Objectives: This study aimed to evaluate the outcomes of the patients who underwent restrictive annuloplasty (RA) plus papillary muscle relocation anteriorly (PMR-A) with the risk factors in mitral valve repair for functional mitral regurgitation (FMR).
Methods: Eighty-six patients underwent mitral valve repair with RA for FMR. Thirty-five of them received additional bilateral papillary muscle relocation for severe leaflet tethering. The papillary muscles were relocated posteriorly (PMR-P) early in the study. Then, in the later period, the technique was modified to PMR-A, in which the papillary muscles were relocated anteriorly for 24 cases. The survival of the patients undergoing RA + PMR-A was examined retrospectively, adjusting for differences in patient background.
Results: Twenty-three deaths were observed during the follow-up period out of the 86 cases. Independent preoperative risk factors for survival were left ventricular ejection fraction, patient age and B-type natriuretic peptide (BNP) level. Among the patients with BNP <1000 pg/ml, 5-year survival after RA plus PMR-A was 84.7%, while RA alone was 78.6% and RA + PMR-P 57.1%. Cox proportional hazards regression adjusted for the preoperative risk factors showed a significantly higher hazard ratio of RA + PMR-P to RA + PMR-A (12.77, P = 0.011), while the hazard ratio of RA alone to RA + PMR-A was not significantly different. Furthermore, reverse remodelling of the left ventricle was observed for 3 years only in RA + PMR-A.
Conclusions: Long-term survival for patients who underwent RA plus bilateral PMR-A was promising. Patients with significantly higher BNP had lower survival after valve repair for FMR.
{"title":"Long-term outcomes of papillary muscle relocation anteriorly for functional mitral regurgitation.","authors":"Keiji Oi, Hirokuni Arai, Eiki Nagaoka, Tatsuki Fujiwara, Kiyotoshi Oishi, Masashi Takeshita, Tatsuhiko Anzai, Tomohiro Mizuno","doi":"10.1093/icvts/ivac245","DOIUrl":"https://doi.org/10.1093/icvts/ivac245","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the outcomes of the patients who underwent restrictive annuloplasty (RA) plus papillary muscle relocation anteriorly (PMR-A) with the risk factors in mitral valve repair for functional mitral regurgitation (FMR).</p><p><strong>Methods: </strong>Eighty-six patients underwent mitral valve repair with RA for FMR. Thirty-five of them received additional bilateral papillary muscle relocation for severe leaflet tethering. The papillary muscles were relocated posteriorly (PMR-P) early in the study. Then, in the later period, the technique was modified to PMR-A, in which the papillary muscles were relocated anteriorly for 24 cases. The survival of the patients undergoing RA + PMR-A was examined retrospectively, adjusting for differences in patient background.</p><p><strong>Results: </strong>Twenty-three deaths were observed during the follow-up period out of the 86 cases. Independent preoperative risk factors for survival were left ventricular ejection fraction, patient age and B-type natriuretic peptide (BNP) level. Among the patients with BNP <1000 pg/ml, 5-year survival after RA plus PMR-A was 84.7%, while RA alone was 78.6% and RA + PMR-P 57.1%. Cox proportional hazards regression adjusted for the preoperative risk factors showed a significantly higher hazard ratio of RA + PMR-P to RA + PMR-A (12.77, P = 0.011), while the hazard ratio of RA alone to RA + PMR-A was not significantly different. Furthermore, reverse remodelling of the left ventricle was observed for 3 years only in RA + PMR-A.</p><p><strong>Conclusions: </strong>Long-term survival for patients who underwent RA plus bilateral PMR-A was promising. Patients with significantly higher BNP had lower survival after valve repair for FMR.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/fe/ivac245.PMC9987210.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9541152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vivek Patel, Vicente Orozco-Sevilla, Joseph S Coselli
Cerebral protection during aortic arch surgery is based on reduction in metabolic demand (hypothermia) and delivery of metabolic nutrients (antegrade or retrograde cerebral perfusion techniques) to reduce the risk of stroke [1]. The risk of neurologic deficit remains 5–10%, despite the advent of adjunctive cerebral perfusion techniques in the 1990s [1, 2]. In a noble effort to determine the most effective type of adjunctive cerebral perfusion, Abjigitova et al. conducted the largest systematic review on this topic, a meta-analysis of 222 studies involving 43 720 patients [3]. The authors conclude that unilateral antegrade cerebral perfusion (ACP) had a lower mortality (6.6%) and stroke rate (4.8%), whereas bilateral ACP (9.1% mortality, 7.3% stroke), retrograde (7.8%, 6.4%) and deep hypothermic circulatory arrest without adjunctive perfusion (9.2%, 6.3%) had higher rates of mortality and stroke. However, these conclusions must be tempered with the following considerations. The data are diverse because it is mostly from observational studies, which include multiple procedures (hemiarch, total arch), indications for surgery (dissection, aneurysms) and experience (smaller and larger centres across the world). Importantly, there is no consensus on the criteria for selecting