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Overall survival, cause of death and time interval between diagnosis and death after Stanford type B acute aortic dissection (TBAAD). B 型急性主动脉夹层(TBAAD)后的总生存率、死亡原因以及诊断与死亡之间的时间间隔。
IF 3.1 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-26 DOI: 10.1093/ejcts/ezae437
Daniel Becker, Alexander Slongo, Murat Yildiz, Selim Mosbahi, Michel Joseph Bosiers, Silvan Jungi, Florian Schoenhoff, Drosos Kotelis, Vladimir Makaloski

Objectives: This study aimed to assess survival rates and the causes of both early and late mortality in patients with Stanford type B acute aortic dissection (TBAAD).

Methods: A retrospective analysis was conducted on all consecutive patients presenting with TBAAD from 2000 to 2018 at a single tertiary care centre. The primary end-point was early (<3 months) and late (>3 months) survival following TBAAD, with causes of both early and late mortality evaluated.

Results: A total of 274 patients, with a mean age of 64 ± 13 years, were included. Among these, 155 patients (57%) presented with uncomplicated TBAAD, including 52 (19%) identified as high-risk, and 119 patients (43%) had complicated TBAAD. Early aorta-related mortality occurred in 9 patients (3.3%), all within the complicated TBAAD group. The median follow-up period for the entire cohort was 8.5 years [95% confidence interval (CI) 7.6-11.2]. Long-term survival was significantly higher in patients with uncomplicated TBAAD compared to those with complicated TBAAD (P < 0.001). Both complicated and high-risk uncomplicated TBAAD cases required significantly more interventions in the chronic phase (>3 months) compared to uncomplicated TBAAD cases [hazard ratio (HR) 9.8, 95% CI 6.4-15.4, P < 0.001; HR 3.3, 95% CI 2.1-5.1, P < 0.001).

Conclusions: Complicated TBAAD presents the greatest risk for aorta-related mortality and interventions. Patients with high-risk uncomplicated TBAAD are also notable for an increased rate of aorta-related mortality and interventions. Thorough evaluation of clinical and anatomical characteristics is essential for determining the optimal therapeutic approach.

目的:本研究旨在评估Stanford B型主动脉夹层(TBAAD)患者的生存率以及早期和晚期死亡的原因。方法:回顾性分析2000年至2018年在一家三级医疗中心连续就诊的所有TBAAD患者。主要终点是TBAAD后的早期(3个月)生存,并评估了早期和晚期死亡的原因。结果:共纳入274例患者,平均年龄64±13岁。其中,155例(57%)患者为无并发症TBAAD,其中52例(19%)为高危患者,119例(43%)患者为合并TBAAD。9例患者(3.3%)发生早期主动脉相关死亡,均属于复杂TBAAD组。整个队列的中位随访期为8.5年(95% CI: 7.6-11.2)。无并发症TBAAD患者的长期生存率明显高于无并发症TBAAD患者(p = 3个月)(HR = 9.8, 95% CI = 6.4-15.4, p)。结论:并发症TBAAD是主动脉相关死亡和干预的最大风险。高危非并发症TBAAD患者也显著增加了主动脉相关死亡率和干预率。全面评估临床和解剖特征是确定最佳治疗方法的必要条件。
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引用次数: 0
Gender representation in cardiothoracic surgical academia: a call to support women across the globe. 心胸外科学术界的性别代表性:呼吁支持全球妇女。
IF 3.1 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-28 DOI: 10.1093/ejcts/ezae398
Cecilia Pompili, Rita Costa, Busra Cangut, Isabelle Opitz, Paula Ugalde Figueroa, Daniela Molena, Leah Backhus, Shanda Blackmon, Amy Fiedler, Jolanda Kluin, Julie Cleuziou, Franca Melfi, Stephanie Fuller, Douglas E Wood, Mara B Antonoff

Central message: Underrepresentation of women in surgical specialties persists, especially in academic leadership roles. Efforts to better understand disparities and support women cardiothoracic surgeons are ongoing.

