ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

PurposeThe ninth TNM staging of non-small-cell lung cancer (NSCLC) was introduced in 2023 to replace the eighth edition that had been in use since 2017. It provides a standardised universal language to discuss management of NSCLC patients. Outcomes across different patient populations can be better evaluated and this process is undertaken by the International Association for the Study of Lung Cancer Lung Cancer Staging Project team to further refine the staging classification past and present.Changes in descriptorsThere is no change to the size-based T-descriptors. Mediastinal nodal N-descriptors followed previous definitions but are now subdivided into N2a and N2b depending on single or multiple nodal stations involvement respectively. M1c M-descriptors that described multiple extra-thoracic metastases were also subclassified into single (M1c1) or multiple (M1c2) organ system involvement.Changes in stagingMajor revisions were made to stage 2 and 3 disease. Previous T1N1M0 disease is downstaged from stage 2B to 2A. T1N2aM0 disease is now downstaged to 2B whilst T1N2bM0 remained as stage 3A. Previous T2N2M0 and T3N2M0 disease were staged 3A and 3B respectively. Under the new classification, T2N2aM0 (unchanged) and T3N2aM0 (downstaged) are now stage 3A whilst T2N2bM0 (upstaged) and T3N2bM0 (unchanged) are now stage 3B.ConclusionThe ninth edition NSCLC TNM staging is now in place. It is important to be familiar with it to allow effective communication between surgical and medical oncologists to optimise patient care. It is also pertinent to start collecting and maintaining databases using the revised staging to help us further improve treatment in lung cancer patients.

Studies have shown that the effective orifice diameter of surgical prosthetic valves is 5-7 mm smaller than the labeled valve size. To improve outcomes of surgical aortic valve replacements, the Y-incision aortic annular enlargement enlarges the surgical aortic annulus to accommodate a prosthetic valve 3-4 sizes larger with an effective orifice area that matches the patient's basal ring. This review described the common mistakes of performing the Y-incision aortic annular enlargement in surgical aortic valve replacement, with a detailed look at early outcomes.

Ross procedure has been a controversial option for treating aortic valve disease in adults since its introduction in 1967. By the early 2000s, it had become a procedure performed in only a small number of centres worldwide, with most cardiac surgeons lacking any firsthand experience during their training. Nevertheless, several centres of excellence continued to pursue mastery of this procedure during this period, and contemporary literature has ignited a renewed interest in the Ross procedure. In this review, we discuss the current landscape of the Ross procedure in aortic surgery.

ObjectiveTo describe the clinical characteristics, operative data, and outcomes of total aortic arch replacement (TAR) performed at a high-volume aortic dedicated center, with a focus on technical aspects and neurologic protection.MethodsWe conducted a retrospective analysis of 536 consecutive patients who underwent TAR between 1997 and 2025. Data were collected from a prospectively maintained institutional database. All procedures were performed via median sternotomy with deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP) for neuroprotection. Arch reconstruction was performed using either island or debranching techniques, based on patient anatomy and comorbidities. Multivariable Cox regression analysis was used to identify predictors of 10-year mortality.ResultsThe mean patient age was 66.9 ± 12.9 years; 41% were female and 36.8% underwent redo operations. The mean cardiopulmonary bypass time was 158.1 ± 34.7 min, cardiac ischemic time was 102.8 ± 40.7 min, and mean circulatory arrest time was 40 ± 12.8 min. Concomitant procedures were performed in 49.6% of patients. Operative mortality was 2.1%, stroke occurred in 2.6%, and renal complications occurred in 3.2%. The 10-year survival rate was 80.7%. Multivariable analysis identified pulmonary disease, renal impairment, larger aneurysm size, and urgent/emergent presentation as independent predictors of late mortality. The use of RCP provided effective cerebral protection across a wide range of operative complexity.ConclusionTotal aortic arch replacement can be performed with low mortality and excellent long-term outcomes using DHCA with RCP. A tailored operative approach and institutional experience are key to optimizing outcomes.

The frozen elephant trunk (FET) procedure has emerged as a transformative approach for complex aortic arch pathology, addressing limitations of conventional elephant trunk procedures, including the need for second-stage operations with interval mortality, inability to expand the true lumen in dissections and lack of distal anastomotic support.Our experience with over 200 procedures demonstrates FET technique evolution and refinement, achieving 13.8% overall mortality. Presenting pathologies were diverse, predominantly aneurysmal disease and acute or chronic dissections. Most utilised Thoraflex Hybrid, though the Jotec E-vita prosthesis has been increasingly used recently. Critical technical advancements include bilateral axillary artery cannulation, which has dramatically reduced neurological complications, including paraplegia and recurrent laryngeal nerve injury, compared to historical series. It also made the procedure technically less complex and more reproducible. In selected cases, we have also adopted a beating heart strategy to reduce the cardiac ischaemic time once the proximal aortic repair has been completed. The beating heart strategy demonstrated a tendency for reduced post-operative adrenaline requirements without compromising outcomes.Frozen elephant trunk demands advanced perfusion strategies, proactive spinal cord protection and meticulous surgical technique but reduces the need for future open repair, facilitating endovascular interventions. Our experience demonstrates that FET represents a paradigm shift toward comprehensive single-stage treatment of complex aortic arch pathology with acceptable outcomes when performed in high-volume centres by experienced multidisciplinary teams.

