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A word to the wise …. 给智者的一句话....
4区 医学 Q2 Medicine Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac252
Augusto D'Onofrio, Gino Gerosa
We read with interest Dr. David’s commentary [1] about our recently published paper entitled ‘Transapical beating heart mitral valve repair versus conventional surgery: a propensity-matched study’ [2]. We would like to clarify some aspects that in our opinion are crucial. We are afraid that Dr. David missed one of the key points of our study that, despite its intrinsic limitations that limit the generalizability of our results, shows that in patients with favourable anatomy (prolapse of the P2 segment), there seem to be no differences in terms of freedom from recurrent mitral regurgitation and of freedom from reoperation. Therefore, despite the worse outcomes in the overall population (this is what Dr. David refers to in his commentary), in well-selected patients, transapical beating heart mitral valve repair with neochords implantation (NC) provides similar outcomes to conventional surgery up to 5 years. We respectfully disagree with Dr. David when he states that NC should be selected in inoperable patients only after excluding the feasibility of a transcatheter Mitraclip (Abbott laboratories, Chicago, IL, USA). There are no data supporting this statement since there are no studies comparing NC and Mitraclip. However, in a recently published article about 100 NC patients with 5-year follow-up (including technical and patient-selection learning curves), we found an incidence of reoperation and of severe mitral regurgitation (MR), in patients with favourable anatomy, of 14.7% and 14.7%, respectively [3]. On the other hand, in the EVEREST-II study (therefore in highly selected patients), rates of reoperation and 3+ or 4+ MR at 5 years in the percutaneous repair group were 43% and 19%, respectively [4]. Noteworthy, 3+ and 4+ MR do not include moderate MR but only moderate– severe and severe MR and also, the EVEREST-II included both degenerative and functional MR. Another important aspect to consider is that so far over 100,000 patients over a 17-year period have been treated with Mitraclip, demonstrating the perseverance of our interventional cardiology colleagues (and some surgeons) that, despite the poor initial outcomes of this procedure, have worked to transform a suboptimal conventional surgical procedure (edge to edge with no annular stabilization) into a successful microinvasive alternative, optimizing technology, technique and patient selection [5, 6]. Meanwhile, NC procedures have been performed only in 1000 patients and we are still using the first-generation device. There are still many aspects that may be improved in order to achieve better results. We certainly agree that conventional surgery so far provides unsurpassed optimal outcomes for degenerative MR, especially if performed in high-volume centres and by highly committed surgeons or, even better, by world-recognized Masters as Dr. David. His results are impressive but the real world is a different thing and such numbers are difficult to replicate. The truth is that not all tennis
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引用次数: 0
Observed versus expected morbidity and mortality in patients undergoing mitral valve repair. 观察到的与预期的二尖瓣修复患者的发病率和死亡率。
4区 医学 Q2 Medicine Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac241
Paige Newell, Richard Tartarini, Sameer Hirji, Morgan Harloff, Siobhan McGurk, Olena Cherkasky, Tsuyoshi Kaneko

Objectives: Mitral valve repair (MVP) is the gold standard treatment for degenerative mitral regurgitation. With the expansion of transcatheter technologies, this study compares the outcome of MVP in low-risk and non-low-risk patients to serve as a benchmark.

Methods: This retrospective, single-institution study examined all patients who underwent MVP for primary mitral regurgitation from 2005 to 2018. Patients were stratified into 2 risk categories: low-risk [Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (STS-PROM) ≤2%] and non-low risk (STS-PROM > 2% or age > 75), with a subgroup of very low risk (STS-PROM ≤1%, age <75).

Results: A total of 1207 patients were included, and 1053 patients were classified as low risk and 154 as non-low risk. The non-low-risk group was significantly older, more likely to be female, and had a higher comorbidity burden than the low-risk group (all P < 0.01). For the low-risk group, the observed-to-expected (O:E) STS mortality ratio was 0.4 and the composite morbidity and mortality ratio was 0.6, whereas for the non-low risk, the O:E mortality was 1.5 and the composite morbidity and mortality was 0.9. When the subgroup of very low-risk group was assessed, the mortality O:E ratio was 0.