中心信息:女性在外科专业的代表性不足仍然存在,特别是在学术领导角色。更好地了解差异和支持女性心胸外科医生的努力正在进行中。
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引用次数: 0
Harnessing physiology in off-pump double lung transplantation: evolving surgical strategies. 在非泵双肺移植手术中利用生理学:不断发展的手术策略。
IF 3.1 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-28 DOI: 10.1093/ejcts/ezae454
Laurens J Ceulemans, Jan Van Slambrouck, Michaela Orlitová, Arne Neyrinck
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引用次数: 0
Preoperative quality of life predicts complications in thoracic surgery needs further evaluation. 术前生活质量对胸外科并发症的预测有待进一步评估。
IF 3.1 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-28 DOI: 10.1093/ejcts/ezae424
Boyou Zhang, Feng Yuan, Chuanchuan Li, Zhengfu He
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引用次数: 0
Managing large thoracoabdominal aneurysms with fenestrated and branched endografts: challenges and insights. 胸腹大动脉瘤开窗和分支内移植物的治疗:挑战和见解。
IF 3.1 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-28 DOI: 10.1093/ejcts/ezae433
Maram Darwish, Vladimir Makaloski
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引用次数: 0
Intra-operative and post-operative management of conduits for coronary artery bypass grafting: a clinical consensus statement of the European Society of Cardiology Working Group on Cardiovascular Surgery and the European Association for Cardio-Thoracic Surgery Coronary Task Force. 冠状动脉旁路移植术中和术后导管的管理:欧洲心脏病学会心血管外科工作组和欧洲心胸外科协会冠状动脉工作组的临床共识声明。
IF 3.1 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-28 DOI: 10.1093/ejcts/ezae400
Sigrid Sandner, Charalambos Antoniades, Etem Caliskan, Martin Czerny, Victor Dayan, Stephen E Fremes, David Glineur, Jennifer S Lawton, Matthias Thielmann, Mario Gaudino

The structural and functional integrity of conduits used for coronary artery bypass grafting is critical for graft patency. Disruption of endothelial integrity and endothelial dysfunction are incurred during conduit harvesting subsequent to mechanical or thermal injury and during conduit storage prior to grafting, leading to acute thrombosis and early graft failure. Late graft failure, in particular that of vein grafts, is precipitated by progressive atherogenesis. Intra-operative management includes appropriate selection of conduit-specific harvesting techniques and storage solutions. Arterial grafts are prone to vasospasm subsequent to surgical manipulation, and application of intra-operative vasodilatory protocols is critical. Post-operative management includes continuation of oral vasodilator therapy and selection of antithrombotic and lipid-lowering agents to attenuate atherosclerotic disease progression in conduits. In this review, the scientific evidence underlying the key aspects of intra- and post-operative management of conduits for coronary artery bypass grafting is examined. Clinical consensus statements for best clinical practice are provided, and areas requiring further research are highlighted.

冠状动脉旁路移植术中导管的结构和功能完整性是保证移植物通畅的关键。在机械或热损伤后的导管收获和移植前的导管储存期间,会发生内皮完整性破坏和内皮功能障碍,导致急性血栓形成和早期移植失败。晚期移植物衰竭,特别是静脉移植物,是由进行性动脉粥样硬化引起的。术中管理包括适当选择导管特定的收集技术和储存解决方案。动脉移植物在手术操作后容易发生血管痉挛,术中血管扩张方案的应用至关重要。术后管理包括继续口服血管扩张剂治疗和选择抗血栓和降脂药物以减轻导管内动脉粥样硬化疾病的进展。在这篇综述中,对冠状动脉旁路移植术中导管的术中和术后管理的关键方面的科学证据进行了研究。提供了最佳临床实践的临床共识声明,并强调了需要进一步研究的领域。
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引用次数: 0
Extracorporeal membrane oxygenation as a bridge to transplant in severe pulmonary hypertension. 体外膜氧合作为重度肺动脉高压移植的桥梁。
IF 3.1 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-28 DOI: 10.1093/ejcts/ezae420
Sophie Kruszona, Khalil Aburahma, Philipp Wand, Nunzio D de Manna, Murat Avsar, Dmitry Bobylev, Carsten Müller, Julia Carlens, Alexander Weymann, Nicolaus Schwerk, Tobias Welte, Bin Liu, Arjang Ruhparwar, Christian Kuehn, Jawad Salman, Mark Greer, Fabio Ius

Objectives: Severe pulmonary hypertension (PH) is the leading indication for a lung transplant in younger patients. Despite the availability of validated risk scores, their influence on lung allocation has been negligible, with continued reliance on decompensation and bridging with extracorporeal membrane oxygenation (ECMO).This single-centre, retrospective study assessed outcome of ECMO bridging in lung transplant for PH and evaluated short-term predictability of ECMO bridging.

Methods: Patients with PH listed for a lung transplant between January 2010 and March 2023 were included. Peri- and postoperative courses were compared dependent upon ECMO bridging status. Bridging risk analysis within 90 days of re-evaluation included patients not requiring ECMO at listing, with listing parameters evaluated using a univariate Cox proportional hazard regression.

Results: A total of 114/123 patients listed underwent lung transplant. Twenty-eight required ECMO bridging. No differences in primary graft dysfunction grade 3 at 72 h (30 vs 20%; P = 0.28) or graft survival (1 year: 82 vs 88%; 5 years: 54 vs 59%; P = 0.84) were evident. ECMO bridging resulted in longer intensive care unit stays post-transplant (P = 0.002) and higher rates of both re-thoracotomy (P = 0.049) and vascular complications (P = 0.031). Factors increasing 90-day ECMO risk included N-terminal pro-B-type natriuretic peptide (P < 0.001), 6-min walk distance (P = 0.03) and O2 requirement at rest (P = 0.006).

