Thoracic and Cardiovascular Surgeon最新文献

Different techniques allow implantation of biological aortic valve prostheses larger than associated with classic annulus sizing. We described a replica-based technique (upsizing) before that utilizes the patient's root anatomy. We here evaluate the safety and efficacy of upsizing compared with standard sizing using the Epic Supra bioprosthesis.We assessed 958 patients undergoing aortic valve replacement with the Epic Supra bioprosthesis between 2010 and 2023. Upsizing was defined as implantation of a prosthesis larger than the measured annular size without enlarging the annulus. We assessed hemodynamic and standard outcome parameters. Mean follow-up was 44.5 ± 31.2 months. Propensity score matching was used to adjust for baseline differences.Patient anatomy allowed upsizing in 62% of patients. Demographics and outcomes (perioperative mortality, reoperation, bleeding, and pacemaker implantation) were comparable between the matched groups. Immediate postoperative and long-term pressure gradients were consistently and significantly lower in the upsizing groups across all annular sizes (upsizing vs. control: 23 mm; 12.9 ± 8.2 vs. 14.0 ± 5.6 mm Hg, p = 0.029; 25 mm; 10.8 ± 4.0 vs. 13.0 ± 4.4 mm Hg, p < 0.001; 27 mm; 10.8 ± 4.0 vs. 13.0 ± 4.4 mm Hg, p < 0.001). Differences persisted at long-term follow-up but were less pronounced for the 25-mm annular size and greatest in the 27-mm group (8.5 ± 4.5 vs. 12.5 ± 5.5 mm Hg; p < 0.001). Long-term survival was numerically higher in the upsizing groups with statistical significance in annular size 25 mm.Implanting a larger Epic Supra prosthesis than classically recommended ("upsizing") is safe and associated with improved immediate- and long-term hemodynamics without increasing pacemaker, perioperative, or long-term mortality risks.

Pediatric lung transplantation is considered to be an effective treatment for end-stage lung disease in children, and this study mainly conducts a bibliometric analysis in the field of pediatric lung transplantation.We used the web of science databases to perform a bibliometric analysis of the progress of research in the field of pediatric lung transplantation from 1996 to 2024. In addition, we used VOSviewer software and the "bibliometrix" package in R to visualize and analyze the authors, countries, journals, institutions, and keywords of the literature.We identified 359 literature studies related to pediatric lung transplantation, which were cited 6,387 times by 1,400 journals. The journal with the highest number of average citations was the "New England Journal of Medicine," while the journals with the highest number of publications were the "Journal of Heart and Lung Transplantation and Pediatric Transplantation." The United States was the country with the highest number of publications (64.3%), followed by the United Kingdom (11.1%) and Canada (8.08%).Research in the field of pediatric lung transplantation is currently on the rise, while research is still dominated by developed countries, with most developing countries in their infancy. Against the background of COVID-19 and global health challenges, the unique need for pediatric lung transplantation is becoming a trend.

This study aimed to compare the gender differences in isolated mitral regurgitation (MR) repair.Of 381 adults aged 54.8 ± 12.3 years undergoing mitral valve repair (MVP) for isolated MR from January 2019 to December 2022, the baseline and operative data, and outcomes were compared between 161 women (42.3%) and 220 men (57.7%).Women tended to be nonsmokers (98.1 vs. 45%, p < 0.001), and have more cerebrovascular accidents (38.5% vs. 24.1%, p = 0.004) and isolated annular dilatation (19.3 vs. 9.1%, p = 0.010), lower creatinine (70.0 ± 19.5 vs. 86.3 ± 19.9 μmol/dL, p < 0.001), and smaller left ventricular end-diastolic diameter (LVEDD; 54.4 ± 6.7 vs. 57.8 ± 6.6 mm, p < 0.001). One female died of stroke at 2 days (0.3%). Another female (0.3%) underwent mitral valve replacement for failed repair. Stroke occurred in 4 (1.0%). Two underwent reexploration for bleeding (0.5%). Women were more likely to have less 24-hour drainage (290 ± 143 vs. 385 ± 196 mL, p < 0.001). Over a mean follow-up of 2.1 ± 1.1 years (100% complete), 1 woman died and 1 man underwent a reoperation; 28 had moderate MR, and 9 had severe MR. Neither did early and late mortality and reoperation, nor freedom from late moderate or severe MR (71.6 vs. 71.4% at 5 years; p = 0.992) differ significantly between the two genders. Predictors for late moderate or severe MR were anterior leaflet prolapse (hazard ratio [HR] 4.45; 95% confidence interval [CI] 1.18-16.72; p = 0.027) and isolated annular dilation (HR 5.47, 95% CI 1.29-23.25; p = 0.021).In this series of patients undergoing isolated MR repair, despite significant differences in smoking, cerebrovascular accidents, creatinine, LVEDD, and isolated annular dilatation at baseline, and 24-hour drainage postoperatively, women and men did not show significant differences in early and late survival, reoperation, and freedom from late moderate or severe MR.

