European Journal of Cardio-Thoracic Surgery最新文献

Objectives: With 2 different Ross autograft implantation techniques: subcoronary versus full-root evolving, the question remains which strategy demonstrates the better early/mid-term performance, especially concerning autograft durability.

Methods: Patients (0-18 years) undergoing Ross procedure from January 2012 to December 2022 in 2 high-volume centres were included. Patients undergoing both subcoronary and full-root Ross were analysed for early mortality, direct postoperative complications, 5-year survival, incidence of reinterventions/reoperations and autograft durability over time. Propensity score matching and regression analysis were used to overcome institutional differences.

Results: A total of 205 paediatric patients were included [median age at Ross: 7.6 years (1.9-13.5), 67% males]. No differences in baseline characteristics were noted between the groups, except for prior aortic valve repair, which occurred more frequently in the full-root Ross (19% vs 6.9%; P = 0.03). Cardiopulmonary bypass durations (median 265 vs 221 min, P < 0.01), ventilatory support and hospital stay were significantly longer in the subcoronary Ross (P = 0.02) with no differences in any postoperative complications. No differences were noted in 5-year survival [full-root: 93.3% (87.5-96.5) versus subcoronary: 96.5% (86.6-99.1), P = 0.45], incidence of autograft reoperations [full-root: 3.2% (1-9.9) versus subcoronary: 2.1% (0.3-14.9), P = 0.98] or incidence of autograft regurgitation ≥ moderate [full-root: 9.8% (5.3-18.2) versus subcoronary: 9.7% (3.1-30.5), P = 0.85) between the groups, also after matching.

Conclusions: Independent of the technique, Ross procedure is performed with excellent survival and low autograft reoperation rates in high-volume centres. The longer, technically more challenging subcoronary Ross demonstrated no differences in early postoperative complications. A superiority in autograft durability has so far not been noticed either in the medium-term follow-up.

Objectives: The impact of conotruncal anomalies (CTAs), including tetralogy of Fallot, truncus arteriosus, ventriculo-arterial discordance, double-outlet right ventricle and interrupted aortic arch type B, on long-term outcomes remains poorly described in the Fontan cohort. We sought to review the outcomes of Fontan patients with CTAs in Australia and New Zealand.

Methods: We reviewed the data from 1835 patients who underwent a Fontan operation between 1975 and 2023 from the Australia and New Zealand Fontan Registry.

Results: CTAs occurred in 895 patients (49%), including D-TGA (Transposition of Great Arteries) (n = 476), double-outlet right ventricle (n = 360) and L-TGA (n = 170). Patients with CTAs had more heterotaxy syndrome (11.3% vs 6.8%, P < 0.001) and less left-ventricular dominance (53% vs 60%, P = 0.011). Median follow-up was 11.7 years (IQR: 5.3-20.3 years). Overall transplant-free survival and freedom from Fontan failure was 84% (95% confidence interval: 81-87%) and 72% (95% confidence interval: 68-75%) at 20 years, respectively. No difference was demonstrated in survival or freedom from Fontan failure between patients with or without CTAs (P = 0.50 and P = 0.83). Pacemaker implantation was more common in patients with CTAs (11.2% vs 8.3%, P = 0.038). Overall, 45 patients underwent outflow tract reinterventions, including semilunar valves, 'after' Fontan operation. Freedom from these reinterventions was 95% (95% confidence interval: 93-96%) at 30 years and was higher in patients with CTAs (P < 0.001).

Conclusions: Patients with CTAs did not have a demonstrable difference in long-term survival and freedom from Fontan failure to other patients undergoing Fontan operation. Patients with CTAs have higher incidence of outflow tract reinterventions, including semilunar valves, and higher rate of pacemaker implantation.

Objectives: Our goal was to assess whether proximal ligation of the pulmonary vein stump (PVS) outside the pericardium reduces the incidence of postoperative cerebral infarction (PCI) after a lobectomy.

Methods: A single-institution retrospective review was conducted of 683 patients undergoing a lobectomy for lung cancer, metastatic lung tumours and benign diseases. Associations among PCI within 90 days, ligation of the PVS and clinicopathological features were analysed. Effects of PVS ligation on PCI were assessed using multivariable regression. PVS length measured on three-dimensional computed tomographic angiography was compared between the non-ligation and ligation groups.

Results: The non-ligation and ligation groups included 356 (January 2010-March 2018) and 327 patients (April 2018-November 2023), respectively. Seven non-ligation group patients (1.96%) had PCIs [3 in a left upper lobectomy (LUL) and left lower lobectomy (LLL) and 1 in a right lower lobectomy]; no ligation group patients suffered PCIs (P = 0.016). Univariable analysis showed that LUL, LLL, chronic kidney disease (CKD), heart failure, cardiovascular disease and PVS ligation were significantly associated with PCIs. Multivariable analysis demonstrated that PVS ligation (P = 0.034) was correlated with decreased PCI and LUL (P = 0.011), LLL (P = 0.010) and CKD (P = 0.004) with increased PCIs. After ligation, PVS length was shortened in each lobe in a subset analysis of 109 patients.

