European Journal of Cardio-Thoracic Surgery最新文献

Objectives: Although there has been rapid development in the field of three-dimensional morphological analyses of congenital heart disease, with the three-dimensional volume-rendered images providing visualization of the external vascular anatomy, the precise reproduction of 'Swiss-cheese' ventricular septum is not well established. We created three-dimensional printed models and computer graphics based on multi-slice computed tomography of patients with complex multiple ventricular septal defects for surgical decision planning of this difficult cardiac defect.

Methods: Seven patients with complex multiple ventricular septal defects were evaluated preoperatively using 3-dimensional printed models and computer graphics to plan therapeutic interventions.

Results: The three-dimensional printed models detected muscular VSDs in 9 out of 15 (60%) regions. On the other hand, 3-dimensional computer graphics detected 10 out of 15 (67%) regions. The 3-dimensional printed models and computer graphics allowed the evaluation of the muscular ventricular septal defects from both the left and right ventricular aspects of the septum.

Conclusions: Our preliminary experiences suggest that three-dimensional printed models and computer graphics can help plan surgery in patients with complex multiple ventricular septal defects. Three-dimensional printed models allowed surgeons to understand the three-dimensional positioning of complex multiple ventricular septal defects preoperatively. High-quality three-dimensional computer graphics provided precise information about the size, shape and localization of muscular ventricular septal defects especially from the left ventricular side.

Objectives: To investigate patterns of lymph node sampling and the potential impact on overall survival regarding adherence to selected intraoperative lymph node sampling guidelines. Additionally, we aimed to identify variables associated with guideline adherence and nodal upstaging.

Methods: A retrospective cohort study was conducted of patients undergoing anatomical lung resection for non-small cell lung cancer (clinical T1-4, N0 disease) from 2012 to 2021 identified through the Danish Lung Cancer Registry. Intraoperative lymph node sampling guidelines according to The National Comprehensive Cancer Network (NCCN) were selected. Missing data were imputed and propensity-score-matched by guideline adherence. Survival outcomes were analysed using Kaplan-Meier curves and log-rank test. Logistic and Cox regression assessed factors associated with survival, guideline adherence and nodal upstaging.

Results: A total of 6615 patients were included, 5670 remained after propensity-score-matched. Adherence to the NCCN guidelines did not impact overall survival (log-rank P-value = 0.31) or nodal upstaging (P-value = 0.26). No patient or tumour characteristics were significantly associated with guideline compliance. Factors associated with higher likelihood of upstaging included higher clinical T stage, histopathology, younger age, open surgery and type of resection.

Conclusions: In this cohort, intraoperative lymph node sampling in adherence with the selected NCCN guidelines did not impact survival or nodal upstaging rates.

A 77-year-old female patient was referred to our department with dyspnoea, peripheral oedema and a history of right heart failure. Echocardiography revealed torrential tricuspid regurgitation. Since tricuspid-transcatheter edge-to-edge repair was not feasible and the patient refused open heart surgery, heart team decision was made to perform transcatheter tricuspid valve implantation in a borderline annulus dimension. During the procedure, migration of the valve in the right ventricle occurred. After patients' consent was obtained surgical explantation of the valve with subsequent surgical tricuspid valve replacement was performed. Postoperative course was complicated by pneumonia, pleural effusion and right heart and respiratory failure. The patient was discharged home on postoperative day 19 in good clinical condition.

Objectives: Chronic kidney disease can develop as a long-term complication after cardiac surgery-a condition associated with increased risk of new cardiovascular events, readmissions and mortality. Diagnosis is often delayed, as the condition is asymptomatic in early stages and post-discharge kidney follow-up is not routinely performed. We aimed to evaluate the occurrence and timing of chronic kidney disease after cardiac surgery in patients with normal preoperative kidney function and describe associated temporal trends in risk factors and mortality.

