Thoracic and Cardiovascular Surgeon最新文献

Simulation-based thoracic surgery training is increasingly incorporating physical models to enhance traditional learning methods. Conventional box trainers, though useful for basic skills, often lack anatomical accuracy and tactile feedback, limiting their relevance for complex procedures like thoracoscopic lung resection. High-fidelity 3D-printed lung models offer realistic anatomy and procedural flow, but their educational impact remains underexplored.Fifty-two surgical residents without prior thoracoscopic experience were randomly assigned to a high-fidelity lung model group or a conventional Fundamentals of Laparoscopic Surgery (FLS) box trainer group. All participants completed a baseline thoracic anatomy test and received standardized educational materials. The lung model group received structured simulation training on procedural anatomy and operative steps, while the FLS group practiced fundamental laparoscopic tasks. After training, participants repeated the anatomy test and performed a thoracoscopic lung wedge resection in a live animal model. Performance was assessed using the Objective Structured Assessment of Technical Skill (OSATS) and a 5-point confidence scale.A total of 52 surgical residents participated in the study, with 26 assigned to the high-fidelity lung model group and 26 to the FLS trainer group. Baseline anatomy scores were similar between groups (65.42  ±  6.10 vs. 66.12  ±  5.92; p  =  0.710). Posttraining, the lung model group showed greater gains in anatomy comprehension (87.60  ±  4.75 vs. 78.19  ±  5.54; p  <  0.001), higher OSATS scores (19.18  ±  2.43 vs. 15.41  ±  2.41; p  <  0.001), and increased confidence (3.13  ±  0.61 vs. 2.27  ±  0.68; p  =  0.002).High-fidelity 3D-printed lung models significantly enhance anatomical understanding, thoracoscopic skills, and confidence compared with conventional box trainers. These results support integrating anatomically accurate simulation into thoracic surgical education to improve both cognitive and psychomotor outcomes.

In obese patients, minimally invasive surgical aortic valve replacement (MIS-AVR) presents challenges, and the risk of patient-prosthesis mismatch (PPM) is elevated. This retrospective single-center study evaluates the impact of body mass index (BMI) on the outcome of an initial MIS-AVR program.A total of 307 patients underwent MIS-AVR between January 2013 and December 2015, the initial phase of our MIS-AVR program. They were divided into normal/overweight (BMI <30 kg/m²) versus obese patients (BMI ≥30 kg/m²). Primary endpoints included 30-day and 2-year mortality and stroke. Secondary endpoints comprised type 3 bleeding, PPM, paravalvular leakage, wound healing disorders (WHDs), and pacemaker rates.In all 191 patients exhibited a BMI <30 kg/m², while 116 patients had a BMI ≥30 kg/m². The BMI groups did not differ in baseline characteristics, excepting a higher peripheral arterial disease incidence among obese patients (15.7% vs. 26.7%; p = 0.01). Aortic clamp time (75 ± 29 min vs. 87 ± 37 min; p = 0.001), cardiopulmonary bypass (104 ± 36 min vs. 124 ± 56 min; p = 0.0002), and ventilation times (26 ± 6 h vs. 44 ± 8 h; p = 0.03) were longer in obese patients. They demonstrated a higher risk for bleeding (2.6% vs. 9.5%; p = 0.008) but lower pacemaker rates (9% vs. 3%; p = 0.02). PPM, paravalvular leakage, and WHD exhibited no group differences. No BMI-related differences revealed in 30-day mortality (4.7% vs. 3.4%) and stroke rates (2% vs. 2.6%), as well as 2-year mortality (12.6% vs. 11.2%) and stroke rates (2.1% vs. 2.6%).In the initial phase of an MIS-AVR program, the 30-day mortality may be elevated. Despite longer operative times and an increased risk for bleeding in obese patients, no influence of BMI on postoperative morbidity, mortality, or stroke rates was observed.

