Abstract Ruxolitinib, a Janus kinase inhibitor, is associated with severe withdrawal phenomena. Adequate tapering is often underemphasized in surgical emergencies and can complicate the postoperative course. We present a case of acute ruxolitinib withdrawal in a gentleman undergoing emergency cardiac surgery
{"title":"Ruxolitinib withdrawal complicating emergency aortic root replacement","authors":"M. Szpytma, D. Gimpel, G. Crouch, J. Bennetts","doi":"10.1093/icvts/ivac143","DOIUrl":"https://doi.org/10.1093/icvts/ivac143","url":null,"abstract":"Abstract Ruxolitinib, a Janus kinase inhibitor, is associated with severe withdrawal phenomena. Adequate tapering is often underemphasized in surgical emergencies and can complicate the postoperative course. We present a case of acute ruxolitinib withdrawal in a gentleman undergoing emergency cardiac surgery","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87888701","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}
Gaku Uchino, H. Murakami, N. Mukohara, Hiroshi Tanaka, Yoshikatsu Nomura, S. Miyahara, Motoharu Kawashima, Jun Fujisue, Shuto Tonoki
Abstract OBJECTIVES This study aimed to examine very-long-term outcomes of a mechanical valve at the mitral position. METHODS This study included all patients who underwent mitral valve replacement (MVR) using a mechanical valve including urgent operation at the Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, from January 1987 to December 2015. RESULTS Five hundred and eighty-three patients (277 men [47.51%]; age, 61 [54–67] years) were included in this study. The implanted valve models were as follows: SJM, 221 (37.91%); ATS, 35 (6.00%); On-X, 68 (11.66%); and Carbomedics 194, (33.28%).The median clinical follow-up duration was 13.3 (7.4–19.6) years. The survival rates at 10, 15, 20 and 25 years were 81.42%, 69.27%, 56.34% and 45.03%, respectively. Thromboembolism was observed in 38 patients, and the linearized ratio for each event was 0.626%/patient-year [95% confidence interval (CI), 0.443–0.859%]. Intracranial haemorrhage and gastrointestinal bleeding were observed in 26 and 9 patients, and the linearized ratio for each event was 0.425%/patient-year (95% CI, 0.277–0.006%) and 0.145%/patient-year (95% CI, 0.067–0.276%), respectively. Major paravalvular leak was observed in 32 patients, and the linearized ratio was 0.532%/patient-year (95% CI, 0.364%–0.751%). The cumulative incidence rate of major paravalvular leak at 10, 15, 20 and 25 years was 3.7%, 5.6%, 6.4% and 10.4%, respectively. Multivariable Cox regression analysis revealed that repeated MVR and male gender were associated with major paravalvular leak. CONCLUSIONS Male gender and repeated MVR were risk factors for paravalvular leak after mechanical MVR. Paravalvular leak could have occurred regardless of postoperative period even at 25 years after implantation. Lifelong clinical follow-up is considered necessary.
{"title":"Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications","authors":"Gaku Uchino, H. Murakami, N. Mukohara, Hiroshi Tanaka, Yoshikatsu Nomura, S. Miyahara, Motoharu Kawashima, Jun Fujisue, Shuto Tonoki","doi":"10.1093/icvts/ivac146","DOIUrl":"https://doi.org/10.1093/icvts/ivac146","url":null,"abstract":"Abstract OBJECTIVES This study aimed to examine very-long-term outcomes of a mechanical valve at the mitral position. METHODS This study included all patients who underwent mitral valve replacement (MVR) using a mechanical valve including urgent operation at the Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, from January 1987 to December 2015. RESULTS Five hundred and eighty-three patients (277 men [47.51%]; age, 61 [54–67] years) were included in this study. The implanted valve models were as follows: SJM, 221 (37.91%); ATS, 35 (6.00%); On-X, 68 (11.66%); and Carbomedics 194, (33.28%).The median clinical follow-up duration was 13.3 (7.4–19.6) years. The survival rates at 10, 15, 20 and 25 years were 81.42%, 69.27%, 56.34% and 45.03%, respectively. Thromboembolism was observed in 38 patients, and the linearized ratio for each event was 0.626%/patient-year [95% confidence interval (CI), 0.443–0.859%]. Intracranial haemorrhage and gastrointestinal bleeding were observed in 26 and 9 patients, and the linearized ratio for each event was 0.425%/patient-year (95% CI, 0.277–0.006%) and 0.145%/patient-year (95% CI, 0.067–0.276%), respectively. Major paravalvular leak was observed in 32 patients, and the linearized ratio was 0.532%/patient-year (95% CI, 0.364%–0.751%). The cumulative incidence rate of major paravalvular leak at 10, 15, 20 and 25 years was 3.7%, 5.6%, 6.4% and 10.4%, respectively. Multivariable Cox regression analysis revealed that repeated MVR and male gender were associated with major paravalvular leak. CONCLUSIONS Male gender and repeated MVR were risk factors for paravalvular leak after mechanical MVR. Paravalvular leak could have occurred regardless of postoperative period even at 25 years after implantation. Lifelong clinical follow-up is considered necessary.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84848683","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}
Albert F. Guerrero, Ivonne G. Pineda-Rodríguez, A. M. Palacio, C. Obando, Tomás Chalela, Jaime Camacho, Carlos Villa, J. Umaña, Néstor Sandoval-Reyes
Abstract OBJECTIVES Given the anatomical variations of tetralogy of Fallot (TOF), different surgical techniques can be used to achieve correction. Transannular patches (TAPs) are the most commonly used technique; they are associated with right ventricular dysfunction, the incidence of which can be reduced through pulmonary valve preservation. METHODS Between January 2010 and July 2019, we performed 274 surgical corrections of tetralogy of Fallot at Fundación Cardioinfantil; 63 patients (23%) underwent repair with a TAP in addition to a pulmonary neovalve (Group I), 66 patients (24.1%) received a TAP without a pulmonary valve (Group II) and 145 patients (52.9%) had a repair with valve preservation (Group III). We analysed patient’s characteristics before, during and after surgery at a 30-day follow-up. RESULTS We found that patients in Group III were older (P = 0.04). Group II had the lowest level of O2 saturation before surgery (82%, P = 0.001). Cardiopulmonary bypass and aortic cross-clamp times were longer in Group I (P < 0.001). Right ventricular dysfunction was less frequent in Group III (15.9%, P = 0.011). Severe residual pulmonary regurgitation was more common in Group II (21.9%, P = 0.001). CONCLUSIONS Preservation of the pulmonary valve is an important factor for immediate postoperative management of tetralogy of Fallot. Patients who were repaired with a TAP with or without a pulmonary neovalve had a higher incidence of right ventricular dysfunction than those with pulmonary valve preservation.
