General Thoracic and Cardiovascular Surgery最新文献

Purpose: This study evaluated the early clinical and echocardiographic outcomes of mitral valve (MV) repair using the Physio Flex Annuloplasty Ring for mitral regurgitation (MR) of various etiologies.

Methods: We retrospectively analyzed 185 patients who underwent MV repair using Physio Flex Annuloplasty Ring between July 2020 and October 2024. Degenerative MR was the most common type (n = 94), followed by functional MR (n = 79). Severe and moderate MR were observed in 126 and 59 patients, respectively.

Results: Artificial chordal reconstruction, leaflet resection, and folding plasty were performed in 61 (33.0%), 21 (11.4%), and 13 (7.0%) patients, respectively, whereas ring annuloplasty alone was performed in 64 (34.6%) patients. The median ring size was 30 mm (interquartile range, 30-32mm). The operative mortality rate was 2.2%. Postoperatively, no/trivial and mild MR were observed in 162 (87.6%) and 18 (9.7%) patients, respectively. Left ventricular end-diastolic and end-systolic diameters significantly decreased from 51 ± 8 mm to 47 ± 7 mm and from 34 ± 9 mm to 32 ± 8 mm, respectively (P < 0.001). The right ventricular systolic pressure also decreased (33 ± 13 mmHg to 29 ± 10 mmHg; P < 0.001). Functional mitral stenosis (mean transmitral pressure gradient of ≥ 5 mmHg) occurred in 13 patients.

Conclusion: MV repair using the Physio Flex Annuloplasty Ring provides effective MR control and satisfactory early outcomes, with an acceptable incidence of functional mitral stenosis.

Thoracoscopic surgery for stage III acute empyema is often limited by poor visualization and anatomical complexity. We developed a standardized, minimally invasive approach using a variable-view rigid endoscope and fixed port placement, regardless of disease extent or patient physique. The variable-view endoscope enabled a wide, adjustable field of view without moving the camera shaft, allowing safe access even in the confined thoracic space. This setup facilitated comprehensive adhesiolysis and decortication via a bidirectional approach by surgeons on both ventral and dorsal sides. Among 43 consecutive patients, all but one underwent successful thoracoscopic management, with favorable clinical outcomes and minimal complications.

Objectives: One of the risks of redo transcatheter aortic valve replacement is coronary artery obstruction caused by the cusps of the first transcatheter aortic valve. We evaluated the feasibility of this procedure based on data from post-transcatheter aortic valve replacement computed tomography scans. We also evaluated whether redo transcatheter aortic valve replacement could be a standard lifetime management option for patients with severe aortic stenosis.

Methods: The post-transcatheter aortic valve replacement computed tomography data of 143 patients who received balloon-expandable transcatheter aortic valves and 187 patients who received self-expanding transcatheter aortic valves were analyzed. The risk of coronary obstruction in redo transcatheter aortic valve replacement, defined by the transcatheter aortic valve commissure level above the coronary height and a transcatheter aortic valve-to-aorta distance of < 2.0 mm in each coronary sinus, was evaluated.

Results: The mean age of the patients was 85.5 ± 5.1 years (35% male), and the mean body surface area was 1.43 ± 0.17 m². The percentage of patients at a high risk of coronary obstruction was significantly higher in the self-expanding valve group (71.1%) than in the balloon-expandable valve group (32.2%). In both the balloon-expandable and self-expanding valve groups, the group at a high risk of coronary obstruction had smaller aortic roots.

Conclusions: Current transcatheter aortic valve devices may carry a higher risk of coronary obstruction in patients with small aortic roots. Careful patient selection and comprehensive pre-procedural assessment are necessary to reduce the risk for the patients' lifetime management.

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.