Conclusions: Proximal ligation of the PVS outside the pericardium may be an option to prevent a PCI during a lobectomy. Patients with CKD and those undergoing left-sided lobectomy are at higher risk for PCI and may benefit from more intensive management.

Objectives: We aimed to determine the incidence of postoperative complete atrioventricular block, the time to recovery or permanent pacemaker implantation and the predictors for postoperative atrioventricular block after congenital heart surgery.

Methods: Patients who underwent open-heart surgery from January 2001 to January 2024 were analysed and predictors of atrioventricular block were identified using a logistic regression model.

Results: Among 9765 congenital heart surgeries, 333 (3.4%) were complicated by atrioventricular block, and 193 patients (1.9%) underwent permanent pacemaker implantation. The highest rates of atrioventricular block were found in patients who underwent repair of congenitally corrected transposition of the great arteries (27.3%), followed by Konno procedure (20.0%), mitral valve replacement (16.0%) and arterial switch with closure of ventricular septal defect and arch repair (15.0%). In 134 (1.4%) patients with transient atrioventricular block, the median time to resolution was 4 days (interquartile range: 2-8 days). After 7 postoperative days, 75% had resolved, and after 12 postoperative days, 90% had resolved. Risk factors for the development of atrioventricular block were older age at operation (odds ratio: 1.012, P = 0.001), preoperative endocarditis (2.422, P < 0.001), longer aortic cross-clamp time (1.018, P < 0.001) and high-risk procedures (1.397, P = 0.012).

Conclusions: Postoperative atrioventricular block is not rare after congenital heart surgery, with more than half of them needing permanent pacemaker implantation. Older age at operation, preoperative endocarditis, longer aortic cross-clamp time and high-risk procedures were risks for the development of atrioventricular block. Pacemaker implantation should be delayed to the 12th postoperative day, when 90% of transient blocks have resolved.

Objective: The aim of the study was to evaluate the outcomes of aortic valve repair techniques using cusp patch-plasty with CardioCel.

Methods: Between September 2014 and June 2021, a total of 167 patients underwent aortic valve reconstruction using cusp repair. In all patients, CardioCel patch was used exclusively. An isolated cusp repair was performed in 117 patients (70%), while 50 patients with concomitant aortopathy needed a combined valve and root repair. Seventy-two patients (43%) presented with tricuspid valve. The mean age of the entire cohort was 54.3 ± 12.3 years, with 143 patients being males.

Results: Early (30-day/in-hospital) mortality was 0.6%. The survival at 2, 4, and 6 years was 98.8, 96.8, and 95.7%, respectively. During the mean follow-up of 4.2 ± 1.7 years (resulting in 697 patient-years), a relevant aortic insufficiency occurred in 10 patients (8 of them presenting with bicuspid valve). All the patients underwent a valve replacement, resulting in a 7.8 ± 2.5% cumulative risk of aortic valve reoperation and/or insufficiency ≥3+ at 6 years. The causes of reoperation were cusp tear at the suture line, progressive valve pathology, endocarditis, and unknown in 4, 4, 1, and 1, respectively. Degeneration and/or calcification of the CardioCel has not been observed.

Conclusions: The intermediate results of aortic cusp repair using CardioCel are good. Anatomo-pathology of the aortic valve and quality of the cusps seem to be the main reasons for repair failure. Further investigations are needed to assess the long-term durability of CardioCel patch-plasty as an alternative to biological valve replacement in specific aortic valve pathologies.

Objectives: Smoking is a modifiable risk factor for lung resections but to what extent preoperative smoking cessation reduces that risk remains unclear. The study hypothesis was that the potential benefit of smoking cessation can be assessed by measuring the risk difference between active and former smokers in a large cohort of patients.

Methods: Data were extracted from the French Society of Thoracic and Cardiovascular Surgeons (Société Française de Chirurgie Thoracique et Cardiovasculaire) database. The study cohort comprised patients who underwent lung resection for cancer from January 2002 to December 2020 and for which information on smoking status was available. The risk of overall and specific postoperative complications according to smoking status was defined by logistic regression models, and results were presented in terms of odds ratios (ORs) and relative 95% confidence intervals (CIs) adjusted for confounding factors.

Results: Of the 7204 analysed patients at the time of their operations, 20.2% were active smokers, 60.7% were ex-smokers and 19.1% were never smokers. Compared to former smokers, active smokers experienced a higher rate of respiratory complications (OR 1.5, CI 1.2-1.7) and infections (OR 1.6, CI 1.3-1.9). Postoperative atelectasis was significantly reduced in former smokers (3%) compared to active smokers (6.9%, P < 0.01). In active smokers, the risk was related to the level of exposure, being higher for smokers of more than 40 pack-year.

Conclusions: After lung surgery, active smokers experience a higher risk of respiratory complications, infections and prolonged air leak compared to former smokers. This risk seems to be related to the level of exposure.