antegrade, bilateral antegrade, retrograde or deep hypothermic circulatory arrest without cerebral perfusion. Confounding considerations (pre-existing cerebrovascular anatomy, history of stroke, anticipated complexity of the procedure) may have led to the selection of 1 cerebral perfusion technique over another. The lowest temperature and total time of cerebral perfusion for each technique were also incomplete across the studies. Unfortunately, without this level of granularity, it becomes quite difficult to conclusively determine if 1 technique is indeed superior to another. Accordingly, the authors are careful to not directly compare 1 technique to another. Nonetheless, the meta-analysis adds to the literature by correlating the findings of similar studies by Angeloni et al., Lou et al. and our group [4–6]. We applaud the authors for reviewing 222 studies with 43,720 patients to gain insights into the trends regarding this important topic and providing real world data for the currently used techniques of cerebral perfusion. Any type of cerebral perfusion (antegrade or retrograde) is preferable compared to having no cerebral perfusion. There is a trend towards less use of retrograde cerebral perfusion [3]. Unilateral ACP is a relatively simple, reproducible technique which has gained popularity. However, since 6–17% of the adult population has an incomplete circle of Willis, our preferred technique is bilateral ACP, especially when a circulatory arrest time of greater than 30 min is anticipated due to the complexity of the procedure, i.e. total arch replacement [6]. Notably, Angeloni et al. [4] and Preventza et al. [6] and found no statistically significant difference in the mort
{"title":"Cerebral protection in aortic arch surgery: systematic review and meta-analysis.","authors":"Vivek Patel, Vicente Orozco-Sevilla, Joseph S Coselli","doi":"10.1093/icvts/ivac270","DOIUrl":"https://doi.org/10.1093/icvts/ivac270","url":null,"abstract":"Cerebral protection during aortic arch surgery is based on reduction in metabolic demand (hypothermia) and delivery of metabolic nutrients (antegrade or retrograde cerebral perfusion techniques) to reduce the risk of stroke [1]. The risk of neurologic deficit remains 5–10%, despite the advent of adjunctive cerebral perfusion techniques in the 1990s [1, 2]. In a noble effort to determine the most effective type of adjunctive cerebral perfusion, Abjigitova et al. conducted the largest systematic review on this topic, a meta-analysis of 222 studies involving 43 720 patients [3]. The authors conclude that unilateral antegrade cerebral perfusion (ACP) had a lower mortality (6.6%) and stroke rate (4.8%), whereas bilateral ACP (9.1% mortality, 7.3% stroke), retrograde (7.8%, 6.4%) and deep hypothermic circulatory arrest without adjunctive perfusion (9.2%, 6.3%) had higher rates of mortality and stroke. However, these conclusions must be tempered with the following considerations. The data are diverse because it is mostly from observational studies, which include multiple procedures (hemiarch, total arch), indications for surgery (dissection, aneurysms) and experience (smaller and larger centres across the world). Importantly, there is no consensus on the criteria for selecting antegrade, bilateral antegrade, retrograde or deep hypothermic circulatory arrest without cerebral perfusion. Confounding considerations (pre-existing cerebrovascular anatomy, history of stroke, anticipated complexity of the procedure) may have led to the selection of 1 cerebral perfusion technique over another. The lowest temperature and total time of cerebral perfusion for each technique were also incomplete across the studies. Unfortunately, without this level of granularity, it becomes quite difficult to conclusively determine if 1 technique is indeed superior to another. Accordingly, the authors are careful to not directly compare 1 technique to another. Nonetheless, the meta-analysis adds to the literature by correlating the findings of similar studies by Angeloni et al., Lou et al. and our group [4–6]. We applaud the authors for reviewing 222 studies with 43,720 patients to gain insights into the trends regarding this important topic and providing real world data for the currently used techniques of cerebral perfusion. Any type of cerebral perfusion (antegrade or retrograde) is preferable compared to having no cerebral perfusion. There is a trend towards less use of retrograde cerebral perfusion [3]. Unilateral ACP is a relatively simple, reproducible technique which has gained popularity. However, since 6–17% of the adult population has an incomplete circle of Willis, our preferred technique is bilateral ACP, especially when a circulatory arrest time of greater than 30 min is anticipated due to the complexity of the procedure, i.e. total arch replacement [6]. Notably, Angeloni et al. [4] and Preventza et al. [6] and found no statistically significant difference in the mort","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9717366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10323660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: We aimed to compare the outcomes of segmentectomy with those of lobectomy in clinical-stage IA radiological solid-predominant non-small-cell lung cancer (NSCLC) >2 cm in maximum tumour size.
