Journal of Cardiac Surgery最新文献

Background: Hybrid coronary revascularization (HCR) combines minimally invasive direct coronary artery bypass (MIDCAB) to the left anterior descending artery (LAD) with percutaneous coronary intervention (PCI) for non-LAD lesions. HCR aims to balance the durability of surgical revascularization with the reduced invasiveness of PCI. This study evaluates 20 years of HCR experience at a single center, focusing on short- and long-term clinical outcomes.

Methods: A retrospective analysis was conducted on 2969 patients who underwent MIDCAB between 1996 and 2020 at the Heart Center Leipzig. A total of 177 patients met the inclusion criteria, defined as MIDCAB followed or preceded by PCI within 100 days. Exclusion criteria included emergency procedures, planned sternotomy, and delayed HCR beyond 100 days. Propensity score matching (PSM) compared outcomes between MIDCAB-first and PCI-first strategies.

Results: The median time interval between MIDCAB and PCI was 22 days. Early stent and graft failure rates were 2.8% and 2.2%, respectively. Kaplan–Meier estimated survival was 79.1% at 5 years, 64.2% at 10 years, 49.8% at 15 years, and 37.8% at 20 years. Freedom from repeat revascularization was 86.3% at 5 years and 73.6% at 10 years. PSM analysis showed no significant difference in 15-year survival (57.7% vs. 50.6%, p = 0.68) or 10-year freedom from repeat revascularization (88.9% vs. 86.1%, p = 0.39) between the MIDCAB-first and PCI-first groups.

Conclusion: HCR provides durable long-term survival and revascularization outcomes, with comparable results between MIDCAB-first and PCI-first strategies. These findings support HCR as a viable alternative to conventional CABG in selected patients.

Background: Aortic stenosis (AS) is frequently seen in elderly individuals. However, the preferred strategy for asymptomatic severe AS remains unclear. We compared early aortic valve replacement (eAVR) with conservative care.

Methods: We conducted a systematic review and meta-analysis of RCTs from major databases until December 20, 2024. Risk ratios (RRs) and mean differences (MDs) were pooled with 95% confidence intervals (CIs) using R version 4.3.

Results: Four RCTs (1427 patients) showed no substantial difference in all-cause mortality between the early intervention and conservative care (RR: 0.69 [95% CI: 0.42–1.11]; p = 0.13). However, early intervention was markedly associated with a lower incidence of cardiovascular mortality (RR: 0.65 [95% CI: 0.44–0.96]; p = 0.03), hospitalization for heart failure (RR: 0.27 [95% CI: 0.13–0.54]; p < 0.01), and stroke (RR: 0.62 [95% CI: 0.40–0.95]; p = 0.03) compared to that of conservative care. Moreover, there was no significant difference between the two groups in myocardial infarction (RR: 0.22 [95% CI: 0.04–1.24]; p = 0.09), repeated aortic-valve surgery (RR: 0.74 [95% CI: 0.12–4.78]; p = 0.75), and thromboembolic complications (RR: 0.72 [95% CI: 0.23–2.21]; p = 0.56).

Conclusion: In asymptomatic severe AS, early AVR did not mitigate overall mortality but substantially lowered cardiovascular mortality, heart failure hospitalizations, and stroke risks compared to conservative management. Perioperative complications were similar in both groups.

Objective: To investigate the effect of different surgical methods on the prognosis of 84 patients with lung cancer complicated with coronary heart disease.

Methods: Data of patients with lung cancer complicated with coronary heart disease who received surgical treatment in our hospital from January 2018 to November 2024 were collected. The patients were divided into OPCAB¹ simultaneous operation group, PCI² postoperative operation group, and non-revascularization operation group according to the surgical method, and then, the PCI postoperative operation group was divided into two groups according to the two surgical intervals. Clinical data such as the evaluation of surgical safety and the effect of the time of operation after PCI on the prognosis of patients with lung cancer were used to guide the treatment of these patients.

Results: The probability of coronary artery complications is higher in patients undergoing pulmonary surgery with PCI indications and no treatment for coronary artery disease. There was no significant difference in the probability of coronary artery complications in lung cancer patients who underwent surgery within 2 months after PCI versus those who underwent surgery within 2–4 months after PCI. However, the time window of surgery after PCI has an impact on the prognosis of patients with lung cancer.

Conclusion: There was no significant difference in the duration of intraoperative bleeding, drainage tube removal, and hospital stay between patients undergoing pulmonary surgery after PCI and those without coronary revascularization. Pulmonary surgery after PCI was safe and feasible, and pulmonary surgery within 2 months after PCI was safe and feasible, and the prognosis of patients undergoing pulmonary surgery after PCI was different in different time windows. Pulmonary surgery should be performed as early as possible within the 2-month time window after PCI. Patients undergoing pulmonary surgery with PCI indications and without prior treatment of coronary artery lesions have a higher probability of postoperative coronary complications. Therefore, lung cancer surgery as soon as possible after PCI can be considered to have a good impact on the prognosis of patients.