We evaluated and compared early postprocedural and midterm incidence and evolution of atrioventricular and intraventricular conduction disorders following rapid deployment aortic valve replacement (RDAVR) and conventional aortic valve replacement (AVR).One hundred and forty-seven patients who underwent isolated rapid deployment AVR between 2017 and 2021 as well as 128 patients after conventional biological AVR in the same period were included in this study. ECGs recorded at baseline, discharge, and 12 months were retrospectively analyzed. Intrinsic rhythm, PQ interval, QRS duration, and atrioventricular and intraventricular conduction were evaluated and compared between both groups.Patients in both groups had comparable Society of Thoracic surgeons risc (STS) scores (2.9 ± 1.6 vs. 3.1 ± 2.2, p = 0.32) and comparable baseline characteristics. The mean age was 73.4 ± 5.7 years in the RDAVR group and 74.2 ± 5.9 years in the AVR group, respectively. At baseline, the mean QRS width was 95.7 ± 25.5 ms in the RDAVR group, and 97.3 ± 23.5 ms in the AVR group, respectively (p = 0.590). At discharge, the mean QRS width in the RDAVR group was significantly increased with 117.4 ± 28.6 ms and a mean ΔQRS width of 21.7 ± 26.3 ms (p < 0.001) compared with baseline. No significant changes in QRS width were found in the AVR group with a mean value of 101.2 ± 24.1 ms and a mean ΔQRS width of 3.9 ± 23.9 ms at discharge (p = 0.193). The left bundle branch block (LBBB) was increased in the RDAVR group after 12 months (19.3% vs. 5.1%, p < 0.001). Permanent pacemaker implantation (PPI) rates were significantly higher in the RDAVR group after 12 months (hazard ratio (HR): 4.68; 95% CI: 2.23-7.43, p < 0.001). Mortality did not differ between both groups after 12 months (HR: 1.09; 95% CI: 0.46-1.83, p = 0.835)Patients after RDAVR showed significantly higher rates of LBBB and PPI after 12 months. However, higher mortality was not observed in the RDAVR group.

After cardiac surgery, long aortic clamping times and extracorporeal circulation times are associated with worse outcomes. This study compares hemodynamic performance, myocardial metabolism, and ultrastructural preservation in rat hearts after applying esmolol crystalloid cardioplegia (ECCP) or Calafiore blood cardioplegia (Cala).Hearts from 18 Wistar rats were perfused in a Langendorff system. Following 120 minutes of ischemia at 36 °C, hearts received either ECCP at 32 °C for 3 minutes or Cala at 36 °C for 2 minutes every 20 minutes. During 90 minutes of reperfusion, coronary blood flow (CF), left ventricular developed pressure (LVDP), and contraction/relaxation velocities (±dp/dt) were recorded. Myocardial oxygen consumption, lactate production, and troponin I levels were measured. Electron microscopy was used for ultrastructural assessment.Baseline (BL) values of LVDP, CF, and ±dp/dt were similar between the two groups. After 90 minutes of reperfusion, CF was significantly higher in the ECCP group: 85 ± 43% of BL in the ECCP group versus 42 ± 24% of BL in the Cala group (p = 0.002). At the end of reperfusion, hearts exposed to ECCP had higher LVDP (91 ± 40%) values than Cala (43 ± 10%), indicating improved cardiac recovery with ECCP. Myocardial contraction and relaxation were notably better in the ECCP group: dLVP/dt_max was 111 ± 40% versus 59 ± 13% in the Cala group (p = 0.002), and dLVP/dt_min was 88 ± 34% versus 40 ± 7% (p = 0.001). Troponin I levels measured in Cala hearts at the end of reperfusion were higher than in ECCP hearts (Cala 1,102.6 ± 361.3 ng/mL vs. ECCP 442.3 ± 788.4 ng/mL, p = 0.036).In rat hearts, ECCP offers better hemodynamic recovery and protects the myocardium from ischemia/reperfusion-related damage, better than Cala blood cardioplegia, even with aortic clamping times of 120 minutes.

