JTCVS Techniques最新文献

英文中文

Rescue bare-metal device placement to treat iatrogenic acute type A aortic dissection during transcatheter aortic valve replacement 经导管主动脉瓣置换术中抢救放置裸金属装置治疗医源性急性A型主动脉夹层

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-15 DOI: 10.1016/j.xjtc.2025.10.002

Hiroaki Osada MD, PhD , José G. Diez MD , Ahmed Khouqeer MD , Susan Y. Green MPH , Marc R. Moon MD , Vicente Orozco-Sevilla MD , Joseph S. Coselli MD

引用次数: 0

Subxiphoid robotic thymectomy for anterior mediastinal tumors located in cervical region 剑突下机器人胸腺切除术治疗颈椎前纵隔肿瘤

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-13 DOI: 10.1016/j.xjtc.2025.09.031

Daisuke Tochii MD, PhD , Takahiro Negi MD , Kazuhiro Shimomura PhD , Mizuki Morota MD, PhD , Sachiko Tochii MD, PhD , Takashi Suda MD, PhD

Objective

Thymomas sometimes are located in the cervical region, and strategies are needed to safely remove these tumors. The purpose of this study was to evaluate the feasibility and safety of subxiphoid robotic thymectomy (SRT) for anterior mediastinal tumors located in cervical region.

Methods

This was a retrospective database review of patients who underwent SRT from January 2011 to April 2024. Of the 81 patients who underwent SRT for anterior mediastinal tumors, 79 patients were included, excluding 2 patients who underwent reconstruction using artificial blood vessels.

Results

In total, 41 patients in whom part of the tumor was located above or in contact with the innominate vein were classified as group A, and 38 patients in which the tumor was located caudal to the innominate vein were classified as group B. The patients in group A were significantly younger (median, 54 years vs 63 years; P = .035). There were no differences in perioperative data between the 2 groups: operative time (median, 192 vs 188 minutes; P = .961), intraoperative blood loss (median: 5 vs 5 g; P = .235), combined resection rate (17.1% vs 21.1%; P = .776), duration of thoracic drain insertion (median: 1 vs 1 day; P = .221), postoperative hospital stay (median: 4 vs 4 day; P = .694), and postoperative complications (9.8% vs 5.3%; P = .677). Conversion to other approaches and perioperative mortality were not observed in either group.

Conclusions

SRT, which enables full visualization of the innominate vein from the midline view, may offer increased safety for complicated thymectomies, including those requiring combined resection of the innominate vein, and may demonstrate safety comparable with that of procedures performed for cases caudal to the innominate vein.

目的胸腺瘤有时位于宫颈区域，需要安全切除这些肿瘤的策略。本研究的目的是评估剑突下机器人胸腺切除术（SRT）治疗颈椎前纵隔肿瘤的可行性和安全性。方法对2011年1月至2024年4月接受SRT的患者进行回顾性数据库分析。81例前纵隔肿瘤行SRT的患者中，包括79例患者，不包括2例人工血管重建患者。结果肿瘤部分位于无名静脉以上或与无名静脉接触者共41例为A组，肿瘤位于无名静脉尾侧者38例为b组，A组患者明显年轻化（中位54岁vs中位63岁，P = 0.035）。两组围手术期数据无差异：手术时间（中位数，192 vs 188分钟；P = 0.961）、术中出血量（中位数：5 vs 5 g； P = 0.235）、联合切除率（17.1% vs 21.1%; P = 0.776）、胸腔引流管插入时间（中位数：1 vs 1天；P = 0.221）、术后住院时间（中位数：4 vs 4天；P = 0.694）、术后并发症（9.8% vs 5.3%; P = 0.677）。两组均未观察到转用其他入路和围手术期死亡率。结论ssrt能够从中线视野全面显示无名静脉，可以为复杂的胸腺切除术提供更高的安全性，包括那些需要联合切除无名静脉的胸腺切除术，并且可以证明其安全性与对无名静脉进行的手术相当。