{"title":"Repair with a pulmonary neovalve in tetralogy of Fallot: does this avoid ventricular dysfunction?","authors":"Albert F. Guerrero, Ivonne G. Pineda-Rodríguez, A. M. Palacio, C. Obando, Tomás Chalela, Jaime Camacho, Carlos Villa, J. Umaña, Néstor Sandoval-Reyes","doi":"10.1093/icvts/ivac155","DOIUrl":"https://doi.org/10.1093/icvts/ivac155","url":null,"abstract":"Abstract OBJECTIVES Given the anatomical variations of tetralogy of Fallot (TOF), different surgical techniques can be used to achieve correction. Transannular patches (TAPs) are the most commonly used technique; they are associated with right ventricular dysfunction, the incidence of which can be reduced through pulmonary valve preservation. METHODS Between January 2010 and July 2019, we performed 274 surgical corrections of tetralogy of Fallot at Fundación Cardioinfantil; 63 patients (23%) underwent repair with a TAP in addition to a pulmonary neovalve (Group I), 66 patients (24.1%) received a TAP without a pulmonary valve (Group II) and 145 patients (52.9%) had a repair with valve preservation (Group III). We analysed patient’s characteristics before, during and after surgery at a 30-day follow-up. RESULTS We found that patients in Group III were older (P = 0.04). Group II had the lowest level of O2 saturation before surgery (82%, P = 0.001). Cardiopulmonary bypass and aortic cross-clamp times were longer in Group I (P < 0.001). Right ventricular dysfunction was less frequent in Group III (15.9%, P = 0.011). Severe residual pulmonary regurgitation was more common in Group II (21.9%, P = 0.001). CONCLUSIONS Preservation of the pulmonary valve is an important factor for immediate postoperative management of tetralogy of Fallot. Patients who were repaired with a TAP with or without a pulmonary neovalve had a higher incidence of right ventricular dysfunction than those with pulmonary valve preservation.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87324157","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}
Akihiro Nagoya, R. Kanzaki, K. Kimura, Eriko Fukui, T. Kanou, N. Ose, S. Funaki, M. Minami, M. Fujii, Y. Shintani
Abstract OBJECTIVES The surgical Apgar score (SAS) is a simple score that predicts postoperative complications based on 3 intraoperative valuables. The present study evaluated the association between the SAS and postoperative outcomes in non-small-cell lung cancer patients who underwent surgery. METHODS A total of 585 patients who underwent lung resection were enrolled in the present study. We calculated the SAS of each patient and investigated its influence on the short- and long-term outcomes. RESULTS Postoperative complications of any grade were detected in 164 cases (28%). The morbidity rate increased with decreasing SAS. When all the patients were divided into 2 groups (SAS <7 vs ≥7), postoperative complications were observed more frequently in the SAS <7 group than in the SAS ≥7 group (41% vs 25%, P < 0.001). In the multivariate analysis, the SAS was an independent risk factor for postoperative complications (odds ratio: 1.64 [1.03–2.61], P = 0.036). In terms of long-term outcomes, the 5-year disease-free survival (54.1% vs 73.2%, P < 0.001) and overall survival (73.8% vs 83.0%, P = 0.031) were significantly worse in the SAS <7 group than in the SAS ≥7 group. In a multivariate analysis, however, the SAS was not found to be an independent prognostic factor for either disease-free survival (hazard ratio: 1.39 [0.97–2.00], P = 0.075) or overall survival (hazard ratio: 0.90 [0.57–1.42], P = 0.642). CONCLUSIONS The SAS reflected preoperative and intraoperative characteristics and was able to stratify the morbidity rate, suggesting it to be a useful predictor of short-term outcomes in non-small-cell lung cancer patients who undergo surgery.