Rapid and accurate diagnosis of infective endocarditis (IE) allows timely management of this life-threatening disease and improves outcome. The Duke criteria have traditionally been the clinical method for diagnosing IE. These criteria were reformulated at different timepoints. We aimed to evaluate the real accuracy of the modified Duke criteria based on several studies that concluded the diagnosis of IE.Three databases were assessed. Studies were considered for inclusion if they reported the use of modified Duke criteria as the initial approach and the confirmation of the diagnosis with the gold standard methods. The meta-analysis of diagnostic test accuracy was performed after fitting the hierarchical summary receiver operating characteristic model (HSROC) with bivariate model and displaying the summarized measures of sensitivity and specificity, and positive and negative likelihood ratios.A total of 11 studies were included. Accuracy in the included studies ranged from 62.3 to 92.2%, sensitivity ranged from 58.3 to 84.0%, and specificity ranged from 50.0 to 100%. The combined overall sensitivity and specificity were 85% (95% CI: 0.77-0.90) and 98% (95% CI: 0.89-0.99), respectively. The positive likelihood ratio was 40.2 (95% CI: 7.26-220.74) and the negative likelihood ratio was 0.15 (95% CI: 0.01-0.23).The analysis reveals that the modified Duke criteria have a high positive likelihood ratio, suggesting a robust correlation between a positive test result and the existence of IE, and a very good overall specificity at 98%. The latter aspect holds significant importance in order to prevent unnecessary overtreatment, given the intricacies involved in managing IE.

Lactate dehydrogenase (LDH) is a standard postoperative marker for hemolysis in the presence of paravalvular leakage (PVL) after replacement of the aortic valve (AVR). LDH is elevated in certain valves by a fluttering phenomenon. Previous studies suggested a correlation between microparticles (MPs) and LDH elevation after AVR. Thus, we analyze the postoperative relevance of LDH after AVR with transapical transcatheter aortic valves (TA-TAVs) or rapid deployment valves (RDVs).We retrospectively analyzed the data from patients who received an AVR with the RDV and TA-TAV groups between 2015 and 2018. We compared PVL and LDH levels before and after surgery, transvalvular gradients, heart block that required pacemaker implantation, and 30-day mortality.In total, 138 consecutive patients were selected for the study: 79 patients in the RDV group (37 Sorin Perceval valve, 42 Edwards Intuity valve) and 59 in the TA-TAV group (Edwards Sapien valve). TA-TAV group was older (median 10 years) and had a higher incidence of PVL (odds ratio 11, 95% confidence interval [CI] 2.5-73.2, p = 0.04)). Interestingly, the TA-TAV group showed lower levels of LDH despite higher rates of PVL. Of note, the Perceval valve trended toward higher LDH values. Additionally, the RDV group showed an increased arrhythmia profile (p = 0.0041); however, the results show lower incidence in pacemaker implantation (95% CI 0.05-1.65, p = 0.635). The 30-day mortality was similar between groups.Our data do not support the association between hemolysis and PVL despite elevated LDH in suture-free valves. Our results suggest that LDH could be a marker of extreme heart muscle output or fluttering phenomenon and not a marker of hemolysis after sutureless AVR.

