Annals of Thoracic Surgery最新文献

Background: Aortic valve repair is preferred for congenital aortic valve disease in children, but its durability is limited. Although acceptable immediate repair results improve outcomes, late failures still occur. This study aimed to identify risk factors for suboptimal outcomes after an initially acceptable repair.

Methods: We retrospectively reviewed 287 patients undergoing primary aortic valve repair (2014-2023). Acceptable repair was defined as less than moderate aortic stenosis (AS) and mild or less aortic insufficiency (AI) after bypass. Suboptimal outcomes were defined as more than moderate AS/AI or reintervention after discharge. Cox analysis identified predictors among patients with acceptable repair, with a nomogram developed for pure AS patients.

Results: Median age at repair was 3.5 years (interquartile range, 1.0-8.1 years). Acceptable repair was achieved in 183 of 287 (64%). Median follow-up was 2.5 years (interquartile range, 0.7-4.7 years). Acceptable repair yielded superior 4-year freedom from suboptimal outcomes vs residual lesions (75% vs 51%, P < .001). Among 121 pure AS patients with acceptable repair, independent predictors for suboptimal outcomes were smaller preoperative annulus z-score (hazard ratio [HR], 0.69; P = .007), higher preoperative peak gradient (HR, 1.02; P = .034), and prior balloon aortic valvuloplasty (HR, 5.92, P < .001). The nomogram showed good discrimination (C index = 0.78). For mixed/pure AI patients, leaflet extension/augmentation was associated with suboptimal outcomes on univariate but not multivariable analysis.

Conclusions: Acceptable initial repair is crucial but does not guarantee long-term success. Smaller annulus z-score, higher gradient, and prior balloon aortic valvuloplasty in pure AS independently predict subsequent valve failure despite adequate initial repair. These factors may aid risk stratification and inform surveillance intensity.

Background: Right ventricular (RV) function is frequently reduced after cardiac surgery, with persistent impairment associated with increased mortality. This study aimed to compare RV function after mitral valve repair through right minithoracotomy vs sternotomy.

Methods: In the UK Mini Mitral trial, patients were randomized to mitral valve repair through right minithoracotomy (small lateral pericardial incision) or sternotomy. Prespecified secondary outcomes included assessment of cardiac function by blinded echocardiography preoperatively and at early (12 weeks) and late (52 weeks) time points. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE). RV to pulmonary artery coupling was determined by the TAPSE to systolic pulmonary artery pressure ratio.

Results: Of 330 patients randomized, 224 had suitable echocardiographic data for analysis. Baseline demographic, clinical, and echocardiographic data were comparable between groups. Cross-clamp and bypass times were significantly longer in the minithoracotomy group. At 12 weeks, there was a significant reduction in TAPSE from baseline in both groups (TAPSE minithoracotomy, -7.52 mm [95% CI, -8.52 to -6.53; P < .001], vs sternotomy, -8.75 mm [95% CI, -9.80 to -7.71; P < .001]), which recovered, but not to preoperative levels, by 52 weeks. The degree of RV impairment was significantly less in the minithoracotomy group at both early (between-group difference in TAPSE at 12 weeks, 1.47 mm [95% CI, 0.37-2.56; P = .009]) and late time points (between-group difference in TAPSE at 52 weeks, 1.37 mm [95% CI, 0.29-2.45; P = .013]).

Conclusions: Despite longer cross-clamp and bypass times, mitral valve repair through minithoracotomy was superior to sternotomy at preserving RV function (measured by TAPSE) at 12 weeks and 1 year.

Background: This study gives evaluations of the early-term results of minimally invasive cardiac surgery for definitive treatment of tetralogy of Fallot (TOF).

Methods: A study of 46 patients who were aged ≥3 months and suffered TOF was carried out during a period from May 2023 to May 2024.

Results: All 46 patients (mean age, 8.4 months; weight, 7.1 ± 1.8 kg) underwent TOF repair through right vertical infra-axillary thoracotomy. Only 1 patient required reintervention for electrode wire bleeding, managed through the same incision. Mean cardiopulmonary bypass and aortic clamp times were 174 ± 48 minutes and 108 ± 35 minutes, respectively. Average postoperative hospital stay was 10.3 ± 8.6 days. The most common early complications were postoperative pneumonia (26.1%) and junctional ectopic tachycardia (23.9%). Follow-up was conducted in all patients, with an average duration of 8.1 ± 4.3 months. At the last follow-up, right ventricular outflow tract pressure gradient decreased from 63 ± 23.2 mm Hg to 20 ± 9.8 mm Hg, and pulmonary valve annulus size increased from 8.7 ± 1.9 mm to 11.6 ± 1.8 mm. No deaths occurred during follow-up. Mild and moderate right ventricular outflow tract stenosis was observed in 22 (47.8%) and 2 (4.2%) patients, respectively. Moderate pulmonary valve regurgitation developed in 1 patient (2.1%).

Conclusions: The early-term result of minimally invasive cardiac surgery in the treatment of TOF is relatively positive, making this a promising alternative to the traditional method. However, further practice in a narrow space is required to reach proficiency.