ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

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.

We present an adult case of iatrogenic aorto-right ventricular fistula that developed after percutaneous transcatheter pulmonary valvuloplasty for pulmonary valve stenosis using Mustang® double balloons following definitive repair of double outlet right ventricle. At outpatient follow-up, an abnormal shunt between the aortic root and the right ventricular outflow tract was detected by echocardiography and enhanced computed tomography. The ratio of pulmonic to systemic blood flow was measured at 1.64 by cardiac catheterization. We successfully performed patch closure of the aorto-right ventricular fistula, concomitant with pulmonary valve replacement and tricuspid valvuloplasty.

BackgroundCoarctation of the aorta (CoA) is a congenital condition that often requires intervention, especially when associated with other intracardiac abnormalities. Surgical approaches to treat complex CoA and associated defects vary, with no universally accepted standard approach. This study evaluates the outcomes of a single-stage extra-anatomic bypass from the ascending to the descending thoracic aorta, along with simultaneous correction of associated intracardiac abnormalities in adult patients.MethodsWe conducted a retrospective analysis of 17 adult patients who underwent a single-stage extra-anatomic bypass for complex CoA repair between January 2014 and December 2023. Patients were treated with an ascending to descending thoracic aorta bypass via a right-sided extra-anatomic approach, with simultaneous correction of associated cardiac defects. The primary outcomes measured were perioperative mortality, haemodynamic improvement, and post-operative complications.ResultsThe mean age of patients was 35.9 years. The single-stage repair showed a 94.1% survival rate, with significant haemodynamic improvement indicated by a reduction in blood pressure gradient from 49.7 ± 7.4 mmHg pre-operatively to 11.2 ± 3.9 mmHg post-operatively. There were minimal complications, with no evidence of graft failure, kinking, or cerebrovascular incidents during follow-up. One patient experienced acute kidney injury and early mortality. Follow-up of up to 10 years demonstrated durable results with favourable outcomes.ConclusionThe single-stage extra-anatomic bypass with simultaneous correction of associated cardiac defects is a safe and effective approach for managing complex CoA in adults.