Journal of Thoracic and Cardiovascular Surgery最新文献

英文中文

Long-term survival and operative outcomes of the Bentall procedure for aortic root aneurysm, aortic dissection, and endocarditis 本特尔手术治疗主动脉根动脉瘤、主动脉夹层和心内膜炎的长期生存率和手术结果。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.09.018

Christopher Lau MD, Alexander Gregg MD, Eilon Ram MD, Charles Mack MD, Katherine Krieger BS, Mohamed Rahouma MD, Ivancarmine Gambardella MD, Giovanni Soletti Jr. MD, Mario Gaudino MD, Leonard N. Girardi MD

Objective

To assess outcomes after aortic root replacement with Bentall procedure for aortic aneurysm, dissection, and endocarditis.

Methods

We identified consecutive patients undergoing Bentall procedures from 1997 to 2023, with stratification based on the primary diagnosis. Operative outcomes and long-term survival were compared.

Results

Of 1493 patients, 1378 (92.3%) underwent surgery for aneurysms, 75 (5%) for dissections, and 40 (2.7%) for endocarditis. The aneurysm group was older (61 years [range, 50-70 years] vs 57 years [range, 47-66.5 years] vs 56 years [range, 49-64 years]; P = .024). Patients with dissection or endocarditis had more preoperative myocardial infarctions (7.4% vs 12% vs 17.5%; P = .026), cerebrovascular accidents (9.6% vs 18.7% vs 45%; P < .001), renal dysfunction (8.3% vs 22.7% vs 45%; P < .001), shock (0.1% vs 10.7% vs 15%; P < .001), and ruptures (0.4% vs 10.7% vs 10%; P < .001). Regarding outcomes, acute renal failure (0.6% vs 1.3% vs 7.5%; P < .001) and operative mortality (0.4% vs 1.3% vs 7.5%; P = .001) were higher for endocarditis. Reexploration for bleeding was highest for dissections (4.1% vs 12% vs 2.5%; P = .004). Ten-year survival was similar between groups (71.8% vs 67% vs 83.7%; P = .94), with mean follow-up 68.2 ± 2.08 months. Multivariable analysis found age (hazard ratio [HR], 1.04; 95% CI, 1.03-1.05; P < .001), chronic obstructive pulmonary disease (HR, 2.12; 95% CI, 1.44-3.11; P < .001), renal dysfunction (HR, 1.97; 95% CI, 1.4-2.78; P < .001), and ejection fraction (HR, 0.97; 95% CI, 0.95-0.98; P < .001) were associated with late mortality but primary diagnosis was not.

Conclusions

The Bentall procedure can be performed with low operative risk for aneurysms and selected dissections. Endocarditis is associated with higher but acceptable operative mortality. Excellent long-term survival can be expected after surviving initial operative risk.

目的：评价本特尔主动脉根置换术治疗主动脉瘤、夹层和心内膜炎的疗效。方法：我们选取了1997-2023年间连续接受本特尔治疗的患者，根据初步诊断进行分层。比较两组患者的手术效果和长期生存率。结果：1493例患者中，动脉瘤手术1378例（92.3%），夹层手术75例（5%），心内膜炎手术40例（2.7%）。动脉瘤组年龄较大（61例[50,70]vs 57例[47,66.5]vs 56例[49,64];p=0.024）。夹层或心内膜炎患者术前心肌梗死发生率（7.4% vs 12% vs 17.5%; p=0.026）、脑血管意外发生率（9.6% vs 18.7% vs 45%）更高。结论：本特尔手术对动脉瘤和部分夹层的手术风险较低。心内膜炎与较高但可接受的手术死亡率相关。在克服了最初的手术风险后，可以预期良好的长期生存。

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引用次数: 0

Commentary: Symptomatic myocardial bridges—Bridging the unknown 评论：症状性心肌桥-桥接未知。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.10.005

Anusha Jegatheeswaran MD, PhD, FRCSC , Ruchika Kamojjala BA

引用次数: 0

Novel anastomotic device for the sandwich technique in type A aortic dissections: A human cadaver study 用于A型主动脉夹层技术的新型吻合装置-一项人体尸体研究。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.09.015

Emilio Osorio-Jaramillo MD , Jasmine El-Nashar MD , Ewald Unger BE , Paata Pruidze MD , Stefan Geyer MD , Thomas Poschner MD , Wilhelm Schreiner BSc , Wolfgang J. Weninger MD , Daniel Zimpfer MD , Marek P. Ehrlich MD

Objective

To assess a new aortic anastomotic device for the repair of acute type A aortic dissection (ATAAD) designed to facilitate and expedite ATAAD repair, potentially minimizing the occurrence of distal anastomotic new entry (DANE) and progression of the disease.