Methods: A retrospective review was performed for radiological solid-predominant NSCLC >2-3 cm in maximum tumour size with a ground-glass opacity component on thin-section computed tomography. Multivariable or propensity score-matched analyses were performed to control for confounders for survival. Overall survival (OS) was analysed using a Kaplan-Meier estimation.
Results: Of the 215 eligible cases, segmentectomy and lobectomy were performed in 46 and 169 patients. Multivariable analysis revealed that standardized uptake value (hazard ratio: 1.148, 95% confidence interval: 1.032-1.276, P = 0.011) was an independently significant prognosticators of OS, while the operative mode was not associated (hazard ratio: 0.635, 95% confidence interval: 0.132-3.049, P = 0.570). The 5 y-OS was excellent and did not differ significantly between segmentectomy and lobectomy (95.5% vs 90.2%; P = 0.697), which was also shown in the propensity score analysis (96.8% vs 94.0%; P = 0.406), with a median follow-up time of 5.2 years. Locoregional recurrence was found in 2 (4.3%) segmentectomy and 13 (7.7%) lobectomy (P = 0.443). In the subgroup analysis stratified by solid component size, the 5 y-OS was similar between segmentectomy and lobectomy in the c-T1b and c-T1c groups, respectively [c-T1b (n = 163): 94.1% vs 91.8%; P = 0.887 and c-T1c (n = 52): 100% vs 84.9%; P = 0.197].
Conclusions: Segmentectomy showed similar oncological results compared to lobectomy in solid-predominant NSCLC with a ground-glass opacity component >2-3 cm in maximum tumour size. More prospective randomized trials are needed to adequately expand the indication of anatomic segmentectomy for early-stage NSCLC.
{"title":"Oncologic outcomes of segmentectomy for stage IA radiological solid-predominant lung cancer >2 cm in maximum tumour size.","authors":"Aritoshi Hattori, Takeshi Matsunaga, Mariko Fukui, Kazuya Takamochi, Shiaki Oh, Kenji Suzuki","doi":"10.1093/icvts/ivac246","DOIUrl":"https://doi.org/10.1093/icvts/ivac246","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to compare the outcomes of segmentectomy with those of lobectomy in clinical-stage IA radiological solid-predominant non-small-cell lung cancer (NSCLC) >2 cm in maximum tumour size.</p><p><strong>Methods: </strong>A retrospective review was performed for radiological solid-predominant NSCLC >2-3 cm in maximum tumour size with a ground-glass opacity component on thin-section computed tomography. Multivariable or propensity score-matched analyses were performed to control for confounders for survival. Overall survival (OS) was analysed using a Kaplan-Meier estimation.</p><p><strong>Results: </strong>Of the 215 eligible cases, segmentectomy and lobectomy were performed in 46 and 169 patients. Multivariable analysis revealed that standardized uptake value (hazard ratio: 1.148, 95% confidence interval: 1.032-1.276, P = 0.011) was an independently significant prognosticators of OS, while the operative mode was not associated (hazard ratio: 0.635, 95% confidence interval: 0.132-3.049, P = 0.570). The 5 y-OS was excellent and did not differ significantly between segmentectomy and lobectomy (95.5% vs 90.2%; P = 0.697), which was also shown in the propensity score analysis (96.8% vs 94.0%; P = 0.406), with a median follow-up time of 5.2 years. Locoregional recurrence was found in 2 (4.3%) segmentectomy and 13 (7.7%) lobectomy (P = 0.443). In the subgroup analysis stratified by solid component size, the 5 y-OS was similar between segmentectomy and lobectomy in the c-T1b and c-T1c groups, respectively [c-T1b (n = 163): 94.1% vs 91.8%; P = 0.887 and c-T1c (n = 52): 100% vs 84.9%; P = 0.197].</p><p><strong>Conclusions: </strong>Segmentectomy showed similar oncological results compared to lobectomy in solid-predominant NSCLC with a ground-glass opacity component >2-3 cm in maximum tumour size. More prospective randomized trials are needed to adequately expand the indication of anatomic segmentectomy for early-stage NSCLC.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9725180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10708876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Since postoperative complications, defined as Clavien-Dindo grade ≥II, correlate with long-term survival after lung resection surgery in patients with primary lung cancer, identification of intraoperative risk factors for postoperative complications is crucial for better perioperative management. In the present study, we investigated the possible association between intraoperative variables for use in anaesthetic management and Clavien-Dindo grade ≥II.
