General Thoracic and Cardiovascular Surgery最新文献

Objective: Pulmonary vein stenosis is a rare but serious complication following catheter ablation for atrial fibrillation. This study aimed to evaluate the mid-term outcomes of the sutureless marsupialization technique for acquired pulmonary vein stenosis or pulmonary vein occlusion.

Methods: Between 2006 and 2024, six patients (mean age: 54.5 ± 9.0 years) with severe pulmonary vein stenosis or pulmonary vein occlusion after catheter ablation underwent surgical repair using the sutureless marsupialization technique. This approach avoids direct suturing to the pulmonary vein wall by covering the opened vein with autologous or xenogeneic tissue (left atrial appendage, pericardium, or atrial wall). A total of 13 pulmonary veins were reconstructed. Restenosis was evaluated using follow-up computed tomography, and 5-year patency was estimated by Kaplan-Meier analysis.

Results: All patients underwent successful repair without perioperative complications. Covering materials included the left atrial appendage (n = 3), bovine pericardium (n = 2), autologous pericardium (n = 1), and atrial wall flap (n = 1). During a mean follow-up of 62.5 ± 46.5 months, restenosis occurred in 2 of 13 veins (15.4%) four months after surgery, both initially classified as stenotic lesions. All patients remained asymptomatic and required no further intervention. The 5-year patency rate was 84.6%.

Conclusions: The sutureless marsupialization technique offers good mid-term outcomes for acquired pulmonary vein stenosis and pulmonary vein occlusion after catheter ablation. By avoiding direct vein wall suturing, this approach may reduce restenosis. These results support its potential as a surgical option in selected patients with this rare complication.

Objectives: This study aims to compare the immediate and mid-term outcomes of Aortic Valve Neocuspidization (AVNeo) with surgical aortic valve replacement using a bioprosthesis (BioSAVR) to determine if neocuspidization can overcome limitations of current techniques.

Methods: From December 2016 to December 2023, 155 patients received AVNeo at the Heart Institute, while 301 underwent BioSAVR. Baseline characteristics were balanced using 1:1 propensity matching.

Results: 132 identical patient pairs were included in the analysis. Neocuspidization had longer ischemic times (98.67 ± 28.47 min vs. 66.76 ± 25.04 min, ρ < 0.001). Permanent pacemaker implantation (ρ = 0.072) and paravalvular leaks (ρ = 0.041) were more common in the BioSAVR group. Follow-up averaged 43.8 ± 27.30 months. Severe post-procedural aortic stenosis (PPAS) was more frequent after BioSAVR (3 (2.8%) vs. 1 (0.9%), ρ = 0.006), but AVNeo experienced more recurrent severe aortic regurgitation (AR) (3 (2.8%) vs. 0, ρ = 0.035). Reoperation rates were similar (AVNeo 3.1%, BioSAVR 1.5%, ρ = 0.680). Prosthetic valve endocarditis (PVE) was responsible for half (2 cases) of the AVNeo reoperations. Survival rate during follow-up was comparable: 92.8% (AVNeo) and 94.4% (BioSAVR), ρ = 0.672.

Conclusions: Immediate and mid-term AVNeo quality outcomes were comparable to those of BioSAVR. Transvalvular hemodynamics were better, and the incidence of PPAS was lower after AVNeo, supporting the recommendation of this procedure for patients at high risk of patient-prosthesis mismatch. During follow-up, AVNeo patients require close monitoring for recurrent AR and aggressive PVE prophylaxis. A multicenter long-term study is needed to confirm the stability of hemodynamic performance, the rate of Structural Valve Deterioration, and the incidence of PVE in AVNeo patients over the long term.

Objective: We investigated whether the coagulation function was improved and bleeding tendency was controlled by fibrinogen concentrate.

Methods: In 32 patients with hypofibrinogenemia < 150 mg/dL during either thoracic or thoracoabdominal aortic surgery, blood coagulation ability was observed using ROTEM Sigma® and the 3 min bleeding amount was measured during surgery.

