Pub Date : 2025-06-01DOI: 10.1053/j.semtcvs.2024.11.006
Bret DeGraaff MD , Scott C. DeRoo MD , Isaac George MD
Transcatheter Aortic Valve Replacement (TAVR) continues to grow in popularity and has become the preferred mechanism for the treatment of aortic stenosis in most patients. Despite significant improvements in the safety of TAVR, complications remain inevitable. Aortic dissection, although rare, is a feared complication following TAVR. Aortic dissection after TAVR has been reported to occur in both the ascending and descending thoracic aorta and may occur acutely during valve placement or in a delayed fashion. Bicuspid aortic valve and ascending aortic aneurysm may increase the risk for Type A dissection following TAVR. Given the rarity of aortic dissection in TAVR, a high index of suspicion must be maintained to provide prompt diagnosis and management. Open surgical repair is the preferred treatment modality for type A aortic dissection, however endovascular management and conservative medical therapy can be utilized in select patients and are more commonly employed for type B dissection.
经导管主动脉瓣置换术（TAVR）越来越受欢迎，已成为大多数患者治疗主动脉瓣狭窄的首选方法。尽管 TAVR 的安全性有了很大提高，但并发症仍然不可避免。主动脉夹层虽然罕见，但却是 TAVR 术后令人担忧的并发症。据报道，TAVR 术后主动脉夹层可发生在升主动脉和降主动脉，可能在瓣膜置入过程中急性发生，也可能延迟发生。主动脉瓣二尖瓣和升主动脉瘤可能会增加 TAVR 术后发生 A 型夹层的风险。鉴于主动脉夹层在 TAVR 中的罕见性，必须保持高度怀疑，以提供及时的诊断和治疗。开放手术修复是 A 型主动脉夹层的首选治疗方式，但血管内治疗和保守药物治疗可用于特定患者，而且更常用于 B 型夹层。
{"title":"Aortic Dissection Following Transcatheter Aortic Valve Replacement","authors":"Bret DeGraaff MD , Scott C. DeRoo MD , Isaac George MD","doi":"10.1053/j.semtcvs.2024.11.006","DOIUrl":"10.1053/j.semtcvs.2024.11.006","url":null,"abstract":"<div><div>Transcatheter Aortic Valve Replacement (TAVR) continues to grow in popularity and has become the preferred mechanism for the treatment of aortic stenosis in most patients. Despite significant improvements in the safety of TAVR, complications remain inevitable. Aortic dissection, although rare, is a feared complication following TAVR. Aortic dissection after TAVR has been reported to occur in both the ascending and descending thoracic aorta and may occur acutely during valve placement or in a delayed fashion. Bicuspid aortic valve and ascending aortic aneurysm may increase the risk for Type A dissection following TAVR. Given the rarity of aortic dissection in TAVR, a high index of suspicion must be maintained to provide prompt diagnosis and management. Open surgical repair is the preferred treatment modality for type A aortic dissection, however endovascular management and conservative medical therapy can be utilized in select patients and are more commonly employed for type B dissection.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 2","pages":"Pages 136-142"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.semtcvs.2025.01.007
Thoralf M. Sundt MD
{"title":"Its My Patient - Surgeon as Team Leader","authors":"Thoralf M. Sundt MD","doi":"10.1053/j.semtcvs.2025.01.007","DOIUrl":"10.1053/j.semtcvs.2025.01.007","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 2","pages":"Pages 168-170"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent clinical trials demonstrated that as adjuvant therapy, immune checkpoint inhibitors (ICIs) following intravenous cytotoxic chemotherapy may have a nonsignificant advantage over intravenous cytotoxic chemotherapy only in completely resected stage IB non-small cell lung cancer (NSCLC). Meanwhile, several studies reported that oral tegafur-uracil may have a comparable benefit to intravenous chemotherapy in long-term survival outcomes in these patients. However, there is currently a lack of head-to-head comparison between ICIs following intravenous cytotoxic chemotherapy and tegafur-uracil. Therefore, we designed a network meta-analysis in assessing overall survival (OS) and a composite endpoint of disease free survival (DFS) and recurrence free survival (RFS) as measures of effect. Our results indicated that, limited to stage IB, calculated hazard ratio (HR) was 1.02 (95% confidence interval [CI]: 0.53−1.96) for OS and calculated HR was 0.90 (95% CI: 0.43−1.87) for DFS, while in stage IB to IIIA patients, calculated HR was 0.97 (95% CI: 0.70−1.37) for OS and calculated HR was 0.75 (95% CI: 0.59−0.95) for DFS. In conclusion, tegafur-uracil may offer a comparable benefit to ICIs following chemotherapy in limitation to stage IB NSCLC patients only. Future clinical trials may be designed for stage IB NSCLC, separately from stage II and III.
