Thoracic and Cardiovascular Surgeon最新文献

The goal of this study is to examine early and midterm results after surgical treatment of acute DeBakey type I aortic dissection (AIAD) and the effect of the range of aortic arch replacement on overall survival and prevention of distal aortic events.Between March 2002 and July 2020, a total of 374 AIAD aortic repairs were reviewed. A total of 154 (41.2%) patients had total arch replacement (TAR), whereas 220 (58.8%) had hemi- or partial arch replacement (PAR).Operative mortality did not show a significant difference (7.7% in PAR, 13.0% in TAR, p = 0.096). Survival at 5 years showed no difference (77.8% in TAR, 72.6% in PAR, p = 0.14). Freedom from reoperations and reinterventions, as well as composite aortic events in the distal aorta, were comparable across groups (p = 0.21, 0.84, and 0.91, respectively). The inverse probability of treatment weighting-adjusted model displayed higher 5-year freedom from reoperations and aortic events in the TAR group (p = 0.029 and 0.054, respectively).The extent of arch replacement is determined based on the patient background, making it difficult to compare the superiority of both surgical methods. However, TAR for appropriately selected patients may provide the benefit of avoiding aortic events in the long term.

Postinfarction left ventricular aneurysm (LVA) still remains a complication after myocardial infarction with a poor prognosis. Its incidence has decreased due to improved treatment, however, it may have experienced a renaissance due to the coronavirus disease 2019 pandemic. In this retrospective, single-center cohort study, we analyzed n = 17 patients who underwent left ventricular reconstruction after Dor. The results show a mean intensive care unit stay of 8 ± 16 days and a 30-day mortality rate of 6%. Mean postoperative ejection fraction was 44 ± 8% indicating an increase in all but three cases. This suggests that patients with an LVA can be successfully treated, and it is safe when performed by experienced surgeons. Therefore, they should still be considered for surgery early on.

Minimally invasive cardiac surgery total arterial coronary artery bypass grafting (MICS-CABG) has emerged as an alternative to conventional coronary artery bypass grafting (CABG). Its safety and efficacy in obese patients remain a concern due to technical challenges. The current study compares early and long-term outcomes of MICS-CABG in obese and non-obese patients.Between January 2015 and December 2023, 279 patients underwent off-pump MICS-CABG at our center. Obesity was defined as body mass index ≥30 (kg/m²). The primary endpoint was 30-day survival. Secondary endpoints were survival and freedom from major adverse cardiac and cerebrovascular events (MACCE) at 5 years.Of all 279 patients, 56 (20.1%) were classified as obese and 223 (79.9%) as non-obese. Obese patients had a higher EuroSCORE II (2.06 ± 1.53 vs. 1.63 ± 0.94, p = 0.008) and a higher prevalence of comorbidities including diabetes mellitus (p < 0.001) and pulmonary hypertension (p = 0.03). The incidence of postoperative complications including repeat thoracotomy for bleeding (p = 0.18), low cardiac output syndrome (p = 0.70), or wound infection (p = 0.38) did not differ between obese and non-obese patients. There were no deaths or myocardial infarctions within 30 days in obese patients (0% vs. 0.5%, p = 0.95; 0% vs. 2.7%, p = 0.47). Long-term outcome at 5 years, including survival (91.9% vs. 92.4%, p = 0.99) and freedom from MACCE (83.3% vs. 84.6%, p = 0.63), showed no difference between the two groups.MICS-CABG can be performed safely and efficaciously in select obese patients by specialized coronary surgeons at high-volume cardiac centers.

Coronary artery disease patients suffering from ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) require rapid decision on invasive therapy relying on state-of-the-art concepts. This article provides evidence-based recommendations on the choice between, or the combination of, the mechanistically different options, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)-with a special focus on multivessel disease patients. Furthermore, strategies of modern CABG in STEMI and NSTEMI patients are presented.

Background In patients at elevated risk for redo mitral valve surgery, transcatheter mitral valve replacement (TMVR) can be taken into consideration as a less invasive alternative. However, long-term outcome data on mitral valve-in-ring (ViR) and valve-in-valve (ViV) procedures is scarce. We herein report the 3-year outcomes following these interventions. Methods Between 2014 and 2023, 51 consecutive patients received ViR/ViV TMVR at our center. Baseline, periprocedural and 3-year outcome parameters were analyzed according to M-VARC criteria. Results Among 51 patients (70.9±13.6 years, STS-Score 3.3±2.3 %, LVEF 50±12%), 19 underwent ViR and 32 ViV TMVR. Follow-up ranged from 1 to 71 months. The 30-day mortality rate was 5.9% (3/51 patients). Over time, access shifted from transapical to transseptal (p for trend <0.01). Rehospitalization, neurological events and myocardial infarction occurred in 2.0% (1/51 patients), 2.0% (1/51 patients) and 0.0% of the cases, respectively. No structural valve failure was observed. Functional failure was 3.9% of cases due to significant residual mitral regurgitation. Most paravalvular leak occluder implantations were performed in ViR patients (6/9, 66.7%) (4 rigid rings and 2 semi-rigid rings). Three-year survival was 87.5% for ViR and 83.4% for ViV, with no differences between groups. Conclusions Mitral ViR and ViV procedures demonstrate acceptable safety and clinical efficacy up to 3 years. Rigid annuloplasty rings are associated with an increased risk of significant residual regurgitation. Over the last decade, a clear transition from the transapical to the transseptal access has been observed, further reducing procedural trauma in this high-risk subset of patients.

