated donor lung can be used safely in the appropriate recipient population. This practice allows expansion of a known scarce donor lung pool and reduction of the waitlist mortality in lung transplant candidates.