{"title":"Adjuvant Therapy in Stage IB Non-Small Cell Lung Cancer: A Network Meta-Analysis of Tegafur-Uracil and Immune Checkpoint Inhibitors","authors":"Masatsugu Hamaji MD, PhD , Jiro Takeuchi MD, PhD , Naoki Ozu MPH , Ryo Miyata MD, PhD , Keiji Yamanashi MD, PhD , Takeshi Kawaguchi MD, PhD , Mitsuharu Hosono MD, PhD","doi":"10.1053/j.semtcvs.2025.03.011","DOIUrl":"10.1053/j.semtcvs.2025.03.011","url":null,"abstract":"<div><div>Recent clinical trials demonstrated that as adjuvant therapy, immune checkpoint inhibitors (ICIs) following intravenous cytotoxic chemotherapy may have a nonsignificant advantage over intravenous cytotoxic chemotherapy only in completely resected stage IB non-small cell lung cancer (NSCLC). Meanwhile, several studies reported that oral tegafur-uracil may have a comparable benefit to intravenous chemotherapy in long-term survival outcomes in these patients. However, there is currently a lack of head-to-head comparison between ICIs following intravenous cytotoxic chemotherapy and tegafur-uracil. Therefore, we designed a network meta-analysis in assessing overall survival (OS) and a composite endpoint of disease free survival (DFS) and recurrence free survival (RFS) as measures of effect. Our results indicated that, limited to stage IB, calculated hazard ratio (HR) was 1.02 (95% confidence interval [CI]: 0.53−1.96) for OS and calculated HR was 0.90 (95% CI: 0.43−1.87) for DFS, while in stage IB to IIIA patients, calculated HR was 0.97 (95% CI: 0.70−1.37) for OS and calculated HR was 0.75 (95% CI: 0.59−0.95) for DFS. In conclusion, tegafur-uracil may offer a comparable benefit to ICIs following chemotherapy in limitation to stage IB NSCLC patients only. Future clinical trials may be designed for stage IB NSCLC, separately from stage II and III.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 2","pages":"Pages 210-216"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.semtcvs.2024.09.005
Majed AL-Mourgi MD, FRCS, FCCP, FACS (Professor of Surgery and Chest Surgeon) , Anwar Shams MD, MSc, PhD (Assistant Professor of Pharmacology)
Primary bone cancers, also called bone sarcomas, can arise anywhere in the body. Less than 1% of cancers are identified as primary bone cancers annually, and they are correlated with high rates of morbidity and death. Twenty to twenty-seven percent of primary malignant osseous neoplasms are chondrosarcomas, the rarest subtype of bone sarcomas. The incidence of chondrosarcomas in Saudi Arabia was less common than globally discovered chondrosarcomas, and only a few cases have been recorded. The most common presentation of the primary chondrosarcoma (CS) is to encompass the bony skeleton of the long bones of the lower extremities and the axial skeleton. Detecting primary CS in the anterior chest wall and the rib cage is rare. To our knowledge, chondrosarcomas of the ribs encroaching on the anterior chest are rare and have never been documented in Saudi Arabian or Middle East medical or surgical literature. We describe a case of a 32-year-old female with chondrosarcoma of the left anterior seventh rib, with no other medical or surgical histories. Further work-up at the tertiary care center, including computed tomography-scan, magnetic resonance imaging, and detailed triple bone scan (nuclear scan) imaging and histological biopsy, revealed features of chondrosarcoma arising from the ribs and involving the surrounding soft tissue. The patient underwent en masse surgical resection with a 4 cm margin, including the sixth rib and partial resection of the left hemidiaphragm and a small piece of the diaphragm. The patient was discharged without any inauspicious consequences. In the current work, we comprehensively discussed a scarce case of the anterior chest wall chondrosarcoma affecting the rib. This case highlights the importance of early detection of a rare tumor using a toolkit diagnostic approach to provide successful management and caring of the patient. Consequently, this will guarantee encouraging outcomes and thus stress the fruitful role of the surgery as the best curative modality in chondrosarcoma patients.