Conclusions: Lung transplant survival outcomes are not affected by ECMO bridging in patients with severe PH. It does, however, expose patients to additional risk, and efforts such as easy-to-measure parameters to pre-emptively identify patients requiring bridging to assist with effective allocation should be encouraged.

目的:严重肺动脉高压是年轻患者肺移植的主要指征。尽管有有效的风险评分,但它们对肺分配的影响可以忽略不计,继续依赖失代偿和ECMO桥接。这项单中心、回顾性研究评估了肺动脉高压患者肺移植中ecmo桥接的结果,并评估了ecmo桥接的短期可预测性。方法:选取2010年1月~ 2023年3月间行肺移植的肺动脉高压患者。根据ecmo桥接状态比较围手术期和术后病程。再评估90天内的桥接风险分析纳入了在纳入时不需要ECMO的患者,纳入参数使用单变量Cox比例风险回归进行评估。结果:123例患者中有114例接受了肺移植。28例需要ECMO桥接。72小时原发性移植物功能障碍3级无差异(30% vs 20%;P = 0.28)或移植物存活明显(1年:82% vs 88%;5年:54% vs 59%;p = 0.84)。ecmo桥接导致肺移植后重症监护病房停留时间更长(p = 0.002),再次开胸(p = 0.049)和血管并发症(p = 0.031)的发生率更高。增加90天ECMO风险的因素包括NT-proBNP (p)。结论:严重肺动脉高压患者的ECMO桥接不影响肺移植生存结局。然而,它确实使患者面临额外的风险,应该鼓励采取诸如易于测量的参数来先发制人地识别需要桥接的患者,以协助有效分配。
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引用次数: 0
Reply to Kleebayoon et al. 对 kleebayoon 等人的答复
IF 3.1 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-28 DOI: 10.1093/ejcts/ezae374
Keitaro Matsumoto, Fumitake Uchida
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引用次数: 0
Hybrid internal annuloplasty: 'Ring and Belt on the outside'. 混合内环成形术:"外环内带"。
IF 3.1 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-28 DOI: 10.1093/ejcts/ezae430
Marek J Jasinski
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引用次数: 0
Adult living-donor lobar lung transplant using a small-for-size graft. 成人活体供体大叶肺小块移植。
IF 3.1 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-28 DOI: 10.1093/ejcts/ezae390
Daisuke Nakajima, Ichiro Sakanoue, Hidenao Kayawake, Ryota Sumitomo, Shigeto Nishikawa, Satona Tanaka, Yojiro Yutaka, Toshi Menju, Hiroshi Date

Objectives: This study was designed to examine the outcomes of adult living-donor lobar lung transplants (LDLLTs) using small-for-size grafts.

Methods: A calculated graft forced vital capacity of <50% of the predicted forced vital capacity of the recipient was considered to indicate a small-for-size graft. Adult recipients (≥18 years) who underwent LDLLTs between 2008 and 2022 were included in this study.

Results: We performed 80 adult LDLLTs, using small-for-size grafts in 15 patients and non-small grafts in 65 patients. Grade 3 primary graft dysfunction developed within 72 h after the transplant in 3 patients (20%) in the small group and in 3 patients (4.6%) in the non-small group (P = 0.0763). The 1- and 5-year survival rates were 86.7% and 69.3% in the small group and 93.8% and 77.1% in the non-small group (P = 0.742). In the small group, the native lungs were spared in 8 patients, whereas 2 lobar grafts were implanted with non-spared native lungs in the other 7 patients. The 1- and 5-year survival rates were significantly better in the spared group (both 100%) than in the non-spared group (71.4% and 23.8%; P = 0.0375). The spared group showed a significantly higher median percent forced vital capacity after the transplant than the non-spared group (68.5% vs 44.9%; P = 0.0027).

Conclusions: Although the use of small-for-size grafts was associated with a higher rate of severe primary graft dysfunction, no differences were found in survival rates. When the graft is small, the native lung should be partially spared if possible.

目的:本研究旨在研究使用小尺寸移植物的成人活体供体大叶肺移植的结果。结果:我们进行了80例成人活体供体大叶肺移植,15例采用小尺寸移植物,65例采用非小尺寸移植物。小组3例(20%)和非小组3例(4.6%)在移植后72 h内发生3级原发性移植物功能障碍(P = 0.0763)。小组的1年和5年生存率分别为86.7%和69.3%,非小组的93.8%和77.1% (P = 0.742)。在小组中,8例患者保留了原生肺,而在另外7例患者中,2例肺叶移植物植入了非保留的原生肺。存活组的1年和5年生存率(均为100%)明显优于非存活组(71.4%和23.8%);p = 0.0375)。存活组移植后强迫肺活量的中位数明显高于非存活组(68.5% vs 44.9%;p = 0.0027)。结论:尽管小尺寸移植物的使用与严重原发性移植物功能障碍的发生率较高相关,但存活率没有差异。当移植物很小时,如果可能,应部分保留原肺。
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European Journal of Cardio-Thoracic Surgery
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