ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

Unicuspid aortic valve (UAV) is a rare congenital defect. Compared with valve replacement, aortic valve repair is a better potential strategy to achieve a low rate of valve-related events and an enhanced quality of life. We herein report two cases of aortic valve repair for UAV accompanied by aneurysm of the ascending aorta. By retaining the free margin tissue and forming a neocommissure to the side of the left lateral commissure that is 180 degrees opposite and the same height, we were able to achieve bicuspidization of the UAV. A glutaraldehyde-treated autologous pericardium patch was placed along the cusp connection to the annulus to expand the aortic cusp. During the follow-up period of over 4 years, the patients showed no signs of aortic regurgitation or significant stenosis.

Video-assisted thoracoscopic surgery is increasingly used for thoracic procedures due to its advantages in reducing postoperative pain and hospital stay. This study aimed to identify predictors and underlying reasons for conversion from video-assisted thoracoscopic surgery to open approach and to assess the impact of such conversions on clinical outcomes, including hospital stay duration, morbidity, and mortality, which remain debated in current literature.Patients and MethodsThis retrospective observational study was conducted on 950 adult patients between May 2016 and March 2023 who underwent elective thoracic surgery. Demographic data, comorbidities, perioperative variables, and outcomes were documented and analyzed. Univariate logistic and multivariate regression analyses were conducted to identify independent predictors of conversion.ResultsA total of 638/950 patients scheduled for video-assisted thoracoscopic surgery are included in the analysis. The mean age of the cohort was 35.68 years, with 61.9% being male. Conversion to open thoracotomy was required in 3.13% (n = 20) of cases, primarily due to anatomical challenges (50%, n = 10), vascular injury (45%, n = 9), and technical difficulties (5%, n = 1). Significant predictors of conversion included diabetes mellitus (p = 0.049), hypertension (p = 0.031), and malignant pathology (p = 0.022). Penalized regression identified anatomical difficulty (OR: 62.4; p = 0.0085) and vascular injury (OR: 57.8; p = 0.0026) as independent predictors of conversion, whereas diabetes, hypertension, and malignant pathology did not retain statistical significance after adjustment.ConclusionHypertension and malignancy were significant only in multivariate analysis, while anatomical challenges and vascular injuries remained significant in penalized regression.

Hemolysis following ascending aorta replacement is rare. A woman in her 70s underwent an ascending aorta replacement for an acute type A aortic dissection using a felt sandwich technique. Postoperative echocardiography revealed moderate aortic valve stenosis. Three years later, the aortic valve stenosis progressed to a severe stage. Cine cardiac magnetic resonance imaging revealed that the aortic jet of the aortic valve stenosis had collided with the inverted felt. Blood chemical data revealed hemolysis. The inner felt was removed, and the patch sutured to dilate the ascending aorta prosthesis. The aortic valve was then replaced, and the hemolysis resolved.

IntroductionFull median sternotomy is the traditional operative approach for ascending aortic aneurysm repair. Minimally invasive approaches are being used more frequently by surgeons to enhance recovery.MethodsThis is a single-institution, multi-surgeon retrospective review of adult patients who underwent elective aneurysm surgery involving the ascending aorta and proximal arch between 1 January 2015 and 30 June 2024 with and without aortic valve replacement/repair. Exclusion criteria included re-operation, aortic root procedure, and other concomitant valve procedure or coronary artery bypass grafting. Operative and short-term clinical outcomes were compared between patients undergoing upper hemi-sternotomy (UHS) and full median sternotomy (FMS).ResultsAmong 166 patients in the analysis dataset, 84 (50.6%) underwent FMS and 82 (49.4%) underwent UHS. UHS and FMS groups had similar median cardiopulmonary bypass time (129 vs. 137 min, p = 0.436) and median aortic cross-clamp time (92 vs. 96.5 min, p = 0.900). Patients undergoing UHS were more likely to be discharged home (93.9% vs. 83.3%, p = 0.032) and had a shorter length of stay (5 vs. 6 days, p < 0.001) compared to FMS. 30-day mortality occurred in one patient (1.2%) in the FMS group.ConclusionsElective aneurysm repair can be performed safely with less invasive hemi-sternotomy approaches. Minimally invasive approaches enhance recovery after surgery. Future prospective studies are needed to clarify potential benefits in postoperative pain and quality of life.

BackgroundValve-in-valve transcatheter aortic valve implantation (TAVI) has been confirmed as effective. Additionally, aortic annular enlargement has been advocated to avoid small valves at initial surgery, because they can cause patient-prosthesis mismatch, particularly after TAVI in surgical aortic valve replacement (SAVR). However, results remain unclear for TAVI with a small initial aortic valve in small body size patients. The purpose is to clarify the TAVI valve function after a small surgical valve in a small body population.MethodsWe retrospectively screened 52 cases of TAVI in SAVR performed from 2018 to 2024. Post-procedural TAVI valve function and post-procedural New York Heart Association (NYHA) functional class were examined.ResultsOf 52 TAVI in SAVR cases, 16 cases had a 19 mm initial surgical aortic valve, and 19 cases had 21 mm. The mean age of these 35 cases was 83.1 years old and 20% were male. Mean body surface area was 1.39 cm². After TAVI in SAVR in 35 cases, the mean pressure gradient was 18.5 mmHg, and the effective orifice area (EOA) was 1.10 cm². Even after 19-mm SAVR, the mean pressure gradient was 13.4 mmHg, and EOA was 1.13 cm², excluding 3 cases of off-label use and 3 cases of balloon-expandable valves. At the time of last follow-up, 86.2% of survivors remained in NYHA I or II.ConclusionsSelf-expanding TAVI in a certain type of SAVR provided sufficient valve function in a population with small body size, even after small-sized initial surgical prostheses. Surgeons need to ensure that the proper type and size of surgical prosthesis are implanted.

