Thoracic and Cardiovascular Surgeon最新文献

This single-center, retrospective analysis presents data from 611 patients with a secundum type atrial septal defect (ASD II) closure. Included were patients >2 years of age. Patients presented at a median (range) age of 6.95 (2-86) years for interventional closure of ASD II. Out of 611 patients, 215 underwent intracardiac repair based on transthoracic echocardiography (ECHO) findings. Transcatheter device closure was attempted and successfully performed in 300 out of 396 patients (Amplatzer™ Septal Occluder [ASO], n = 290 patients). Follow-up was 3.3 years (1 day-21.8 years) in patients with interventional closure of ASD II and 0.7 years (3 days-14.7 years; p < 0.001; Mann-Whitney) in patients after surgical closure. There was no in-hospital mortality in both groups. One patient, after Amplatzer device closure with an absent aortic rim, developed erosion, which was treated by cardiac surgery and patch closure of ASD II. Two patients showed dislocation of the device. In 231 out of 396 patients, right ventricular dimension normalized completely as determined on the last follow-up visit. Six patients at a median age of 60 (49.4-68.7) years presented with atrial fibrillation, which persisted after ASD II closure. About 26 patients (6.6%) showed pulmonary hypertension (PH), with 1 presenting with coincidental ASD II and severe PH. Closure of ASD II can be accomplished safely by interventional catheterization and intracardiac repair. In most cases, perioperative transthoracic and transesophageal ECHO is sufficient to decide whether a surgical approach or interventional closure is the best option to close the defect.

Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. We investigated how POAF affects the manifestation of atrial fibrillation (AF) during long-term follow-up.We conducted a prospective all-comers investigation involving patients undergoing cardiac surgery. In propensity score-matched cohorts (POAF vs. sinus rhythm [SR]), ECGs were evaluated regarding P-wave duration (PWD), amplitude (PWA), morphology, variability, and their dynamics preoperatively pre-POAF and at follow-up. Predictive value of these parameters regarding the development of manifest AF after POAF was analyzed.Of 212 patients included, 50 patients (23.6%) developed POAF. Ninety patients underwent propensity score matching (PSM), 64 (71%) participated in follow-up, 21 (23%) died prior to follow-up (POAF: 13 vs. SR: 8), and 5 (6%) withdrew consent. No patient developed persistent AF. In nine patients, paroxysmal AF (pAF) events were detected (POAF: 6 vs. SR: 3). PWD, P-dispersion (PD), PWA, and interatrial block differed between POAF and SR. From pre- to postoperative ECGs, PD and P-wave peak time (PWPT) increased, and P-amplitude decreased in these. Preoperative β-blockers had only minor modulating potency. P-wave modulation was pronounced in POAF patients.Patients with POAF are prone to episodes of pAF. P-wave indices and perioperative dynamics of these indices may indicate a higher risk of manifest AF initiation among POAF patients.

Primary palmar hyperhidrosis (PPH) causes excessive hand sweating, impacting daily activities and quality of life. Endoscopic thoracic sympathectomy (ETS), including ganglionectomy, is a common treatment, but the risk of compensatory hyperhidrosis (CH) remains a concern. This study compares unilateral versus bilateral T3 ganglionectomy, focusing on differences in CH occurrence and patient satisfaction.We retrospectively analyzed 118 patients who underwent either unilateral or bilateral T3 ganglionectomy for PPH at our institution from November 2023 to January 2025. Data on patient characteristics and surgical outcomes were extracted from electronic medical records. Patient satisfaction and incidence of CH were assessed at postoperative 3 months.Of the 118 patients with severe PPH, 77 underwent bilateral T3 ganglionectomy, and 41 received unilateral T3 ganglionectomy. No significant differences in baseline characteristics were observed between the groups. Postoperative satisfaction was higher in the unilateral group, with 93% reporting being "very satisfied" compared with 61% in the bilateral group (p < 0.001). The unilateral group also had fewer incidences of CH, with 80% reporting no CH, while 43% of the bilateral group experienced mild CH (p = 0.007). The most common areas affected by CH were the back, thighs, chest, abdomen, and hips. In the unilateral group, 7.5% showed improvement in contralateral sweating, with 22% necessitating contralateral ganglionectomy.This study is the first to compare the effectiveness and incidence of CH between unilateral and bilateral ETS for PPH. Our results show that 93% of unilateral ETS patients reported high satisfaction, compared with 61% in the bilateral group. Eighty percent of the unilateral group experienced no CH, while only 43% in the bilateral group reported mild CH. Statistically significant differences were observed in both satisfaction scores (p < 0.001) and CH occurrence (p = 0.007), suggesting unilateral ETS may provide better symptom relief with fewer adverse effects. Compared with prior studies, our cohort showed improved bilateral ETS outcomes, with only 48% developing CH. These findings indicate that unilateral ETS may be preferred for patients seeking higher satisfaction and reduced risk of CH, though further long-term studies are needed to confirm such results.