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引用次数: 0

Automated annular suture device versus conventional annular suture technique in endoscopic aortic valve replacement: A propensity score–matched analysis 内镜主动脉瓣置换术中自动环缝合装置与传统环缝合技术：倾向评分匹配分析

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-13 DOI: 10.1016/j.xjtc.2025.09.034

Saad Salamate MD , Ali El-Sayed Ahmad MD, PhD , Ali Bayram MD , Sami Sirat MD , Ömür Akhavuz MD , Mohamed Amer MD , Jacqueline Kruse MD , Miriam Silaschi MD, PhD , Mirko Doss MD, PhD , Farhad Bakhtiary MD, PhD

Objective

To overcome some of the challenges of endoscopic aortic valve replacement, an automated annular suturing device has been developed and used in aortic valve replacement surgeries. The current study compares the early clinical outcomes of patients who received endoscopic aortic valve replacement with the help of the RAM device (LSI Solutions) versus the conventional annular suture technique.

Methods

From March 2017 to March 2025, 1280 patients underwent endoscopic aortic valve replacement via right anterior minithoracotomy in 3 cardiac referral centers in Germany. The RAM automated suture device was used in 259 cases, and the conventional annular suture technique was used in 1021 patients. A propensity score analysis was performed in 259 matched pairs.

Results

The mean age in the matched cohort was 61.87 ± 11.24 years, and mean body mass index was 27.04 ± 4.83 kg/m² across both genders. Mean aortic crossclamping time was significantly lower in the RAM group: 54.67 ± 16.42 minutes versus 62.02 ± 24.72 minutes (P < .001). Mean cardiopulmonary bypass time was also lower in the RAM group (83.75 ± 23.29 minutes vs 97.22 ± 36.45 minutes, P < .001). Reexploration for bleeding occurred more often in the conventional suture group (7.3% without RAM vs 2.3% with RAM (P = .004). There were no significant differences in the incidence of paravalvular leak between groups (RAM 0% vs conventional 0.4%, P = .5).

Conclusions

The use of the RAM device in endoscopic aortic valve replacement is as safe, feasible, and effective as the conventional annular suture technique and yields excellent early outcomes. After a short learning curve, the RAM device was associated with reduced surgical time by facilitating annular suturing in endoscopic fashion.

目的为了克服内镜主动脉瓣置换术中存在的问题，研制了一种自动环缝合装置，并将其应用于主动脉瓣置换术中。目前的研究比较了在RAM设备（LSI Solutions）的帮助下接受内窥镜主动脉瓣置换术的患者与传统环缝合技术的早期临床结果。方法2017年3月至2025年3月，1280例患者在德国3家心脏转诊中心接受了经右前小胸切开的内镜主动脉瓣置换术。采用RAM自动缝合装置259例，采用常规环缝技术1021例。对259对配对进行倾向评分分析。结果匹配队列中男女平均年龄为61.87±11.24岁，平均体重指数为27.04±4.83 kg/m2。RAM组平均主动脉交叉夹持时间明显缩短，分别为54.67±16.42 min和62.02±24.72 min （P < .001）。RAM组的平均体外循环时间也较低（83.75±23.29分钟vs 97.22±36.45分钟，P < 0.001）。常规缝合组再次探查出血的发生率更高（无RAM组为7.3%，有RAM组为2.3%,P = 0.004）。两组间瓣旁漏发生率无显著差异（RAM 0% vs常规0.4%,P = 0.5）。结论在内镜下主动脉瓣置换术中使用RAM装置与常规环缝技术一样安全、可行、有效，早期效果良好。经过短暂的学习曲线，RAM装置通过促进内窥镜环形缝合缩短了手术时间。

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引用次数: 0

Hybrid management of iatrogenic right coronary artery occlusion during minimally invasive tricuspid valve repair 微创三尖瓣修复术中医源性右冠状动脉闭塞的综合治疗

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-13 DOI: 10.1016/j.xjtc.2025.09.028

Mathieu Rheault-Henry MD , Joaquin Gundelach MD , Brandon R. Loshusan MD, MFE , Shahar Lavi MD , Michael W.A. Chu MD, MEd

