Seminars in Thoracic and Cardiovascular Surgery最新文献

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Current Status of Treatment for the Acute Type A Aortic Dissection in Japan 日本急性A型主动脉夹层的治疗现状

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.semtcvs.2025.02.008

Yutaka Okita MD, PhD

Presenting the current status of patient outcomes with acute type A aortic dissection in Japan. The Japanese Association for Thoracic Surgery (JATS), Japanese Registry of All cardiac and Vascular Disease (JROAD), Japan Registry of Acute Aortic Dissection (JRAD), Japan Cardiovascular Surgery Database (JCVSD), National Clinical Database (NCD), The Tokyo acute aortic super network, and J-Open caRdiac aortic arCH DisEase replacement Surgical TheRApy (J-ORCHESTRA) database were used. The incidence of AAD ranged from 10 to 20 per 100,000 population. Thirty percent of patients were older than 70 years. Malperfusion syndrome or ruptured aorta was found in 10–20%. Over 90% of patients had surgery within 24-hour after diagnosis. The mortality tended to be higher in the super-acute phases from onset to surgical treatment. Acute organ malperfusion requires an accurate and prompt diagnosis to proceed with an appropriate intervention before repairing the central aorta. Antegrade cerebral perfusion was used in 70–80% and deep hypothermic circulatory arrest with/without retrograde cerebral perfusion in 20–30%. High-moderate or mild hypothermia was applied in more than 50% of patients. Replacement of the ascending aorta was performed in 70% and total arch replacement in 30%. Treatment with frozen elephant trunk as well as thoracic endovascular aortic repair (TEVAR) has increased. The aortic valve was replaced in 8–10%. Thirty-day mortality was 9.0–10%. The number of operations has increased over time. Stroke occurred in 10–12%. Although the early outcomes are acceptable, there is still room to be improved in patients with preoperative comorbidities.

目的：介绍日本急性A型主动脉夹层患者预后的现状。方法：采用JATS、JROAD、JRAD、JCVSD、NCD、东京急性主动脉超级网络和J-ORCHESTRA数据库。结果：AAD的发病率为10 ~ 20 / 10万人。30%的患者年龄在70岁以上。10 - 20%为灌注不良综合征或主动脉破裂。超过90%的患者在诊断后24小时内进行了手术。从发病到手术治疗的超急性期死亡率较高。急性器官灌注不良需要准确和及时的诊断，并在修复中央主动脉之前进行适当的干预。70% ~ 80%采用逆行脑灌注，20% ~ 30%采用深度低温停搏伴/不伴逆行脑灌注。50%以上的患者采用了高中度或轻度低温治疗。升主动脉置换术占70%，全弓置换术占30%。冷冻象鼻治疗和TEVAR治疗增加了。主动脉瓣置换术占8 - 10%。30天死亡率为9.0% ~ 10%。手术的数量随着时间的推移而增加。卒中发生率为10% ~ 12%。结论：虽然早期结果是可以接受的，但术前合并症患者的预后仍有改善的空间。

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引用次数: 0

Partial Heart Transplant Update: Where Are We In 2025? 部分心脏移植更新：2025年我们在哪里？

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.semtcvs.2025.03.002

Seth E.M. Wolf MD , Berk Aykut MD , Cathlyn K. Medina BA , John A. Kucera MD , Hiba Z. Ghandour MD , Joseph W. Turek MD, PhD, MBA , Douglas M. Overbey MD, MPH

Partial heart transplantation (PHT) creates a new and innovative approach to allow for patient and disease tailored intervention with the ability to treat a larger patient base. It offers the growth capacity of a heart transplantation without the need for high dose immunosuppression. The importance of a valve replacement with the potential of growth is imperative in the pediatric population as these patients will otherwise outgrow their new valves requiring repeat and high-risk interventions. Adaptive valve growth has been observed prior to PHT, in the case of orthotopic heart transplantation and Ross pulmonary autografts. The first human PHT was performed in April of 2022 at Duke. The recipient was a 17-day old infant with truncus arteriosus and severe truncal valve regurgitation. The operation was a success and the transplanted PHT conduit showed appropriate adaptive valve growth. Due to the low immunogenicity and recipient endothelialization of the transplanted PHT graft, the immunosuppressive requirements for PHT patients are low. One of the benefits of PHT is that it utilizes hearts which would otherwise not be suitable for orthotopic heart transplantation. Furthermore, the prospect of domino and split root PHT increases the potential of ethical and efficient organ stewardship. Currently PHT is regulated by the Food and Drug Administration, a ruling which was released in early 2024 as human cells, tissues, or cellular or tissue-based products (HCT/Ps). This means it does not compete with hearts suitable for orthotopic heart transplantation which are regulated as organs under the Organ Procurement and Transplantation Network (OPTN).