目的外科Apgar评分(SAS)是一种基于3项术中价值预测术后并发症的简单评分。本研究评估了接受手术的非小细胞肺癌患者的SAS与术后预后之间的关系。方法本研究共纳入585例行肺切除术的患者。我们计算了每位患者的SAS，并研究了其对短期和长期预后的影响。结果164例(28%)术后出现不同程度的并发症。发病率随SAS的降低而升高。将所有患者分为2组(SAS <7 vs≥7)，SAS <7组术后并发症发生率高于SAS≥7组(41% vs 25%， P < 0.001)。在多因素分析中，SAS是术后并发症的独立危险因素(优势比:1.64 [1.03-2.61]，P = 0.036)。在长期结局方面，SAS <7组的5年无病生存率(54.1% vs 73.2%， P < 0.001)和总生存率(73.8% vs 83.0%， P = 0.031)显著低于SAS≥7组。然而，在多变量分析中，SAS并不是无病生存(风险比:1.39 [0.97-2.00]，P = 0.075)或总生存(风险比:0.90 [0.57-1.42]，P = 0.642)的独立预后因素。结论:SAS反映了术前和术中特征，能够对发病率进行分层，表明它是非小细胞肺癌手术患者短期预后的有效预测指标。
{"title":"Utility of the surgical Apgar score for predicting the short- and long-term outcomes in non-small-cell lung cancer patients who undergo surgery","authors":"Akihiro Nagoya, R. Kanzaki, K. Kimura, Eriko Fukui, T. Kanou, N. Ose, S. Funaki, M. Minami, M. Fujii, Y. Shintani","doi":"10.1093/icvts/ivac150","DOIUrl":"https://doi.org/10.1093/icvts/ivac150","url":null,"abstract":"Abstract OBJECTIVES The surgical Apgar score (SAS) is a simple score that predicts postoperative complications based on 3 intraoperative valuables. The present study evaluated the association between the SAS and postoperative outcomes in non-small-cell lung cancer patients who underwent surgery. METHODS A total of 585 patients who underwent lung resection were enrolled in the present study. We calculated the SAS of each patient and investigated its influence on the short- and long-term outcomes. RESULTS Postoperative complications of any grade were detected in 164 cases (28%). The morbidity rate increased with decreasing SAS. When all the patients were divided into 2 groups (SAS <7 vs ≥7), postoperative complications were observed more frequently in the SAS <7 group than in the SAS ≥7 group (41% vs 25%, P < 0.001). In the multivariate analysis, the SAS was an independent risk factor for postoperative complications (odds ratio: 1.64 [1.03–2.61], P = 0.036). In terms of long-term outcomes, the 5-year disease-free survival (54.1% vs 73.2%, P < 0.001) and overall survival (73.8% vs 83.0%, P = 0.031) were significantly worse in the SAS <7 group than in the SAS ≥7 group. In a multivariate analysis, however, the SAS was not found to be an independent prognostic factor for either disease-free survival (hazard ratio: 1.39 [0.97–2.00], P = 0.075) or overall survival (hazard ratio: 0.90 [0.57–1.42], P = 0.642). CONCLUSIONS The SAS reflected preoperative and intraoperative characteristics and was able to stratify the morbidity rate, suggesting it to be a useful predictor of short-term outcomes in non-small-cell lung cancer patients who undergo surgery.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81554363","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}
Abstract The association of the diastasis of the rectus abdominis muscle and the medial pectus excavatum was reported. We have been using soft silicone block, sculpted intraoperatively, to correct pectus excavatum. The horizontal access used, 2 cm at a subxiphoid position, allows us to expose the sternum and the rectus abdominis muscles (RAMs). We report a case, male, 31 years presenting medial pectus excavatum and supraumbilical diastasis of the rectus abdominis muscle with a width of 35 mm at the costal arches, and 27 mm at 6 cm from the xiphoid process edge. The muscle borders presented a curved lateral deviation up to the insertion in the costal arches. The necessary space for the implant was dissected and the block was sculpted. The medial and superior aponeurosis borders of the RAM were incised at 6 cm from the xiphoid, and the posterior border of the RAM was released. The aponeurosis borders were brought together, promoting a medial and anterior positioning of the RAM. The inferior border of the implant was attached to the raw superior borders of the RAM. The result was considered satisfactory, and a magnetic resonance image 14 months after showed continuity of the implant and the muscles, promoting a uniform body contour. Registry: CAAE63181616.7.0000.0071.