Conclusions: The observed composite morbidity and mortality of patients undergoing MVP were persistently lower in low-risk patients, mainly driven by the very low-risk group. The excellent outcome of MVP in low-risk patients should be validated on a national level to determine how transcatheter technologies can be utilized in these patients.

目的:二尖瓣修复(MVP)是退行性二尖瓣反流的金标准治疗方法。随着经导管技术的扩展,本研究比较低风险和非低风险患者的MVP结果,作为基准。方法:这项回顾性的单机构研究调查了2005年至2018年所有因原发性二尖瓣反流接受MVP治疗的患者。将患者分为低危[胸外科学会(STS)预测死亡风险(STS- prom)≤2%]和非低危(STS- prom > 2%或年龄> 75岁)2类,并分为极低危亚组(STS- prom≤1%,年龄)。结果:共纳入1207例患者,其中1053例为低危,154例为非低危。非低危组年龄明显大于低危组,女性居多,合并症负担明显高于低危组(均P)。结论:低危组观察到的MVP患者综合发病率和死亡率持续较低,主要由极低危组驱动。MVP在低风险患者中的出色结果应在国家层面进行验证,以确定如何在这些患者中使用经导管技术。
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引用次数: 0
Lung transplantation in patients with a history of anatomical native lung resection. 有解剖性原生肺切除史的患者进行肺移植。
4区 医学 Q2 Medicine Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac256
Ilker Iskender, Ylenia Pecoraro, Paula Moreno Casado, Bartosz Kubisa, Marco Schiavon, Eleonora Faccioli, Jonas Ehrsam, Francesco Damarco, Mario Nosotti, Ilhan Inci, Federico Venuta, Dirk Van Raemdonck, Laurens J Ceulemans

Objectives: History of anatomical lung resection complicates lung transplantation (LTx). Our aim was to identify indications, intraoperative approach and outcome in these challenging cases in a retrospective multicentre cohort analysis.

Methods: Members of the ESTS Lung Transplantation Working Group were invited to submit data on patients undergoing LTx after a previous anatomical native lung resection between January 2005 and July 2020. The primary end point was overall survival (Kaplan-Meier estimation).

Results: Out of 2690 patients at 7 European centres, 26 (1%) patients (14 males; median age 33 years) underwent LTx after a previous anatomical lung resection. The median time from previous lung resection to LTx was 12 years. The most common indications for lung resection were infections (n = 17), emphysema (n = 5), lung tumour (n = 2) and others (n = 2). Bronchiectasis (cystic fibrosis or non-cystic fibrosis related) was the main indication for LTx (n = 21), followed by COPD (n = 5). Two patients with a previous pneumonectomy underwent contralateral single LTx and 1 patient with a previous lobectomy had ipsilateral single LTx. The remaining 23 patients underwent bilateral LTx. Clamshell incision was performed in 12 (46%) patients. Moreover, LTx was possible without extracorporeal life support in 13 (50%) patients. 90-Day mortality was 8% (n = 2) and the median survival was 8.7 years.

Conclusions: The history of anatomical lung resection is rare in LTx candidates. The majority of patients are young and diagnosed with bronchiectasis. Although the numbers were limited, survival after LTx in patients with previous anatomical lung resection, including pneumonectomy, is comparable to reported conventional LTx for bronchiectasis.

