Seminars in Thoracic and Cardiovascular Surgery最新文献

Endograft infections following thoracic endovascular treatment are rare but associated with high morbidity and mortality. This study describes our experience with the surgical management of infections involving descending thoracic and thoracoabdominal aorta. The study retrospectively reviewed patients who underwent open descending thoracic and thoracoabdominal aortic aneurysm repair between January 1991 and March 2025, including cases of stent graft infections and secondary aortobronchial or aortoenteric fistula. Perioperative characteristics, operative outcomes and overall survival were evaluated. Of 2220 patients who underwent descending thoracic and thoracoabdominal aortic aneurysm repair, 20 patients (0.9%) received surgical treatment for endograft infections: 8 with endograft infection; 7 with aortoesophageal fistula; and 5 with aortobronchial fistula. The extent of repair involved the descending thoracic aneurysm in 18 patients (90%), and thoracoabdominal aortic aneurysm in 2 patients (10%). Endograft explantation and in-situ aortic reconstruction were performed in 19 patients (95%) while flap reconstruction was utilized in 16 patients (80%). Operative mortality was 6 patients (30%). Postoperative stroke occurred in 1 patient (5%) and temporary paraparesis also occurred in 1 patient (5%). Overall survival was 43.5% at 1 year and 36.3% at 5 years. Management of endograft infection involving the descending thoracic and thoracoabdominal aortic aneurysm remains challenging. Surgical repair, including endograft explantation, in-situ reconstruction, and flap installation, yielded acceptable mortality and morbidity rates in this high-risk patient population.

Routine daily chest radiographs (CXR) in intensive care units (ICUs), including cardiovascular (CVICUs) and cardiothoracic (CTICUs), are widely used for early complication detection during the post-operative period. However, evidence suggests that this practice lacks clinical utility, with low diagnostic and therapeutic yields. The evidence consistently demonstrates that an on-demand CXR strategy, performed only for specific clinical indications, offers comparable patient safety, reduced radiation exposure, and substantial cost savings without increasing adverse outcomes, ICU length of stay, or mortality. For post-cardiothoracic surgery patients, complications such as pleural effusions and pneumothoraces are of important concern, yet routine CXRs rarely identify such abnormalities, with very few requiring intervention. Data support an on-demand approach, even after procedures such as chest tube removal, as clinical signs and symptoms are reliable indicators of complications. Transitioning from routine to on-demand CXR practices aligns with evidence-based guidelines, including Choosing Wisely® and the Critical Care Societies Collaborative recommendations. This approach promotes high-value care, minimizes unnecessary imaging, and supports the safe, cost-effective management of ICU patients. Routine CXRs should be reconsidered as standard practice in favor of tailored, patient-specific imaging strategies.

The bronchial sleeve represents a pivotal advancement in thoracic surgery, allowing for oncological radicality while preserving respiratory function. We present 29 cases of telescopic monofilament continuous suture bronchial sleeves out of a total of 43 bronchial sleeve resections performed by us. There were no mortalities, no bronchial positive margins, no local recurrences, and only one anastomotic fistula requiring pneumonectomy with open window thoracostomy, which closed after a few months (Fig. 2). The telescopic intussusception technique avoids the significant problem of caliber discrepancy, and this type of suture consolidates with the physiological increases in airway pressure due to Valsalva maneuver or coughing, because the internal "endobronchial" pressure generated is applied radially on the smaller caliber bronchus, pushing it and causing it to adhere to the larger caliber external bronchus.

Ventricular assist device (VAD) technologies have advanced in recent years from large, pulsatile devices to smaller continuous flow (CF) pumps. As such, their design has allowed surgeons to pioneer less invasive methods of implantation with alternative configurations to treat a larger number of patients with varied types of cardiomyopathies who are often sick with high-risk clinical scenarios. In recent years, these patients appear to have a higher degree of vascular disease and have had multiple prior cardiac surgeries. In this review, we highlight both standard as well as alternative VAD configurations including additional inflow and outflow cannulation techniques along with considerations for biventricular support for both durable biventricular VADs and as a total artificial heart configuration.