Results: The mean blood fibrinogen levels decreased to 109 ± 26 mg/dl at the end of cardiopulmonary bypass, but significantly increased to 231 ± 38 mg/dl after the administration of fibrinogen concentrate (p < 0.0001). The 3 min bleeding amount was 144 ± 88 ml after heparin neutralization, but it significantly decreased to 85 ± 74 ml with fibrinogen concentrate (p = 0.0001). FIBTEM A10 was extremely low at 4.8 ± 2.7 mm after heparin neutralization, but the value increased to 14.1 ± 4.1 mm with fibrinogen concentrate (p < 0.0001). EXTEM A10 (the extrinsic coagulation ability) and INTEM A10 (the intrinsic coagulation ability) were both low at 31.3 ± 11.0 mm and 30.9 ± 10.7 mm, after heparin neutralization, but they both significantly increased to 42.2 ± 8.9 mm and 39.1 ± 8.7 mm (p < 0.0001) with fibrinogen concentrate. There were no operative deaths, but there were three cases in which thromboembolism could not be ruled out. Two patients had myocardial infarction due to occlusion of the reconstructed right coronary artery and the other had newly developed cerebral infarction, but the causes could not be clarified.

Conclusion: The administration of fibrinogen concentrate rapidly increased blood fibrinogen levels and significantly reduced the 3 min bleeding amount. In addition, significant improvements in extrinsic and intrinsic coagulation abilities were observed with the administration of fibrinogen concentrate.

Purpose: The intrapulmonary location of a tumor is important for evaluating recurrence risk. This study assessed the prognostic impact of the tumor-pleura distance (TPd) in patients with clinical stage IA solid-predominant or pure-solid non-small cell lung cancer (NSCLC), as well as associations with pleural invasion, recurrence, and tumor subtype defined by the consolidation-to-tumor ratio (CTR).

Methods: A total of 358 patients who underwent anatomical lung resection for clinical stage IA NSCLC between 2014 and 2023 were retrospectively analyzed. TPd and CTR were measured on preoperative computed tomography. Receiver-operating characteristic analysis for pleural invasion identified an optimal TPd cutoff of 2.0 mm.

Results: A 2-mm cutoff classified tumors as pleura-adjacent (< 2 mm) or non-pleura-adjacent (≥ 2 mm), with pleural invasion observed in 23.5% of pleura-adjacent and 4.5% of non-pleura-adjacent tumors (P < 0.001). The 5-year recurrence-free survival (RFS) rate was significantly lower in the pleura-adjacent group (68.9% vs. 80.2%, P = 0.021). Multivariate analysis identified pleura-adjacent as an independent predictor of RFS (HR, 1.755; 95% confidence interval (CI) 1.097-2.805; P = 0.019). In the pure-solid subgroup, pleura-adjacent tumors were an independent predictor of RFS (HR, 2.168; 95% CI 1.283-3.663; P = 0.004); no association was found in the solid-predominant subgroup. In the pure-solid subgroup, competing-risk analysis identified pleura-adjacent as an independent risk factor for locoregional recurrence (HR, 2.558; 95% CI 1.250-5.234; P = 0.010).

Conclusion: TPd < 2 mm is a radiological marker strongly associated with pleural invasion. Its adverse prognostic impact was the most evident in pure-solid tumors, in which pleura-adjacent lesions were linked to poorer RFS and higher locoregional recurrence.

Objectives: Cryopreserved aortic allografts in pediatric patients have limited durability due to graft calcification, resulting in high rate of reoperations. Physiological hyperphosphatemia in the young, coupled with inflammatory responses against post-transplant allografts, accelerates allograft calcification in a rat model. We aimed to examine the anti-calcification effect of a phosphate binder, lanthanum carbonate, on aortic allografts in a growing porcine model with blood flow and pressure that resembled clinical settings.

Methods: Four-week-old male specific pathogen-free crossbred piglets were used as donors and recipients. The descending aortas harvested from 5 donors were divided, cryopreserved, and transplanted into the descending aorta of 10 recipient piglets. The lanthanum group received lanthanum carbonate (45 mg/kg/day for 1 week preoperatively and 4 weeks postoperatively; n = 5) and was compared to the control group (without lanthanum carbonate; n = 5). The conduits were explanted at 8 weeks and examined using von Kossa staining and for calcium content quantification by atomic absorption spectroscopy. The sera and femurs were also retrieved to analyze adverse events of lanthanum carbonate.

Results: In the lanthanum group, allograft medial calcification developed less frequently, and the calcium content of the allografts was significantly lower than that in controls (p = 0.009). Body weight, hematocrit levels, and femur mineral density did not differ significantly between the groups at 8 weeks.

Conclusions: Our results suggest that short-term lanthanum carbonate administration may alleviate cryopreserved allograft calcification in young recipients, without adverse effects.