General Thoracic and Cardiovascular Surgery最新文献

Objective: Systolic anterior motion (SAM) is an important factor for hypertrophic obstructive cardiomyopathy (HOCM) patients with a hypertrophic interventricular septum. We developed the 'floating stitch technique' to relieve SAM and have used it since 2017. The mid-term results of the floating stitch technique are reported.

Methods: Ten consecutive HOCM patients (5 male, mean age 65.6 years) who underwent septal myectomy and the floating stitch technique from 2017 to 2022 were included. All patients underwent preoperative, pre-discharge, and annual follow-up echocardiographic evaluations. The median postoperative observation period was 3.5 (range 1.2-6.6) years.

Results: There were no cases of cutting or elongation of the floating stitch during the follow-up period. The median mitral valve area (MVA) was 2.9 [interquartile range (IQR) 2.6-3.1] cm² before surgery, 2.6 (IQR 2.2-2.7) cm² before discharge, and 2.6 (IQR 2.2-2.8) cm² at the latest follow-up. There were no cases of mitral stenosis clinically. All cases showed a significant decrease in the left ventricular outflow tract pressure gradient after surgery, but one case required re-operation due to recurrent obstruction at the mid-cardiac position. SAM did not recur in any cases, and all patients were in NYHA class 1 at the latest follow-up.

Conclusions: The floating stitch technique showed an excellent SAM-suppression effect and durability. MVA decreased about 10% following the floating stitch technique, but sufficient area was secured without functional mitral stenosis. The combination of septal myectomy and floating stitch technique is a simple and reproducible procedure for HOCM, especially with severe SAM.

Purpose: This study aimed to evaluate the effectiveness of a cadaver surgical training program at the Clinical Anatomy Laboratory Nagoya (CALNA), focusing on its impact on procedural skills, confidence, and anatomical understanding among young and mid-career thoracic surgeons.

Methods: From 2016 to 2024, 13 cadaver surgical training sessions were conducted, divided into basic, advanced, and specialized courses. The program included hands-on practice using cadavers preserved with Thiel or hypertonic saline methods. The surveys were administered post-training to assess confidence, satisfaction, and practical applicability. Statistical analysis was performed on the survey results.

Results: A total of 100 participants attended the training sessions (mean: 12.5/session). The survey responses indicated that 92% of participants rated the training content as "good" or "excellent," and 88% found the training "applicable" or "highly applicable" to clinical practice. Reflective discussions following each session facilitated iterative program refinement. The key improvements included enhanced surgical instrument availability and optimized trainee-to-instructor ratios.

Conclusions: Our cadaver surgical training program was shown to significantly enhance surgical skills, boost confidence, and deepen thoracic anatomical understanding, demonstrating its value in advancing thoracic surgical education. Further development of standardized programs across institutions is needed to enable novice surgeons to acquire advanced skills efficiently.

Objective: A nationwide questionnaire survey was conducted by the Research and Education Committee of the Japanese Association for Thoracic Surgery to investigate current practices of myocardial protection using cardioplegia (CP) in cardiovascular surgery, with the aim of developing a recommendation statement on CP.

Methods: The survey was sent to 521 facilities and focused on adult cardiac surgery (ACS), aortic surgery (AS), and pediatric cardiac surgery (PCS). The response rate was 86.0%, with 448 institutions participating.

Results: Among the participating hospitals, 64.3% used blood CP (BCP), 22.5% crystalloid CP (CCP), and 13.2% a combination of both. In CCP, the most common base solution was Miotector®, an extracellular fluid. In approximately half of the cases where CCP was used initially, BCP was employed for subsequent infusions. In BCP, a customized or modified version of Miotector® was also used as the base solution in over 50% of the cases. The ratio of blood to crystalloid solutions varied across institutions. For both forms of CP, the initial infusion volumes were typically around 20 ml/kg, with subsequent infusions averaging 10 ml/kg. A combined antegrade and retrograde CP infusion method was preferred by most institutions, and terminal warm CP was used in approximately 75% of institutions. Notably, the CP techniques used in minimally invasive cardiac surgery were consistent with those used in conventional surgery via median sternotomy.

Conclusions: This survey provides valuable insights into the diverse practices of myocardial protection, highlighting the need for further comprehensive studies to develop standardized guidelines for CP in cardiovascular surgery.