Methods: In this multi-institutional observational study, consecutive adult patients undergoing video-assisted thoracic surgery for primary lung cancer under general anaesthesia from March 2019 to April 2021 were enrolled. All patients were divided into 2 groups with Clavien-Dindo grade
Results: After univariable analysis between patients with Clavien-Dindo grade
Conclusions: Higher mean NR, as intraoperative variables for use in anaesthetic management, is associated with the higher incidence of postoperative complications after primary lung cancer surgery.
{"title":"Association between averaged intraoperative nociceptive response index and postoperative complications after lung resection surgery.","authors":"Takuma Okamoto, Yuka Matsuki, Hiroki Ogata, Hiroai Okutani, Ryusuke Ueki, Nobutaka Kariya, Tsuneo Tatara, Munetaka Hirose","doi":"10.1093/icvts/ivac258","DOIUrl":"https://doi.org/10.1093/icvts/ivac258","url":null,"abstract":"<p><strong>Objectives: </strong>Since postoperative complications, defined as Clavien-Dindo grade ≥II, correlate with long-term survival after lung resection surgery in patients with primary lung cancer, identification of intraoperative risk factors for postoperative complications is crucial for better perioperative management. In the present study, we investigated the possible association between intraoperative variables for use in anaesthetic management and Clavien-Dindo grade ≥II.</p><p><strong>Methods: </strong>In this multi-institutional observational study, consecutive adult patients undergoing video-assisted thoracic surgery for primary lung cancer under general anaesthesia from March 2019 to April 2021 were enrolled. All patients were divided into 2 groups with Clavien-Dindo grade <II and ≥II. Uni- and multivariable analyses were performed to identify intraoperative risk factors.</p><p><strong>Results: </strong>After univariable analysis between patients with Clavien-Dindo grade <II (n = 415) and ≥II (n = 121), multivariable analysis revealed higher averaged nociceptive response (NR) index during surgery (mean NR), male sex, lower body mass index, longer duration of surgery, higher blood loss and lower urine volume, as independent risk factors for postoperative complications. In sensitivity analysis, based on the cut-off value of mean NR for postoperative complications, all patients were divided into high and low mean NR groups. The incidence of postoperative complications was significantly higher in patients with high mean NR (n = 332) than in patients with low mean NR (n = 204; P < 0.001).</p><p><strong>Conclusions: </strong>Higher mean NR, as intraoperative variables for use in anaesthetic management, is associated with the higher incidence of postoperative complications after primary lung cancer surgery.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9725181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10347079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andreas Koster, Armin Zittermann, Jan F Gummert, Vera von Dossow, Marcus-André Deutsch
We retrospectively compared transfusion rates and early outcomes in 1621 consecutive patients with preoperative anaemia undergoing off-pump coronary artery bypass grafting (OPCAB) or on-pump coronary artery bypass grafting (ONCAB) surgery using a propensity score analysis with inverse probability of treatment weighting. Endpoints were transfusions, early morbidity, and mortality. Surgeries were performed by 45 dedicated OPCAB and/or ONCAB surgeons during the 10-year study period. Operative data did not differ significantly between study groups with the exception of a more frequent use of bilateral internal mammary artery revascularization approach in OPCAB patients than ONCAB patients. OPCAB was associated with fewer transfusions and lower risk for the need of postoperative renal replacement therapy, but higher risk of wound infections than ONCAB. Perioperative stroke risk and 30-day and 1-year mortality did not differ significantly between the groups. Our data in a 'real-world setting' indicate that in patients with preoperative anaemia both ONCAB and OPCAB are feasible surgical approaches regarding early morbidity and mortality.