目的:解剖肺切除并发肺移植(LTx)的病史。我们的目的是在回顾性多中心队列分析中确定这些具有挑战性病例的适应症、术中入路和结果。方法:邀请ESTS肺移植工作组成员提交2005年1月至2020年7月间解剖性原生肺切除术后行LTx患者的数据。主要终点为总生存期(Kaplan-Meier估计)。结果:在7个欧洲中心的2690例患者中,26例(1%)患者(14例男性;中位年龄33岁),先前解剖性肺切除术后行LTx。从上一次肺切除术到LTx的中位时间为12年。肺切除术最常见的适应症是感染(17例)、肺气肿(5例)、肺肿瘤(2例)和其他(2例)。支气管扩张(囊性纤维化或非囊性纤维化相关)是LTx的主要适应症(n = 21),其次是COPD (n = 5)。2例既往行肺切除术的患者行对侧单侧LTx, 1例既往行肺叶切除术的患者行同侧单侧LTx。其余23例患者行双侧LTx。12例(46%)患者行翻盖切口。此外,13例(50%)患者在没有体外生命支持的情况下可以进行LTx。90天死亡率为8% (n = 2),中位生存期为8.7年。结论:肺解剖切除史在LTx患者中是罕见的。大多数患者是年轻人,诊断为支气管扩张。尽管数量有限,但先前解剖性肺切除术(包括全肺切除术)患者的LTx生存率与报道的常规支气管扩张LTx相当。
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引用次数: 0
Repair of coronary artery ostium with a ring-shaped bovine pericardial patch. 环形牛心包补片修复冠状动脉开口。
4区 医学 Q2 Medicine Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac251
Dong Zhang, Gui-Jun Zhu, Xiang-Yang Wei, Bin Li, Jie Hu, Wei-Guo Ma, Xing-Peng Chen

As an approach to coronary artery ostial injury in type A aortic dissection and infective endocarditis, we describe a technique of coronary ostial repair using a ring-shaped bovine pericardial patch. The inner and outer rims of the patch were sutured to the involved coronary ostium (to close the ostial tear) and to the aortic wall (to cover the sinus), respectively. Four patients were successfully managed and computed tomographic coronary arteriogram at follow-up showed patent coronary ostia and arteries. The favourable preliminary results imply that this technique is a simple, safe and effective approach to coronary ostial repair in patients with type A aortic dissection or infective endocarditis.

作为A型主动脉夹层和感染性心内膜炎的冠状动脉口损伤的一种方法,我们描述了一种使用环形牛心包补片修复冠状动脉口的技术。将补片的内外缘分别缝合在受累的冠状动脉口(封闭口口撕裂)和主动脉壁(覆盖窦)上。4例患者治疗成功,随访时冠状动脉ct显示冠脉口和动脉未闭。初步结果表明,该技术对a型主动脉夹层或感染性心内膜炎患者的冠状动脉口修复是一种简单、安全、有效的方法。
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引用次数: 0
Staged single-port thoracoscopic R2 sympathicotomy as a reproducible, safe and effective treatment option for debilitating severe facial blushing. 分期单孔胸腔镜R2交感神经切开术是一种可重复、安全、有效的治疗方法。
4区 医学 Q2 Medicine Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac257
Emma van der Weijde, Michiel Kuijpers, Wobbe Bouma, Massimo A Mariani, Theo J Klinkenberg

Objectives: Our goal was to investigate the safety, feasibility, success rate, complication rate and side effects of staged single-port thoracoscopic R2 sympathicotomy in the treatment of severe facial blushing. Facial blushing is considered a benign condition; however, severe facial blushing can have a major impact on quality of life. When nonsurgical options such as medication and psychological treatments offer no or insufficient relief, surgical treatment with thoracoscopic sympathicotomy should be considered.

Methods: All patients who underwent a staged thoracoscopic sympathicotomy at level R2 for severe facial blushing between January 2016 and September 2021 were included. Clinical and surgical data were prospectively collected and analysed.

Results: A total of 16 patients with low operative risk (American Society of Anesthesiologists class 1) were treated. No major perioperative complications were encountered. One patient experienced postoperative unilateral Horner's syndrome that resolved completely after 1 week. Two patients experienced compensatory hyperhidrosis. The success rate was 100%. One patient experienced a slight recurrence of blushing symptoms after 3 years that did not interfere with their quality of life. All patients were satisfied with the results and had no regrets of having undergone the procedure.