Methods: Patients undergoing cardiac surgery at Odense University Hospital, Denmark, between January 2000 and May 2022 were identified from the Western Denmark Heart Registry. Clinical data were extracted and merged with biochemical data from regional laboratory systems. Only the most recent operation was included in the analysis. Patients with pre-existing kidney disease and endovascular procedures were excluded.

Results: A total of 13 299 patients were included. Median follow-up time was 88 months (42-141 months). Competing risk analysis revealed that 13.8% developed chronic kidney disease within 3 years after surgery and 18.8% within 5 years. Overall 90-day mortality was 3.6%, and 1-year mortality was 5.1%, with variations over time. During the observation period, patients became older and more comorbid, while preoperative kidney function improved. Postoperative acute kidney injury occurred in 25-30% of patients, with increasing severity over time.

Conclusions: Chronic kidney disease is a common and serious complication following cardiac surgery. Identification of patients in high risk of chronic kidney disease is important to develop post-discharge follow-up programs and improve patient outcomes.

Objectives: The German Registry of Acute Aortic Dissection Type A (GERAADA) score is a risk score for predicting 30-day mortality after an operation for type A acute aortic dissection (TAAAD). This meta-analysis sought to assess the performance of the GERAADA model and compare it to the performance of the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II).

Methods: A systematic search of 3 online databases was conducted to identify studies that externally validated the GERAADA score. A random-effect meta-analysis was conducted, pooling area under the curve (AUC) data, operative mortality observed/expected (O/E) ratios and observed-expected (O-E) differences-of the GERAADA model in all studies and of the EuroSCORE II when available.

Results: Eleven studies were selected, including a total of 10 360 patients. The observed in-hospital mortality rate was 12.2%. Pooled expected mortality rates estimated by the GERAADA score and the EuroSCORE II were 18.4% and 5.8%, respectively. The pooled analyses for the GERAADA scores showed moderate discrimination [AUC 0.70, 95% confidence interval (CI) 0.66-0.73] and good calibration [observed-expected (O-E) differences -12.3, 95% CI -27.1 to 2.58; O/E ratio 0.81, 95% CI 0.57-1.05]. Results from 5 studies (2133 patients) investigating both scores simultaneously revealed similar AUC results (P = 0.50), significantly lower O-E differences (P = 0.03) and a trend towards O/E ratios closer to 1 (P = 0.08) with the GERAADA score compared to the EuroSCORE II.

Conclusions: The GERAADA score seemed to offer a better calibration for predicting 30-day postoperative death following TAAAD operations, even though further studies are needed to confirm these findings. The moderate discriminatory capacity of both scores highlights the challenges of predicting outcomes in complex cardiovascular conditions like TAAAD.

Objectives: The goal of this study was to assess the feasibility, safety and efficacy of consecutive treatment with isoprenaline/adenosine (ISO/ADE) in a pig model of myocardial infarction and cardiac surgery.

Methods: The final ISO/ADE dose was selected from a pilot study (n = 8). In the subsequent randomized trial, 16 pigs underwent cardiac magnetic resonance imaging 4 weeks after a myocardial infarction, then were randomized to either the ISO/ADE (n = 8) or the control (n = 8) group before undergoing cardiac surgery with 1 h recovery. Feasibility and safety end points included the method of ISO/ADE delivery, serial blood pressure, heart rate, pH, HCO3-, circulating lactate levels, troponin levels and arrhythmias. Biomarkers of efficacy included serial lactate levels and serial pO2 mean arterial-to-venous functional ratio along with histologic levels of glycogen, protein carbonyls, O2, CO2, HCO3- and fibrosis. Postoperative rates of low cardiac output and death were also recorded.

Results: Cardiac magnetic resonance measures of myocardial infarction did not differ between the groups. The selected method of ISO/ADE delivery was feasible. At no time were all safety outcomes measured in the ISO/ADE group worse than those in the control group. ISO/ADE reduced circulating lactate levels, preserved the serial pO2 mean arterial-to-venous functional ratio and reduced tissue-based glycogen and protein carbonylation. No other differences were observed. Low cardiac output and death occurred in 3/8 (37.5%) and 2/8 (25%) control animals versus 0% in the ISO/ADE group.