部分心脏移植（PHT）创造了一种新的创新方法，允许对患者和疾病进行量身定制的干预，能够治疗更大的患者群体。它提供了心脏移植的生长能力，而不需要高剂量的免疫抑制。具有生长潜力的瓣膜置换术的重要性在儿科人群中是必不可少的，因为这些患者将无法生长出新的瓣膜，需要重复和高风险的干预。在原位心脏移植和罗斯自体肺移植的情况下，在PHT之前观察到适应性瓣膜生长。首例人体PHT于2022年4月在杜克大学进行。受体是一名17天大的婴儿，患有动脉干和严重的主动脉瓣反流。手术成功，移植的PHT导管显示出适当的适应性瓣膜生长。由于移植的PHT移植物具有低免疫原性和受体内皮化，因此PHT患者的免疫抑制需求较低。PHT的好处之一是它利用了原本不适合原位心脏移植的心脏。此外，多米诺骨牌和劈根PHT的前景增加了道德和有效的器官管理的潜力。目前PHT是由FDA监管的，该裁决于2024年初发布，作为人类细胞、组织或细胞或组织产品（HCT/Ps）。这意味着它不会与适合原位心脏移植的心脏竞争，原位心脏移植是OPTN规定的器官。

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引用次数: 0

Acute Type B Management; Implications of Initial Treatment Strategy: The NIH Type B Trial 急性B型血管理；初始治疗策略的含义：NIH B型试验。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.semtcvs.2024.11.013

Alexander P. Nissen MD, Bradley G. Leshnower MD

引用次数: 0

Malperfusion, Malperfusion Syndrome, and Mesenteric Ischemia in Aortic Dissection 主动脉夹层的灌注不良、灌注不良综合征和肠系膜缺血。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.semtcvs.2024.11.005

Gardner Yost MD, MS, Bo Yang MD PhD

Aortic malperfusion occurs in a significant percentage of patients with acute aortic dissection, and causes malperfusion syndrome, the clinical entity defined by end organ ischemia, in 10–33% of patients. Malperfusion syndrome can be rapidly lethal and can involve the coronary, cerebral, visceral, or lower extremity vessels. Depending on presentation, it may be appropriately and well treated with endovascular fenestration prior to definitive central aortic repair.

主动脉灌注不良在急性主动脉夹层患者中占相当大的比例，并在10-33%的患者中引起灌注不良综合征，即终器官缺血定义的临床实体。灌注不良综合征可迅速致死，可累及冠状动脉、大脑、内脏或下肢血管。根据不同的表现，在最终的中央主动脉修复之前，可以适当和良好地进行血管内开窗治疗。

引用次数: 0

Experience Working With 3rd Party: Lung Bioengineering 有与第三方合作的经验：肺生物工程。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.semtcvs.2025.03.010

Caitlin T. Demarest MD, PhD

引用次数: 0

When to Opt for Univentricular versus Biventricular Repair in Complex Congenitally Corrected Transposition of the Great Arteries 复杂先天性大动脉转位何时选择单心室修复还是双心室修复。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.semtcvs.2025.03.012

Morgan K. Moroi MD , Alice V. Vinogradsky MD , Amee Shah MD , Kanwal Farooqi MD , Oliver Barry MD , Emile Bacha MD , David M. Kalfa MD PhD

The surgical management of complex congenitally corrected transposition of the great arteries (ccTGA) remains a subject of ongoing debate due to wide anatomic variability and limited comparative outcomes data. Available strategies include the anatomic repair, physiologic repair, 1.5-ventricular repair, and biventricular repair, each selected based on anatomic severity and the presence of associated lesions. This commentary reviews the existing literature to inform decision-marking between univentricular, 1.5-ventricular, and biventricular repair strategies in complex ccTGA and underscores the need for further comparative studies to guide management.

复杂的先天性纠正性大动脉转位（ccTGA）的手术治疗仍然是一个持续争论的主题，由于广泛的解剖变异性和有限的比较结果数据。可用的策略包括解剖修复、生理性修复、1.5心室修复和双心室修复，每一种都是根据解剖严重程度和相关病变的存在来选择的。这篇评论回顾了现有的文献，为复杂ccTGA的单室、1.5室和双室修复策略的决策提供信息，并强调需要进一步的比较研究来指导治疗。

引用次数: 0

Contemporary Review of the Current Status of Cardiothoracic Trainees and Early Career Surgeons 心胸外科培训生和早期职业外科医生现状的当代回顾。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-05-30 DOI: 10.1053/j.semtcvs.2025.03.014

Justin A. Robinson MD , Anish Katta BA , Rashed Mahboubi MD , Ruchika Kamojjala BA , Rimsha Hussaini BS , Shivni Patel BA , John P. Costello MD , Tara Karamlou MD, MSc

There have been profound shifts in the landscape of cardiothoracic surgery (CTS) training and practice in recent decades, influenced by evolving demographics, changing career aspirations among trainees, and emerging challenges in workforce diversity. This commentary synthesizes current literature and data to (1) explore changes in training paradigms, career trajectories, and the broader professional environment and (2) provide a comprehensive exploration of the factors shaping CTS training and early career experiences. Key themes include the impact of demographic trends, efforts to enhance diversity, adjustments in training programs—such as the extension of congenital heart surgery training to 2 years and the development of integrated CTS pathways—and initiatives to increase and sustain interest among aspiring cardiothoracic surgeon-scientists. By contextualizing these issues, this commentary provides insights into complexities and opportunities defining contemporary CTS practice.