引用次数: 0

Slide tracheoplasty for repair of complex tracheoesophageal fistulas in children: A salvage technique 滑梯气管成形术修复儿童复杂气管食管瘘：一种抢救技术

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-13 DOI: 10.1016/j.xjtc.2025.09.032

Jiaxi Huang MD , Li Jiang MM , Gong Chen MD , Chen Chao MD , Weicheng Chen MD , Ming Ye MD , Shunmin Wang MD , Gang Chen MD

Objective

Complex tracheoesophageal fistula (TEF), encompassing recurrent, large-defect, or foreign-body-induced TEF caused by congenital or acquired origin, represents a formidable surgical challenge. Although various endoscopic and surgical techniques have been developed, the optimal approach remains controversial. Slide tracheoplasty with cardiopulmonary bypass provides excellent exposure of both the trachea and esophagus, making it a potentially valuable salvage technique for the treatment of complex TEF in children. We present a series of patients who underwent successful slide tracheoplasty by a multidisciplinary team in our institution.

Methods

We retrospectively reviewed 3 consecutive patients who underwent slide tracheoplasty for complex TEF between January and April 2024. Data collected included demographic characteristics, etiology, surgical details, perioperative parameters, and outcomes.

Results

All 3 patients successfully underwent slide tracheoplasty and esophageal repair with cardiopulmonary bypass support. All patients were successfully weaned from mechanical ventilation and had an uneventful recovery. At a median follow-up of 12 months, there were no cases of postoperative infection, vocal cord paralysis, esophageal or tracheal strictures, recurrent fistula, or need for reintervention.

Conclusions

Slide tracheoplasty with cardiopulmonary bypass demonstrates excellent early outcomes for the management of complex tracheoesophageal fistula in children. This technique represents a promising salvage option when conventional repair approaches are inadequate or have failed.

目的复杂气管食管瘘（TEF），包括先天性或后天来源的复发性、大缺损或异物诱发的TEF，是一项艰巨的手术挑战。尽管各种内窥镜和手术技术已经发展起来，但最佳方法仍然存在争议。体外循环气管滑梯成形术提供了气管和食道的良好暴露，使其成为治疗儿童复杂TEF的潜在有价值的挽救技术。我们介绍了一系列由我们机构的多学科团队成功进行气管滑梯成形术的患者。方法回顾性分析2024年1月至4月连续3例行气管滑梯成形术治疗复杂TEF的患者。收集的数据包括人口统计学特征、病因、手术细节、围手术期参数和结果。结果3例患者均在体外循环支持下成功行气管滑梯成形术和食管修复术。所有患者均成功脱离机械通气，并顺利康复。在中位随访12个月时，无术后感染、声带麻痹、食管或气管狭窄、瘘管复发或需要再干预的病例。结论滑梯气管成形术联合体外循环治疗儿童复杂气管食管瘘早期疗效良好。当传统的修复方法不充分或失败时，这种技术代表了一种有希望的修复选择。

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引用次数: 0

Aortic valve repair after failed Ross operation in an adolescent 一名青少年罗斯手术失败后主动脉瓣修复

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-10 DOI: 10.1016/j.xjtc.2025.09.023

Igor E. Konstantinov MD, PhD, FRACS , Carolina Rodrigues MD , Sergei I. Konstantinov BMedSci , Tyson A. Fricke MD, PhD, FRACS

引用次数: 0

Mid-term outcomes of a modified prosthetic aortic valve implantation technique for prosthetic valve endocarditis complicated by aortic annular abscess 改良人工主动脉瓣植入术治疗人工瓣膜心内膜炎并发主动脉环脓肿的中期结果

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-09 DOI: 10.1016/j.xjtc.2025.09.017

Giuseppe Nasso MD, PhD , Walter Vignaroli MD , Raffaele Bonifazi MD , Flavio Fiore MD , Giacomo Schinco MD , Felice Agrò PhD , Ernesto Greco PhD , Antongiulio Valenzano MD , Giacomo Errico MD , Dritan Hila MD , Tommaso Loizzo MD , Giuseppe Santarpino MDP , Giuseppe Speziale MD, PhD

Background

Prosthetic valve endocarditis (PVE) complicated by complex paraannular aortic abscess remains a surgical challenge. We aimed to evaluate the mid-term outcomes of a standardized, patch-free, supra-annular aortic valve replacement strategy that avoids complete root replacement in these high-risk patients.