Traditionally, the modified Blalock-Taussig-Thomas shunt (mBTTS) has been the standard palliation for duct-dependent pulmonary blood flow (DDPBF) lesions, including tetralogy of Fallot with pulmonary atresia (TOF-PA). However, the risks associated with mBTTS, especially in neonates with low birth weight and small pulmonary arteries, have led to the exploration of less invasive alternatives like ductal stenting (DS). This review compares the anatomy and physiology of TOF with pulmonary stenosis and TOF-PA, noting that TOF-PA often relies on the patent ductus arteriosus (PDA) for pulmonary blood flow. It details the complexities of PDA morphology in DDPBF lesions, which can present as simple or complex structures. Historically, early experiences with DS revealed high complication rates, resulting in cautious recommendations against its use in certain anatomical contexts. However, improvements in stent technology and understanding of the complex congenital cardiac anatomy have improved the feasibility of DS as a viable option when the PDA is the sole source of pulmonary blood flow. We also explore issues like the less durable palliation compared to mBTTS, technically challenging stent placement, rapid neointimal proliferation causing in-stent stenosis and compromising pulmonary artery (PA) perfusion, and asymmetrical PA branch growth in the presence of stent jailing of a branch PA. In conclusion, this review suggests that while DS is increasingly seen as a reasonable alternative to mBTTS, it requires careful patient selection and close monitoring, alongside ongoing research to refine techniques and improve long-term outcomes for TOF-PA patients.

Obstructive hypertrophic cardiomyopathy (oHCM) presents a significant clinical challenge, with left ventricular outflow tract obstruction being a primary driver of symptoms and adverse outcomes. Surgical septal myectomy (SM) performed under cardiopulmonary bypass and cardioplegic arrest has stood as the gold standard therapy, offering durable and complete relief of obstruction. However, its widespread adoption has been severely hampered by the limited surgical field, lack of real-time intraoperative assessment, and steep learning curve. In an effort to streamline SM, we have developed an innovative transapical beating-heart SM (TA-BSM) procedure. In this article, we outline the design of the beating-heart myectomy device that enables off-pump, real-time assessment of resection via a small left thoracotomy. We synthesize the evidence from the initial feasibility study in swine, the first-in-human trial, and large-scale clinical applications, indicating its compelling safety and efficacy profile. Furthermore, we analyze the learning curve of the TA-BSM procedure and present a structured framework for training future surgeons. Finally, we discuss the profound implications of this technique for global dissemination of oHCM care, potentially making this life-changing surgery accessible to thousands of underserved patients worldwide. In summary, TA-BSM represents not merely an incremental improvement but a true paradigm shift, moving oHCM surgery from a static, blind procedure to a dynamic, precise intervention.

It is desirable to preserve the pulmonary valve annulus as much as possible, but the decision to preserve the annulus should be made by taking into account not only the annulus diameter but also the characteristics of the valve leaflets. Even if the valve annulus diameter is 70% or more of the normal value, in cases where the valve leaflets are poorly mobile or thickened, there is a concern that pulmonary regurgitation will worsen after pulmonary commissurotomy, so it is desirable to reconstruct the right ventricular outflow tract using a valved conduit in order to preserve right ventricular function. The choice of conduit is extremely important. The bovine jugular vein graft, which is associated with a high incidence of complications such as infection, should be avoided as much as possible. The ePTFE valved conduit is useful for preserving right ventricular function, and is recommended as a conduit for right ventricular outflow tract reconstruction. Although ePTFE valved conduits may cause relative stenosis due to weight gain, the possibility of pulmonary regurgitation is low, and the frequency of thrombosis and infection is also low. The conduit exchange free rate for large-diameter ePTFE valved conduits is high, and the need for reintervention is low.

The conventional primary-secondary classification of spontaneous pneumothorax fails to capture the complexity encountered during thoracoscopic surgery, where CT imaging often misses subtle apical scarring, early emphysematous changes, or fibrotic, noncompliant lung tissue. To provide a more operative-relevant clinical framework, we hereby propose the PLEX Classification, based on Pattern of lung abnormality, Location of leak and lung reserve, Extent of disease, and eXpected surgical complexity and surgical outcome. This system categorizes pneumothorax into four different variants: Type I (apical vulnerability pneumothorax), Type II (multibullous pneumothorax), Type III (emphysematous pneumothorax), and Type IV (fibrotic lung pneumothorax). Applied to 710 surgeries, PLEX demonstrated a clear gradient of increasing surgical difficulty and complications from Type I to Type IV. PLEX offers a pragmatic, surgically actionable system for planning, communication, as well as outcome prediction.

Although purulent pericarditis is rare in the modern era, early diagnosis and appropriate therapy with antibiotics and drainage are critical because it remains a rapidly progressive and highly fatal infection. Purulent pericarditis typically occurs as a secondary infection through hematogenous dissemination or contiguous spread from an intrathoracic infection, with most cases occurring in immunocompromised individuals. Herein, we report the case of a 52-year-old male patient with a history of diabetes mellitus who had difficult-to-diagnose chest pain. He was ultimately diagnosed with purulent pericarditis using ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography, then treated via surgical drainage, pericardiectomy, and long-term antibiotic therapy.