Objective: This study compared early postoperative outcomes of Custodiol-HTK versus cold intermittent blood cardioplegia in patients undergoing complete atrioventricular septal defect (CAVSD) repair.

Methods: From January 2012 to December 2022, we retrospectively analyzed 305 patients undergoing CAVSD repair at our center. Patients were divided into two groups based on cardioplegia: Group 1 received Custodiol-HTK (n = 159), and Group 2 received cold intermittent blood cardioplegia (n = 146). Outcomes that were compared included mortality, ECMO requirement, cross-clamp and cardiopulmonary bypass (CPB) times, cardioplegia doses, valvular edema (assessed intraoperatively via a visual scale), postoperative intubation time, ICU stay, and hospital stay.

Results: Mortality was 1.9% in Group 1 versus 8.2% in Group 2 (p = 0.01). ECMO was required in 0.6% of Group 1 versus 11.0% of Group 2 (p < 0.001). Cross-clamp time (56 ± 12 min vs. 76 ± 16 min, p < 0.001) and CPB time (83 ± 14 min vs. 97 ± 17 min, p = 0.002) were shorter in Group 1. Cardioplegia doses were 1 in Group 1 versus 4.7 ± 1.2 in Group 2 (p < 0.001). Intubation time, ICU stay, and hospital stay were significantly shorter in Group 1 (p < 0.01 for each).

Conclusion: Custodiol-HTK was associated with improved early outcomes, including reduced mortality, ECMO use, and shorter operative and recovery times, in CAVSD repair. It appears to offer superior myocardial protection, particularly in complex cases, though potential risks such as hyponatremia require careful perioperative management.

Objective: The research evaluated both safety and effectiveness of the Ozaki procedure when performed through right infra-axillary mini-thoracotomy on adult patients. Mini-thoracotomy approaches in the surgical treatment of aortic valve diseases produce better cosmetic outcomes and faster recovery times than traditional sternotomy procedures. The study examined clinical results from the Ozaki procedure when surgeons used this approach for short- and medium-term follow-up.

Methods: Between January 2021 and March 2025, 21 patients aged 18 years or older with symptomatic aortic valve pathology and eligible for elective surgery were included in the study. The Ozaki procedure was performed on all patients using the right infra-axillary mini-thoracotomy approach. Clinical and demographic data, surgical technique details, early postoperative, and 6-month follow-up findings were examined. The main analysis parameters included surgery duration, complication rates, intensive care and hospital stay duration, echocardiographic results, and the need for reoperation.

Results: The mean age was 65 ± 12 years, and 62% were male. Aortic stenosis was the most common pathology (81%). The mean surgery duration was 210 ± 30 min, and the intensive care unit stay was 2.5 ± 1 day. No cases of aortic valve insufficiency or major complications were observed in the early postoperative period. At 6-month follow-up, no reoperation was required except for endocarditis development in one patient (5%). Mortality was zero.

Conclusion: The Ozaki procedure with mini-thoracotomy provides successful and safe results in suitable patients. This method, which offers both cosmetic and functional advantages, can be considered an effective alternative in aortic valve surgery.

Objectives: This study evaluated early and midterm prognostic outcomes of transcatheter aortic valve implantation (TAVI) in combination with percutaneous coronary intervention (PCI) compared with surgical aortic valve replacement (SAVR) plus coronary artery bypass grafting (CABG) in patients with severe aortic stenosis and anatomically complex coronary artery disease (CAD).

Methods: Between 2010 and 2020, 1232 consecutive patients underwent TAVI with PCI or SAVR with CABG at a tertiary referral center. Eligibility required the presence of complex CAD (SYNTAX I score > 22). Propensity score matching (1:1) generated 76 well-balanced patient pairs. The primary endpoint was early mortality; secondary endpoints included major adverse cardiac and cerebrovascular events (MACCE) and midterm mortality.

Results: Matched cohorts exhibited intermediate operative risk (STS score: 3.0 ± 1.7 vs. 3.4 ± 1.2; EuroSCORE II: 6.89 ± 4.3 vs. 7.41 ± 4.7). No significant intergroup differences were observed regarding all-cause mortality (p = 0.262), ischemic stroke (p = 0.527), or myocardial infarction (p = 0.474) during follow-up. Similarly, reintervention rates did not differ (p = 0.515, HR: 2.1, 95% CI: 0.282–15.200). MACCE (p = 0.061, HR: 1.8, 95% CI: 0.938–3.509) and new pacemaker implantation (p = 0.087, HR: 0.5, 95% CI: 0.187–1.089) occurred numerically more frequently in the TAVI + PCI group without statistical significance. Prosthetic valve regurgitation > Grade II was less common in SAVR + CABG, whereas mean transvalvular gradients favored TAVI + PCI.

Conclusion: In patients with severe aortic stenosis and advanced CAD, TAVI + PCI yielded overall outcomes comparable to SAVR + CABG. However, the surgical strategy demonstrated superiority in terms of MACCE incidence and device-related conduction disturbances. Prospective randomized evidence is imperative to optimize patient selection and refine guideline-directed decision-making in this complex cohort.

