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Delayed bowel necrosis due to inferior mesenteric artery occlusion in Stanford type A acute aortic dissection. Stanford A型急性主动脉夹层中肠系膜下动脉闭塞引起的延迟性肠坏死。
4区 医学 Q2 Medicine Pub Date : 2022-11-08 DOI: 10.1093/icvts/ivac265
Yasuhiko Kawaguchi, Yuichiro Fukumoto, Mototsugu Tamaki, Hideki Kitamura

Although inferior mesenteric artery occlusion due to acute aortic dissection sometimes occurs, it is usually not considered an important finding. Herein, we present an extremely rare case of delayed bowel ischaemia due to inferior mesenteric artery occlusion in Stanford type A acute aortic dissection that highlights the need for cardiac surgeons to be mindful of inferior mesenteric artery occlusion in patients with superior mesenteric artery dissection or vascular anomalies in the mesenteric arteries.

虽然有时会发生急性主动脉夹层引起的肠系膜下动脉闭塞,但通常不认为这是一个重要的发现。在此,我们报告了一例极其罕见的Stanford A型急性主动脉夹层患者因肠系膜下动脉闭塞导致的延迟性肠缺血,这突出了心脏外科医生在肠系膜上动脉夹层或肠系膜动脉血管异常患者中注意肠系膜下动脉闭塞的必要性。
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引用次数: 0
Ultrasound location of ground-glass opacity during thoracoscopic surgery. 胸腔镜手术中毛玻璃混浊的超声定位。
4区 医学 Q2 Medicine Pub Date : 2022-11-08 DOI: 10.1093/icvts/ivac234
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.

目的:视频胸腔镜的应用使肺部手术进入微创时代;使用VATS缺乏触觉反馈仍然是一个缺点,因为外科医生无法用手指或设备定位病变。本研究旨在探讨术中超声(IU)在肺实质小磨玻璃混浊(GGO)病变定位中的有效性、适用性和实用性,并以此作为在肺萎陷中寻找其边缘的指导。材料和方法:我们纳入了2019年11月至2021年12月在那不勒斯“Luigi Vanvitelli”大学胸外科通过VATS进行GGOs诊断性切除术的连续15例患者。他们处于全身麻醉状态,当肺部塌陷时,根据低剂量计算机断层扫描,探针被放置在目标病变所在的区域。在肺完全放气时,可通过超声识别其大小和回声水平,并记录后腔回声。结果:我们进行了一项回顾性单中心研究。所有ggo均通过IU进行鉴定。平均大小为14.1±0.5 mm,深度为4.8±0.3 mm。6例(40%)病变为高回声模式,9例(60%)为混合回声,高回声模式不规则地与低回声模式混合。最终诊断包括2例(15%)非典型性腺瘤性增生;2例(15%)原位腺癌;3例(23%)为微创性腺癌,6例(46%)为浸润性腺癌。结论:本研究结果表明,IU能够安全有效地检测出GGOs。
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引用次数: 2
Transfusions and early outcomes in anaemic patients undergoing off- or on-pump coronary artery bypass grafting. 输血和早期结局的贫血患者接受无泵或有泵冠状动脉旁路移植术。
4区 医学 Q2 Medicine Pub Date : 2022-11-08 DOI: 10.1093/icvts/ivac276
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.

我们回顾性比较了1621例连续接受非泵式冠状动脉旁路移植术(OPCAB)或非泵式冠状动脉旁路移植术(ONCAB)手术的术前贫血患者的输血率和早期结局,采用治疗加权逆概率的倾向评分分析。终点是输血、早期发病率和死亡率。在10年的研究期间,手术由45名专门的OPCAB和/或ONCAB外科医生进行。除了OPCAB患者比ONCAB患者更频繁地使用双侧乳腺内动脉重建术外,各研究组之间的手术数据没有显著差异。OPCAB与输血减少和术后肾替代治疗风险降低相关,但与ONCAB相比伤口感染风险更高。围手术期卒中风险、30天和1年死亡率在两组间无显著差异。我们在“现实环境”中的数据表明,在术前贫血患者中,ONCAB和OPCAB都是早期发病率和死亡率方面可行的手术方法。
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引用次数: 0
Retrograde type A aortic dissection: a different evil. 逆行A型主动脉夹层:另一种罪恶。
4区 医学 Q2 Medicine Pub Date : 2022-11-08 DOI: 10.1093/icvts/ivac264
Ana Lopez-Marco, Benjamin Adams, Aung Ye Oo