Conclusions: The therapy was feasible and safe and improved biomarkers of efficacy. ISO/ADE was not associated with any postoperative low cardiac output and deaths versus 37.5% and 25%, respectively, in the control group. A pilot human study is warranted.

Objectives: This study aimed to investigate the impact of left pulmonary artery stenting on outcomes after Fontan procedure in patients with single ventricle physiology.

Methods: Patients who underwent staged Fontan palliation between 1994 and 2023 were reviewed. The records of patients who had left pulmonary artery stents implanted were analysed, and their impact on outcomes after Fontan completion was evaluated.

Results: Among 601 patients who underwent staged Fontan completion during the study period, 64 patients (10.6%) had a left pulmonary artery stent implanted (19 before Glenn and 49 before Fontan). Patients with a left pulmonary artery stent exhibited higher pulmonary artery pressure (10 vs 9 mmHg, P = 0.005) and smaller left pulmonary artery diameter (5.7 vs 6.6 mm, P = 0.002) before Fontan. The left pulmonary artery stenting group had longer cardiopulmonary bypass times (75 vs 62 min, P = 0.006) and a higher incidence of prolonged effusion (17.2% vs 9.5%, P = 0.049) at Fontan. Long-term follow-up revealed higher rates of reintervention of the left pulmonary artery (P = 0.001), plastic bronchitis (P = 0.007) and failing Fontan (P = 0.008) in the patients with left pulmonary artery stenting compared to those without. Hypoplastic left heart syndrome (odds ratio = 2.65, P = 0.008) and patent ductus arteriosus stenting (odds ratio = 4.03, P = 0.002) were identified as independent risk factors for the need for left pulmonary artery stenting.

Conclusions: A left pulmonary artery stent had been implanted in 10.6% of patients before Fontan completion. Left pulmonary artery stenting does not adversely affect survival but affects in-hospital morbidities and late morbidities of reintervention, plastic bronchiolitis, and failing Fontan.

Objectives: The aim was to evaluate the incidence of acute kidney injury in patients treated with open surgical repair and suprarenal cross-clamp comparing no-perfusion strategy versus the renal perfusion with the histidine-tryptophan-ketoglutarate solution.

Methods: It is a physician-initiated, multicentre, retrospective observational study including patients treated with open surgical repair for abdominal aortic aneurysm between 1 January 2015 and 31 December 2021. Patients already on dialysis were excluded from the final analysis. A coarsened exact match identified 2 cohorts: no-perfusion strategy versus renal perfusion with the histidine-tryptophan-ketoglutarate solution. Primary outcomes were acute kidney injury incidence and survival at 30 day. Secondary outcomes were freedom from haemodialysis and survival at 1 year.

Results: We analysed 125 (28.7%) patients: 63 (14.5%) who did not receive renal perfusion and 62 (14.2%) who received the histidine-tryptophan-ketoglutarate perfusion. At 30 day, acute kidney injury rate (37.6%) was not different between the 2 groups [n = 24 (38.7%) vs 23 (36.5%); OR: 1.1, P = 0.855]. At 30 day, acute kidney injury development was associated with aneurysm extent (pararenal, OR: 2.28, 95% CI: 1.031-5.031, P = 0.042) and total time of intervention (threshold: 365 min, OR: 1.008, 95% CI: 1.003-1.012, P = 0.001). At 1 year, postoperative acute kidney injury did not impact mortality (OR: 3.4, P = 0.556), and freedom from haemodialysis was 100%.

Conclusions: Postoperative acute kidney injury remains high at nearly 38%, but it did not impact on freedom from haemodialysis at 1 year as well as on overall survival.