The inferior vena cava distensibility index (dIVC) has been proposed as an alternative dynamic parameter for predicting fluid responsiveness (FR) in mechanically ventilated patients. This study explored the correlation between dIVC and commonly used FR indicators in patients undergoing robotic-assisted off-pump coronary artery bypass (OPCAB) surgery. Thirty-two patients were prospectively enrolled, and hemodynamic parameters, including stroke volume variation (SVV), pulse pressure variation (PPV), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), and the right ventricular end-diastolic volume index (RVEDVI), were recorded at four intraoperative time points. These time points were selected to represent distinct physiological phases during surgery: two-lung ventilation (TLV), one-lung ventilation (OLV), capnothorax, and mini-thoracotomy. dIVC showed a weak but significant positive correlation with SVV (r = 0.28, p < 0.001) and PPV (r = 0.28, p < 0.001), whereas no significant correlation was observed with static preload indicators (CVP, PCWP, and RVEDVI). Given that transesophageal echocardiography (TEE) is routinely employed in OPCAB surgery, dIVC measured via TEE may serve as a valuable adjunct for FR assessment when the SVV and PPV are unreliable, such as in patients with irregular heartbeats. However, using dIVC to predict intraoperative FR should be approached with caution, considering factors such as ventilator settings, inspiratory efforts, cardiopulmonary conditions, and intraabdominal hypertension.

Background: There is no ideal aortic valve replacement. When compared to bioprosthetic and mechanical valves, a Ross procedure may offer significant advantages such as improved durability and restoration of normal life-expectancy. Whether such advantages are maintained in older patients is not well established. This study compares perioperative and medium-term outcomes of the Ross procedure in patients under the age of 45 and 45–65 years.

Methods: This study retrospectively reviewed 76 patients undergoing the Ross procedure between 2020 and 2023 at a single academic center. The patients were stratified into young (18–44, n = 47) and middle-aged groups (ages 45–65, n = 29). Perioperative and medium-term outcomes to 1 year are reported.

Results: The average age of the young group was 32 (± 6.5) years versus 54.1 (± 5.2) years in the older group (p < 0.001) with more comorbidities and bicuspid aortic valve disease in the older group and no difference in primary symptoms, NYHA class, or ventricular function between the groups. There were no significant differences in the operative details between the groups. Perioperative outcomes showed a higher rate of atrial fibrillation 34.5% (n = 10) versus 12.8% (n = 6), p < 0.05 and prolonged inotrope use (over 48 h) 20.7% (n = 6) versus 2.1% (n = 1), p < 0.05 for the older group. There were no in-hospital mortalities. Medium-term outcomes showed no differences in ventricular or valvular function between the groups. There was one postdischarge mortality in the entire cohort (2.13%). No patients required autograft reintervention.

Conclusions: The Ross procedure can be safely performed in selected patients 45–65 years of age with comparable perioperative and short-term outcomes to younger patients.

Introduction: Coronary artery bypass grafting (CABG) is commonly performed for treating coronary artery disease (CAD) in octogenarians. This entails higher risk and resource utilization compared to younger patients. This retrospective multicenter study evaluates CABG outcomes in octogenarians, with a particular focus on the impact of off-pump (OPCAB) versus on-pump (ONCAB) CABG techniques.

Methods: We conducted a retrospective analysis of isolated OPCAB and ONCAB procedures in octogenarians from January 1, 2015, to June 30, 2023, across 8 centers within a single health system. All cases submitted to the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were included. The primary outcome was 30-day mortality; secondary outcomes included STS-defined postoperative complications. We performed a stabilized inverse probability treatment weighted (sIPTW) matching technique to balance baseline covariates between the two groups.

Results: Across eight centers, 470 (7%) CABG procedures were performed in octogenarians, with 207 (44%) underwent OPCAB and 263 (56%) ONCAB. Prior to matching, overall 30-day all-cause mortality rate was 6.6% in octogenarians. After sIPTW matching, 30-day mortality (primary outcome) rates were comparable between OPCAB and ONCAB (2.4% vs. 4.4%; p = 0.71). However, OPCAB was associated with lower rates of composite complications (28% relative risk reduction (RRR), p = 0.003), including pneumonia (89% RRR, p = 0.023), atrial fibrillation (30% RRR, p = 0.013), and discharge-to-acute care facilities (ACFs) (36% RRR, p = 0.003). Resource utilization was also lower in the OPCAB group, with shorter median hospital stays (6 [3–7] vs. 7 [6–9] days, p = 0.002) and reduced ventilator time (4.3 [0.8–9] vs. 8.4 [4.7–21] hours, p = 0.009).

Conclusion: In octogenarians, OPCAB and ONCAB found comparable 30-day mortality. However, OPCAB was associated with fewer complications, shorter hospital stays, reduced ventilator hours, lower blood transfusion requirements, and higher discharge-to-home rates, suggesting potential advantages in resource utilization and patient recovery.