Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery最新文献

Objective: Esophageal cancer is a leading cause of cancer-related mortality, with a 5-year survival rate of 20%. Surgical resection remains the primary treatment for early and locally advanced disease. Anastomotic leak is a major concern, which significantly increases morbidity and mortality. Impaired conduit perfusion and tissue ischemia are key risk factors. This series describes the use of ELUXEO Oxygen Saturation Endoscopic Imaging (OXEI) technology (Fujifilm Healthcare Americas Corp, Lexington, MA, USA) to assess tissue oxygen saturation during esophagectomy.

Methods: OXEI was used in 6 cases to evaluate conduit perfusion during esophagectomy procedures. Real-time hemoglobin oxygen saturation imaging identified ischemic areas, with StO₂ levels ranging from 17% in poorly perfused regions to 92% in well-perfused areas. OXEI findings were congruent with indocyanine green fluorescence imaging but avoided dye-related limitations.

Results: OXEI technology offered a dye-free alternative that allowed real-time assessment of tissue oxygenation, facilitating accurate perfusion quantification. Its reproducibility without dye administration and limitations of tissue saturation or washout concerns added reliability, especially during long multistage procedures. In addition, OXEI has been shown to be consistent irrespective of distances from the targeted area, providing precise tissue saturation quantification throughout critical steps of esophagectomy. These findings highlight the potential of this technology as a valuable adjunct in esophageal surgery.

Conclusions: The experience with ELUXEO technology in esophagectomy is promising. It provides a reliable, dye-free method for real-time perfusion assessment, potentially reducing the incidence of anastomotic leaks, preventing dye-associated complications, and improving surgical outcomes. Further studies are warranted to validate these findings in esophagectomies.

Objective: The objective of this study was to assess our institutional outcomes for aortic surgery through a ministernotomy approach.

Methods: A prospectively maintained database was used to retrospectively obtain outcomes for adult patients undergoing elective proximal aortic surgery between January 2015 and December 2021. Patients with chronic dissections and those undergoing isolated aortic valve replacement, redo, concomitant coronary artery bypass grafting, or total arch procedures were excluded. Multivariable logistic and linear regressions were used to explore the influence of surgical approach on a composite outcome of mortality, stroke, acute renal failure, and reoperation for bleeding. Secondary outcomes were total blood products transfused for the hospital stay and total intensive care and postoperative length of stay.

Results: There were 547 patients included in this analysis, of whom 74 (13.5%) had a ministernotomy. The mean age of the cohort was 61.6 ± 14.5 years, and 121 (22.1%) were female patients. Unadjusted outcomes were comparable between the groups in terms of in-hospital mortality, stroke, acute renal failure, postoperative hospital stay, and deep wound infection. Reoperation for bleeding and total blood products transfused were higher in the ministernotomy group, which may be secondary to a higher proportion undergoing concomitant arch procedures and the effect of the learning curve. Multivariable analysis did not find the ministernotomy approach to be associated with the primary or secondary outcomes.

Conclusions: The ministernotomy approach is a safe and effective way to perform complex proximal aortic surgery in selected patients. The outcomes of this study add to the growing evidence base of minimal access aortic surgery.

Objective: During pulmonary surgery, the lung is deflated to facilitate the procedure. This study aimed to assess the deformation of the bronchial tree and pulmonary parenchyma during lung collapse, for eventual use in augmented reality (AR) guidance during pulmonary resections.

Methods: The concept was first tested in 2 porcine models by analyzing paired computed tomography scans of collapsed and inflated lungs, then applied to 6 human patients. Bronchus and parenchyma were segmented, and a bronchus centerline was calculated. The diameter, length differences, angular deformations, and volume differences of the parenchyma were calculated. Finally, these deformations were applied on the inflated bronchus centerline to generate an artificially collapsed bronchus.

Results: In both the porcine and human models, the pulmonary collapse resulted in substantial volumetric and anatomical changes. For the humans, the right lung showed a median displacement of 14.41 mm in the dorsomedial direction, while the left lung was displaced 11.99 mm in the dorsolateral direction (P = 0.79). Median volume reduction was 970 mL for the right lung and 878 mL for the left lung. Bronchial narrowing was observed, with a median diameter reduction of 0.14 mm for the right lung and 1.23 mm for the left lung. Moreover, the lengths of the bronchial segments were reduced, with a median length reduction of 0.20 mm for the right sided and 0.72 mm for the left sided.

Conclusions: Algorithmically driven calculations of the intraoperative pulmonary collapse of human and porcine lungs were performed and applied onto an inspirated bronchus. This resulted in an artificial collapsed bronchus. This method could be a foundation for a dynamical deformable deflation model, suitable for intraoperative AR-based pulmonary navigation.

Objective: Minimally invasive cardiac surgery (MICS) may require one-lung ventilation (OLV) during minithoracotomy. One of the problems associated with MICS is postoperative unilateral pulmonary edema of the collapsed lung, which may be fatal. Several reports have demonstrated the effects of inhaled nitric oxide (NO) on lung ischemia-reperfusion injury. In this study, we created an in vivo pig model using cardiopulmonary bypass (CPB) and OLV, enabling us to compare bilateral lung injury at the same time point in the same individual. The aim of this study is to examine the effects of inhaled NO in a model that approximates MICS.

Methods: Ten pigs were subjected to 3 h of CPB and OLV with clamping of the main pulmonary artery. The bilateral lungs of the pigs were categorized into 4 groups according to their ventilation status and the presence or absence of NO inhalation (n = 5 per group). Lungs were collected after the experiment, and inflammatory cytokine measurements and pathological evaluations were performed.

Results: In the OLV group (group 1 vs 2), the levels of interleukin-6, interleukin-8, and myeloperoxidase in collapsed lung tissue increased, along with an increase in the number of apoptotic cells and exacerbation of pulmonary edema. In the collapsed lungs (group 2 vs 4), NO inhalation reduced the levels of interleukin-6 and myeloperoxidase, the number of apoptotic cells, and pulmonary edema.

Conclusions: In an animal model using a combination of CPB and OLV, inhaled NO suppressed pulmonary edema and improved the exacerbated lung injury of collapsed lungs.

Objective: The Bentall procedure is a well-established surgical technique for managing aortic root disease involving the ascending aorta and aortic valve. The use of automated suturing technology may facilitate ergonomic, reliable suture placement, especially in minimally invasive approaches. Here we present the results of a study to evaluate the feasibility of using automated suturing technology for Bentall procedures in an ex vivo porcine model using a passive beating heart simulator.

Methods: This study included 20 ex vivo porcine hearts, divided into an automated suturing cohort (n = 10) and a manual suturing cohort (n = 10). A Bentall procedure was performed on each heart, with the subject automated suturing technology used in place of manual suturing in the first cohort. After the procedure, each heart was tested in a passive beating heart testing simulator under increasingly challenging hemodynamic conditions (80, 100, and 120 mm Hg); any fluid leakage at the proximal anastomosis was quantified. Data were analyzed using nonparametric statistical tests.

Results: Overall, leakage from the proximal anastomosis increased with higher pressure and longer duration in both groups (P < 0.001). There was no statistically significant difference in leakage between the automated and manual suture cohorts (P > 0.05), indicating that the study technology appears to be feasible and effective for placing sutures in Bentall procedures. Correlation analysis indicated a moderate positive relationship between aortic pressure and leakage in both groups.

Conclusions: The subject automated suturing technology demonstrated comparable performance to manual suturing in ex vivo Bentall procedures, with no significantly different leakage across a range of increasing aortic pressures.