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

Objective: To describe the technique and the results of left ventricular aneurysm (LVA) repair with simultaneous coronary artery bypass grafting (CABG) and/or mitral valve (MV) surgery through the left anterior thoracotomy.

Methods: Between October 2018 and June 2024, a cohort of 40 patients underwent repair for postinfarction LVA through left anterior thoracotomy. Simultaneous procedures included CABG (40 patients, 100%) and MV surgery (15 patients, 37.5%) and were performed through the same thoracotomy incision. The mean age of the patients was 61.4 ± 11.4 years (range, 33 to 82 years), the mean body mass index was 27.9 ± 4.3 kg/m² (range, 19.9 to 35.9 kg/m²), and the mean LV ejection fraction was 29.9% ± 8.6% (range, 10% to 55%). The surgical technique in all patients included peripheral cardiopulmonary bypass, minithoracotomy in the fourth intercostal space, aortic cross-clamping, and cold blood cardioplegia.

Results: Successful visualization and repair of the LVA and complete revascularization was achieved in all patients without conversion to sternotomy. The mean number of distal anastomoses per patient was 2.03 ± 1.12 (range, 1 to 5). The mean cardiopulmonary bypass time was 207 ± 51.0 min, and the mean cross-clamp time was 115.5 ± 28.7 min. The average intensive care unit stay was 2.1 ± 1.4 days (range, 1 to 8 days), and the total hospital stay was 6.8 ± 2.9 days (range, 4 to 14 days). No strokes, major complications, or hospital mortality were observed. The 30-day mortality included 1 patient.

Conclusions: LVA repair (isolated or combined with simultaneous cardiac surgical procedures) through the left anterior thoracotomy is shown to be efficient and safe in our experience.

Aortic arch replacement operations have undergone substantial evolution with technical advancements, notably the introduction of the frozen elephant trunk (FET) technique. The purpose of this state-of-the-art review is to detail our approach to contemporary aortic arch replacement with FET operations. First, we review the evolution of FET procedures over the years and discuss technical modifications, including cerebral perfusion options, to the aortic arch replacement with FET. We also discuss state-of-the-art technical considerations of head vessel reconstruction and management of the difficult left subclavian artery. We also discuss selected considerations related to the endovascular stent graft component, including landing zone management and when to consider extended distal aortic interventions. We briefly discuss potential complications of which the vigilant clinician should be aware, as well as highlight subtleties in managing aortic dissection compared with aortic aneurysms.

In endoscopic mitral valve repair and replacement, direct valve sizing is impractical because skin incisions have become very small and do not fit traditional sizers. Until now, procedure planning using dedicated computed tomography (CT) software has not been the standard of care. However, proper CT analysis can help anticipate procedural challenges and enhance procedure planning in endoscopic mitral valve surgery. Cannulation and valve implantation strategy may be chosen, risk of injury to the circumflex artery as well as left ventricular outflow tract obstruction may be anticipated, and digital phantoms of surgical prostheses may be simulated inside the annulus. We propose digital simulation and procedure planning for surgeons by CT-based reconstructions.

Objective: Previous studies have evaluated the feasibility of robot-assisted thoracoscopic segmentectomy (RVATS) in comparison with video-assisted thoracoscopic segmentectomy (VATS). We report both short-term and long-term outcomes comparing RVATS and VATS at a single institution.

Methods: This is a retrospective propensity-matched cohort study reviewing RVATS and VATS for primary non-small cell lung cancer (NSCLC) performed from 2013 to 2021 at our institution; 1:2 propensity matching was performed.

Results: There were 108 patients who underwent RVATS and 370 who underwent VATS for primary lung cancer. After propensity matching, we had 2 well-matched cohorts of 102 patients in the RVATS group and 204 in the VATS group. Our data showed no significant difference in 90-day mortality, 30-day hospital readmission rate, or median number of lymph nodes between the RVATS and VATS groups. There was also no significant difference in postoperative morbidity except for pleural effusion. RVATS had a significantly greater median number of lymph node stations harvested and longer operative time. Although both groups achieved R0 resections in all patients, RVATS showed a greater negative tumor margin distance compared with VATS. There was no significant difference in disease-free survival or overall survival between the 2 groups at 3 years.

Conclusions: In our experience, RVATS showed a greater number of lymph node stations harvested and greater negative tumor margin distance without compromising perioperative and oncological outcomes for segmentectomy performed for NSCLC.