Conclusions: Staged single-port thoracoscopic R2 sympathicotomy is a reproducible, safe and highly effective surgical treatment option with low compensatory hyperhidrosis rates and the potential to significantly improve quality of life in carefully selected patients suffering from severe facial blushing. We would like to increase awareness among healthcare professionals for debilitating facial blushing and suggest timely referral for surgical treatment.

目的:探讨分期单孔胸腔镜R2交感神经切开术治疗重度面红症的安全性、可行性、成功率、并发症发生率及不良反应。面部脸红被认为是一种良性状况;然而,严重的面部脸红会对生活质量产生重大影响。当药物和心理治疗等非手术治疗不能缓解或不能充分缓解时,应考虑胸腔镜下交感神经切开术的手术治疗。方法:纳入2016年1月至2021年9月期间因严重面部脸红接受分期胸腔镜交感神经切开术的所有患者。前瞻性地收集和分析临床和手术资料。结果:共收治低手术风险患者16例(美国麻醉医师学会1级)。围手术期无重大并发症。1例患者术后出现单侧霍纳综合征,1周后完全消退。2例患者出现代偿性多汗症。成功率为100%。一名患者在3年后经历了轻微的脸红症状复发,但没有影响他们的生活质量。所有患者对结果都很满意,没有后悔接受手术。结论:分期单孔胸腔镜R2交感神经切开术是一种可重复、安全、高效的手术治疗选择,代偿性多汗症发生率低,对精心挑选的严重面部发红患者有显著改善生活质量的潜力。我们希望提高医疗保健专业人员对使人衰弱的面部脸红的认识,并建议及时转诊进行手术治疗。
{"title":"Staged single-port thoracoscopic R2 sympathicotomy as a reproducible, safe and effective treatment option for debilitating severe facial blushing.","authors":"Emma van der Weijde,&nbsp;Michiel Kuijpers,&nbsp;Wobbe Bouma,&nbsp;Massimo A Mariani,&nbsp;Theo J Klinkenberg","doi":"10.1093/icvts/ivac257","DOIUrl":"https://doi.org/10.1093/icvts/ivac257","url":null,"abstract":"<p><strong>Objectives: </strong>Our goal was to investigate the safety, feasibility, success rate, complication rate and side effects of staged single-port thoracoscopic R2 sympathicotomy in the treatment of severe facial blushing. Facial blushing is considered a benign condition; however, severe facial blushing can have a major impact on quality of life. When nonsurgical options such as medication and psychological treatments offer no or insufficient relief, surgical treatment with thoracoscopic sympathicotomy should be considered.</p><p><strong>Methods: </strong>All patients who underwent a staged thoracoscopic sympathicotomy at level R2 for severe facial blushing between January 2016 and September 2021 were included. Clinical and surgical data were prospectively collected and analysed.</p><p><strong>Results: </strong>A total of 16 patients with low operative risk (American Society of Anesthesiologists class 1) were treated. No major perioperative complications were encountered. One patient experienced postoperative unilateral Horner's syndrome that resolved completely after 1 week. Two patients experienced compensatory hyperhidrosis. The success rate was 100%. One patient experienced a slight recurrence of blushing symptoms after 3 years that did not interfere with their quality of life. All patients were satisfied with the results and had no regrets of having undergone the procedure.</p><p><strong>Conclusions: </strong>Staged single-port thoracoscopic R2 sympathicotomy is a reproducible, safe and highly effective surgical treatment option with low compensatory hyperhidrosis rates and the potential to significantly improve quality of life in carefully selected patients suffering from severe facial blushing. We would like to increase awareness among healthcare professionals for debilitating facial blushing and suggest timely referral for surgical treatment.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/aa/bb/ivac257.PMC9596140.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33512314","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}
引用次数: 0
Use of virtual reality for procedural planning of transcatheter aortic valve replacement. 虚拟现实技术在经导管主动脉瓣置换术中的应用。
4区 医学 Q2 Medicine Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac248
Xavier Ruyra, Eduard Permanyer, Marina Huguet, Giuliana Maldonado