{"title":"A Rare Entity of the Anterior Chest Cage Rib Chondrosarcoma: A Case Report and Review of Literature","authors":"Majed AL-Mourgi MD, FRCS, FCCP, FACS (Professor of Surgery and Chest Surgeon) , Anwar Shams MD, MSc, PhD (Assistant Professor of Pharmacology)","doi":"10.1053/j.semtcvs.2024.09.005","DOIUrl":"10.1053/j.semtcvs.2024.09.005","url":null,"abstract":"<div><div>Primary bone cancers, also called bone sarcomas, can arise anywhere in the body. Less than 1% of cancers are identified as primary bone cancers annually, and they are correlated with high rates of morbidity and death. Twenty to twenty-seven percent of primary malignant osseous neoplasms are chondrosarcomas, the rarest subtype of bone sarcomas. The incidence of chondrosarcomas in Saudi Arabia was less common than globally discovered chondrosarcomas, and only a few cases have been recorded. The most common presentation of the primary chondrosarcoma (CS) is to encompass the bony skeleton of the long bones of the lower extremities and the axial skeleton. Detecting primary CS in the anterior chest wall and the rib cage is rare. To our knowledge, chondrosarcomas of the ribs encroaching on the anterior chest are rare and have never been documented in Saudi Arabian or Middle East medical or surgical literature. We describe a case of a 32-year-old female with chondrosarcoma of the left anterior seventh rib, with no other medical or surgical histories. Further work-up at the tertiary care center, including computed tomography-scan, magnetic resonance imaging, and detailed triple bone scan (nuclear scan) imaging and histological biopsy, revealed features of chondrosarcoma arising from the ribs and involving the surrounding soft tissue. The patient underwent en masse surgical resection with a 4 cm margin, including the sixth rib and partial resection of the left hemidiaphragm and a small piece of the diaphragm. The patient was discharged without any inauspicious consequences. In the current work, we comprehensively discussed a scarce case of the anterior chest wall chondrosarcoma affecting the rib. This case highlights the importance of early detection of a rare tumor using a toolkit diagnostic approach to provide successful management and caring of the patient. Consequently, this will guarantee encouraging outcomes and thus stress the fruitful role of the surgery as the best curative modality in chondrosarcoma patients.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 2","pages":"Pages 217-232"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.semtcvs.2025.05.004
{"title":"Recent Articles in AATS Journals","authors":"","doi":"10.1053/j.semtcvs.2025.05.004","DOIUrl":"10.1053/j.semtcvs.2025.05.004","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 2","pages":"Pages e1-e3"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/S1043-0679(25)00070-X
{"title":"Masthead (copyright and information page)","authors":"","doi":"10.1053/S1043-0679(25)00070-X","DOIUrl":"10.1053/S1043-0679(25)00070-X","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 2","pages":"Page I"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.semtcvs.2025.01.009
Michael Salna MD, Michael Argenziano MD, Craig R. Smith MD
{"title":"Just Short of the Silver Medal: The Radial is a Close Third to the Right Internal Thoracic Artery in the Hierarchy of Arterial Coronary Bypass Grafts","authors":"Michael Salna MD, Michael Argenziano MD, Craig R. Smith MD","doi":"10.1053/j.semtcvs.2025.01.009","DOIUrl":"10.1053/j.semtcvs.2025.01.009","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 2","pages":"Pages 123-127"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.semtcvs.2025.04.001
Travis C. Geraci MD, Justin C.Y. Chan MD, Anna Niroomand MD, PhD, Stephanie H. Chang MD