Retrograde type A aortic dissection (RTAAD) can be spontaneous or secondary to the instrumentation of the descending and thoraco-abdominal aorta. It has anatomical differences compared to antegrade type A aortic dissection that impact the management and prognosis. Treatment is not standardized. We report our approach to spontaneous RTAAD in our institution between 2018 and 2022 (n = 15). The mean age was 60.1 years and 93% were male. Aortic valve, coronary arteries and supra-aortic trunks were spared by the dissection in 80% of the cases; distal extension to iliacs was common and lower limb malperfusion was present in 4 cases (27%). The ascending aorta was dilated at presentation in 60% of the cases. Emergency surgery with arch/FET replacement was offered to 11 patients (73%); 3 patients (20%) received a limited proximal aortic repair; 1 patient was treated conservatively. Overall mortality was 47% (100% for limited proximal repair and 22% for those who received arch/FET). We advocate for aggressive treatment of RTAAD excluding the primary entry tear to prevent immediate- and mid-term complications.

逆行A型主动脉夹层(RTAAD)可以是自发的或继发于下行主动脉和胸腹主动脉内固定。与顺行性A型主动脉夹层相比,其解剖差异影响了处理和预后。治疗不规范。我们报告了我们在2018年至2022年期间在本机构自发性RTAAD的方法(n = 15)。平均年龄60.1岁,93%为男性。80%的病例主动脉瓣、冠状动脉和主动脉上干被剥离;髂远端延伸是常见的,下肢灌注不良4例(27%)。60%的病例在发病时升主动脉扩张。11例患者(73%)接受了急诊手术并置换足弓/FET;3例(20%)接受了主动脉近端有限修复术;保守治疗1例。总死亡率为47%(有限近端修复为100%,弓/FET组为22%)。我们提倡积极治疗RTAAD,排除原发性入口撕裂,以防止即时和中期并发症。
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引用次数: 0
Mid-term performance of decellularized equine pericardium in congenital heart surgery. 脱细胞马心包在先天性心脏病手术中的中期表现。
4区 医学 Q2 Medicine Pub Date : 2022-11-07 DOI: 10.1093/icvts/ivac269
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.

目的:旨在报告用于修复小儿各种先天性心脏缺损的脱细胞马心包的中期性能:目的是报告用于修复儿科各种先天性心脏缺损的脱细胞马心包的中期表现:方法:对 2016-2020 年间接受补片植入术的所有患者进行回顾性研究。对所有患者的补片质量、手术操作、止血和早期补片相关并发症进行了研究。对随访时间≥12个月、出院时补片完好无损(无再次手术/支架植入)的患者进行中期表现观察:中位年龄为 2.5 岁[四分位距(IQR):0.6-6.5]的 201 名患者在 314 个植入位置接受了 207 次手术。使用补片的人数/位置如下171例用于肺动脉 (PA) 增强术,36例用于主动脉修复术,35例用于房间隔缺损闭合术,22例用于瓣膜修复术,50例用于其他部位。早期/30 天死亡率为 6.5%。与早期补片相关的再手术/支架植入发生在 28 个部位(8.9%)。除 3 处(1%)植入部位出血外,未发现与补片相关的并发症。132 名患者/200 个部位的随访时间≥ 12 个月。在 29.7 个月[IQR:20.7-38.3]的中位随访期间,发生了 53 次与贴片相关的再手术/导管再介入(26.5%),其中大部分发生在 PA 位置(88.7%,47/53)。12个月和24个月内,每个位置的补片相关再手术/导管再介入的总体自由度分别为91.5%(95% CI:86.7%-94.6%)和85.2%(95% CI:78.9%-89.6%):结论:用于修复各种先天性心脏缺损的脱细胞马心包在中期表现尚可。再手术/再介入率与之前报道的其他异种材料的再手术/再介入率在一定范围内,最常发生在PA增强术后。
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引用次数: 0
Unravelling early sinus node dysfunction after pediatric cardiac surgery: a pre-existing arrhythmogenic substrate. 揭示小儿心脏手术后的早期窦房结功能障碍:预先存在的致心律失常基质。
4区 医学 Q2 Medicine Pub Date : 2022-11-02 DOI: 10.1093/icvts/ivac262
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。
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引用次数: 0
On the Three-dimensionality of Flow in the Neo-sinus and its Implications for Subclinical Leaflet Thrombosis. 新窦内血流的三维性及其对亚临床肺叶血栓形成的影响
4区 医学 Q2 Medicine Pub Date : 2022-10-22 DOI: 10.1093/icvts/ivac263
Dong Qiu, Ali N Azadani