{"title":"Transfusions and early outcomes in anaemic patients undergoing off- or on-pump coronary artery bypass grafting.","authors":"Andreas Koster, Armin Zittermann, Jan F Gummert, Vera von Dossow, Marcus-André Deutsch","doi":"10.1093/icvts/ivac276","DOIUrl":"https://doi.org/10.1093/icvts/ivac276","url":null,"abstract":"<p><p>We retrospectively compared transfusion rates and early outcomes in 1621 consecutive patients with preoperative anaemia undergoing off-pump coronary artery bypass grafting (OPCAB) or on-pump coronary artery bypass grafting (ONCAB) surgery using a propensity score analysis with inverse probability of treatment weighting. Endpoints were transfusions, early morbidity, and mortality. Surgeries were performed by 45 dedicated OPCAB and/or ONCAB surgeons during the 10-year study period. Operative data did not differ significantly between study groups with the exception of a more frequent use of bilateral internal mammary artery revascularization approach in OPCAB patients than ONCAB patients. OPCAB was associated with fewer transfusions and lower risk for the need of postoperative renal replacement therapy, but higher risk of wound infections than ONCAB. Perioperative stroke risk and 30-day and 1-year mortality did not differ significantly between the groups. Our data in a 'real-world setting' indicate that in patients with preoperative anaemia both ONCAB and OPCAB are feasible surgical approaches regarding early morbidity and mortality.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9c/da/ivac276.PMC9695756.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10673458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gaetana Messina, Mary Bove, Giovanni Natale, Antonio Noro, Mario Martone, Giorgia Opromolla, Vincenzo Di Filippo, Beatrice Leonardi, Morena Fasano, Rita Polito, Alfonso Fiorelli, Mario Santini, Giovanni Vicidomini
Objectives: Application of video-assisted thoracoscopy brought lung surgery into the minimally invasive era; the lack of tactile feedback using VATS, remains a disadvantage because surgeons are unable to locate lesions with a finger or device. This study aimed to investigate the effectiveness, the applicability and the utility of intraoperative ultrasound (IU), for the localization of small ground-glass opacity (GGO) lesions in the parenchyma, as a guide in finding their margins in a deflated lung.
Materials and methods: We included 15 consecutive patients undergoing diagnostic resection of GGOs via VATS in the Thoracic Surgery Unit of the University of 'Luigi Vanvitelli' of Naples from November 2019 to December 2021. They were under general anaesthesia, when the lung had been collapsed, the probe was placed in the region where the target lesion was thought to reside on the basis of low-dose computed tomography scanning. GGO could be identified their sizes, echo levels and posterior echo was recorded by IU when the lung was completely deflated.
Results: We conducted a retrospective single-centre study. All GGOs were identified by IU. The mean size and depth were 14.1 ± 0.5 and 4.8 ± 0.3 mm, respectively. Six (40%) lesions had hyperechoic patterns, 9 (60%) had mixed echogenicity where the hyperechoic patterns were irregularly mixed with hypoechoic patterns. The final diagnoses included 2 (15%) atypical adenomatous hyperplasia; 2 (15%) adenocarcinomas in situ; 3 (23%) minimally invasive adenocarcinomas and 6 (46%) invasive adenocarcinomas.
Conclusions: The results of our study showed that IU could safely and effectively detect GGOs.
