Journal of Thoracic and Cardiovascular Surgery最新文献

Background: With the rapid growth and evolution of transcatheter valve therapies, surgeons are foreseeing a crucial change in their practice. Their role is rapidly evolving and the concept of a structured heart valve team is becoming central in every established SHD program. The knowledge and expertise of surgeons is adapting to a novel and revolutionized field of transcatheter valve therapies, where a multidisciplinary approach is crucial for optimal outcomes and patient satisfaction. This manuscript aims to discuss the evolving role of surgeons in structural heart interventions METHODS: We depict the importance of the heart valve team and outline the challenges surgeons are facing to establish themselves as structural heart operators.

Results: The switch in clinical practice surgeons are experiencing is extremely important for the future of cardiac surgery. The results of a globally conducted real-world survey shows that despite 97% of surgeons are active members of the heart team, 80% take part to TAVR procedures, and the percentage drops significantly in mitral and tricuspid interventions.

Conclusions: Surgeons need to evolve, adapt and embrace this new patient-centered paradigm and broaden their skills and competences maintaining a primary role in the treatment of valvular heat pathologies.

Objective: To assess whether use of epiaortic ultrasound for assessment of aortic calcification impacts the rate of postoperative stroke following coronary artery bypass grafting (CABG).

Methods: This was a retrospective study using an institutional database of CABGs performed from 2010 to 2023. All patients undergoing isolated index CABG were included. Patients were dichotomized according to the use of epiaortic ultrasound for intraoperative aortic assessment. Postoperative stroke rates were compared, and multivariable logistic regression for postoperative stroke was performed. Cox regression was performed for the multivariable analysis of mortality.

Results: A total of 10,049 patients underwent isolated index CABG. Intraoperative epiaortic ultrasound was utilized in 1,572 (15.6%) of these patients. The STS predicted risk of stroke was 1% and did not differ between the two groups. Postoperative stroke occurred in 13 patients in the epiaortic ultrasound group (0.8%) versus 116 patients in the group in which epiaortic ultrasound was not used (1.4%, p=0.08). On multivariable logistic regression, use of epiaortic ultrasound was not associated with a reduced odds of postoperative stroke (OR 0.62, 95% CI 0.34-1.14, p=0.12). Epiaortic ultrasound use was also not significantly associated with hazards of mortality on Cox regression (HR 1.14, 95% CI: 0.94, 1.38, p=0.12). Postoperative stroke was significantly associated with an increased hazard of death (HR 2.25, 95% CI: 1.61-3.14, p<0.001).

Conclusion: Stroke rates after CABG were 0.8% and 1.4% with and without the use of epioartic ultrasound, respectively. The current study did not find an independent association between epiaortic ultrasound use and postoperative stroke.

Objective: Donation after circulatory death (DCD) heart transplants have increased in US with DPP and TA-NRP techniques. There remains a paucity of data examining DPP and TA-NRP outcomes. The purpose of this study was to investigate the impact of DCD technique on post-transplant outcomes compared to DBD donors.

Methods: Adult patients undergoing heart transplantation between December 1, 2019, and June 30, 2023 were identified in the UNOS registry. DPP and TA-NRP cohorts were detected using time of death to aortic cross-clamp of 30 minutes. Categorical variables were compared using chi-square or Fisher exact tests, while continuous variables were compared using Mann-Whitney U tests. Propensity score matching was performed using a 1:3 match. 1-year survival was analyzed using log-rank test and Cox proportional hazard regression model.

Results: During the study period, there were 7338 DBD and 419 DCD heart transplants. At 1-year, there was no difference in survival between unmatched (p=0.13) and matched (p=0.36) DBD and DCD recipients. There was an increase in acute rejection and rejection requiring treatment in DCD compared to DBD in the matched cohort. 134 TA-NRP and 242 DPP transplants occurred. 1-year survival and post-transplant outcomes were similar in DPP and TA-NRP. TA-NRP functional warm ischemia times increased significantly during the study period.

Conclusions: In a matched cohort, DCD heart recipients experience increased acute rejection, both treated and non-treated, compared to DBD. Despite differences in the techniques, and likely functional warm ischemic times, acute rejection, survival, and other secondary outcomes are similar between DPP and TA-NRP.

Background: Saphenous venous grafts (SVG) remain the most widely used conduits in coronary artery bypass graft surgery (CABG). Data comparing outcomes of single saphenous venous grafting (SinCABG) versus sequential venous grafting (SeqCABG), however, are limited.

Methods: Between 2002 and 2012, 2,375 patients with 3-vessel coronary artery disease underwent isolated elective CABG at the Leipzig Heart Center with a left internal mammary artery graft to left anterior descending artery and ≥2 distal SVG anastomoses. Of these, 1,278 received ≥2 singular saphenous venous grafts (SinCABG) and 563 received ≥1 sequential saphenous vein grafts with >1 distal anastomoses (SeqCABG). The primary end point was long term survival. Secondary outcomes included short-term survival, early postoperative outcomes as well as early and late graft patency.

Results: At 30-days, mortality was 1.3% following SinCABG as compared to 2.3% after SeqCABG (p=0.13). The postoperative complications rate did not differ between groups. Early postoperative coronary angiographies were performed in 127 patients (7%), while clinically indicated follow-up coronary angiographies were performed in 372 patients (20%) over a median follow up of 5 years (IQR 1.7-8.9). No differences in early or late patency rates were found between both grafting techniques (p=0.79 and p=0.39, respectively). The median duration of long-term clinical follow-up was 8.4 years (IQR 5.6-11.4). Long-term survival rates at 1, 5, 10 and 15 years in SinCABG versus SeqCABG were 95% versus 94%, 83% versus 82%, 63% versus 62%, and 47% versus 41%, respectively (p=0.22).

Conclusions: Short and long-term mortality as well as early and late graft patency rates did not differ in patients undergoing SinCABG as compared to patients undergoing SeqCABG.