Methods

This retrospective, single-center study included 70 consecutive patients treated between 2015 and 2023 for complex aortic PVE using a consistent surgical protocol: radical debridement, supra-annular prosthetic valve implantation, inside the Valsalva sinuses, and external felt reinforcement—without annular or root patching. Follow-up included annual clinical and echocardiographic assessment (mean duration, 5.2 ± 1.3 years). The primary endpoint was freedom from the composite of reinfection or aortic reoperation. Secondary endpoints included survival, valve performance, and predictors of late adverse events.

Results

Hospital mortality was 5.7% (n = 4 of 70). At 5 years, overall survival was 86.0% (95% confidence interval [CI], 78.0%-93.9%), and freedom from reinfection or aortic reoperation was 89.2% (95% CI, 82.1%-96.2%). Outcomes were comparable between the original (n = 47) and expanded (n = 23) cohorts (log-rank P = .71). Two late reinfections (2.9%) were managed medically. One patient required reoperation for structural valve degeneration at 54 months. Mean transvalvular gradient remained stable at 5 years (10.4 ± 3.1 mm Hg at discharge vs 11.1 ± 3.6 mm Hg; P = .27) whereas mean left ventricular ejection fraction improved significantly (from 52 ± 10% to 58 ± 8%; P < .01). Ninety-two percent of survivors were in New York Heart Association class I-II. Independent predictors of late events included EuroSCORE II >12% and incomplete abscess excision.

Conclusions

Patch-free supra-annular valve replacement offers durable infection control and excellent hemodynamic outcomes, avoiding the need for complete root replacement in complex aortic PVE.

背景：人工瓣膜心内膜炎（PVE）合并复杂的主动脉环旁脓肿仍然是一个外科挑战。我们的目的是评估标准化、无补片、环上主动脉瓣置换术的中期结果，避免在这些高风险患者中进行完全根置换术。方法：本回顾性单中心研究纳入了2015年至2023年间连续治疗的70例复杂主动脉PVE患者，采用一致的手术方案：根治性清创、环上人工瓣膜植入、Valsalva窦内植入和外部毡强化，不进行环或根修补。随访包括年度临床和超声心动图评估（平均持续时间，5.2±1.3年）。主要终点是无再感染或主动脉再手术。次要终点包括生存、瓣膜性能和晚期不良事件的预测因子。结果住院死亡率为5.7%（70例中4例）。5年总生存率为86.0%(95%可信区间[CI]， 78.0%-93.9%)，无再感染或主动脉再手术率为89.2% （95% CI, 82.1%-96.2%）。原始队列（n = 47）和扩展队列（n = 23）的结果具有可比性（log-rank P = 0.71）。2例晚期再感染（2.9%）经药物治疗。1例患者在54个月时因结构性瓣膜退变需要再次手术。平均经瓣梯度在5年内保持稳定（出院时10.4±3.1 mm Hg vs 11.1±3.6 mm Hg; P = 0.27），而平均左室射血分数显著改善（从52±10%到58±8%；P < 0.01）。92%的幸存者属于纽约心脏协会I-II级。晚期事件的独立预测因子包括EuroSCORE II >；12%和不完全脓肿切除。结论无补片环上瓣膜置换术能持久控制感染，血流动力学结果良好，避免了复杂主动脉瓣PVE的全根置换术。

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Temporary femorobilateral subclavian bypass for supra-aortic trunk revascularization: A strategy to ensure cerebral perfusion 临时股双侧锁骨下搭桥治疗主动脉上主干血运重建术：一种确保脑灌注的策略

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Yuki Akaguma MD, Hideki Tsubota MD, PhD, Masanori Honda MD, Masafumi Kudo MD, Hitoshi Okabayashi MD, PhD

引用次数: 0

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