{"title":"Ultrasound location of ground-glass opacity during thoracoscopic surgery.","authors":"Gaetana Messina, Mary Bove, Giovanni Natale, Antonio Noro, Mario Martone, Giorgia Opromolla, Vincenzo Di Filippo, Beatrice Leonardi, Morena Fasano, Rita Polito, Alfonso Fiorelli, Mario Santini, Giovanni Vicidomini","doi":"10.1093/icvts/ivac234","DOIUrl":"https://doi.org/10.1093/icvts/ivac234","url":null,"abstract":"<p><strong>Objectives: </strong>Application of video-assisted thoracoscopy brought lung surgery into the minimally invasive era; the lack of tactile feedback using VATS, remains a disadvantage because surgeons are unable to locate lesions with a finger or device. This study aimed to investigate the effectiveness, the applicability and the utility of intraoperative ultrasound (IU), for the localization of small ground-glass opacity (GGO) lesions in the parenchyma, as a guide in finding their margins in a deflated lung.</p><p><strong>Materials and methods: </strong>We included 15 consecutive patients undergoing diagnostic resection of GGOs via VATS in the Thoracic Surgery Unit of the University of 'Luigi Vanvitelli' of Naples from November 2019 to December 2021. They were under general anaesthesia, when the lung had been collapsed, the probe was placed in the region where the target lesion was thought to reside on the basis of low-dose computed tomography scanning. GGO could be identified their sizes, echo levels and posterior echo was recorded by IU when the lung was completely deflated.</p><p><strong>Results: </strong>We conducted a retrospective single-centre study. All GGOs were identified by IU. The mean size and depth were 14.1 ± 0.5 and 4.8 ± 0.3 mm, respectively. Six (40%) lesions had hyperechoic patterns, 9 (60%) had mixed echogenicity where the hyperechoic patterns were irregularly mixed with hypoechoic patterns. The final diagnoses included 2 (15%) atypical adenomatous hyperplasia; 2 (15%) adenocarcinomas in situ; 3 (23%) minimally invasive adenocarcinomas and 6 (46%) invasive adenocarcinomas.</p><p><strong>Conclusions: </strong>The results of our study showed that IU could safely and effectively detect GGOs.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10484571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Viktoria H M Weixler, Kira Kuschnerus, Olga Romanchenko, Stanislav Ovroutski, Mi-Young Cho, Felix Berger, Matthias Sigler, Nicodème Sinzobahamvya, Joachim Photiadis, Peter Murin
Objective: The aim was to report mid-term performance of decellularized equine pericardium used for repair of various congenital heart defects in the pediatric population.
Methods: A retrospective review of all patients undergoing patch implantation between 2016 - 2020 was performed. Patch quality, surgical handling, hemostasis and early patch-related complications were studied on all patients. Mid-term performance was observed in patients with ≥12 months follow-up and intact patch at discharge (without reoperation/stent implantation).
Results: A total of 201 patients with median age of 2.5 years [interquartile range (IQR): 0.6-6.5] underwent 207 procedures at 314 implant locations. The patch was used in following numbers/locations: 171 for pulmonary artery (PA) augmentation, 36 for aortic repair, 35 for septal defect closure, 22 for valvular repair and 50 at other locations. Early/30-day mortality was 6.5%. Early patch-related reoperations/stent implantations occurred in 28 locations (8.9%). No patch-related complications were noted except for bleeding from implant site in three locations (1%). Follow-up ≥ 12 months was available for 132 patients/200 locations. During a median follow-up of 29.7 months [IQR: 20.7-38.3], 53 patch-related reoperations/catheter reinterventions occurred (26.5%) with the majority in PA position (88.7%, 47/53). Overall 12- and 24-months freedom from patch-related reoperation/catheter reintervention per location was 91.5% (95% CI: 86.7%-94.6%) and 85.2% (95% CI: 78.9%-89.6%) respectively.
Conclusion: Decellularized equine pericardium used for repair of various congenital heart defects showed acceptable mid-term performance. Reoperation/reintervention rates were in a range as observed with other xenogeneic materials previously reported articles, occurring most frequently after PA augmentation.
