Kyobu geka. The Japanese journal of thoracic surgery最新文献

In arrhythmia surgery, creating a reliable conduction block is fundamental. Traditional cut-and-sew techniques, while effective, pose risks such as bleeding and prolonged operative time. Modern surgical ablation devices-such as cryoablation, radiofrequency, microwave, and ultrasound-enable targeted, transmural myocardial necrosis with greater safety and efficiency. However, improper use or incomplete ablation may lead to residual conduction, resulting in arrhythmia recurrence or new arrhythmogenic circuits. Each device has distinct energy sources, thermal profiles, and tissue interactions. Cryoablation, for example, remains reliable with minimal collateral damage, while bipolar radiofrequency allows precise, real-time monitoring of lesion transmurality. Ultrasound and microwave technologies offer deeper tissue penetration but have varying long-term efficacy. Thorough understanding of device characteristics, lesion depth, and intraoperative confirmation of conduction block is essential. As minimally invasive techniques advance, the role of appropriately selected and applied ablation devices becomes increasingly vital for safe and effective arrhythmia surgery.

We present the case of a 27-year-old male who collapsed due to severe stenosis of an artificial vessel caused by a pseudoaneurysm at the central anastomotic site after acute aortic dissection Stanford type A. Although we believe that BioGlue mediated tissue toxicity may be one cause of this pseudoaneurysm, other factors, such as tissue separation due to tissue fragility caused by infection, inflammation, and cutting caused by the surgical procedure, are also thought to have contributed. Emergency re-operation was performed after resuscitation. The patient was eventually discharged home without adverse events on the 34th postoperative day. Careful observation in mid- to long-term and remote post-operative phases is necessary for patients subjected to procedures using BioGlue, and prompt repair of pseudoaneurysms is desirable.

Recent years have witnessed significant advancements in prosthetic heart valves, particularly bioprosthetic valves. The main challenges for bioprosthetic valves have been structural valve deterioration (SVD) and long-term durability. This review focuses on three major innovations: anti-calcification treatments, valve-in-valve (ViV) compatible designs, and sutureless/rapid deployment valves. Modern bioprosthetic valves incorporate proprietary anti-calcification technologies that have demonstrated excellent mid-term durability in clinical trials. Valve designs increasingly consider future ViV procedures, incorporating features such as expandable bands, optimized dimensions, and enhanced radiopaque markers. Sutureless/rapid deployment valves have shown promising results with reduced operative times, particularly beneficial for minimally invasive approaches. Recent guidelines reflect these advances, with age thresholds for bioprosthetic valves decreasing. Emerging evidence suggests tissue-specific characteristics may influence valve selection. Future developments will likely focus on further enhancing durability and establishing personalized valve selection algorithms.

The Impella is a catheter-based microaxial flow pump that is inserted through a small vascular graft (Impella 5.5) or directly from femoral artery (Impella CP) and placed across the aortic valve. By draining blood from the left ventricle and pumping it to the ascending aorta, the device not only increases cardiac output, but also unloads the left ventricle which facilitates recovery of damaged cardiac muscles. It has been used in more than 14,000 cardiogenic shock patients in Japan and excellent clinical outcomes have been published in more than 20 major journals in the last three years using J-PVAD registry which is a mandatory national database. New evidences and guidelines may upgrade the value of this device as a less invasive left ventricular unloading device even more in the near future.

Transesophageal echocardiography (TEE) is a valuable diagnostic and intraoperative tool that allows high-resolution, real-time imaging of deep cardiovascular structures without interfering with surgery. It offers dynamic information similar to computed tomography (CT) or magnetic resonance imaging (MRI) but without radiation exposure, making repeated assessments feasible. During cardiovascular surgery, TEE guides cannula placement, monitors myocardial protection, detects complications like air embolism and intraoperative aortic dissection, and facilitates real-time surgical navigation. Its utility extends to postoperative intensive care unit (ICU) care and emergency settings, where it helps diagnose complications when CT is not feasible. In thoracic surgery, TEE aids in assessing tumor invasion into cardiovascular structures. However, TEE's effectiveness heavily relies on the operator's skill, unlike the objectivity of radiologic modalities. Thus, fostering collaboration between anesthesiologists and surgeons is essential. As a critical part of perioperative management, TEE proficiency is now a requirement for board certification in cardiovascular anesthesia in Japan. Supporting anesthesiologists in developing TEE skills enhances surgical outcomes and institutional capability.

