General Thoracic and Cardiovascular Surgery最新文献

Background: We aimed to establish the most predictive echocardiographic indicator of appropriate tightness of bilateral pulmonary artery banding (BPAB).

Methods: In part A of the study, we retrospectively analyzed the peak flow velocity (PV) and nadir flow velocity (NV) across the band and the ratio of NV to PV (velocity ratio: VR) to determine appropriate band tightness. In part B, we prospectively studied the utility of the best predictive indicators.

Results: Thirty-one patients undergoing BPAB were enrolled in part A and identified as having appropriate pulmonary blood flow (APF), high pulmonary blood flow (HPF), or low pulmonary blood flow (LPF) during the postoperative period. The areas under the receiver operating characteristic curve (AUC) for HPF were 0.92 for PV, 0.99 for NV, and 0.99 for VR; the velocity thresholds were 2.47, 1.15, and 0.45 m/sec, respectively. For LPF, the AUCs were 0.63 for PV, 0.78 for NV, and 0.81 for VR, and the velocity thresholds were 2.70, 1.59, and 0.58 m/sec, respectively; thus, VR best indicated band tightness. In part B, we performed BPAB in 34 patients, adjusting the bands to achieve VRs between 0.45 and 0.58. The prevalence of HPF was significantly lower in part B than in part A, whereas those of LPF did not differ.

Conclusion: In BPAB, we consider the optimal range of VR at banding site is between 0.45 and 0.58.

Objectives: Uniportal video-assisted thoracoscopic surgery (U-VATS) is gaining global recognition as a minimally invasive approach. However, its current status and issues in Japan remain unclear. This study aimed to assess U-VATS adoption and barriers among Japanese thoracic surgeons through a nationwide survey.

Methods: The Japanese Uniportal VATS Interest Group conducted an online survey of 3287 thoracic surgeons on the Japan Association for Chest Surgery mail list. Responses were collected from October 25 to November 30, 2024, yielding 851 valid responses (25.9%) from 497 institutions (78.0% of JACS-registered institutions).

Results: The adoption rate of U-VATS among the institutions was 42.5%. However, the proportions of thoracic surgeons who primarily performed lobectomy, segmentectomy, and wedge resection using U-VATS were 10.3%, 10.2%, and 22.0%, respectively. The main reasons for non-adoption included concerns regarding safety and surgical precision (57.2%), preference for other approaches (50.9%), and lack of instruments (48.8%). Among surgeons with no prior U-VATS experience, 34.1% were willing to adopt it. To facilitate broader adoption, respondents highlighted the need for troubleshooting resources (61.3%), high-precision surgical videos (59.0%), and hands-on training programs (51.5%).

Conclusion: Despite the relatively high institutional adoption rate, the proportion of thoracic surgeons using U-VATS as the primary approach remained low. Key barriers include concerns about safety and surgical precision, limited educational opportunities, and a lack of scientific evidence on U-VATS in Japan. To promote the wider adoption of U-VATS, it is essential to develop structured educational programs and generate evidence to ensure both safety and surgical precision.

Objective: Patients with congenital heart defects, such as tetralogy of Fallot (TOF) or right ventricular outflow tract stenosis or atresia, often require pulmonary valve replacement (PVR) decades after the primary repair. The purpose of this study was to assess the safety and efficacy of a novel synthetic hybrid fabric (SHF) for PVR in adult congenital heart disease.

Methods: SHF, consisting of bio-absorbable and non-absorbable yarns coated with cross-linked gelatin, was used in a prospective, multicenter, single-arm pivotal clinical trial involving subjects with an age range of 0-59 years. The overall study was registered in the Japan Registry of Clinical Trials (jRCT1080224691). This paper specifically presents a subgroup analysis focusing on five adult patients (aged 18-42 years) from the multicenter trial.

Results: The procedures were performed similarly to those using existing products, with no SHF-specific complications observed. The SHF material allowed surgeons to clearly observe the bioprosthetic valve annulus during suturing. None of the patients required blood transfusion or developed adverse events. At a mean follow-up of 4.5 years (range 4.0-4.9 years), no re-interventions or reoperations were needed.

Conclusion: SHF shows promise as a patch material for PVR, offering significant benefits such as clear visualization during surgery, which facilitates precise valve placement. This transparency is crucial for adults with repaired TOF, as it helps reduce surgery time and complication risks. This study suggests that SHF could be a valuable material for adult PVR, extending its potential applications beyond pediatric cardiology.

Objective: This study analyzed the changes in health-related quality of life (HRQOL) and employment status of patients undergoing lung cancer surgery in Japan.

Methods: This was a single-center, prospective study on patients who underwent lung anatomical resection. The eligible patients completed self-reported HRQOL and employment surveys at baseline and 6 and 12 months postoperatively. HRQOL was assessed using questionnaires including the European Organization for Research and Treatment of Cancer Core Quality of Life questionnaire (EORTC QLQ-C30) and EORTC QLQ and Lung Cancer module and additional social engagement and work-related stress evaluation tools.

Results: In total, 93 patients completed the baseline survey, and 80 provided survey data at 6 months postoperatively. The HRQOL scores of several factors significantly declined immediately after the surgery and then gradually improved. The EORTC global health score, which represents overall health status, returned to baseline levels at 12 months postoperatively. However, symptoms such as fatigue, dyspnea, and coughing did not return to baseline levels at 12 months postoperatively. Approximately 68% of the patients who were employed preoperatively continued to work at 12 months postoperatively.

Conclusions: Lung cancer surgery significantly affected the HRQOL and employment status of the patients within the first 6 months after surgery. For patients who decide to return to work before full recovery of QOL, we consider the need for enhanced support to assist them as they can reintegrate into work and activities of daily living.