This study sought to evaluate the impact of virtual reality (VR) tools in procedural planning of transcatheter aortic valve replacement. A prospective study involving 11 patients referred for transcatheter aortic valve replacement was conducted. A multidetector computed tomography was used to acquire and segment the anatomy of the access route and landing zone. From the information obtained with the multidetector computed tomography in DICOM format, we built a virtual platform (VisuaMed, Techer Team, Valencia, Spain) that contains all the clinical information of the patients and a virtualized model of their anatomy. Wearing VR devices, the professional was able to 'walk inside' the anatomy in an interactive and immersive way. Decisions after the evaluation of routine clinical images were compared with those after experience with VR models and intraprocedural findings.

本研究旨在评估虚拟现实(VR)工具在经导管主动脉瓣置换术程序规划中的影响。对11例经导管主动脉瓣置换术患者进行前瞻性研究。使用多探测器计算机断层扫描来获取和分割通道和着陆区的解剖结构。根据DICOM格式的多探测器计算机断层扫描获得的信息,我们建立了一个虚拟平台(VisuaMed, Techer Team, Valencia, Spain),其中包含了患者的所有临床信息和他们的解剖虚拟模型。戴上虚拟现实设备,这位专业人士能够以一种互动和沉浸式的方式“走进”解剖结构。将常规临床图像评估后的决定与VR模型经验和术中发现后的决定进行比较。
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引用次数: 0
Aortic remodelling and late outcomes following thoracic endovascular repair with a bare-metal stent distal extension among patients with complicated type-B aortic dissection. 复杂b型主动脉夹层患者经远端延伸裸金属支架胸腔内修复后的主动脉重构和晚期预后
4区 医学 Q2 Medicine Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac244
Isaac Wamala, Mir Timo Zadegh Nazari-Shafti, Roland Heck, Adam Penkalla, Matteo Montagner, Steven J Staffa, Volkmar Falk, Semih Buz

Objectives: The goal of this study was to describe the factors affecting mid and late aortic remodelling following thoracic endovascular aortic repair with the PETTICOAT (Provisional Extension To Induce Complete Attachment) technique among patients with complicated acute or subacute type B aortic dissection.

Methods: A retrospective single-centre study that evaluates clinical and morphological outcomes among 65 consecutive patients. The area and diameter of the true and false lumen, overall aortic diameter and false lumen perfusion were evaluated.

Results: Concomitant direct visceral artery stenting was successfully conducted in 32 (49%) patients. There was one (1.5%) postoperative stroke; three (4.6%) patients developed spinal cord ischaemia; two (3%) patients suffered retrograde type A dissection; and two (3%) patients had mesenteric ischaemia, despite successful reperfusion, that required a bowel resection. Median postoperative follow-up was 63.1 (interquartile range, 32.1- 91.8) months. The probability of survival was 96.9% [95% confidence interval (CI) 88.3%-99.2%] at 30 days, 93.9% (95% CI 84.4%-97.6%) at 1 year, 78.0 (95% CI 64.2%-87.0%) at 5 years and 72.8% (95% CI at 57.9%-83.2%) at 10 years postoperatively. There was a statistically significant postoperative increase in true-lumen area, diameter and true-lumen index in all five aortic levels measured. Complete false lumen (FL) thrombosis at the coeliac trunk, renal arteries and aortic bifurcation levels was observed in 47%, 15% and 24% of patients at midterm (6-15 months) and in 29%, 21% and 29% on late (later than 21 months) computed tomography angiograms (CTA). Persistent false lumen (FL) perfusion at the coeliac level on midterm CTA was associated with a larger extent of late aortic growth (P = 0.042) and was, in the majority of cases, caused by iliac re-entries either alone (28.57) or in combination with visceral and lumbar (28.57%) or distal aortic (10.71%) re-entries. A larger abdominal aortic diameter at midterm was associated with an increased probability of distal aortic reinterventions (hazard ratio 7.26, 95% CI 2.41-21.9, P < 0.001).