Ischemic mitral regurgitation (IMR) is associated with high mortality and poor outcomes. The surgical management of moderate IMR is still an object of debate.Patients with moderate IMR who underwent isolated off-pump coronary bypass grafting (OPCAB) with facile stabilization between January 2015 and February 2022 were analyzed. The primary endpoint was the remaining IMR and echocardiographic findings while the secondary outcomes were defined as mortality, major adverse events, and postoperative functional status.Of 541 patients who underwent isolated OPCAB in this period, there were 62 patients with concomitant moderate IMR. The mean follow-up period was 19.4 ± 21.6 months. The median number of the coronary anastomosis was 4. In 58.06% (n = 36), the regurgitation regressed. Left atrial (LA) diameter significantly decreased postoperatively (p = 0.040). Increased LA diameter was associated with increased major adverse events (p = 0.010). Rehospitalization rates were higher in low ejection fraction (EF). The postoperative poor functional status (New York Heart Association [NYHA] III-IV) was correlated with an increased postoperative left ventricular end-systolic diameter (LVESD; 41.75 ± 6.13 vs. 34.79 ± 6.8 mm, p = 0.05). Mortality (4.8%, n = 3) was associated with older age and increased preoperative systolic pulmonary artery pressure (PAP; p = 0.050 and p = 0.046, respectively).LA diameter, LVESD, mean systolic PAP, left ventricular ejection fraction (LVEF), and age are important predictors for outcomes in IMR. Remaining IMR per se is not directly correlated with increased mortality and major adverse cardiac and cerebrovascular events. The facile stabilization technique we used appears to be advantageous due to the feasibility of full revascularization of all intended vessels, particularly of the inferoposterior wall by providing excellent vision without compression of the heart.

This study aimed to compare the early postoperative outcomes of cardiopulmonary bypass-supported beating-heart coronary artery bypass grafting (CPB-BH CABG) and off-pump coronary artery bypass (OPCAB) surgery.A total of 589 patients who underwent beating-heart CABG between October 2021 and January 2025 were retrospectively analyzed. Patients were categorized into two groups based on CPB usage: CPB-BH CABG (n = 177) and OPCAB (n = 412). Primary outcomes included mortality and major complications, while secondary outcomes encompassed complete revascularization rates, number of distal anastomoses, hospital stay, and transfusion requirements.No significant differences were observed between the groups regarding preoperative characteristics. The CPB-BH group had longer operative times (268.7 vs. 223.6 minutes, p < 0.001) and prolonged hospital stays (7 vs. 5 days, p < 0.001). The rates of complete revascularization and the number of bypass grafts were slightly higher in the CPB-BH group, but did not reach statistical significance. The CPB-BH group required more blood transfusions (p < 0.001) and had a higher incidence of new-onset atrial fibrillation (33.9% vs. 24.0%, p = 0.016). No significant differences were found for other major complications.CPB-BH CABG is a viable alternative to OPCAB, offering comparable revascularization outcomes while allowing the flexibility of cardiopulmonary bypass support when needed. Surgeons should not hesitate to utilize CPB when necessary to optimize surgical outcomes. Future prospective, randomized controlled trials are warranted to assess the long-term outcomes of both surgical techniques and their effectiveness in specific patient subgroups.

Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are invasive treatment options for coronary artery disease (CAD), aiming to improve quality of life and reduce cardiovascular morbidity and mortality. Guidelines-based revascularization decisions should consider anatomical complexity, comorbidities, and patient preferences, with procedural risk assessed through validated scoring systems. However, the current legal quality assurance (QA) programs in Germany remain procedure specific and therefore lack a patient-centered, diagnosis-oriented approach. This study proposes a paradigm shift toward diagnosis-based QA to optimize individualized treatment selection, improve outcome attribution, and ensure transparent quality assessment. By integrating guideline recommendations with enhanced data linkage, this framework aims to standardize and improve CAD care quality while addressing limitations of existing QA schemes.This mixed-methods study aims to develop a cross-disciplinary QA framework for CAD patients undergoing elective PCI or CABG. Qualitative methods will be employed to formulate preliminary evidence-based quality indicators (QI), while secondary data analyses will provide empirical support for QI prioritization, modeling, and future evaluation. Findings from both approaches will undergo a structured consensus process to establish validated QI as basis of a redesigned QA scheme.The resulting framework seeks to standardize and improve QA procedures across CAD care pathways, integrating clinical expertise with real-world data to enhance patient outcome.The study proposes a patient-centered, diagnosis-based quality assurance framework for coronary artery disease care, aiming to improve treatment decisions and outcomes. By integrating guideline, expert input, and real-world data, it seeks to enhance transparency and standardization in quality assessment across CAD treatment pathways.

Lung volume reduction surgery (LVRS) is an important treatment option for patients with advanced emphysema and is typically performed in a non-anatomical fashion. This study reports the outcome of anatomical LVRS by means of uniportal video-assisted thoracoscopic surgery (VATS).We retrospectively evaluated patients who underwent anatomical LVRS between June 2017 and September 2023 at our institution. Patient characteristics, including demographic data, lung function, as well as morbidity and mortality, were extracted from hospital records.A total of 44 patients (17 males, 38.6%) underwent anatomical LVRS at our institution during the observation period. The preoperative forced expiratory volume per second (FEV1) and FEV1% were 35.4 ± 20.0% and 45.7 ± 18.2%, respectively. Lobectomy was performed in 37 patients (84.1%), while segmentectomy was performed in 10 patients (22.7%, duplicated). Postoperative FEV1 and FEV1% significantly improved compared to preoperative values at the initial follow-up (11.8 ± 6.9 months after the operation): 38.3 ± 19.5%, p < 0.002 and 49.4 ± 18.4%, p < 0.01, respectively. Unfortunately, two patients (4.5%) died within 30 days postoperation. A further follow-up lung function test was performed in 25 patients (56.8%) at 33.1 ± 13.8 months after the operation, showing that FEV1 and FEV1% remained similar to the preoperative values (33.9 ± 20.7%, p = 0.10 and 45.3 ± 18.1%, p = 0.06, respectively).Anatomical lung resection via uniportal VATS is an effective procedure for LVRS in patients with severe emphysema and is associated with acceptable morbidity and mortality.

Ex-vivo lung perfusion (EVLP) is a novel organ preservation technique introduced to assess extended lung donors and determine their suitability for human use.This retrospective cohort study analyzed lung transplant recipients in the U.S. from 2011 to 2021, using data from the Scientific Registry of Transplant Recipients (SRTR). Kaplan-Meier curves were used for time-to-event survival analysis, and the Cox proportional hazards model was used to determine hazard ratios for overall survival.Of 23,261 patients, 608 had EVLP-donor lungs. The 5-year survival was similar across groups. Centers with EVLP access had median wait times of 48 days (SD 260.80) versus 68 days (SD 273.73) at other centers. Cox proportional hazards model showed no significant disparity in 5-year survival with EVLP (HR 1.14, p 0.08), gender (HR 1.04, p 0.07), and high volume (HR 0.8, p 0.07). Perioperative extracorporeal membrane oxygenation (ECMO) (HR 1.29, p < 0.01) and black recipient race (HR 1.15, p < 0.01) influenced survival; there were no statistical differences in any other race. Black EVLP-assessed recipients showed a nonsignificant trend toward a survival benefit (p = 0.26) with a 14.2% higher 5-year survival (95% CI 2.7-28.7).EVLP has not adversely affected 5-year survival rates in lung transplantation recipients and is associated with shorter wait times. A survival advantage in black recipients with EVLP-assessed lungs needs further research.