Purpose: To compare the short-term outcomes and the incidence of post-thoracotomy pain syndrome following dual- versus multi-portal robotic-assisted thoracic surgery.

Methods: We retrospectively analyzed a database of 287 patients from two institutions in Japan that perform dual- and multi-portal robotic-assisted thoracic surgery between September 2019 and August 2024. Patients underwent surgery for non-small cell lung cancer and were evaluated for short-term outcomes. Propensity score matching was performed to address differences in the patients' background characteristics between the two surgical groups. Logistic regression analyses were performed to identify the risk factors for post-thoracotomy pain syndrome after robotic-assisted thoracotomy.

Results: Before matching and compared with the multi-portal group, the dual-portal group underwent fewer segmentectomies (p = 0.002) and had fewer dissected lymph nodes (p = 0.014). Patient's characteristics were similar between the groups after matching. There was no significant difference in the short-term perioperative outcomes of both groups. The dual-portal group experienced a significantly lower rate of post-thoracotomy pain syndrome than the multi-portal group (p = 0.038). The predictive factors for post-thoracotomy pain syndrome in the multivariate analysis were multi-portal thoracic surgery and postoperative complications.

Conclusions: The short-term outcomes after dual- and multi-portal robotic-assisted thoracic surgery were comparable. However, multi-portal surgery was a predictive factor for post-thoracotomy pain syndrome.

Background: Although retrosternal route reconstruction is commonly used in esophagectomy, its anatomical constraints may increase the risk of anastomotic leakage because of the compression of reconstructed organs and deformation of the anastomosis. Therefore, this study retrospectively investigated the effect of anastomosis deformation on leakage.

Methods: In this study, 228 patients who underwent esophagectomy with the McKeown method and triangular anastomosis between 2009 and 2022 were included. The postoperative computed tomography images were analyzed to measure the axial deviation of the esophagogastric anastomosis in the coronal (AD-C) and sagittal (AD-S) images. Moreover, the relationship between axial deviation and anastomotic leakage was examined.

Results: No significant differences were observed between patients with and without anastomotic leakage in terms of patient background, cancer stage, or surgical technique. However, the patients with anastomotic leakage had significantly greater AD-C and AD-S values than those without. Multivariate analysis identified AD-C > 20° as an independent risk factor for anastomotic leakage (odds ratio, 4.93; 95% confidence interval, 2.06-11.92; p < 0.01).

Conclusions: The axial deviation of the esophagogastric anastomosis is a potential risk factor for anastomotic leakage during retrosternal reconstruction. Further studies incorporating three-dimensional imaging and biomechanical analysis are needed to clarify its impact and optimize the anastomotic geometry.

Objective: To identify predictors of left atrial appendage thrombus formation.

Methods: We retrospectively analyzed 149 patients with persistent or paroxysmal atrial fibrillation who underwent cardiovascular surgery between January 2015 and October 2023. Resected left atrial appendages were histologically evaluated for thrombus and amyloid deposition. After excluding 11 patients with transthyretin-type amyloids and 10 with rheumatic mitral valve stenosis, 128 patients (median age, 72.0 years; range, 37-84 years) were assessed. Patients were categorized into the thrombus and no-thrombus groups. Clinical data, echocardiographic findings, and atrial natriuretic peptide amyloid grades (0-3) were compared.

Results: Fresh or organized thrombi and atrial natriuretic peptide amyloid deposition were observed in 28 (21.9%) and 110 (85.9%) patients, respectively. Moderate or greater aortic stenosis was more frequent in the thrombus group (p  = 0.004). Although overall atrial natriuretic peptide amyloid deposition rates were similar (p = 0.377), amyloid deposition degree was significantly greater in the thrombus group (p < 0.001). Multivariate logistic regression identified moderate or greater aortic stenosis and amyloid deposition degree as independent predictors, whereas moderate or greater mitral regurgitation was a negative predictor.

Conclusions: Moderate or greater aortic stenosis and atrial natriuretic peptide amyloid deposition degree predicted left atrial appendage thrombus formation, whereas moderate or greater mitral regurgitation was a negative predictor.

Objective: Generally, lung cancer originating from interstitial pneumonia (IP) is considered more aggressive; however, lung cancer in patients with autoimmune disease (AD)-related IP (AD-IP) is not well documented. This study aimed to clarify surgical outcomes and the risk of postoperative acute exacerbation (AE) in patients with lung cancer associated with AD-IP.