{"title":"Mid-term performance of decellularized equine pericardium in congenital heart surgery.","authors":"Viktoria H M Weixler, Kira Kuschnerus, Olga Romanchenko, Stanislav Ovroutski, Mi-Young Cho, Felix Berger, Matthias Sigler, Nicodème Sinzobahamvya, Joachim Photiadis, Peter Murin","doi":"10.1093/icvts/ivac269","DOIUrl":"10.1093/icvts/ivac269","url":null,"abstract":"<p><strong>Objective: </strong>The aim was to report mid-term performance of decellularized equine pericardium used for repair of various congenital heart defects in the pediatric population.</p><p><strong>Methods: </strong>A retrospective review of all patients undergoing patch implantation between 2016 - 2020 was performed. Patch quality, surgical handling, hemostasis and early patch-related complications were studied on all patients. Mid-term performance was observed in patients with ≥12 months follow-up and intact patch at discharge (without reoperation/stent implantation).</p><p><strong>Results: </strong>A total of 201 patients with median age of 2.5 years [interquartile range (IQR): 0.6-6.5] underwent 207 procedures at 314 implant locations. The patch was used in following numbers/locations: 171 for pulmonary artery (PA) augmentation, 36 for aortic repair, 35 for septal defect closure, 22 for valvular repair and 50 at other locations. Early/30-day mortality was 6.5%. Early patch-related reoperations/stent implantations occurred in 28 locations (8.9%). No patch-related complications were noted except for bleeding from implant site in three locations (1%). Follow-up ≥ 12 months was available for 132 patients/200 locations. During a median follow-up of 29.7 months [IQR: 20.7-38.3], 53 patch-related reoperations/catheter reinterventions occurred (26.5%) with the majority in PA position (88.7%, 47/53). Overall 12- and 24-months freedom from patch-related reoperation/catheter reintervention per location was 91.5% (95% CI: 86.7%-94.6%) and 85.2% (95% CI: 78.9%-89.6%) respectively.</p><p><strong>Conclusion: </strong>Decellularized equine pericardium used for repair of various congenital heart defects showed acceptable mid-term performance. Reoperation/reintervention rates were in a range as observed with other xenogeneic materials previously reported articles, occurring most frequently after PA augmentation.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9104794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nawin L Ramdat Misier, Yannick J H J Taverne, Mathijs S van Schie, Rohit K Kharbanda, Wouter J van Leeuwen, Janneke A E Kammeraad, Ad J J C Bogers, Natasja M S de Groot
Early post-operative sinus node dysfunction (SND) is common in paediatric patients undergoing surgical correction of congenital heart defects (CHD). At present, the pathophysiology of these arrhythmias is incompletely understood. In this case series, we present three paediatric patients in whom we performed intraoperative epicardial mapping and who developed early post-operative SND. All patients had either an inferior or multiple sinoatrial node (SAN) exit sites, in addition to extensive conduction disorders at superior and inferior right atrium. Our findings contribute to the hypothesis that pre-existing alterations in SAN exit sites in combination with atrial conduction disorders may predispose paediatric patients with CHD for early post-operative SND. Such insights in the development of arrhythmias are crucial as it may be the first step in identifying high-risk patients.
在接受先天性心脏缺陷（CHD）手术矫正的儿科患者中，术后早期窦房结功能障碍（SND）很常见。目前，这些心律失常的病理生理学尚不完全清楚。在本病例系列中，我们介绍了三例在术中进行心外膜测图并在术后早期出现 SND 的儿科患者。除了右心房上部和下部的广泛传导障碍外，所有患者都有一个下部或多个中房结 (SAN) 出口位点。我们的研究结果提出了一个假设，即 SAN 出口位点的原有改变与心房传导障碍相结合，可能会导致患有心脏病的儿科患者术后早期出现 SND。这种对心律失常发展的认识至关重要，因为它可能是识别高危患者的第一步。
{"title":"Unravelling early sinus node dysfunction after pediatric cardiac surgery: a pre-existing arrhythmogenic substrate.","authors":"Nawin L Ramdat Misier, Yannick J H J Taverne, Mathijs S van Schie, Rohit K Kharbanda, Wouter J van Leeuwen, Janneke A E Kammeraad, Ad J J C Bogers, Natasja M S de Groot","doi":"10.1093/icvts/ivac262","DOIUrl":"10.1093/icvts/ivac262","url":null,"abstract":"<p><p>Early post-operative sinus node dysfunction (SND) is common in paediatric patients undergoing surgical correction of congenital heart defects (CHD). At present, the pathophysiology of these arrhythmias is incompletely understood. In this case series, we present three paediatric patients in whom we performed intraoperative epicardial mapping and who developed early post-operative SND. All patients had either an inferior or multiple sinoatrial node (SAN) exit sites, in addition to extensive conduction disorders at superior and inferior right atrium. Our findings contribute to the hypothesis that pre-existing alterations in SAN exit sites in combination with atrial conduction disorders may predispose paediatric patients with CHD for early post-operative SND. Such insights in the development of arrhythmias are crucial as it may be the first step in identifying high-risk patients.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/21/08/ivac262.PMC10021071.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9131631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Subclinical leaflet thrombosis is a silent phenomenon commonly observed following transcatheter aortic valve implantation (TAVI). Leaflet thrombosis is associated with ischaemic complications and structural valve deterioration. Prior studies have shown that blood stasis in neo-sinus contributes to the initiation and growth of subclinical leaflet thrombosis. This study aimed to quantify temporal and spatial characteristics of the flow field from a fundamental perspective.
