Thoracic and Cardiovascular Surgeon最新文献

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.

In patients who underwent surgical myectomy for hypertrophic obstructive cardiomyopathy (HOCM), additional mitral valve repair may offer additional benefits in terms of further reducing left ventricular outflow tract (LVOT) gradients, systolic anterior motion (SAM), and mitral regurgitation (MR). We performed a systematic review of the literature to evaluate the evidence of surgical myectomy with additional secondary chordal cutting in patients with HOCM. A systematic literature search in MEDLINE and EMBASE was performed until April 2024. The primary outcome studied was postoperative echocardiographic LVOT gradient. A random effects meta-analysis of means was performed for the primary outcome. The secondary outcomes studied were postoperative residual MR grade, 30-day new permanent pacemaker implantation, and in-hospital mortality. From 1,911 unique publications, a total of 6 articles fulfilled the inclusion criteria and comprised 471 patients with a pooled mean preoperative resting LVOT gradient of 84 mm Hg (95% confidence interval [CI]: 76-91). The postoperative pooled mean LVOT gradient was 11 mm Hg (95% CI: 10-12) with a low heterogeneity (I ² = 44%). The residual LVOT gradient exceeding 30 mm Hg was present in nine (1%) patients. MR grade 3 or 4 at hospital discharge was present in seven (1%) patients. The 30-day new permanent pacemaker implantation rate was 7% and the in-hospital mortality was 0.4%. This systematic review and meta-analysis demonstrate that combining surgical myectomy with secondary chordal cutting can be performed safely and effectively eliminate LVOT obstruction in HOCM patients. Further studies are needed to determine the additive effectiveness of additional secondary chordal cuttings.

Contraceptive implants are widely used for long-acting reversible contraception (LARC) due to their high efficacy and convenience. However, complications including migration and, rarely, embolisation to the pulmonary arterial system have been reported. This case series presents three cases of contraceptive implant embolisation to the pulmonary arterial system, managed at a tertiary thoracic surgery unit between 2021 and 2024. Different surgical management was performed in all three cases influenced by factors including: length of time since possible embolisation, implant location, and suspected degree of endothelialisation. The cases highlight challenges in surgical management of embolized contraceptive implants, focusing on arteriotomy and anatomical resection approaches. The importance of prompt diagnosis, multidisciplinary decision-making, and necessity for further research to establish guidelines for the management of embolized contraceptive implants is exemplified. Suppliers should be aware of this rare complication and consider methods to prevent its occurrence.

DeBakey type I aortic dissection requires circulatory arrest during arch reconstruction, putting the brain at risk. In resource-limited centers, deep hypothermia can exacerbate coagulopathy and lead to increased bleeding. This study compares outcomes between mild and moderate hypothermia under unilateral cerebral perfusion (UCP).Retrospective analysis of 60 patients who underwent modified Bentall procedures with hemiarch replacement under UCP between 2014 and 2024. Patients were divided into two groups: mild hypothermia (mH, 32°C; n = 40) and moderate hypothermia (MH, 24°C; n = 20). Exclusion criteria included bilateral cerebral perfusion, additional procedures (e.g., total arch replacement, bypass surgery), preexisting neurological or renal conditions, and incomplete datasets. Neurological events, blood loss, transfusion requirements, acute kidney injury (AKI), and mortality were assessed.Neurological outcomes (permanent neurological dysfunction and transient neurological dysfunction) were comparable in both groups (20% each). The mH group had significantly lower blood loss (787 vs. 1,183 mL), reduced red blood cell transfusion (200 vs. 828 mL), and less fresh frozen plasma use (259.5 vs. 882 mL). The mH group also had lower rates of AKI (15 vs. 30%), rethoracotomy (10 vs. 22.5%), and infections (10 vs. 20%). Mortality was 20% (mH) versus 35% (MH).Mild hypothermia under UCP provides cerebral protection comparable to moderate hypothermia while reducing coagulopathy, transfusion needs, and complications-particularly relevant for centers in resource-limited countries.

This study aimed to determine the impact of symptom-to-surgery time on mortality in acute type A aortic dissection (ATAAD) patients, with and without malperfusion.A retrospective analysis of 288 ATAAD patients was conducted. Patients were separated into the early (≤10 h) and late (>10 h) groups by symptom-to-surgery time. Data on characteristics, surgery, and complications were compared, and multivariable logistic regression determined mortality risk factors.Mortality rates did not significantly differ between early and late groups. Age (odds ratio [OR] 1.09, 95% CI 1.05-1.13, p < 0.001), extracorporeal membrane oxygenation use (OR 10.73, 95% CI 2.51-45.87, p = 0.001), and malperfusion (OR 6.83, 95% CI 2.84-16.45, p < 0.001) predicted operative death. Subgroup analysis showed cerebral (OR 3.20, 95% CI 1.11-9.26, p = 0.031), cardiac (OR 5.89, 95% CI 1.32-26.31, p = 0.020), and limb (OR 6.20, 95% CI 1.75-22.05, p = 0.005) malperfusion as predictors of operative death. One (OR 6.30, 95% CI 2.39-16.61, p < 0.001), two (OR 12.79, 95% CI 2.74-59.81, p = 0.001), and three (OR 46.99, 95% CI 7.61-288.94, p < 0.001) organs malperfusion, together with Penn B (OR 7.96, 95% CI 3.04-20.81, p < 0.001) and Penn B-C (OR 12.50, 95% CI 2.65-58.87, p = 0.001) classifications predict operative mortality. Survival analysis revealed significant differences between malperfusion and no malperfusion (34% vs. 9%, p < 0.001) but not between late and early (14% vs. 21%, p = 0.132) groups. Malperfusion remained an essential predictor of operative (OR 7.06 95% CI 3.11-17.19, p < 0.001) and midterm mortality (OR 3.38 95% CI 1.97-5.77, p < 0.001) in subgroup analysis.Preoperative malperfusion status, rather than symptom-to-surgery time, significantly impacts both operative and midterm mortality in ATAAD patients.