Conclusions: Persistent FL perfusion of the distal aorta at midterm following TEVAR with the PETTICOAT technique among patients with acute and subacute type B dissection is caused mainly by iliac, visceral, lumber and distal aorta re-entries. Patients with persistent FL perfusion have an increased risk of aortic aneurysmal growth at late follow-up.

目的:本研究的目的是描述在并发急性或亚急性B型主动脉夹层患者中,应用PETTICOAT(临时延伸诱导完全附着)技术进行胸腔血管内主动脉修复术后中晚期主动脉重构的影响因素。方法:回顾性单中心研究,评估65例连续患者的临床和形态学结果。评估真、假腔面积、直径、主动脉总直径及假腔灌注情况。结果:32例(49%)患者成功行直接内脏动脉支架植入术。术后卒中1例(1.5%);3例(4.6%)患者发生脊髓缺血;2例(3%)患者发生逆行A型夹层;2例(3%)患者有肠系膜缺血,尽管再灌注成功,但需要肠切除术。术后中位随访时间为63.1个月(四分位数间距为32.1 ~ 91.8个月)。术后30天生存率为96.9%[95%可信区间(CI) 88.3% ~ 99.2%], 1年生存率为93.9% (95% CI 84.4% ~ 97.6%), 5年生存率为78.0 (95% CI 64.2% ~ 87.0%), 10年生存率为72.8% (95% CI 57.9% ~ 83.2%)。术后真腔面积、直径和真腔指数均有统计学意义的增加。在中期(6-15个月),47%、15%和24%的患者在腹腔干、肾动脉和主动脉分叉水平观察到完全假腔(FL)血栓形成,在晚期(21个月以上)ct血管造影(CTA)中观察到29%、21%和29%的患者出现完全性假腔血栓形成。中期CTA显示腹腔水平持续假腔(FL)灌注与较大程度的晚期主动脉生长相关(P = 0.042),并且在大多数情况下,由髂再入引起,单独(28.57%)或合并内脏和腰椎(28.57%)或远端主动脉(10.71%)再入。中期腹主动脉直径增大与主动脉远端再介入的可能性增加相关(风险比7.26,95% CI 2.41-21.9, P)。结论:急性和亚急性B型夹层患者采用PETTICOAT技术进行TEVAR后中期远端主动脉持续FL灌注主要是由髂、内脏、腰椎和远端主动脉再进入引起的。持续FL灌注的患者在后期随访时动脉瘤生长的风险增加。
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引用次数: 2
AVNeo improves early haemodynamics in regurgitant bicuspid aortic valves compared to aortic valve repair. 与主动脉瓣修复术相比,AVNeo 可改善反流性双尖瓣主动脉瓣的早期血液动力学状况。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac226
Anatol Prinzing, Johannes Böhm, Konstantinos Sideris, Keti Vitanova, Rüdiger Lange, Markus Krane

Objectives: Calcified or fibrotic cusps in patients with bicuspid aortic valves and aortic regurgitation complicate successful aortic valve (AV)-repair. Aortic valve neocuspidization (AVNeo) with autologous pericardium offers an alternative treatment to prosthetic valve replacement. We compared patients with regurgitant bicuspid valves undergoing AV-repair or AVNeo.

Methods: We retrospectively analysed patients with regurgitant bicuspid valves undergoing AV-repair or AVNeo. We focused on residual regurgitation, pressure gradients and effective orifice area, determined preoperatively and at discharge.

