Seminars in Thoracic and Cardiovascular Surgery最新文献

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Recent Articles in AATS Journals AATS期刊近期文章

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 Epub Date: 2025-05-28 DOI: 10.1053/j.semtcvs.2025.05.004

引用次数: 0

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 离银牌不远了：在冠状动脉旁路移植术的层级中，桡动脉是仅次于右胸内动脉的第三条动脉。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 Epub Date: 2025-04-04 DOI: 10.1053/j.semtcvs.2025.01.009

Michael Salna MD, Michael Argenziano MD, Craig R. Smith MD

引用次数: 0

Post Lung Transplant Primary Graft Dysfunction 肺移植后原发性移植物功能障碍。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 Epub Date: 2025-04-21 DOI: 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.

原发性移植物功能障碍（PGD）是肺移植术后发病率和死亡率的主要来源，在移植后72小时内表现为急性肺损伤。尽管手术技术和围手术期护理有所进步，但供体、受体和围手术期因素的复杂相互作用促进了PGD的发展，强调了PGD的多因素性质。PGD受者的临床管理依赖于支持性护理策略，包括肺保护性通气、吸入一氧化氮和体外膜氧合（ECMO）。严重的PGD病例可能导致显著的短期和长期不良后果，包括早期死亡。即使对于从PGD中恢复的患者，也存在慢性同种异体肺移植功能障碍的相关风险增加，进一步加剧了其临床影响。这篇综述简要回顾了目前关于PGD的知识，详细介绍了危险因素、诊断标准和管理方法，同时确定了在理解其病理生理学方面的关键差距。正在进行的研究对于开发创新的治疗策略和改善肺移植受者的预后至关重要。

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引用次数: 0

A Beating Heart is a Happy Heart, Especially in Patients with Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Grafting 一颗跳动的心脏是一颗快乐的心脏，特别是在接受冠状动脉旁路移植术的左室功能障碍患者中。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 Epub Date: 2025-01-21 DOI: 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.

左室功能障碍患者的心脏搭桥可以通过限制心脏骤停引起的心肌损伤提供最好的治疗。完全血运重建是可能的，与停搏心脏冠脉搭桥相比，移植物数量没有区别。此外，心脏搏动冠脉搭桥更经常减少术中和术后机械支持的需要，减少了与这些设备相关的并发症和费用。中心信息：心脏搏动冠脉搭桥避免了对心脏的缺血性损伤，同时允许完全的血运重建。

引用次数: 0

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 Epub Date: 2025-03-12 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 Epub Date: 2025-03-19 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

Aortic Valve Repair: Wisdom or Folly? 主动脉瓣修复：明智还是愚蠢？

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Seminars in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 Epub Date: 2025-03-26 DOI: 10.1053/j.semtcvs.2025.03.004

David Blitzer MD, Emile Bacha MD, FACS

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 Epub Date: 2024-12-08 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

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 Epub Date: 2024-12-25 DOI: 10.1053/j.semtcvs.2024.11.013

Alexander P. Nissen MD, Bradley G. Leshnower MD

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 Epub Date: 2025-04-18 DOI: 10.1053/j.semtcvs.2025.03.010

Caitlin T. Demarest MD, PhD

引用次数: 0

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