{"title":"The correction of the diastasis of the rectus abdominis muscle concomitant with a moulded silicone implant insertion in a patient with medial pectus excavatum","authors":"J. Anger, J. M. D. de Campos","doi":"10.1093/icvts/ivac147","DOIUrl":"https://doi.org/10.1093/icvts/ivac147","url":null,"abstract":"Abstract The association of the diastasis of the rectus abdominis muscle and the medial pectus excavatum was reported. We have been using soft silicone block, sculpted intraoperatively, to correct pectus excavatum. The horizontal access used, 2 cm at a subxiphoid position, allows us to expose the sternum and the rectus abdominis muscles (RAMs). We report a case, male, 31 years presenting medial pectus excavatum and supraumbilical diastasis of the rectus abdominis muscle with a width of 35 mm at the costal arches, and 27 mm at 6 cm from the xiphoid process edge. The muscle borders presented a curved lateral deviation up to the insertion in the costal arches. The necessary space for the implant was dissected and the block was sculpted. The medial and superior aponeurosis borders of the RAM were incised at 6 cm from the xiphoid, and the posterior border of the RAM was released. The aponeurosis borders were brought together, promoting a medial and anterior positioning of the RAM. The inferior border of the implant was attached to the raw superior borders of the RAM. The result was considered satisfactory, and a magnetic resonance image 14 months after showed continuity of the implant and the muscles, promoting a uniform body contour. Registry: CAAE63181616.7.0000.0071.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"45 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72583860","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}
A. Patukale, F. Shikata, Shilpa S Marathe, Pervez Patel, S. Marathe, T. Colen, P. Venugopal, J. Suna, K. Betts, T. Karl, Janelle Johnson, K. Versluis, N. Alphonso
Abstract OBJECTIVES The aim of this study was to evaluate the mid-term outcomes after the repair of aortic arch using a standard patch augmentation technique. METHODS The study included all patients who underwent repair of a hypoplastic/interrupted aortic arch (IAA) in a single institute from June 2012 to December 2019 by a standardized patch augmentation (irrespective of concomitant intra-cardiac lesions). End points evaluated were reintervention for arch obstruction and persistent/new-onset hypertension. RESULTS The study included 149 patients [hypoplastic aortic arch, n = 92 (62%), IAA, n = 9 (6%), Norwood procedure, n = 48 (32%)]. The patch material used for augmentation of the aortic arch included pulmonary homograft (n = 120, 81%), homograft pericardium (n = 18, 12%), CardioCel® (n = 9, 6%) and glutaraldehyde-treated autologous pericardium (n = 2, 1%). The median age and weight at surgery were 7 days [interquartile range (IQR) 5–17 days] and 3.5 kg (IQR 3–3.9 kg), respectively. The median follow-up was 3.27 years (IQR 1.28, 5.08), range (0.02, 8.76). Freedom from reintervention at 1, 3 and 5 years was 95% [95% confidence interval (CI) = 89%, 98%], 93% (95% CI = 86%, 96%) and 93% (95% CI = 86%, 96%) respectively. One patient (0.6%) had persistent hypertension 8 years after correction for interrupted arch with truncus arteriosus. CONCLUSIONS Repair of hypoplastic/IAA by transection and excision of all ductal tissue and standardized patch augmentation provide good mid-term durability. The freedom from reintervention at 5 years is >90%. The incidence of persistent systemic hypertension following arch reconstruction is low. The technique is reproducible and applicable irrespective of underlying arch anatomy.
{"title":"A single-centre, retrospective study of mid-term outcomes of aortic arch repair using a standardized resection and patch augmentation technique","authors":"A. Patukale, F. Shikata, Shilpa S Marathe, Pervez Patel, S. Marathe, T. Colen, P. Venugopal, J. Suna, K. Betts, T. Karl, Janelle Johnson, K. Versluis, N. Alphonso","doi":"10.1093/icvts/ivac135","DOIUrl":"https://doi.org/10.1093/icvts/ivac135","url":null,"abstract":"Abstract OBJECTIVES The aim of this study was to evaluate the mid-term outcomes after the repair of aortic arch using a standard patch augmentation technique. METHODS The study included all patients who underwent repair of a hypoplastic/interrupted aortic arch (IAA) in a single institute from June 2012 to December 2019 by a standardized patch augmentation (irrespective of concomitant intra-cardiac lesions). End points evaluated were reintervention for arch obstruction and persistent/new-onset hypertension. RESULTS The study included 149 patients [hypoplastic aortic arch, n = 92 (62%), IAA, n = 9 (6%), Norwood procedure, n = 48 (32%)]. The patch material used for augmentation of the aortic arch included pulmonary homograft (n = 120, 81%), homograft pericardium (n = 18, 12%), CardioCel® (n = 9, 6%) and glutaraldehyde-treated autologous pericardium (n = 2, 1%). The median age and weight at surgery were 7 days [interquartile range (IQR) 5–17 days] and 3.5 kg (IQR 3–3.9 kg), respectively. The median follow-up was 3.27 years (IQR 1.28, 5.08), range (0.02, 8.76). Freedom from reintervention at 1, 3 and 5 years was 95% [95% confidence interval (CI) = 89%, 98%], 93% (95% CI = 86%, 96%) and 93% (95% CI = 86%, 96%) respectively. One patient (0.6%) had persistent hypertension 8 years after correction for interrupted arch with truncus arteriosus. CONCLUSIONS Repair of hypoplastic/IAA by transection and excision of all ductal tissue and standardized patch augmentation provide good mid-term durability. The freedom from reintervention at 5 years is >90%. The incidence of persistent systemic hypertension following arch reconstruction is low. The technique is reproducible and applicable irrespective of underlying arch anatomy.