Results: AV-repair was performed in 61 patients (mean age: 43.2 ± 11.3 years) and AVNeo in 22 (45.7 ± 14.1). Prior to the operation patients of the AV-repair group showed severe regurgitation in 38 cases (62.3%) and moderate in 23 (37.6%); in the AVNeo group, all patients exhibited severe regurgitation. Postoperatively, 57 patients (93.4%) patients had no or mild regurgitation after AV-repair and 21 (95.4%) after AVNeo. In AVNeo-patients, peak (10.6 ± 3.1 mmHg vs 22.7 ± 11 mmHg, P< 0.001) and mean pressure gradients (5.9 ± 2 mmHg vs 13.8 ± 7.3 mmHg, P < 0.001) were significantly lower and the orifice area significantly larger (2.9 ± 0.8 cm2 vs 1.9 ± 0.7 cm2, P < 0.001) compared to repair.

Conclusions: Compared to AV-repair, patients AVNeo showed lower mean pressure gradients and larger orifice areas at discharge. The functional result was not different.

目的:二尖瓣主动脉瓣和主动脉瓣反流患者的瓣尖钙化或纤维化会使主动脉瓣(AV)的成功修复复杂化。使用自体心包进行主动脉瓣新瓣膜化(AVNeo)是替代人工瓣膜置换术的一种治疗方法。我们对接受主动脉瓣修复术或 AVNeo 术的双尖瓣反流患者进行了比较:我们对接受房室修复术或 AVNeo 手术的二尖瓣反流患者进行了回顾性分析。我们重点研究了术前和出院时测定的残余反流、压力梯度和有效瓣口面积:61名患者(平均年龄为43.2 ± 11.3岁)接受了房室修复术,22名患者(45.7 ± 14.1岁)接受了AVNeo术。手术前,房室修复组患者中有 38 例(62.3%)表现为严重反流,23 例(37.6%)表现为中度反流;在 AVNeo 组中,所有患者均表现为严重反流。术后,57 名患者(93.4%)在房室修复术后没有反流或反流程度较轻,21 名患者(95.4%)在房室奈何术后没有反流或反流程度较轻。与修复术相比,AVNeo 患者的峰值(10.6 ± 3.1 mmHg vs 22.7 ± 11 mmHg,P< 0.001)和平均压力梯度(5.9 ± 2 mmHg vs 13.8 ± 7.3 mmHg,P< 0.001)明显降低,孔口面积明显增大(2.9 ± 0.8 cm2 vs 1.9 ± 0.7 cm2,P< 0.001):结论:与 AV 修复术相比,AVNeo 患者出院时平均压力梯度较低,管口面积较大。功能结果没有差异。
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引用次数: 0
Outcomes in the treatment of aberrant subclavian arteries using the hybrid approach. 使用混合方法治疗锁骨下动脉异常的疗效。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac230
Sabrina Ben Ahmed, Nicla Settembre, Joseph Touma, Anthony Brouat, Jean-Pierre Favre, Elixene Jean Baptiste, Xavier Chaufour, Eugenio Rosset

Objectives: Aberrant subclavian artery (ASCA) occurs rarely but is one of the most frequent anatomical variations of the supra-aortic trunks. No consensus has been established on its best treatment. The goal of this study was to report the outcomes of ASCA treated by the hybrid approach.

Methods: This non-interventional retrospective multicentre analysis included patients treated for ASCA by the hybrid approach in 12 French university hospitals between 2007 and 2019. The hybrid approach was defined as an endovascular procedure combined with open surgery or a hybrid stent graft. Patients were divided in 4 groups (from less to more complex treatment). The primary end point was 30-day mortality. The secondary end points were 30-day complications and late mortality.