Coagulatory alterations are common after pediatric cardiac surgery and can be addressed with point-of-care (POC) coagulation analysis. The aim of the present study is to evaluate a preventive POC-controlled coagulation algorithm in pediatric cardiac surgery.This single-center, retrospective data analysis included patients younger than 18 years who underwent cardiac surgery with cardiopulmonary bypass (CPB) and received a coagulation therapy according to a predefined POC-controlled coagulation algorithm. Patients were divided into two groups (<10 and >10 kg body weight) because of different CPB priming strategies.In total, 173 surgeries with the use of the POC-guided hemostatic therapy were analyzed. In 71% of cases, target parameters were achieved and only in one case primary sternal closure was not possible. Children with a body weight ≤10 kg underwent surgical re-evaluation in 13.2% (15/113), and respectively 6.7% (4/60) in patients >10 kg. Hemorrhage in children ≤10 kg was associated with cyanotic heart defects, deeper intraoperative hypothermia, longer duration of CPB, more complex procedures (RACHS-1 score), and with more intraoperative platelets, and respectively red blood cell concentrate transfusions (all p-values < 0.05). In children ≤10 kg, fibrinogen levels were significantly lower over the 12-hour postoperative period (without revision: 3.1 [2.9-3.3] vs. with revision 2.8 [2.3-3.4]). Hemorrhage in children >10 kg was associated with a longer duration of CPB (p = 0.042), lower preoperative platelets (p = 0.026), and over the 12-hour postoperative period lower platelets (p = 0.002) and fibrinogen (p = 0.05).The use of a preventive, algorithm-based coagulation therapy with factor concentrates after CPB followed by POC created intraoperative clinical stable coagulation status with a subsequent executable thorax closure, although the presented algorithm in its current form is not superior in the reduction of the re-exploration rate compared to equivalent collectives. Reduced fibrinogen concentrations 12 hours after surgery may be associated with an increased incidence of surgical revisions.

For the 11th consecutive time, we systematically reviewed the cardio-surgical literature for the past year (2024), using the PRISMA approach for a results-oriented summary. In 2024, the discussion on the value of randomized and registry evidence increased, triggered by consistent findings in the field of coronary artery disease (CAD) and discrepant results in structural heart disease. The literature in 2024 again confirmed the excellent long-term outcomes of CABG compared with PCI in different scenarios, generating further validation for the CABG advantage reported in randomized studies. This has been reflected in the new guidelines for chronic CAD in 2024. Two studies indicate novel perspectives for CABG, showing that cardiac shockwave therapy in CABG improves myocardial function in ischemic hearts and that CABG guided by computed tomography is safe and feasible. For aortic stenosis, an early advantage for transcatheter (TAVI) compared with surgical (SAVR) treatment has found more support; however, long-term TAVI results keep being challenged, this year by new FDA and registry data in favor of SAVR. For failed aortic valves, redo-SAVR showed superior results compared with valve-in-valve TAVI. In the mitral field, studies showed short-term noninferiority for transcatheter treatment compared with surgery for secondary mitral regurgitation (MR), and significant long-term survival benefit in registries with surgery for primary MR. Finally, surgery was associated with better survival compared with medical therapy for acute type A aortic intramural hematoma. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation but provides up-to-date information for patient-specific decision-making.

This study presents the early and midterm outcomes of combining atrial fibrillation (AF) treatment with minimally invasive mitral valve surgery (MIMVS) at our center.From January 2017 to June 2022, our center treated a total of 86 patients with both MIMVS and surgical AF ablation. The patient cohort included 62 women (72.1%) and 24 men (27.9%). The average EuroScore II was 2.64 ± 1.49%, and the patients were followed up for an average period of 46.31 ± 9.84 months.Postoperatively, 95.3% of patients experienced a change in sinus rhythm, and 86.2% were discharged in sinus rhythm. The hospital's mortality rate was 2.3%, with a late mortality rate of 3.5%. Survival analysis revealed an atrial fibrillation-free 5-year follow-up rate of 59.1 ± 9.1%. The 5-year survival rate was 92.7 ± 3.3%.Our 5-year experience demonstrates that the combination of MIMVS and surgical AF ablation can be routinely performed with favorable peri- and postoperative outcomes. This reflects our hospital's culture and guidance on patient selection, particularly when adopting minimally invasive approaches for multiple procedures.