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

Objective: Minimally invasive cardiac surgery for mitral valve (MV) disease is a rising strategy. Axillary access is linked to reduced pain and faster recovery, but its efficacy and safety compared with median sternotomy for MV surgery (MVS) remain unclear. We conducted a meta-analysis comparing the clinical outcomes of MVS via axillary access and median sternotomy.

Methods: Four databases were analyzed. The primary endpoint was perioperative mortality. Secondary endpoints included cardiopulmonary bypass (CPB) and cross-clamp times, rethoracotomy, wound complications, mechanical ventilation duration, stroke, hospital and intensive care unit (ICU) stay, and residual moderate mitral regurgitation. A random-effects model was used.

Results: We included 2,129 patients from 4 studies, with 1,135 (53.3%) undergoing axillary access. Perioperative mortality was comparable between approaches (odds ratio [OR] = 0.34, 95% confidence interval [CI]: 0.09 to 1.23, P = 0.10). Axillary access was associated with longer CPB times (mean difference [MD] = 16.38, 95% CI: 6.42 to 26.34, P = 0.001), fewer wound complications (OR = 0.41, 95% CI: 0.21 to 0.80, P = 0.009), shorter ventilation time (MD = -4.93, 95% CI: -8.79 to -1.08, P < 0.01), and shorter hospital (MD = -0.78, 95% CI: -1.41 to -0.14, P = 0.02) and ICU stays (MD = -10.84, 95% CI: -19.54 to -2.14, P = 0.01). No difference was found in cross-clamp time, rethoracotomy, stroke, or residual mitral regurgitation.

Conclusions: Axillary access for MVS shows comparable mortality to median sternotomy, with benefits in wound complications, ventilation, and recovery but longer CPB times. Further research is needed to confirm long-term safety and efficacy.

Objective: Robot-assisted thoracoscopic (RATS) lung resection is a widely used treatment modality. We hypothesized that geographic and sociodemographic factors would affect trends in RATS use versus video-assisted thoracoscopic (VATS) for lung resection in the United States.

Methods: Retrospective study of patients who underwent either RATS or VATS lung resection from 2016 to 2020 within the National Inpatient Sample. Cohorts were stratified by extent (lobectomy vs sublobar) and technique (RATS vs VATS) of resection and compared with respect to sociodemographic, hospital-level, and geographic factors.

Results: From 2016 to 2020, 81,340 patients underwent lobectomy (35.8% vs 64.3% for RATS vs VATS) and 88,620 underwent sublobar resection (24.2% vs 75.8% for RATS vs VATS). RATS lung resection rates varied by year and geographic division (P < 0.05). The odds ratio (OR) of RATS for lobectomies (reference = East South Central) ranged from 1.64 (95% confidence interval [CI]: 1.35 to 2.0) for Pacific to 3.88 (95% CI: 3.23 to 4.67) for East North Central. For sublobar resection, they ranged from 1.64 (95% CI: 1.31 to 2.06) for Pacific to 3.27 (95% CI: 2.69 to 4.02) for South Atlantic. Race, ruralness, treatment year, age, admission status, hospital teaching status, and certain insurance types were independently associated with the odds of RATS lobectomy use (P < 0.05). Findings were similar for sublobar resection use, except for insurance status (P > 0.05) and hospital bed size (P < 0.05).

Conclusions: Geographic division remained independently associated with the odds of RATS lung resection after adjusting for sociodemographic factors. The overall rates of RATS use ranged from 16.9% to 44.7% for lobectomy and from 11.5% to 30.6% for sublobar lung resection between geographic regions.