Methods

Ten repairs were conducted in an iatrogenically induced ATAAD model using fresh human cadavers and the felt sandwich technique. Five were repaired with conventional 4-0 polypropylene, and 5 were repaired with the new device. With the device, pins were stapled circumferentially through the sandwich and fixed outside with a cap. The sandwich anastomosis was timed. The aortic arch and vascular prosthesis were explanted and connected to a pressure pump filled with glycerol/H₂O solution pressurized at 170/90 mm Hg over 5 minutes. Fluid loss was measured. The anastomoses were checked for DANE, false lumen perfusion (FLP), and dissection progression.

Results

Fifty-four pins (100%) were successfully deployed, with a median of 11 pins (interquartile range [IQR], 10-11.5) per cadaver. Sandwich median time was significantly shorter with the stapler (02:22 [IQR, 01:49-03:05] min/sec vs 06:40 [IQR, 06:23-07:47] min:sec; P = .008). The time for end-to-end anastomosis with the vascular prosthesis (P = .31), as well as measured fluid loss (P = 1.00), were similar in the 2 groups. The suture group showed DANE in 2 specimens, FLP in 3 specimens, and dissection progression in 1 specimen, whereas the stapler group showed none of these conditions. Microscopy showed tearing at stitch channels in all sutured samples and no tears in the stapler group (P = .008).

Conclusions

The new aortic anastomotic device was safe and faster than the conventional technique and may produce more homogeneous and stronger sealing, potentially reducing DANE through less tissue trauma. Further studies in humans are needed to confirm the potential benefits of this novel device.

目的：评估一种用于急性a型主动脉夹层（ATAAD）修复的新型主动脉吻合装置，旨在促进和加速ATAAD修复，潜在地减少远端吻合口新入段（DANE）的发生和疾病的进展。方法：采用新鲜人尸体和毡夹技术对医源性ATAAD模型进行10次修复。5例用常规4-0聚丙烯修复，5例用该装置修复。使用该装置，将销钉周向钉穿夹芯，并用帽固定在夹芯外。定时夹芯吻合。取出主动脉弓和血管假体，连接到压力泵上，泵入甘油/ h2o溶液，加压170/90mmHg，加压5分钟。测量失液量。检查吻合口DANE、假腔灌注（FLP）及夹层进展情况。结果：54个针100%成功部署[平均11 (IQR10-11.5) /具尸体]。使用订书机的三明治中位时间明显缩短[02:22 (01:49-03:05)vs 06:40 (06:23-07:47) min:sec, p=0.008]。与血管假体端到端吻合的时间相似（p=0.31），测量的液体损失（p=1.00）。缝合组2例出现DANE， 3例出现FLP， 1例出现夹层进展。订书机组没有上述症状。镜检显示所有缝合标本的缝合通道均有撕裂，订书机组无撕裂（p=0.008）。结论：该装置比传统技术安全、快速，可产生更均匀、更强的密封，可能通过减少组织损伤来减少DANE。需要进一步的人体研究来证实这种新设备的潜在益处。

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引用次数: 0

Rwanda as a model for integrated surgical care of women of reproductive age with rheumatic heart disease 卢旺达是对患有风湿性心脏病的育龄妇女进行综合外科护理的典范。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.09.007

Valdano Manuel MD, PhD , Adriana Bernardo MD , Joaquim Gouveia MD

引用次数: 0

Reply: The evolving role of artificial intelligenge in pediatric cardiovascular surgery: A call for transparency, collaboration, and rigorous validation 回复：人工智能在儿科心血管手术中的作用：呼吁透明度、协作和严格的验证。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.04.005

Rittal Mehta MS, BDS , Justus G. Reitz MD , Yves d’Udekem MD, PhD

引用次数: 0

On the hindered path of evidence in postinfarction mechanical complications: How research can support improved management 关于梗塞后机械并发症的证据受阻：研究如何支持改进的管理。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.06.004

Daniele Ronco MD , Matteo Matteucci MD, PhD , Michele Di Mauro MD, PhD, MStat , Giulio Massimi MD , Marco Gemelli MD , Albert Ariza-Solé MD, PhD , Roberto Lorusso MD, PhD

引用次数: 0

Commentary: Testing the warranty on your BITA graft 评论：测试BITA保修。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.08.010

Craig R. Smith MD

引用次数: 0

Ensuring safety and reliability in ChatGPT-assisted pediatric cardiovascular surgical decision-making 确保chatgpt辅助儿科心血管手术决策的安全性和可靠性。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.02.015