BackgroundThe saphenous vein graft (SVG) remains widely used in coronary artery bypass grafting (CABG). The no-touch (NT) technique offers atraumatic procedures in vein harvesting. Its effectiveness is still compared to conventional (CON) methods.MethodWe conducted a systematic review using electronic databases, focusing on studies that compared the NT and CON techniques in CABG. The primary outcomes assessed were major adverse cardiac and cerebrovascular events (MACCE), graft patency, and leg complications. Kaplan-Meier estimates and the Cox proportional hazards model were used to analyze MACCE-free survival. This study has been registered on PROSPERO(CRD42024553619).ResultsA total of seven studies, including three randomized controlled trials and four prospective cohort studies, encompassing 3859 patients, were included in the analysis. The NT technique showed significantly higher overall graft patency (OR 1.59; 95% CI 1.18-2.15; p < 0.001; I²= 49%), especially in the right coronary artery (OR 1.63; 95% CI 1.25-2.13; p < 0.001; I²= 0%). However, the NT technique had a higher incidence of leg complications (OR 2.49; 95% CI 1.73-3.60; p < 0.001; I²= 10%). No significant difference in 3-year MACCE-free survival (log-rank p = 0.47).ConclusionThe NT SVG harvesting technique has the potential to improve patency rates, especially when utilized as a conduit to the right coronary artery territory.

A 75-year-old woman with prior coronary bypass, endovascular aortic repair, and femoral bypass presented with a ruptured thoracic aortic aneurysm and type Ib endoleak. Conventional access routes were unsuitable due to severe calcification and tortuosity. The left common carotid artery was selected after confirming cerebral ischemia tolerance with a Matas test. A stent-graft was successfully deployed using a pull-through technique without complications. The patient recovered fully without neurological deficits. This case highlights the feasibility of carotid access for emergent endovascular repair and suggests that a simple Matas test may be sufficient for assessing cerebral tolerance in urgent settings.

Direct fistulization of a hepatic hydatid cyst into the lung, causing rapid pulmonary destruction, is exceedingly rare. We report a 41-year-old male presenting with acute asphyxia due to a complicated hepatic hydatid cyst with a giant transdiaphragmatic fistula into the right lung, leading to complete lung destruction and massive tracheobronchial aspiration. Emergency right pneumonectomy was performed for irreversible lung damage. Intraoperative findings confirmed heavy adhesions, lung destruction, and an extensive scolex-laden fistula. The postoperative course was challenging, complicated by ARDS and Acinetobacter sepsis, requiring prolonged ICU care, though follow-up was ultimately successful. This case highlights the aggressive progression of this rare complication and the crucial importance of early diagnosis and comprehensive surgical intervention in endemic areas to prevent devastating outcomes.

BackgroundThe optimal cerebral protection strategy during complex aortic surgery remains controversial, and various brain monitoring modalities are used to provide different information to improve cerebral protection. This study aims to compare the effect of the change in cerebral oxygen saturation during hypothermic circulatory arrest on the early postoperative neurological outcome in antegrade cerebral perfusion (ACP) versus retrograde cerebral perfusion (RCP) during circulatory arrest in adult aortic surgery using cerebral oximetry.MethodsThis was a cross-sectional analytic study that enrolled a total of 84 patients undergoing total circulatory arrest during adult aortic surgery divided into two groups. Group A: 42 cases undergoing selective ACP; Group B: 42 cases undergoing RCP.ResultsCerebral oxygen saturation before and after circulatory arrest (right and left), cerebral oxygen saturation after cardiopulmonary bypass (right and left) and cross clamp time were significantly lower in Group A than Group B. Cerebral oxygen saturation during circulatory arrest (right and left) and circulatory arrest time were significantly higher in Group A than Group B. Regaining of conscious level time, mechanical ventilation time, neurological dysfunction, other organs dysfunction, and mortality were significantly lower in Group A than Group B.ConclusionsDuring hypothermic circulatory arrest in complex aortic surgery in adults, cerebral oxygen saturation was an independent predictor of neurological dysfunction in patients who underwent RCP and in patients who underwent ACP.

BackgroundMalignant pleural effusion is characterized by the presence of malignant cells in the pleural fluid. Malignant cells from pleural lavage performed in patients without a coexistent pleural effusion have been identified as an indicator of micrometastatic disease and are associated with a higher recurrence rate and poorer survival. The aim of this study was to evaluate the efficacy and safety of the short-term postoperative outcomes with patients who underwent awake and intubated video-assisted thoracoscopic surgery (VATS) in the management of recurrent malignant pleural effusion. We hypothesized that nonintubated VATS is as safe and effective as intubated VATS for MPE management.MethodsA case series of 315 consecutive patients from January 2021 to November 2023 with malignant pleural effusion. The patients were randomized into two groups as nonintubated video-assisted thoracoscopic Pleurodesis with sedoanalgesia (nonintubated as group A) and video-assisted thoracoscopic pleurodesis with general anesthesia (intubated as group B).ResultsThe study included 315 patients who underwent video-assisted thoracoscopic pleurodesis either intubated or not. The mean average age was noted to be 54.58 ± 7.93. There were 178 cases of male patients (65.5%). Visual analogue score showed a significant difference after procedure 4 h without any difference after 24 h. There was a nonsignificant difference between both groups according to changes in dyspnea score and grades of chest X-ray findings of pleural effusion.ConclusionsNonintubated VATS is safe in patients, especially those with comorbidity who couldn't tolerate general anesthesia. It has also similar reliability compared to VATS performed under general anesthesia.