Primary graft dysfunction (PGD) is a major source of morbidity and mortality following lung transplantation, presenting as acute lung injury within 72 hours post-transplantation. Despite advances in surgical techniques and perioperative care, the complex interplay of donor, recipient, and perioperative factors contributes to its development, underscoring the multifactorial nature of PGD. Clinical management of recipients with PGD relies on supportive care strategies, including lung-protective ventilation, inhaled nitric oxide, and extracorporeal membrane oxygenation (ECMO). Severe cases of PGD may result in significant short- and long-term adverse outcomes, including early mortality. Even for patients who recover from PGD, there is also an associated increased risk of chronic lung allograft dysfunction, further compounding its clinical impact. This review provides a brief review of current knowledge regarding PGD, detailing risk factors, diagnostic criteria, and management approaches while identifying critical gaps in understanding its pathophysiology. Ongoing research is essential to develop innovative therapeutic strategies and improve outcomes for lung transplant recipients.
{"title":"Post Lung Transplant Primary Graft Dysfunction","authors":"Travis C. Geraci MD, Justin C.Y. Chan MD, Anna Niroomand MD, PhD, Stephanie H. Chang MD","doi":"10.1053/j.semtcvs.2025.04.001","DOIUrl":"10.1053/j.semtcvs.2025.04.001","url":null,"abstract":"<div><div>Primary graft dysfunction (PGD) is a major source of morbidity and mortality following lung transplantation, presenting as acute lung injury within 72 hours post-transplantation. Despite advances in surgical techniques and perioperative care, the complex interplay of donor, recipient, and perioperative factors contributes to its development, underscoring the multifactorial nature of PGD. Clinical management of recipients with PGD relies on supportive care strategies, including lung-protective ventilation, inhaled nitric oxide, and extracorporeal membrane oxygenation (ECMO). Severe cases of PGD may result in significant short- and long-term adverse outcomes, including early mortality. Even for patients who recover from PGD, there is also an associated increased risk of chronic lung allograft dysfunction, further compounding its clinical impact. This review provides a brief review of current knowledge regarding PGD, detailing risk factors, diagnostic criteria, and management approaches while identifying critical gaps in understanding its pathophysiology. Ongoing research is essential to develop innovative therapeutic strategies and improve outcomes for lung transplant recipients.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 2","pages":"Pages 192-198.e1"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.semtcvs.2025.01.001
Meghana R.K. Helder MD, Jong Kim MD
Beating-heart coronary artery bypass grafting (CABG) in patients with left ventricular (LV) dysfunction can provide the best of all words by limiting myocardial injury purported by cardioplegic arrest. Complete revascularization is possible and graft numbers are not different when compared to arrested heart CABG. Furthermore, beating-heart CABG more often reduces the need for intraoperative and postoperative mechanical support reducing the complications and costs associated with these devices.
{"title":"A Beating Heart is a Happy Heart, Especially in Patients with Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Grafting","authors":"Meghana R.K. Helder MD, Jong Kim MD","doi":"10.1053/j.semtcvs.2025.01.001","DOIUrl":"10.1053/j.semtcvs.2025.01.001","url":null,"abstract":"<div><div>Beating-heart coronary artery bypass grafting (CABG) in patients with left ventricular (LV) dysfunction can provide the best of all words by limiting myocardial injury purported by cardioplegic arrest. Complete revascularization is possible and graft numbers are not different when compared to arrested heart CABG. Furthermore, beating-heart CABG more often reduces the need for intraoperative and postoperative mechanical support reducing the complications and costs associated with these devices.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 2","pages":"Pages 128-131"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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