Xiaobin Zhang (Dr), Jiawei Wang (Dr)

引用次数: 0

Reply: Preoperative diabetes duration and long-term outcomes in patients with acute myocardial infarction undergoing coronary artery bypass grafting 回复：接受冠状动脉旁路移植术的急性心肌梗死患者术前糖尿病持续时间与长期预后。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.03.008

Jun Ho Lee MD, PhD, Hee Jung Kim MD, PhD

引用次数: 0

Long-term outcomes of semirigid ring and band annuloplasty in functional mitral regurgitation patients without advanced left ventricular dilation 半刚性环和带状环成形术治疗无晚期左室扩张的功能性二尖瓣返流患者的长期疗效。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery

Pub Date : 2026-02-01 DOI: 10.1016/j.jtcvs.2025.06.023

Preetha Pamidighantam BS , Carol Chen MD , Nabin Shrestha PhD , Holliann Umana MD, JD , Kevin Patterson MD , Justin Fanning MD , Stephane Leung Wai Sang MD, MSc , Edward Murphy MD , Charles Willekes MD , Tomasz Timek MD, PhD

Objective

Our study aims to compare the long-term survival and clinical outcomes of ring and band prostheses for annuloplasty repair of functional mitral regurgitation.

Methods

From March 2005 to November 2017, 160 patients with moderate to severe functional mitral regurgitation underwent undersized annuloplasty using semirigid complete ring (N = 69) or partial band (N = 91) prostheses of the same material and manufacturer. Primary outcomes were long-term survival and clinical outcomes, and secondary outcomes included comparison of postoperative echocardiography data.

Results

Both groups had comparable baseline characteristics, cardiac function, functional mitral regurgitation severity, and perioperative complications. Complete ring and partial band groups experienced equivalent 10-year freedom from cardiovascular mortality (65.2% vs 68.3%, P = .39) and functional mitral regurgitation recurrence (78.5% vs 71.4%, P = .27). At a mean follow-up of 58 ± 46 months, both groups had a parallel increase in ejection fraction (+7% ± 16% vs +5% ± 15%, P = .35) and reduction of left ventricle internal diameter end-diastole (−0.5 ± 0.8 cm vs −0.4 ± 0.9 cm, P = .61). The complete ring group had greater reduction in left ventricle internal diameter end-systole (−0.6 ± 0.9 cm vs −0.2 ± 0.9 cm, P = .007) but higher mean (5.6 ± 3.4 mm Hg vs 5.0 ± 7 mm Hg, P = .025) and peak (16.7 ± 19.4 mm Hg vs 12.9 ± 10.7 mm Hg, P = .048) transvalvular pressure gradients. Mean transvalvular pressure gradient predicted postoperative mortality at 10 years (hazard ratio, 1.19; 95% CI, 1.0037-1.357; P = .013).

Conclusions

Complete ring and partial band annuloplasty for functional mitral regurgitation confer equivalent 10-year survival and mitral regurgitation recurrence. Complete ring repair was associated with increased left ventricle reverse remodeling yet higher long-term valvular gradients.

目的：比较环状和带状假体用于功能性二尖瓣反流（FMR）成形术修复的长期生存率和临床结果。方法：从2005年3月至2017年11月，160例中重度FMR患者采用相同材料和制造商的半刚性完整环（CR， N=69）或部分带（PB， N=91）假体进行小尺寸环成形术。主要结果是长期生存和临床结果，而次要结果包括术后超声心动图数据的比较。结果：两组的基线特征、心功能、FMR严重程度和围手术期并发症具有可比性。CR和PB的10年无CV死亡率（65.2% vs 68.3%， P= 0.39）和FMR复发率（78.5% vs 71.4%， P= 0.27）相同。平均随访58±46个月，两组患者射血分数平行升高（+7±16 vs +5±15%，P= 0.35），左心室舒张末期内径减小（-0.5±0.8 vs -0.4±0.9 cm， P= 0.61）。CR组左心室收缩末期内径（-0.6±0.9 vs -0.2±0.9 cm， P= 0.007）明显降低，但平均（5.6±3.4 vs 5.0±7 mmHg， P= 0.025）和峰值（16.7±19.4 vs 12.9±10.7 mmHg， P= 0.048）跨瓣压力梯度（TPG）明显升高。平均TPG预测术后10年死亡率（HR 1.19[CI 95% (1.0037-1.357)]， P= 0.013）。结论：CR和PB环成形术治疗FMR可获得相当的10年生存率和MR复发率。CR修复与左室反向重构增加和长期瓣膜梯度升高相关。

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Journal of Thoracic and Cardiovascular Surgery

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