Postoperative recurrence of c-ros oncogene 1 (ROS1)-rearranged non-small cell lung cancer is rarely reported, and the role of tyrosine kinase inhibitors (TKIs) remains unclear. We retrospectively reviewed four patients with completely resected ROS1-positive lung adenocarcinoma who developed recurrence, three receiving crizotinib. The median disease-free interval was 33.4 months, and the median overall survival from postoperative recurrence and initial surgery was 40.7 and 71.2 months, respectively. Brain metastases were the most common initial recurrence site (75%). Crizotinib showed limited efficacy with a median progression-free survival of 3.5 months. These findings highlight indolent disease behavior but limited TKI benefit, supporting the need for adjuvant trials.

We describe a technique for concomitant coronary artery bypass grafting (CABG) and mitral valve (MV) replacement or annuloplasty with ring implantation performed through a single left anterior minithoracotomy (LAmT). Four patients underwent combined MV and CABG surgery using peripheral cardiopulmonary bypass, a transseptal approach to the MV, and complete coronary revascularization. MV exposure was successfully achieved in all cases without conversion to sternotomy. No major complications such as stroke, reoperation for bleeding, or early mortality occurred. Our initial results demonstrate that single LAmT is a feasible sternum-sparing approach for patients requiring simultaneous coronary and mitral procedures.

The frozen elephant trunk (FET) and Ascyrus Medical Dissection Stent (AMDS) are hybrid techniques used in managing acute type A aortic dissection (ATAAD). This systematic review and meta-analysis compared their perioperative outcomes, aortic remodeling, and incidence of distal anastomotic new entry (DANE).A comprehensive search yielded 611 studies; after screening, 68 were included-59 on FET and 9 on AMDS-covering 7,420 patients (7,070 FET; 350 AMDS). The primary outcome was DANE incidence. Secondary outcomes included operative time, false lumen thrombosis, ICU/hospital stay, and 30-day/in-hospital mortality.DANE incidence was 7% in both groups. FET was associated with shorter operative times (353-369 vs. 422 minutes), higher false lumen thrombosis rates (88-89% vs. 84%), and longer hospital stays (17-19 vs. 9-11 days). AMDS had longer ICU stays (7.7-8.5 vs. 5.3-7.5 days). Mortality rates were similar (FET: 8-9%; AMDS: 7-10%). Critically, neurological complication rates were substantially higher with AMDS (33% [15-53%]) compared with FET (13% [10-16%]). However, the evidence base for AMDS remains limited (9 studies) compared with FET (59 studies). Egger's test showed publication bias in FET studies for DANE and length of stay outcomes; bias assessment for AMDS was limited by study number.Limited available evidence suggests that FET and AMDS show similar DANE and mortality outcomes. FET may favor better remodeling and a safer neurological profile, but longer hospitalization, though high heterogeneity and limited AMDS data underscore the need for robust comparative trials.

Mechanisms of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) differ as CABG provides surgical collateralization and may prolong life by preventing future myocardial infarctions (MIs). However, evidence for CABG in patients with chronic total occlusion (CTO) has not been fully elucidated and the impact of PCI is discussed controversially.We performed a meta-analysis of studies comparing outcomes in patients with/without multivessel disease undergoing CABG or PCI for CTO. The primary outcome was long-term all-cause mortality (≥5 years). Secondary outcomes were MIs, repeat revascularization, cardiac mortality, major adverse cardiovascular events, and stroke, as well as short-term mortality (30 days/in-hospital) and stroke. A pooled Kaplan-Meier survival curve after reconstruction analysis was generated. Random-effects models were used.Six studies totaling 12,504 patients were included. In the pooled Kaplan-Meier analysis, PCI showed a significantly higher risk of death in the follow-up compared with CABG (hazard ratio [HR]: 2.12, 95% confidence interval [CI]: 1.88-2.38, p < 0.01). During the observation period, PCI was also associated with higher rates of MI (odds ratio [OR]: 2.86, 95% CI: 1.82-4.48, p < 0.01) and more repeat revascularization (OR: 4.88, 95% CI: 1.99-11.91, p = 0.0005). The other outcomes did not show significant differences.CABG is associated with superior survival to PCI over time in patients with CTO who are eligible for both PCI and CABG. This survival advantage is associated with fewer events of MI and repeat revascularization.

Based on a voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (DGTHG) in 1980, well-defined but limited datasets of all cardiac and vascular surgery procedures performed in 77 German heart surgery departments are reported annually. For the year 2024, a total of 178,547 procedures were submitted to the registry. A total of 103,617 of these operations are defined as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 28,843 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 2.5:1) was 97.8%. A total of 97.2% for the 45,422 isolated heart valve procedures (24,957 transcatheter interventions included) and 99.3% for 20,114 pacemaker/implantable cardioverter defibrillator procedures, respectively. Concerning short- and long-term mechanical circulatory support, a total of 3,168 extracorporeal life support/extracorporeal membrane oxygenation implantations, and 809 ventricular assist device implantations (L-/R-/biventricular assist device, total artificial heart) were reported. In 2024, 348 isolated heart transplantations, 287 isolated lung transplantations, and 2 combined heart-lung transplantations were performed. This annually updated registry of the DGTHG represents nonrisk-adjusted voluntary public reporting encompasses actual data for nearly all heart surgical procedures in Germany, constitutes trends in heart medicine, and represents a basis for quality management (e.g., benchmark) for all participating institutions.