ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

BackgroundFenestrated endovascular aneurysm repair (FEVAR) has become an essential option for the treatment of complex abdominal aortic aneurysms (AAA). While technological advances and growing operator experience have expanded its applicability, outcomes remain heterogeneous across centers and patient subsets. Evaluating real-world results is crucial to better define the effectiveness, safety, and durability of FEVAR in current practice.MethodsThis is a single-center, retrospective, observational study. Consecutive patients treated with FEVAR for complex AAA with a custom-made Cook device from January 2015 to October 2025 were included. Outcomes accessed included technical success, early major systemic complications, overall survival, freedom from reinterventions, target vessel instability, endoleaks, and sac expansion.ResultsSixty-four consecutive patients were treated with FEVAR Cook, of which 23 (35.9%) for juxtarenal AAA, 35 (54.7%) pararenal AAA and 6 (9.4%) thoraco-abdominal type IV aortic aneurysm. All but three patients were treated electively (95.3%). Two hundred twenty-two target vessels were successfully cannulated and treated with a bridging stent. Technical success was 98.4%. Early major systemic complications rate was 14.1%. Median follow-up was 29.5 months (IQR 47). Overall survival estimates at 1 and 4 years were 86.9% and 71.3%, respectively. Estimates at 4 years of freedom from reinterventions and target vessel instability were 90.9% and 93.8%, respectively. Freedom from type I/Ic and III/IIIc endoleak was 95.3% at 4 years. Sac regression, stability, and expansion at follow-up occurred in 29.5%, 63.9%, and 6.6%, respectively.ConclusionsFEVAR emerges as an appropriate and effective treatment option for complex aortic aneurysms. In our experience, the procedure provides high technical success and durable target-vessel preservation, with very satisfactory outcomes even at mid- to long-term follow-up.

BackgroundThe Fontan operation is the definitive palliation for single-ventricle physiology. In low- and middle-income countries, delayed diagnosis and limited paediatric cardiac services often result in adults presenting for primary Fontan rather than staged completion.MethodsAdults (≥18 years) undergoing extracardiac or lateral-tunnel Fontan between January 2021 and June 2025 were retrospectively reviewed. Variables included demographics, conduit and fenestration, cardiopulmonary bypass and cross-clamp times, re-exploration, extubation time, intensive care unit (ICU) stay, pulmonary-artery pressure, atrioventricular valve regurgitation, pleural effusion >14 days, arrhythmia and survival.ResultsTwenty-four adults (median age 20.5 years (interquartile range 19-22); 17 males (71%)) underwent primary Fontan: 18 (75%) extracardiac and 6 (25%) lateral tunnel. Fenestration was created in 14 (58%). Mean pulmonary-artery pressure increased from 12.6 ± 3.2 to 13.7 ± 3.5 mmHg (p = .12). Systemic oxygen saturation improved significantly from 79 ± 4% to 92.8 ± 3.1% (p < .001). Atrioventricular-valve regurgitation decreased significantly (p = .03), and New York Heart Association (NYHA) I-II class increased from 25% to 88% (p < .001). Pleural effusion >14 days occurred in nine (38%) and arrhythmia in three (13%) patients. Kaplan-Meier survival was 100% at 2 years and 95.8% at 3 years (95% confidence interval [83-100]).ConclusionsPrimary Fontan beyond childhood can be performed safely in adults with favourable haemodynamics, achieving excellent early survival and functional improvement. Standardised technique and vigilant postoperative care are central to recovery in low- and middle-income country settings.

BackgroundWe investigated the difference in the extracted surfaces between extractions carried out using forceps and a needle holder, focusing on needle extraction manipulation for smaller needle-hole defects.MethodsIn this prospective observational study, we included patients who underwent aortic surgery at our Hospital between December 2023 and January 2025. Aortic wall samples were collected from the patients with acute type A aortic dissection (n = 20) and thoracic aortic aneurysm (n = 20). Two hundred needle holes were created in the samples from each disease type and randomized into two groups: the forceps (n = 100) and needle holder (n = 100) groups. The long axis, short axis, and area of needle-hole defects were measured and compared between the two groups.ResultsOverall, the long axis in the needle holder group was significantly shorter than that in the forceps group (forceps: 0.52 ± 0.18 vs. needle holder: 0.48 ± 0.12 mm, P = 0.036). The short axis was not significantly different between the groups (forceps: 0.26 ± 0.07 vs. needle holder: 0.25 ± 0.06 mm, P = 0.223). The defect area in the needle holder group was significantly smaller than that in the forceps group (forceps: 0.11 ± 0.06 vs. needle holder: 0.09 ± 0.03 mm2, P = 0.022). Acute aortic dissection showed a similar tendency, whereas thoracic aortic aneurysm showed no significant differences.ConclusionsThe defect area formed when using a needle holder tended to be smaller than that when using forceps, especially in acute aortic dissection. When performing anastomotic pullouts in fragile aortic walls, using a needle holder may help reduce bleeding and prevent distal anastomotic new entry tears.

BackgroundPrimary tumors of the pulmonary artery are rare and frequently misdiagnosed as thromboembolic disease. Benign chondroid tumors arising from this location are exceptionally uncommon.Case DescriptionA 23-year-old man presented with exertional dyspnea and syncope. Imaging revealed a well-defined mass occupying the main pulmonary artery. Positron emission tomography/computed tomography showed no metabolic activity. The mass was completely excised under cardiopulmonary bypass. Histopathological examination demonstrated mature hyaline cartilage with low proliferative activity, consistent with a benign chondroid tumor. The postoperative course was uneventful, and no recurrence was observed at 12-month follow-up. This case highlights a rare benign etiology of pulmonary artery obstruction. Surgical resection remains the definitive diagnostic and therapeutic approach in selected patients with atypical intraluminal pulmonary artery masses.