Objective: Bronchopleural fistula (BPF) is a serious complication that can occur after lung resection. This pilot study aimed to evaluate the effectiveness of autologous multilayered fibroblast sheet transplantation in reinforcing bronchial stump healing after lung resection in a canine model.

Methods: Four beagles underwent left caudal lobe excision. Two dogs received autologous multilayered fibroblast sheet transplantation on the stapled bronchial stump, while two served as controls. Fibroblast sheets generated from autologous oral mucosal fibroblasts were optimized for growth factor secretion. Fourteen days after lobectomy, the bronchial stumps were histologically and immunohistochemically analyzed to assess connective tissue formation, blood vessel formation, and inflammation.

Results: Fibroblast sheets secreted high levels of pro-healing and pro-angiogenic factors in vitro. No adverse events or serious postoperative complications associated with the fibroblast sheet transplantation were observed. The cell sheet-transplanted group exhibited a layered structure of newly formed tissue around the bronchial stump. This was associated with enhanced blood vessel formation, as indicated by increased CD31-positive cells and high VEGF levels. The untreated control group showed a localized nodule of inflammation near the bronchial stump, which lacked evidence of blood vessel formation.

Conclusion: Autologous multilayered fibroblast sheet transplantation promoted connective tissue formation and blood vessel growth around the bronchial stump after lobectomy in a canine model. These findings suggest that fibroblast sheet transplantation is a promising therapeutic approach for preventing BPF after lung resection.

Objectives: Introduction of the radiofrequency identification (RFID) marking system has enabled the precise localization of small pulmonary nodules, facilitating precise sublobar lung resection (PSR). However, the necessary hybrid operating room (HOR) for such precision procedures is mainly available in advanced medical institutions and not universally accessible. Performance of marker placement and lung resection at different facilities without the HOR can promote the widespread adoption of PSR.

Methods: We retrospectively analyzed the data of five patients who underwent thoracoscopic PSR at Fukuoka University Hospital after placement of RFID markers under cone beam computed tomography guidance at the Fukuoka Seisyukai Hospital from March to June 2024.

Results: In all patients, the RFID marker was successfully placed in the intended locations, and no marker migration and no clinical complications occurred during patient transfer from the Fukuoka Seisyukai Hospital to Fukuoka University Hospital. All patients underwent uneventful simultaneous marker removal and lesion resection within 72 h of marker placement.

Conclusion: It is feasible to transfer a patient to another facility after placing an RFID marker and subsequently perform PSR.

Objective: This study aimed to report "real-world" mid-term clinical experiences and outcomes after surgical mitral valve replacement with the Epic bioprosthesis in a high-volume Japanese heart center.

Methods: Patients undergoing surgical mitral valve replacement with the Epic bioprosthesis from 2012 to 2023 were enrolled. Postoperative outcomes, survival, and hemodynamic performance were analyzed. The study endpoints were all-cause mortality, freedom from mitral valve reintervention, and major adverse cardiac events.

Results: A total of 122 patients (mean age: 73 ± 8 years, 73 males) successfully underwent surgical mitral valve replacement with the Epic bioprosthesis (25 mm, n = 22; 27 mm, n = 37; 29 mm, n = 26; and 31 mm, n = 37). The primary valve etiologies were infective endocarditis (n = 17), stenosis (n = 18), stenosis and regurgitation (n = 13), regurgitation (n = 73), and thrombosis (n = 1). The median follow-up period was 33 (interquartile range: 20-48) months. Overall survival rates at 1, 3, and 5 years after mitral valve replacement were 86.8%, 82.0%, and 76.9%. The rates of freedom from rehospitalization for heart failure were 96.7% at 1 year, 95.5% at 3 years, and 91.2% at 5 years. The mean pressure gradient was 5 (interquartile range: 4-6.4) mmHg at discharge, 5.4 (interquartile range: 4.3-6.9) mmHg at 1 year, and 5.4 (interquartile range: 4-7.5) mmHg at late follow-up (Friedman test, p = 0.46). During the study period, only one patient required reintervention because of valve deterioration at 31 postoperative months.

Conclusion: The clinical outcomes of mitral valve replacement with the Epic bioprosthesis are satisfactory, with stable hemodynamics and extremely low incidence of structural valve deterioration and reintervention over 5 years.

Background: Despite advances in cerebral protection strategies, aortic arch surgery remains associated with significant neurological risk. Unilateral antegrade cerebral perfusion (uACP) and bilateral ACP (bACP) are widely used during moderate hypothermic circulatory arrest, but the optimal strategy remains controversial.

Methods: A comprehensive literature search was performed to identify RCT and comparative studies comparing uACP and bACP in patients undergoing aortic arch surgery. Studies were pooled using the random-effects model to perform a pairwise meta-analysis. Primary outcomes were 30-day mortality, permanent neurological deficit (PND), and transient neurological deficit (TND). Secondary outcomes included paraplegia, transfusion, acute kidney injury, tracheostomy, and long-term mortality.

Results: A total of 20 studies with 5,647 patients were included. There was no significant difference between uACP and bACP in 30-day mortality (RR 1.16, p = 0.26) or PND (RR 1.10, p = 0.57). However, uACP was associated with a significantly higher risk of 30-day TND (RR 1.32, p = 0.006). No significant difference was observed for any other explored outcomes. Meta-regression revealed no significant correlation between duration of circulatory arrest or ACP on primary outcomes.

Conclusion: Compared to bACP, uACP during aortic arch surgery is associated with increased transient neurologic deficits but similar rates of mortality and PND. Selection of cerebral perfusion strategy should be individualized to patient anatomy, operative context, and anticipated circulatory arrest duration, recognizing that some subgroups may derive greater benefit from bACP.