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80848958","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}
In this issue of the Interactive CardioVascular and Thoracic Surgery, D’Onofrio and colleagues [1] from the University of Padua compared the perioperative and 5-year outcomes of correction of mitral regurgitation (MR) due to posterior leaflet prolapse with Neochord DS1100 (NeoChord, Inc. St. Louis Park, MN, USA) versus conventional mitral valve repair. Patients were enrolled from 2010 to 2018 and after exclusions, the authors had 281 patients available for the study: 169 had Neochord and 112 had surgical repair, suggesting the authors’ preference for Neochord to treat posterior leaflet prolapse. To compensate for discrepancies procedure selection, the authors used a propensity score analysis using preoperative clinical variables believed to affect outcome. They identified 88 pairs of patients with similar clinical profiles except for functional class which was worse in the Neochord group. The patients in this study were younger than in most reports on longitudinal outcomes of mitral valve repair [2, 3]. The chose patients’ survival as the primary endpoint of the study but since a propensity score analysis was used to compensate for differences in age and comorbidities, this does not seem rational. The secondary endpoints of reoperation on the mitral valve and freedom from moderate or severe MR are far more pertinent in this type of comparing procedures to treat MR. Before discharge from hospital, 8 patients in the Neochord and 1 patient in the surgical repair group had moderate or severe MR. The 5-year survival was similar, as one would expect, but the freedom from recurrent MR was only 57.6% in the Neochord group and 84.6% in the surgical repair group, and the freedom from reoperation was 78.9% in the first group and 92% in the second. Neochord DS1100 gained European market approval in 2016 and FDA approval for a randomized clinical trial in the USA in the same year [4]. I have not been able to find any publication on that randomized trial, likely because it is still enrolling patients in spite of the fact that 6 years have passed since its FDA approval [4]. Hopefully, this randomized clinical trial will help us to determine the usefulness of this device. Based on D’Onofrio and colleagues [1] experience and on that of others [3], I am not sure this device should be used in any patient who can have conventional mitral valve repair. There are, however, patients with posterior leaflet prolapse with intractable heart failure that would not tolerate a median sternotomy or even a right mini-thoracotomy with cardiopulmonary bypass and, perhaps, they should be considered for this device but only after excluding the feasibility of a transcatheter Mitraclip (Abbott Laboratories, Chicago, IL, USA), which is likely to provide better and safer outcomes [5]. I have been practicing cardiac surgery for over 4 decades and prospectively followed certain groups of my patients. Mitral valve surgery is one of them, and I have over 3000 mitral valve repairs in my dat
在这一期的《互动心血管与胸外科》杂志上，帕多瓦大学的D 'Onofrio及其同事[1]比较了Neochord DS1100 (Neochord, Inc.)矫正后小叶脱垂导致的二尖瓣反流(MR)的围手术期和5年结果。St. Louis Park, MN, USA)与传统二尖瓣修复。2010年至2018年招募了患者，排除后，作者有281名患者可用于研究:169名患者接受了Neochord, 112名患者接受了手术修复，这表明作者倾向于使用Neochord治疗后小叶脱垂。为了弥补手术选择的差异，作者使用倾向评分分析，使用术前临床变量被认为会影响结果。他们确定了88对具有相似临床特征的患者，除了Neochord组的功能分类更差。本研究的患者比大多数二尖瓣修复纵向结果报道的患者更年轻[2,3]。选择患者的生存作为研究的主要终点，但由于使用倾向评分分析来补偿年龄和合并症的差异，这似乎是不合理的。在这类治疗MR的比较方法中，二尖瓣再手术和无中度或重度MR的次要终点更为相关。出院前，Neochord组和外科修复组分别有8例和1例患者有中度或重度MR。正如人们所预料的，5年生存率相似，但Neochord组和外科修复组的MR复发率仅为57.6%和84.6%。第一组和第二组的再手术成功率分别为78.9%和92%。Neochord DS1100于2016年获得欧洲市场批准，同年在美国获得FDA的随机临床试验批准[4]。我还没有找到任何关于该随机试验的出版物，可能是因为尽管自FDA批准以来已经过去了6年[4]，但该试验仍在招募患者。希望这个随机临床试验能帮助我们确定这个装置的有用性。根据D 'Onofrio等人[1]和其他人[3]的经验，我不确定这种装置是否应该用于任何可以进行常规二尖瓣修复的患者。然而，有一些后小叶脱垂合并顽固性心力衰竭的患者不能忍受正中胸骨切开术甚至右小胸切开术联合体外循环，也许他们应该考虑使用这种装置，但必须排除经导管Mitraclip (Abbott Laboratories, Chicago, IL, USA)的可行性，后者可能提供更好、更安全的结果[5]。我从事心脏外科手术已有40多年，并对我的某些患者群体进行了前瞻性随访。二尖瓣手术就是其中之一，我的数据库中有超过3000个二尖瓣修复的患者。很少有心脏手术可以恢复寿命和生活质量，以及修复由于小叶脱垂的MR的二尖瓣。在过去的2000年的修复中，我没有失去一个病人，在我们单位最近的一份报告中[2]，20年的再手术累计发生率为4.6%，复发的中度或重度MR累计发生率为12.5%。现有的技术(如NeoChord或Mitraclip)很难提供类似的结果。