Methods: We retrospectively reviewed patients with lung cancer who underwent surgery between January 2011 and March 2021. Clinicopathological characteristics, recurrence-free survival (RFS), overall survival (OS), and perioperative outcomes were compared according to the presence of IP with or without AD.

Results: Among 1281 patients with lung cancer, 61 (4.8%) had idiopathic interstitial pneumonia (IIP), 87 (6.8%) had AD without IP, and 26 (2.0%) had AD-IP. The 5-year RFS rates were 80.9% for patients without IIP or AD, compared with 48.0% for IIP, 76.1% for AD without IP, and 29.8% for AD-IP. The corresponding 5-year OS rates were 84.1%, 53.9%, 77.0%, and 34.5%. Patients with AD-IP were significantly younger (P = 0.001), were more often female (P < 0.001), had a lower % vital capacity (P = 0.002), and more frequently received preoperative steroids (P < 0.001). The overall incidence of AE among the 87 patients with IP was 10.3% (9/87): 9.8% (6/61) with IIP and 11.5% (3/26) with AD-IP, with no significant difference.

Conclusions: Lung cancer with AD-IP had a poor prognosis, as did lung cancer with IIP, and the frequency of postoperative AE of patients with AD-IP was as high as that in those with IIP.

Objectives: This study evaluates the initial surgical results of our proposed minimally invasive extended thymectomy procedure using the "lateral view preceding method," which precedes dissection of the lower poles of the thymus and mediastinal fat around the cardiophrenic angles with lateral thoracoscopic views, followed by a robot-assisted subxiphoid approach for the remaining extended thymectomy.

Methods: The lateral view preceding method was introduced in October 2020. We retrospectively reviewed patients with suspected thymomas in the anterior mediastinum having anti-acetylcholine receptor antibodies who underwent minimally invasive extended thymectomy between April 2011 and April 2025. Surgical outcomes were analyzed and compared with those of conventional bilateral video-assisted thoracic surgery.

Results: Nine patients, seven of whom had myasthenia symptoms, underwent the lateral view preceding approach. Mean operative, pre-robot, and robot console times were 261 ± 43, 79 ± 20, and 144 ± 28 min, respectively. No postoperative complications were observed. All patients with myasthenic symptoms showed improved minimal manifestations and better status. Compared with patients who underwent the lateral view preceding method, those who underwent the conventional approach (21 patients) had more ports (mean, 8.4 ± 1.3 and 4.2 ± 0.5, respectively, p < 0.001) and longer operative time (mean, 346 ± 117 min and 261 ± 43 min, respectively, p  = 0.024). Postoperative complications occurred in five (31%) patients who underwent the conventional approach.

Conclusion: Extended thymectomy using the lateral view preceding method resulted in safe and effective initial surgical outcomes. We believe that this is a promising and minimally invasive approach.

Objective: In this study, the difference in anatomical variables was considered between Aortic stenosis (AS) and Aortic regurgitation (AR) groups by preoperative computed tomography (CT) in minimally invasive cardiac surgery for aortic valve replacement (MIAVR).

Methods: Patients who underwent AVR between 2012 and 2021 at our center were retrospectively analyzed in two groups, AS and AR. The final 278 samples possessed detailed clinical information of the patients. The six items were measured in preoperative CT and compared in significant difference in number.

Results: No significant differences were found in the patients' characteristics between the AS and AR groups except for age, sex and body surface area. The number of younger and male patients was higher in the AR group than in the AS group (P <  0.01), including a larger body surface area (P <  0.01). The AR group had larger rightward laterality aorta and third ICS (AS vs AR - 3.9 ± 8.9 vs 0.6 ± 8.9 mm, P < 0.01; 14.2 ± 1.3 vs 15 ± 1.6 cm, P <  0.01, respectively).

Conclusions: Preoperative CT revealed thoracic anatomical differences between AS and AR patients undergoing MIAVR. Although no direct correlation with cross-clamp time was observed except for AP distance in both AR and AS, surgeons should be aware that these anatomical features-particularly the rightward aorta and deeper and more caudally positioned AV in AR patients to make surgical decision making, surgical planning. CT-based evaluation is a valuable tool for guiding approach strategy and patient selection in MIAVR.