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.

目的:亚临床瓣叶血栓是经导管主动脉瓣植入术(TAVI)后常见的一种无声现象。瓣叶血栓与缺血性并发症和瓣膜结构恶化有关。先前的研究表明,新窦道中的血液淤积会导致亚临床瓣叶血栓的形成和发展。本研究旨在从根本上量化流场的时间和空间特征。方法:采用体外实验分析和流固相互作用模拟来描述脉冲复制器中具有环内设计的经导管主动脉瓣(TAV)的流场特征。在新窦和 TAV 瓣膜表面测量了血液停留时间(BRT)和流动引起的粘性剪切应力:结果:在新窦中观察到了时间和空间速度的变化,表明血流具有时间依赖性和全三维性。新窦内(体液)和 TAV 小叶表面的血液瘀滞程度在很大程度上取决于局部血流特征。新窦道内的区域血流变化导致新窦道和 TAV 小叶表面的 BRT 幅值发生巨大变化。在瓣叶固定边界边缘附近观察到血液高度淤滞的区域:研究表明,瓣叶运动是新窦内血流的主要驱动因素。考虑到新窦道(大量流体)中 BRT 量级的巨大变化,应对外来(瓣膜)材料表面的局部瘀血进行量化,以避免在预测 TAVI 患者亚临床瓣叶血栓风险时出现误差。
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引用次数: 0
AORTLANTIC: French registry of aortic valve-sparing root replacement, preliminary multicentre results from western France. 主动脉瓣保留根置换术的法国注册,来自法国西部的初步多中心结果。
4区 医学 Q2 Medicine Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac240
Clément Dubost, Jacques Tomasi, Antoine Ducroix, Kevin Pluchon, Pierre Escrig, Olivier Fouquet, Arthur Aupart, Alain Mirza, Imen Fellah, Eric Bezon, Christophe Baufreton, Jean Marc El Arid, Jean-Christian Roussel, Jean-Philippe Verhoye, Thomas Senage

Objectives: Aortic root aneurysms often affect younger patients in whom valve-sparing surgery is challenging. Among current techniques, aortic valve-sparing root replacement described by Tirone David has shown encouraging results. The AORTLANTIC registry was instituted for a multicentre long-term evaluation of this procedure. The current initial study evaluates the hospital outcomes of the procedure.

Methods: This is a retrospective study of patients operated between 1 January 2004 and 31 December 2020 in 6 hospitals in western France. All study data were recorded in the national digital database of the French Society of Cardiac Surgery: EPICARD.

Results: A total of 524 consecutive patients with a mean age of 53 (15.1) years underwent surgery. 13% (n = 68) of patients presented with acute aortic dissection, 16.5% (n = 86) had associated connective tissue pathology and 7.3% (n = 37) had bicuspid aortic valves. Preoperative aortic regurgitation (AR) ≥2/4 was present in 65.3% (n = 341) of patients. Aortic valvuloplasty was required in 18.6% (n = 95) of patients. At discharge, 92.8% (n = 461) of patients had no or 1/4 AR. The stroke rate was 1.9% (n = 10). Intra-hospital mortality was 1.9% (n = 10).