{"title":"Neochord DS1000 system versus conventional mitral valve repair for correction of mitral regurgitation due to prolapse of the posterior leaflet","authors":"T. David","doi":"10.1093/icvts/ivac139","DOIUrl":"https://doi.org/10.1093/icvts/ivac139","url":null,"abstract":"In this issue of the Interactive CardioVascular and Thoracic Surgery, D’Onofrio and colleagues [1] from the University of Padua compared the perioperative and 5-year outcomes of correction of mitral regurgitation (MR) due to posterior leaflet prolapse with Neochord DS1100 (NeoChord, Inc. St. Louis Park, MN, USA) versus conventional mitral valve repair. Patients were enrolled from 2010 to 2018 and after exclusions, the authors had 281 patients available for the study: 169 had Neochord and 112 had surgical repair, suggesting the authors’ preference for Neochord to treat posterior leaflet prolapse. To compensate for discrepancies procedure selection, the authors used a propensity score analysis using preoperative clinical variables believed to affect outcome. They identified 88 pairs of patients with similar clinical profiles except for functional class which was worse in the Neochord group. The patients in this study were younger than in most reports on longitudinal outcomes of mitral valve repair [2, 3]. The chose patients’ survival as the primary endpoint of the study but since a propensity score analysis was used to compensate for differences in age and comorbidities, this does not seem rational. The secondary endpoints of reoperation on the mitral valve and freedom from moderate or severe MR are far more pertinent in this type of comparing procedures to treat MR. Before discharge from hospital, 8 patients in the Neochord and 1 patient in the surgical repair group had moderate or severe MR. The 5-year survival was similar, as one would expect, but the freedom from recurrent MR was only 57.6% in the Neochord group and 84.6% in the surgical repair group, and the freedom from reoperation was 78.9% in the first group and 92% in the second. Neochord DS1100 gained European market approval in 2016 and FDA approval for a randomized clinical trial in the USA in the same year [4]. I have not been able to find any publication on that randomized trial, likely because it is still enrolling patients in spite of the fact that 6 years have passed since its FDA approval [4]. Hopefully, this randomized clinical trial will help us to determine the usefulness of this device. Based on D’Onofrio and colleagues [1] experience and on that of others [3], I am not sure this device should be used in any patient who can have conventional mitral valve repair. There are, however, patients with posterior leaflet prolapse with intractable heart failure that would not tolerate a median sternotomy or even a right mini-thoracotomy with cardiopulmonary bypass and, perhaps, they should be considered for this device but only after excluding the feasibility of a transcatheter Mitraclip (Abbott Laboratories, Chicago, IL, USA), which is likely to provide better and safer outcomes [5]. I have been practicing cardiac surgery for over 4 decades and prospectively followed certain groups of my patients. Mitral valve surgery is one of them, and I have over 3000 mitral valve repairs in my dat","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86207187","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}
Yunan Wang, Yunliang Cao, Mengjia Wu, Yanyi Lu, Bo He, Lei Zhou, Wei Hu
Abstract OBJECTIVES The aim of this study was to investigate the effect of preoperative radiotherapy (PrORT) on the overall survival (OS) of patients with stage ipsilateral mediastinal lymph node metastasis (N2) non-small-cell lung cancer. METHODS A total of 1390 patients with stage N2 non-small-cell lung cancer between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results database. The efficacy of PrORT combined with surgery was compared with that of surgery alone on OS. Propensity score matching (PSM) was performed to balance the baseline characteristics of patients who received (n = 239) and did not receive (n = 1151) PrORT. We compared the OS of the 2 groups using the Kaplan–Meier method and log-rank were used to compare the OS between the 2 groups test before and after PSM and to analyse subgroups of patients with squamous cell carcinoma (SCC) and adenocarcinoma. RESULTS In whole group analysis before PSM, the median OS was superior in the PrORT group than in the surgery alone group (44.0 [34.4–56.6] vs 39.0 [34.5–43.5] months). There was a significant difference in OS [hazard ratio (HR): 0.819; 95% confidence interval (CI): 0.677–0.991; P = 0.029]. Nevertheless, no statistically significant difference was found in OS between the 2 groups after PSM (HR: 0.856; 95% CI: 0.654–1.122; P = 0.260). Among subgroup analysis of the SCC group before PSM revealed that patients who received PrORT had significantly higher median OS than those who did not receive PrORT (52.0 [40.0–NA] vs 27.0 [22.0–32.0] months; HR: 0.591, 95% CI: 0.442–0.792, P = 0.000) and the differences in OS existed after PSM (P = 0.043). However, no significant difference was found in OS before and after matching in the adenocarcinoma group (P = 0.827 and P = 0.801, respectively). CONCLUSIONS PrORT demonstrated an OS benefit for patients with stage N2 lung SCC; however, further prospective randomized clinical trials are warranted to confirm this finding.
