Annals of Thoracic Surgery最新文献

The Society of Thoracic Surgeons 2026 Expert Consensus Pathway on Robotic Cardiac Training outlines principles for the safe initial introduction and subsequent expansion of robotic cardiac programs. The 25-year history of robotic cardiac surgery has established safety and efficacy while providing multiple innovations. There is currently a unique opportunity to coalesce best practices and evidence to inform a recent global surge in interest in incorporating robotic techniques into standard cardiac surgical practice. This consensus is a collaborative effort between the Society of Thoracic Surgeons (STS) Workforce on Evidence Based Surgery, the STS Robotic Cardiac Surgery Taskforce, and multinational leaders in robotic cardiac surgery that aims to standardize initial core principles of preparatory elements, followed by four phases of robotic cardiac training to proceed from program commencement to mastery.

The Society of Cardiovascular Anesthesiologists (SCA) along with The Society of Thoracic Surgeons (STS) sought to improve the care of adult patients undergoing cardiac surgery who are taking direct oral anticoagulants (DOACs), such as factor Xa and direct thrombin inhibitors. To fulfill this, a systematic review of the literature on cessation of DOACs before cardiac surgery, options for monitoring DOACs, the need for bridging, reversal agents, and resuming the medications after surgery was performed. Additionally, an expert consensus around the management of these patients was completed. Summary statements were created using evidence and expert consensus to guide care of patients in each of these domains, with the ultimate goal to enhance patient safety and outcomes.

Background: Pediatric cardiac surgery with cardiopulmonary bypass (CPB) is associated with systemic inflammation. This trial aims to determine whether continuous high-exchange ultrafiltration during CPB has a clinical immunomodulatory effect.

Methods: This single-center, double-blinded trial enrolled pediatric patients less than 15 kg undergoing cardiac surgery, who were randomly allocated to continuous high-exchange subzero-balance ultrafiltration (H-SBUF, 60 ml/kg/hr effluent extraction) or continuous low-exchange subzero-balance ultrafiltration (L-SBUF, 6 ml/kg/hr effluent extraction) administered during CPB. The primary outcome was peak post-operative vasoactive-ventilation-renal (VVR) score. Secondary outcomes included acute kidney injury, low cardiac output syndrome, health care utilization and inflammatory mediator fold change throughout CPB.

Results: A total of 104 patients were randomly allocated to H-SBUF (n=52) or L-SBUF (n=52). The primary outcome was similar between groups as the peak VVR was 26.9 (2.1 - 77.9) in the H-SBUF group and 27.8 (0.8 - 76.7) in the L-SBUF group (p = 0.67). There were no operative mortalities and no significant differences in acute kidney injury, low cardiac output syndrome, ventilation time, inotrope use time, ICU or hospital length of stay (p > 0.05). The H-SBUF group had a higher fold change for IL-1α, P-selectin, and VCAM-1 (p < 0.05), while thirty-six other mediators were not significantly different between groups (p > 0.05).

Conclusions: Among pediatric patients undergoing cardiac surgery with CPB, continuous high-exchange SBUF did not reduce peak VVR when compared to low-exchange SBUF. Furthermore, there were no differences in secondary clinical outcomes, and the immunologic profile was largely similar between groups.

A 79-year-old man with permanent atrial fibrillation and cardiomyopathy had previously received an implantable cardioverter-defibrillator. Despite anticoagulation, he had experienced three cerebral infarctions and underwent thoracoscopic left atrial appendage closure (LAAC). Transthoracic echocardiography on postoperative day 5 revealed free-floating thrombus in the left atrium, prompting emergency surgical removal and tricuspid valve repair. Incomplete exclusion of the appendage was identified as a key procedural pitfall leading to thrombus formation. Concomitant severe tricuspid regurgitation may have contributed to atrial stasis. In patients with markedly impaired atrial hemodynamics, concomitant tricuspid valve repair at LAAC may help mitigate the risk of thrombus formation.