Ischemia with nonobstructive coronary arteries (INOCA) is a clinically significant yet underrecognized condition characterized by anginal symptoms and evidence of myocardial ischemia in the absence of obstructive coronary artery disease. Once considered benign, INOCA is now associated with adverse outcomes such as myocardial infarction and heart failure.¹ This narrative review synthesizes current understanding of the multifactorial pathophysiology underlying INOCA, including coronary microvascular dysfunction (CMD), epicardial coronary vasospasm, endothelial dysfunction, hormonal influences, and autonomic nervous system imbalance. Diagnostic challenges are explored, highlighting the utility of both invasive and noninvasive modalities (e.g. coronary flow reserve, index of microcirculatory resistance, acetylcholine provocation testing, cardiac PET, MRI, and single-photon emission computed tomography). Evidence-based management strategies are discussed with emphasis on mechanism-targeted pharmacologic therapy, alignment of treatments with specific pathophysiological processes, emerging interventions (such as Rho-kinase inhibitors), and lifestyle modifications. By identifying knowledge gaps, this review provides a narrative overview of current diagnostic approaches and management options for INOCA, while underscoring areas of ongoing research and clinical uncertainty.

Endovascular repair of the aortic arch has evolved rapidly over the past decade, driven by the development of fenestrated and branched techniques, expanding treatment options for patients at high-risk for open or hybrid repair. This narrative review summarizes contemporary evidence on endovascular aortic arch repair, focusing on fenestrated and branched techniques using both custom-made and off-the-shelf devices, with emphasis on device design, anatomical considerations, clinical outcomes, limitations, and patient selection. Fenestrated endovascular repair is most commonly applied to distal arch pathology, particularly Ishimaru zone 2 and distal zone 1, and offers high technical success, and excellent target vessel patency. Branched endografts enable more extensive arch reconstruction and facilitate proximal landing in zone 0, at the cost of increased procedural complexity and higher stroke risk. Off-the-shelf platforms play an important role in urgent and emergent settings, while custom-made devices allow tailored solutions for elective cases. Across all strategies, outcomes are strongly influenced by patient selection, landing zone, and technical execution rather than device type alone. Endovascular aortic arch repair has become a viable treatment option for selected patients. Despite encouraging early and mid-term outcomes, stroke and reintervention remain key limitations, and long-term durability data are limited. Careful patient selection, meticulous planning, and multidisciplinary decision-making remain essential, while ongoing technological refinement are expected to further improve safety and expand applicability.

The Y-incision aortic annular enlargement technique offers a reliable solution for the aortic valve replacement in patients with small aortic annuli. By enlarging the annulus and root using a Y-incision and rectangular patch, this technique enables implantation of significantly larger prostheses to effectively avoid prosthesis-patient mismatch without affecting mitral geometry. Based on our experience using minimally invasive access, tailored patch design, modified closure of aortotomy, and integration with ascending aortic replacement when needed, the technique is reproducible and adaptable. Early outcomes are promising, though long-term follow-up and multicenter comparison are required to evaluate its benefits and potential risks.

Patients with post-tubercular sequelae often present with aspergilloma, bronchiectasis, or dense fibrosis, despite adequate medical therapy, making it the most challenging subset for thoracic surgery. In our experience of 632 post-tubercular lung parenchymal sequelae cases, 17% demonstrated trans-fissural extension. Among various predictors of poor surgical outcomes, trans-fissural extension in post-tubercular sequelae was the critical determinant, showcasing the chronicity and aggressiveness of parenchymal involvement. It necessitated extended lobar resections, leading to longer operative time, more intra-operative blood loss, higher incidence of residual space, prolonged air leak, post-operative infected collections, and requirement of re-surgery (i.e. window thoracostomy or completion pneumonectomy) compared to patients with lobe limited disease. In this complex cohort, recognizing the trans-fissural extension preoperatively is necessary for risk stratification, operative planning, and adopting the preventive strategies to optimize the surgical outcomes.

Over the last two decades, there have been dramatic advancements in fenestrated and branched technology for endovascular repair of the thoracoabdominal aorta. The global development of these minimally invasive techniques decreased their short-term morbidity and mortality, compared to open aortic replacement. However, the need for secondary reinterventions remains frequent, although they are typically percutaneous. Continual device modifications, improved implantation techniques, and greater understanding of the endovascular tenets constantly improve rates of long-term success. Challenges exist in endovascular repair of post-dissection thoracoabdominal aortic aneurysms (PD TAAAs) with narrow paravisceral true lumen, and our institutional experience evolved from fenestrated to inner/outer branched technology to mitigate the long-term risk of target vessel instability. Refined strategies in bridging stent grafts, particularly in target vessels off the false lumen, lowered target vessel reintervention rates. Prophylactic and therapeutic management of the false lumen is essential to prevent continued aortic degeneration and to mitigate the risk of spinal cord ischemia. Over the next decade, endovascular management of PD TAAAs will continue to evolve, further improving long-term outcomes.

In surgical correction of tetralogy of Fallot (TOF), transannular patch (TAP) repair has been the most prevalent right ventricular outflow tract (RVOT) reconstruction technique. However, resultant pulmonary regurgitation affects postoperative mortality and morbidity, and reintervention for RVOT lesion is frequently required late after TAP repair. There is no consensus for the best technique for TAP repair even in the current era. The optimal design of the patch, patch material, and reconstruction technique for the best long-term preservation of RVOT function should be explored in the future.