{"title":"Effect of preoperative radiotherapy on overall survival in N2 non-small-cell lung cancer: a propensity score-matched analysis of Surveillance, Epidemiology, and End Results database","authors":"Yunan Wang, Yunliang Cao, Mengjia Wu, Yanyi Lu, Bo He, Lei Zhou, Wei Hu","doi":"10.1093/icvts/ivab321","DOIUrl":"https://doi.org/10.1093/icvts/ivab321","url":null,"abstract":"Abstract OBJECTIVES The aim of this study was to investigate the effect of preoperative radiotherapy (PrORT) on the overall survival (OS) of patients with stage ipsilateral mediastinal lymph node metastasis (N2) non-small-cell lung cancer. METHODS A total of 1390 patients with stage N2 non-small-cell lung cancer between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results database. The efficacy of PrORT combined with surgery was compared with that of surgery alone on OS. Propensity score matching (PSM) was performed to balance the baseline characteristics of patients who received (n = 239) and did not receive (n = 1151) PrORT. We compared the OS of the 2 groups using the Kaplan–Meier method and log-rank were used to compare the OS between the 2 groups test before and after PSM and to analyse subgroups of patients with squamous cell carcinoma (SCC) and adenocarcinoma. RESULTS In whole group analysis before PSM, the median OS was superior in the PrORT group than in the surgery alone group (44.0 [34.4–56.6] vs 39.0 [34.5–43.5] months). There was a significant difference in OS [hazard ratio (HR): 0.819; 95% confidence interval (CI): 0.677–0.991; P = 0.029]. Nevertheless, no statistically significant difference was found in OS between the 2 groups after PSM (HR: 0.856; 95% CI: 0.654–1.122; P = 0.260). Among subgroup analysis of the SCC group before PSM revealed that patients who received PrORT had significantly higher median OS than those who did not receive PrORT (52.0 [40.0–NA] vs 27.0 [22.0–32.0] months; HR: 0.591, 95% CI: 0.442–0.792, P = 0.000) and the differences in OS existed after PSM (P = 0.043). However, no significant difference was found in OS before and after matching in the adenocarcinoma group (P = 0.827 and P = 0.801, respectively). CONCLUSIONS PrORT demonstrated an OS benefit for patients with stage N2 lung SCC; however, further prospective randomized clinical trials are warranted to confirm this finding.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"187 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77591795","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}
Qi Li, N. Hussein, Yunyi Zhang, Yibing Fang, Yue Wang, Q. An, O. Honjo, S. Luo
Abstract OBJECTIVES To demonstrate that improvement in technical performance of congenital heart surgical trainees during ventricular septum defect (VSD) closure simulation translates to better patient outcomes. METHODS Seven trainees were divided into 2 groups. Experienced-fellows group included 4 senior trainees who had performed >5 VSD closures. Residents group consisted of 3 residents who had never performed a VSD closure. Experienced-fellows completed 3 VSD closures on real patients as a pretest. Both groups participated in a 4-week simulation requiring each participant to complete 2 VSD closures on three-dimensional printed models per week. One month later, all trainees returned for a post-test operation in real patients. All performances were recorded, blinded and scored independently by 2 cardiac surgeons using the validated Hands-On Surgical Training–Congenital Heart Surgery (HOST-CHS). Predefined surgical outcomes were analysed. RESULTS The median HOST-CHS score increased significantly from week 1 to 4 [50 (39, 58) vs 73 (65, 74), P < 0.001] during simulation. The improvement in the simulation of experienced-fellows successfully transferred to skill acquisition [HOST-CHS score 72.5 (71, 74) vs 54 (51, 60), P < 0.001], with better patients outcomes including shorter total cross-clamp time [pretest: 86 (70, 99) vs post-test: 60 (53, 64) min, P = 0.006] and reduced incidence of major patch leak requiring multiple pump runs [pretest: 4/11 vs post-test: 0/9, P = 0.043]. After simulation, the technical performance and surgical outcomes of Residents were comparable to Experienced-fellows in real patients, except for significantly longer cross-clamp time [Residents: 76.5 (71.7, 86.8) vs Experienced-fellows: 60 (53, 64) min, P = 0.002]. CONCLUSIONS Deliberate practice using simulation translates to better performance and surgical outcomes in real patients. Residents who had never completed a VSD closure could perform the procedures just as safely and effectively as their senior colleagues following simulation.
摘要目的:研究先天性心脏手术学员在室间隔缺损(VSD)闭合模拟过程中技术表现的改善可转化为更好的患者预后。方法7名学员分为2组。资深研修生组包括4名完成5次以上VSD闭合的资深研修生。住院医生组由3名从未做过室间隔封闭手术的住院医生组成。有经验的研究员在真实患者身上完成了3次室间隔闭合作为前测。两组都参加了为期4周的模拟，要求每个参与者每周在三维打印模型上完成2次VSD闭合。一个月后，所有的受训者都回到真实的病人身上进行测试后的手术。由2名心脏外科医生使用经过验证的hands - practical Surgery Training-Congenital Heart Surgery (HOST-CHS)进行记录、盲法和独立评分。分析预先确定的手术结果。结果在模拟过程中，HOST-CHS评分中位数从第1周到第4周显著升高[50 (39,58)vs 73 (65,74)， P < 0.001]。有经验的患者在模拟方面的改善成功转移到技能习得方面[HOST-CHS评分72.5 (71,74)vs 54 (51,60)， P < 0.001]，患者预后更好，包括总交叉钳装时间缩短[前测:86 (70,99)vs后测:60(53,64)分钟，P = 0.006]，需要多次泵送的主要贴片泄漏发生率降低[前测:4/11 vs后测:0/9,P = 0.043]。经过模拟，住院医生的技术表现和手术结果与实际患者的经验人员相当，除了交叉钳夹时间明显更长[住院医生:76.5 (71.7,86.8)vs经验人员:60(53,64)分钟，P = 0.002]。结论:在真实患者中，采用模拟方法进行刻意练习可获得更好的手术效果。从未完成过VSD关闭的住院医生可以像他们的资深同事一样安全有效地完成模拟手术。