近几十年来，受人口结构变化、受训者职业抱负变化以及劳动力多样性新挑战的影响，心胸外科（CTS）培训和实践的格局发生了深刻变化。这篇评论综合了当前的文献和数据，以1)探索培训范式、职业轨迹和更广泛的专业环境的变化；2)全面探索影响CTS培训和早期职业经历的因素。关键主题包括人口趋势的影响、加强多样性的努力、培训计划的调整（如将先天性心脏手术培训延长至两年）和综合CTS途径的发展，以及提高和维持有抱负的心胸外科科学家兴趣的举措。通过将这些问题置于背景中，本评论提供了对定义当代CTS实践的复杂性和机遇的见解。

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引用次数: 0

Predictors of Recurrence Following Sublobar Resection for Clinical T1N0M0 Non-Small Cell Lung Cancer 临床T1N0M0非小细胞肺癌肺叶下切除术后复发的预测因素。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-05-20 DOI: 10.1053/j.semtcvs.2025.05.002

Lauren Drake DO, Benny Weksler MD

Recurrence is a significant concern after sublobar resection for clinical T1N0M0 lung cancer. Identifying modifiable risk factors is essential for improving oncologic outcomes. This review examines recurrence risk factors following sublobar resection, focusing on disease stage, tumor characteristics, and surgeon-related factors. Data from randomized trials and retrospective studies were analyzed to assess the impact of tumor biology, stage, surgical margins, and lymph node dissection on recurrence. Recurrence is influenced by tumor stage, biology, and surgical technique. While tumor characteristics and stage are non-modifiable, inadequate surgical margins and incomplete nodal dissection significantly increase recurrence risk. A margin of ≥1 cm or equal to the tumor diameter is associated with lower recurrence rates. Systematic nodal dissection enhances staging accuracy and informs adjuvant therapy. Although sublobar resection is non-inferior to lobectomy in select cases, inadequate margins and suboptimal nodal assessment elevate recurrence risk. Surgical margins and lymph node dissection are the most critical modifiable risk factors for recurrence. To optimize long-term survival, adequate margins and systematic nodal evaluation should be prioritized. Further research is needed to assess the role of completion lobectomy or adjuvant therapy, particularly in patients with multiple high-risk features.

背景：临床T1N0M0型肺癌肺叶下切除术后复发是一个重要的问题。确定可改变的危险因素对于改善肿瘤预后至关重要。目的：本综述探讨叶下切除术后复发的危险因素，重点是疾病分期、肿瘤特征和手术相关因素。方法：分析随机试验和回顾性研究的数据，以评估肿瘤生物学、分期、手术边缘和淋巴结清扫对复发的影响。结果：复发与肿瘤分期、生物学及手术技术有关。虽然肿瘤的特征和分期是不可改变的，但手术切缘不充分和淋巴结清扫不完全会显著增加复发风险。切缘≥1cm或等于肿瘤直径与较低的复发率相关。系统淋巴结清扫可提高分期准确性，为辅助治疗提供依据。虽然在某些病例中，叶下切除术的效果不逊于肺叶切除术，但不充分的切缘和不理想的淋巴结评估会增加复发的风险。结论：手术切缘和淋巴结清扫是复发最关键的可改变危险因素。为了优化长期生存，应优先考虑足够的裕度和系统的淋巴结评估。需要进一步的研究来评估完成肺叶切除术或辅助治疗的作用，特别是在具有多种高危特征的患者中。

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引用次数: 0

Commentary: The Composite Allocation Score (CAS) Lung Allocation System − The Good, the Bad, and the Ugly 评论：CAS的肺分配系统——好、坏、丑。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-05-20 DOI: 10.1053/j.semtcvs.2025.05.001

Faiza M. Khan MD, Ramiro Fernandez MD

引用次数: 0

Myocardial Bridge in Children: Do We Care About It? 儿童心肌桥：我们关心它吗？

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-05-20 DOI: 10.1053/j.semtcvs.2025.04.007

Arvind Kumar Bishnoi MD, Michael Ma MD

引用次数: 0

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Seminars in Thoracic and Cardiovascular Surgery

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