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

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.

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.