Results: This study included 43 patients. The mean age was 65 (SD, standard deviation: 16) years. Symptoms were found in 33 patients. Subclavian revascularization combined with aberrant subclavian artery occlusion was undertaken in 13 patients. Unilateral and bilateral subclavian revascularization combined with a thoracic aortic stent graft was undertaken in 11 and 6 patients, respectively. Total aortic arch repair combined with a thoracic aortic stent graft was undertaken in 13 patients. Thirty-day mortality was 2.3% with a technical success rate of 95.3%. The 30-day major postoperative complication rate was 16.3%: 4 strokes, 2 tamponades, 1 acute respiratory distress syndrome. Mean follow-up was 56.3 (SD: 44.7) months. The late mortality was 18.6%.

Conclusions: The ASCA hybrid approach is feasible, safe and effective with low early mortality. Morbidity is rather high. However, it increases with the complexity of the hybrid approach, which should be kept as simple as possible if the anatomical morphology allows.

目的:锁骨下动脉畸变(ASCA)很少发生,但却是主动脉上干最常见的解剖变异之一。目前尚未就其最佳治疗方法达成共识。本研究的目的是报告采用混合方法治疗 ASCA 的结果:这项非干预性回顾性多中心分析包括2007年至2019年期间在法国12所大学医院接受混合方法治疗的ASCA患者。杂交方法的定义是血管内手术结合开放手术或杂交支架移植。患者被分为4组(从治疗难度较低到较复杂)。主要终点是30天死亡率。次要终点为30天并发症和晚期死亡率:本研究共纳入 43 名患者。平均年龄为 65(标准差:16)岁。33名患者出现症状。13名患者接受了锁骨下血管再通手术,同时合并锁骨下动脉异常闭塞。分别有11名和6名患者接受了单侧和双侧锁骨下血管重建术,并结合胸主动脉支架移植术。13名患者接受了主动脉弓全修补术和胸主动脉支架移植术。30天死亡率为2.3%,技术成功率为95.3%。术后 30 天的主要并发症发生率为 16.3%:4例中风、2例血栓形成、1例急性呼吸窘迫综合征。平均随访时间为 56.3 个月(标准差:44.7 个月)。晚期死亡率为18.6%:结论:ASCA 杂交方法可行、安全、有效,早期死亡率低。发病率相当高。结论:ASCA 杂交手术可行、安全、有效,早期死亡率低。
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引用次数: 0
Endoscopic mitral valve repair utilizing cavitron ultrasonic surgical aspirator for active endocarditis. 腔室超声手术吸引器治疗活动性心内膜炎的内窥镜二尖瓣修复术。
4区 医学 Q2 Medicine Pub Date : 2022-10-10 DOI: 10.1093/icvts/ivac259
Soh Hosoba, Toshiaki Ito, Riku Kato

Mitral valve repair for endocarditis in an acute setting is still challenging due to difficulties in debriding friable tissue and in leaving enough non-infected tissue for reconstruction. Endoscopic approaches for complex mitral valve procedures via a minimally invasive approach have been reported from high-volume programs. However, the role of endoscopic mitral valve surgery for acute infective endocarditis has not been clearly defined. We report our technique of endoscopic mitral valve repair using the cavitron ultrasonic surgical aspirator system for active endocarditis. The cavitron ultrasonic surgical aspirator with a low power setting provides enough debridement of the infective tissue and leaves healthy tissue adequate for repair under a totally endoscopic vision.

由于清除易碎组织和留下足够的非感染组织进行重建的困难,急性心内膜炎的二尖瓣修复仍然具有挑战性。经微创入路进行复杂二尖瓣手术的内镜入路已在大量项目中得到报道。然而,内窥镜二尖瓣手术在急性感染性心内膜炎中的作用尚未明确界定。我们报告我们的技术,内窥镜下修复二尖瓣使用腔腔超声手术吸引系统对活动性心内膜炎。低功率设置的腔室超声手术吸引器提供足够的感染组织清创,并在完全内窥镜视野下留下足够的健康组织进行修复。
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引用次数: 1
期刊
Interactive cardiovascular and thoracic surgery
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