In thoracic surgery, where precision and safety are paramount, advanced lighting and optical technologies play a critical role in enhancing surgical outcomes. Recent developments in lighting systems have improved brightness, reduced heat generation, and enabled more accurate color rendering, supporting safer and more efficient procedures. The shift toward minimally invasive techniques, such as thoracoscopic and robot-assisted surgeries, has further accelerated the need for high-quality visualization tools. Three-dimensional (3D) imaging, high-resolution displays, and fluorescence-guided visualization now allow for better identification of anatomical structures. Furthermore, augmented reality (AR) and artificial intelligence (AI) are being integrated into surgical practice. Preoperative imaging data can be reconstructed in 3D and overlaid during surgery to enhance accuracy in tumor localization and vascular mapping. Wearable optical devices and digital operating room systems are also improving communication and collaboration among surgical teams, allowing for real-time sharing of visual information and remote guidance. These technologies are increasingly contributing not only to surgical precision but also to team-based workflows, education, and training. Looking ahead, real-time AI-AR fusion systems and remote navigation support may further transform thoracic surgery by enabling safer, more informed decision-making in complex procedures.

Thoracic endovascular aortic repair (TEVAR) has made a significant contribution to the treatment of aortic dissection. Comprehensive management of aortic surgery, including lifesaving and prevention of aortic complications, is more important than ever in Japan, where the population is aging, through the successful use of TEVAR in combination with conservative treatment and open repair. The evolution of new technologies, such as bifurcated stent grafts, is expected to lead to more advanced treatment.

In this paper, we would like to discuss the usefulness and safety of lung resection by using the da Vinci SP. Thirty-seven patients who underwent surgery for lung cancer from February to December 2024 at our hospital were included. The mean age was 70 (28~87) years, 21 were male and 16 were female, with a median operative time of 213 (135~417) minutes and a median console time of 149 (96~254) minutes. The resected lungs were the right upper lobe in 11 cases, the right middle lobe in 3 cases, the right lower lobe in 9 cases, the left upper lobe in 5 cases and the left lower lobe in 10 cases. The conversion to thoracotomy was performed in 2 cases. Postoperative complications included atrial fibrillation, decreased intestinal peristalsis due to vagal neuropathy, and pneumonia, but no complications above Clavien-Dindo classification grade Ⅲ were observed. Although there are very small number of reports, those have shown that thoracic surgery using the da Vinci SP has been performed safely. Lung cancer surgery with the da Vinci SP is still in its infancy, and further expansion of the device and cost reductions are desirable.

The causes of constrictive pericarditis are known to include previous cardiac surgery, radiotherapy, collagen disease, and tuberculosis, but in recent years, reports of constrictive pericarditis due to immunoglobulin(Ig)G4-related diseases have increased. We report a case of IgG4-related constrictive pericarditis that relapsed early after pericardiectomy and was well controlled by steroid therapy. The patient was a 69-year-old man who was diagnosed with idiopathic constrictive pericarditis. He underwent pericardiectomy and very early postoperative course was favorable, but the disease recurred around a week or so. Postoperative pathological examination and immunohistochemistry revealed IgG4-related constrictive pericarditis, and steroid therapy was started. The patient's heart failure symptoms were alleviated, and thickened pericardium got thin following steroid therapy. During treatment of constrictive pericarditis, it is necessary to keep IgG4-related diseases in mind.

Minimally invasive cardiac surgery (MICS) has revolutionized the field of cardiac surgery by offering reduced surgical trauma, shorter hospital stays, and faster patient recovery compared to conventional median sternotomy. The success of MICS heavily depends on the continuous advancements in surgical instrumentation. This review discusses the recent innovations in surgical tools and technologies designed to enhance precision, safety, and efficiency in MICS. Key developments include robotic-assisted systems, endoscopic instruments, percutaneous devices, and novel visualization techniques. We further explore the clinical impact of these technologies and future prospects in the field.