Cardioplegia, a therapy designed to induce reversible cardiac arrest, revolutionized cardiovascular surgery. Among the various pharmacological approaches is the histidine-tryptophan-ketoglutarate (HTK) solution. Despite numerous studies, no meta-analysis has investigated the efficacy of the HTK solution in the pediatric population. Therefore, we aim to conduct a meta-analysis comparing HTK and other cardioplegia solutions in pediatric patients undergoing cardiovascular surgery.PubMed, Embase, and Cochrane databases were searched from inception through April 2024. Endpoints were computed in odds ratios (OR) with 95% confidence intervals (CI) for dichotomous variables, whereas continuous variables were compared using mean differences (MD) with 95% CI.A total of 11 studies comprising 1,349 patients were included, of whom 677 (50.19%) received HTK cardioplegia. The results were similar between groups regarding mortality (OR 0.98; 95% CI 0.29, 3.29), length of hospital stay (MD 0.32 days; 95% CI -0.88, 1.51), Mechanical ventilation (MV) (MD -17.72 hours; 95% CI -51.29, 15.85), arrhythmias (OR 1.27; 95% CI 0.83, 1.95), and delayed sternal closure (OR 0.89; 95% 0.56, 1.43). However, transfusion volume was lower in the HTK group (MD -452.39; 95% CI -890.24, -14.53; p = 0.04).The use of HTK solution was demonstrated to be similar regarding its clinical efficacy to other approaches for cardioplegia, and it may present advantages to patients prone to hypervolemia.

Video-assisted minimally invasive (MIC) tricuspid valve repair or replacement through right minithoracotomy offers a less invasive option for the treatment of tricuspid valve insufficiency compared with conventional sternotomy approach.We present our postoperative results regarding the two different surgical approaches.From 2017 to 2021, 180 patients underwent isolated or combined tricuspid valve procedures in our heart center, either through median sternotomy (n = 152, group 1) or via MIC approach (n = 28, group 2). Mean age was 68 ± 11 years in group 1 and 69 ± 11 years in group 2. A propensity matching analysis was performed comparing 21 patients from each group. The majority of the patients in both groups received tricuspid valve repair (90% in unmatched group 1 and 79% in unmatched group 2). Tricuspid valve replacement was performed in 10% of group 1 versus 21% of group 2. The 30-day mortality was higher in matched group 1 patients (14%) in comparison to matched group 2 patients (5%; odds ratio [OR] = 3.00; [0.31, 28.84]; p = 0.341). Mean required packed red blood cells was 9.43 ± 11.79 units in group 1, respectively, 3.57 ± 4.75 units in group 2 (OR = 1.12; [0.98, 1.29]; p = 0.099). Postoperative echocardiography revealed excellent tricuspid valve function in both matched groups.Video-assisted minimally invasive (MIC) tricuspid valve repair or replacement through right mini-thoracotomy is a good alternative to sternotomy approach. Our postoperative results demonstrate that MIC approach is safe and feasible.

Aortic valve replacement improves and prolongs lives of patients with aortic valve disease, but requires significant healthcare resources, which are mainly determined by the length of associated hospital stays. Therefore, this study aims to identify risk factors for extended length of stay after surgical aortic valve replacement.Between 2018 and 2023, 458 consecutive patients underwent isolated surgical aortic valve replacement at our center and were included in our analysis. To identify independent predictors for hospital and intensive care unit stay, multivariable linear regression analysis using backward elimination process was performed.Upon multivariable linear regression, endocarditis (regression coefficient [β] 2.98; 95% confidence interval [CI] 1.51, 4.45; p < 0.001]) and prior aortic valve surgery (β 1.72; 95% CI 0.18, 3.26; p = 0.029) were associated with prolonged hospital stay. Prior aortic valve surgery was associated with prolonged intensive care unit stay (β 0.99; 95% CI 0.39, 1.59; p = 0.001) as well as chronic obstructive pulmonary disease (COPD) (β 1.61; 95% CI 0.66, 2.55; p = 0.001), smaller prosthetic valve sizes (β -0.18; 95% CI -0.30, -0.06; p = 0.003), preoperative atrial fibrillation (β 1.06; 95% CI 0.32, 1.79; p = 0.005), and reduced left ventricular ejection fraction (β -0.03; 95% CI -0.05, -0.01; p = 0.006).Pending further validation, structured programs aiming to accelerate intensive care unit and hospital discharge after surgical aortic valve replacement should focus on patients with prior cardiac surgery, atrial fibrillation, and COPD. Surgeons should aim to implant large-diameter valves. Furthermore, the identified predictors should be used to discuss surgical versus transcatheter procedures in the interdisciplinary heart team.