Methods: in vitro experimental analysis and fluid-solid interaction simulations were employed to characterize the flow field of a transcatheter aortic valve (TAV) with an intra-annular design in a pulse duplicator. Blood residence time (BRT) and flow-induced viscous shear stress were measured in the neo-sinus and on the surface of TAV leaflets.
Results: Temporal and spatial velocity variations were observed in neo-sinus, indicating that the flow is time-dependent and fully three-dimensional. The degree of blood stasis in the neo-sinus (bulk fluid) and on the surface of the TAV leaflets highly depends on the local flow characteristics. Regional flow variation in the neo-sinus resulted in substantial variations in BRT magnitude in the neo-sinus and on the surface of the TAV leaflet. Areas with a high degree of blood stasis were observed near the fixed boundary edge of the leaflets.
Conclusions: The study indicated that leaflet motion is a primary driver of flow in neo-sinus. Considering the substantial variations in BRT magnitude in the neo-sinus (bulk fluid), blood stasis should be quantified locally on the surface of foreign (valve) materials to avoid errors in forecasting the risk of subclinical leaflet thrombosis in patients undergoing TAVI.
{"title":"On the Three-dimensionality of Flow in the Neo-sinus and its Implications for Subclinical Leaflet Thrombosis.","authors":"Dong Qiu, Ali N Azadani","doi":"10.1093/icvts/ivac263","DOIUrl":"10.1093/icvts/ivac263","url":null,"abstract":"<p><strong>Objectives: </strong>Subclinical leaflet thrombosis is a silent phenomenon commonly observed following transcatheter aortic valve implantation (TAVI). Leaflet thrombosis is associated with ischaemic complications and structural valve deterioration. Prior studies have shown that blood stasis in neo-sinus contributes to the initiation and growth of subclinical leaflet thrombosis. This study aimed to quantify temporal and spatial characteristics of the flow field from a fundamental perspective.</p><p><strong>Methods: </strong>in vitro experimental analysis and fluid-solid interaction simulations were employed to characterize the flow field of a transcatheter aortic valve (TAV) with an intra-annular design in a pulse duplicator. Blood residence time (BRT) and flow-induced viscous shear stress were measured in the neo-sinus and on the surface of TAV leaflets.</p><p><strong>Results: </strong>Temporal and spatial velocity variations were observed in neo-sinus, indicating that the flow is time-dependent and fully three-dimensional. The degree of blood stasis in the neo-sinus (bulk fluid) and on the surface of the TAV leaflets highly depends on the local flow characteristics. Regional flow variation in the neo-sinus resulted in substantial variations in BRT magnitude in the neo-sinus and on the surface of the TAV leaflet. Areas with a high degree of blood stasis were observed near the fixed boundary edge of the leaflets.</p><p><strong>Conclusions: </strong>The study indicated that leaflet motion is a primary driver of flow in neo-sinus. Considering the substantial variations in BRT magnitude in the neo-sinus (bulk fluid), blood stasis should be quantified locally on the surface of foreign (valve) materials to avoid errors in forecasting the risk of subclinical leaflet thrombosis in patients undergoing TAVI.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e6/77/ivac263.PMC10021490.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9135587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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