{"title":"Clinical translation of surgical simulated closure of a ventricular septum defect","authors":"Qi Li, N. Hussein, Yunyi Zhang, Yibing Fang, Yue Wang, Q. An, O. Honjo, S. Luo","doi":"10.1093/icvts/ivac122","DOIUrl":"https://doi.org/10.1093/icvts/ivac122","url":null,"abstract":"Abstract OBJECTIVES To demonstrate that improvement in technical performance of congenital heart surgical trainees during ventricular septum defect (VSD) closure simulation translates to better patient outcomes. METHODS Seven trainees were divided into 2 groups. Experienced-fellows group included 4 senior trainees who had performed >5 VSD closures. Residents group consisted of 3 residents who had never performed a VSD closure. Experienced-fellows completed 3 VSD closures on real patients as a pretest. Both groups participated in a 4-week simulation requiring each participant to complete 2 VSD closures on three-dimensional printed models per week. One month later, all trainees returned for a post-test operation in real patients. All performances were recorded, blinded and scored independently by 2 cardiac surgeons using the validated Hands-On Surgical Training–Congenital Heart Surgery (HOST-CHS). Predefined surgical outcomes were analysed. RESULTS The median HOST-CHS score increased significantly from week 1 to 4 [50 (39, 58) vs 73 (65, 74), P < 0.001] during simulation. The improvement in the simulation of experienced-fellows successfully transferred to skill acquisition [HOST-CHS score 72.5 (71, 74) vs 54 (51, 60), P < 0.001], with better patients outcomes including shorter total cross-clamp time [pretest: 86 (70, 99) vs post-test: 60 (53, 64) min, P = 0.006] and reduced incidence of major patch leak requiring multiple pump runs [pretest: 4/11 vs post-test: 0/9, P = 0.043]. After simulation, the technical performance and surgical outcomes of Residents were comparable to Experienced-fellows in real patients, except for significantly longer cross-clamp time [Residents: 76.5 (71.7, 86.8) vs Experienced-fellows: 60 (53, 64) min, P = 0.002]. CONCLUSIONS Deliberate practice using simulation translates to better performance and surgical outcomes in real patients. Residents who had never completed a VSD closure could perform the procedures just as safely and effectively as their senior colleagues following simulation.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"323 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75469979","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}
Matto Pettinari, M. Gianoli, M. Palmen, Š. Černý, B. Onan, Sandeep Singh, P. Segers, C. Bolcal, C. Alhan, E. Navarra, H. de Praetere, J. Vojáček, T. Cebotaru, P. Modi, F. Doguet, U. Franke, A. Ouda, L. Melly, G. Malapert, L. Labrousse, A. Agnino, T. Philipsen, J. Jansens, T. Folliguet, D. Pereda, F. Musumeci, P. Suwalski, K. Cathenis, F. Van Praet, J. Bonatti, W. Oosterlinck
Matto Pettinari *†, Monica Gianoli†, Meindert Palmen , Stepan Cerny, Burak Onan, Sandeep Singh, Patrique Segers , Cengiz Bolcal, Cem Alhan, Emiliano Navarra, Herbert De Praetere, Jan Vojacek, Theodor Cebotaru, Paul Modi, Fabien Doguet , Ulrich Franke, Ahmed Ouda, Ludovic Melly, Ghislain Malapert, Louis Labrousse , Alfonso Agnino, Tine Philipsen, Jean-Luc Jansens, Thierry Folliguet, Daniel Pereda , Francesco Musumeci, Piotr Suwalski , Koen Cathenis, Frank Van Praet, Johannes Bonatti and Wouter Oosterlinck; on behalf of the European Robotic CardioThoracic
{"title":"Robotic coronary revascularization in Europe, state of art and future of EACTS-endorsed Robotic Cardiothoracic Surgery Taskforce","authors":"Matto Pettinari, M. Gianoli, M. Palmen, Š. Černý, B. Onan, Sandeep Singh, P. Segers, C. Bolcal, C. Alhan, E. Navarra, H. de Praetere, J. Vojáček, T. Cebotaru, P. Modi, F. Doguet, U. Franke, A. Ouda, L. Melly, G. Malapert, L. Labrousse, A. Agnino, T. Philipsen, J. Jansens, T. Folliguet, D. Pereda, F. Musumeci, P. Suwalski, K. Cathenis, F. Van Praet, J. Bonatti, W. Oosterlinck","doi":"10.1093/icvts/ivac108","DOIUrl":"https://doi.org/10.1093/icvts/ivac108","url":null,"abstract":"Matto Pettinari *†, Monica Gianoli†, Meindert Palmen , Stepan Cerny, Burak Onan, Sandeep Singh, Patrique Segers , Cengiz Bolcal, Cem Alhan, Emiliano Navarra, Herbert De Praetere, Jan Vojacek, Theodor Cebotaru, Paul Modi, Fabien Doguet , Ulrich Franke, Ahmed Ouda, Ludovic Melly, Ghislain Malapert, Louis Labrousse , Alfonso Agnino, Tine Philipsen, Jean-Luc Jansens, Thierry Folliguet, Daniel Pereda , Francesco Musumeci, Piotr Suwalski , Koen Cathenis, Frank Van Praet, Johannes Bonatti and Wouter Oosterlinck; on behalf of the European Robotic CardioThoracic","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79110367","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}
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