Conclusions: The AORTLANTIC registry includes 6 centres in western France with >500 patients. Despite numerous complex cases (acute aortic dissections, bicuspid aortic valves, preoperative AR), aortic valve-sparing root replacement has a low intra-hospital mortality. The initial encouraging results of this multicentre study warrant further long-term evaluation by future studies.

目的:主动脉根部动脉瘤常发生在年轻患者身上,他们的瓣膜保留手术具有挑战性。在目前的技术中,Tirone David描述的保留主动脉瓣的根置换已经显示出令人鼓舞的结果。为对该手术进行多中心的长期评估,建立了aoratlantic登记系统。目前的初步研究评估了手术的医院结果。方法:回顾性研究2004年1月1日至2020年12月31日在法国西部6家医院手术的患者。所有的研究数据都记录在法国心脏外科学会的国家数字数据库:EPICARD中。结果:共有524例患者连续接受手术治疗,平均年龄53(15.1)岁。13% (n = 68)的患者表现为急性主动脉夹层,16.5% (n = 86)的患者有相关的结缔组织病理,7.3% (n = 37)的患者有二尖瓣主动脉瓣。术前主动脉瓣返流(AR)≥2/4的患者占65.3% (n = 341)。18.6% (n = 95)的患者需要主动脉瓣成形术。出院时,92.8% (n = 461)的患者无AR或1/4 AR,卒中发生率为1.9% (n = 10)。院内死亡率为1.9% (n = 10)。结论:aoratlantic登记包括法国西部的6个中心,超过500例患者。尽管有许多复杂的病例(急性主动脉夹层、二尖瓣主动脉瓣、术前AR),保留主动脉瓣的主动脉根置换术具有较低的院内死亡率。这项多中心研究的初步结果令人鼓舞,值得未来的研究进行进一步的长期评估。
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引用次数: 0
Editorial: looking for the best treatment of bicuspid aortic valves. 社论:寻找治疗双尖瓣主动脉瓣的最佳方法。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac253
Ruggero De Paulis
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引用次数: 0
Aortic wrapping is life-saving in high-risk acute aortic dissection and intramural haematoma. 主动脉包裹术是挽救高危急性主动脉夹层和壁内血肿的重要手段。
4区 医学 Q2 Medicine Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac254
Thierry Carrel, Juri Sromicki, Martin Schmiady, Raed Aser, Ahmed Ouda, Paul Robert Vogt

Aortic wrapping is a controversial repair in patients presenting with acute type A aortic dissection or intramural haematoma, but this method may be a potential alternative to medical treatment or conventional repair in patients aged >80 years and in those presenting with prohibitive co-morbidities such as stroke, circulatory collapse, full oral anticoagulation with the last generation drugs. We report on 5 high-risk and/or patients over 80 years who received external aortic wrapping with or without cardiopulmonary bypass during the last 18 months. All survived the procedure and could be extubated early postoperatively. No patient remained on the intensive care longer than 2 days and all were discharged without additional complications. Postoperative radiological control was acceptable and no patient had any new aortic event up to 18 months postoperatively.

对于急性a型主动脉夹层或壁内血肿患者,主动脉包裹术是一种有争议的修复方法,但对于年龄>80岁的患者,以及那些有中风、循环衰竭、全口服抗凝等禁忌性合并症的患者,这种方法可能是药物治疗或传统修复的潜在替代方法。我们报告了5例80岁以上的高危和/或患者在过去18个月内接受了外主动脉包裹术,伴或不伴体外循环。所有患者均存活,术后早期可拔管。所有患者均未在重症监护室停留超过2天,出院时均无其他并发症。术后放射学控制是可接受的,术后18个月没有患者出现任何新的主动脉事件。
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引用次数: 0
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Interactive cardiovascular and thoracic surgery
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