JTCVS Techniques最新文献

英文中文

Hybrid robotic mitral valve surgery with staged percutaneous coronary intervention for degenerative mitral regurgitation and coronary artery disease 混合机器人二尖瓣手术与分阶段经皮冠状动脉介入治疗退行性二尖瓣反流和冠状动脉疾病

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2026-02-01 Epub Date: 2025-12-13 DOI: 10.1016/j.xjtc.2025.102178

Ali Hage MD, MPH, Caroline Magro BSE, Eugene A. Grossi MD, Aubrey C. Galloway MD, Didier F. Loulmet MD

Objectives

Some patients with degenerative mitral valve regurgitation have incidental coronary artery disease. When these patients are referred to our robotic cardiac surgery program, they are offered robotic mitral valve surgery combined with staged percutaneous coronary intervention performed during the same hospital admission. The objective of this study is to compare this new “hybrid” approach with the “conventional” operation consisting of sternotomy mitral valve surgery with coronary artery bypass grafting performed as a single procedure.

Methods

Between 2011 and 2024, 181 consecutive patients with degenerative mitral valve regurgitation and coronary artery disease underwent hybrid robotic mitral valve surgery + percutaneous coronary intervention (n = 79) or conventional sternotomy mitral valve surgery + coronary artery bypass grafting (n = 102) at a single high-volume quaternary care center. Information was prospectively entered into Society of Thoracic Surgeons, regional, and institutional data collection instruments. Survival was obtained from a National Death Index.

Results

Significant mitral annular calcification (requiring en bloc excision and patch reconstruction) was more frequent in the hybrid group (7.6% [6/79] vs 2.0% [2/102], P = .06). The repair rate was significantly higher in the hybrid group. Median aortic occlusion time was shorter in the hybrid group (90.0 vs 106.0 minutes, P = .01). In the hybrid group, 92.4% (73/79) of percutaneous coronary interventions were performed after robotic mitral valve surgery and 58.7% (44/75) involved a single coronary distribution only. In the conventional group, 53.9% (55/102) coronary artery bypass grafting surgeries consisted of 1 distal anastomosis. In the hybrid group, the median hospital length of stay was shorter by 2 days. The 30-day mortality and 5-year survival were excellent and identical in both groups.

Conclusions

For patients with degenerative mitral valve regurgitation and coronary artery disease, a hybrid approach (robotic mitral valve surgery + percutaneous coronary intervention) provided enhanced postoperative outcomes with short- and mid-term survival comparable to the conventional operation (sternotomy mitral valve surgery + coronary artery bypass grafting).

目的退行性二尖瓣反流患者中有部分并发冠心病。当这些患者转到我们的机器人心脏手术项目时，他们在同一住院期间接受机器人二尖瓣手术联合分阶段经皮冠状动脉介入治疗。本研究的目的是比较这种新的“混合”入路与“传统”手术，包括胸骨切开二尖瓣手术和冠状动脉旁路移植术作为一个单一的手术。方法2011年至2024年间，181例退行性二尖瓣反流合并冠状动脉疾病患者在单个大容量四级护理中心连续接受机器人二尖瓣手术+经皮冠状动脉介入治疗（n = 79）或传统胸骨切开二尖瓣手术+冠状动脉搭桥手术（n = 102）。前瞻性地将信息输入胸外科学会、地区和机构数据收集工具。生存数据来源于国家死亡指数。结果杂交组明显的二尖瓣环钙化（需要整体切除和补片重建）发生率更高（7.6% [6/79]vs 2.0% [2/102], P = 0.06）。杂交组的修复率明显高于杂交组。混合组中位主动脉阻断时间较短（90.0 vs 106.0 min, P = 0.01）。在混合组中，92.4%（73/79）的经皮冠状动脉介入手术是在机器人二尖瓣手术后进行的，58.7%（44/75）的经皮冠状动脉介入手术仅涉及单一冠状动脉分布。在常规组中，53.9%（55/102）的冠状动脉搭桥术包括1个远端吻合。在混合组中，住院时间中位数缩短了2天。两组患者的30天死亡率和5年生存率均良好且相同。结论对于退行性二尖瓣返流合并冠状动脉疾病的患者，混合入路（机器人二尖瓣手术+经皮冠状动脉介入治疗）可提高术后预后，其短期和中期生存率与传统手术（胸骨切开二尖瓣手术+冠状动脉搭桥手术）相当。

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引用次数: 0

The cardinal technique for symmetric reorientation during bicuspid aortic valve-sparing root replacement 保留双尖瓣主动脉瓣根置换术中对称重新定位的基本技术

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2026-02-01 Epub Date: 2025-10-25 DOI: 10.1016/j.xjtc.2025.10.011

Albert J. Pedroza MD , Alexander K. Reed MD , Y. Joseph Woo MD

引用次数: 0

Controlled patient blood management under visceral perfusion in open treatment of complex aortic pathologies 复杂主动脉病变开放治疗中内脏灌注控制患者血液管理

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2026-02-01 Epub Date: 2025-11-11 DOI: 10.1016/j.xjtc.2025.11.002

Melanie Rusch MD, Grischa Hoffmann MD, PhD, Nawar Alasad MD, Rene Rusch MD, PhD

引用次数: 0

Practical technique for robotic giant paraesophageal hernia repair 机器人修复巨大食管旁疝的实用技术

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2026-02-01 Epub Date: 2025-12-06 DOI: 10.1016/j.xjtc.2025.102174

Natacha M. Wathieu MD, Christopher Stone MD, Abbas E. Abbas MD

引用次数: 0

Robotic transhiatal revision of gastric conduit after esophagectomy: A technical overview 机器人食管切除术后胃导管的经食管修复：技术综述

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2026-02-01 Epub Date: 2025-10-30 DOI: 10.1016/j.xjtc.2025.09.038

SangMin Kim MD, James D. Luketich MD, Gabriella M. Lloyd BA, Marissa A. Matto MD, Ian G. Christie MD, Samuel L. Luketich BS, Evan T. Alicuben MD

引用次数: 0

Open, hybrid, and endovascular repair of recoarctation, aneurysm, and pseudoaneurysm after aortic coarctation repair 主动脉缩窄修复后再狭窄、动脉瘤和假性动脉瘤的开放、混合和血管内修复

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2026-02-01 Epub Date: 2025-10-14 DOI: 10.1016/j.xjtc.2025.09.033

Jonathan P. Putnam BS , Matthew A. Thompson MD , William C. Frankel MD , Patrick R. Vargo MD , Joanna Ghobrial MD , Patcharapong Suntharos MD , Margaret Fuchs MD , Sean P. Lyden MD , Francis J. Caputo MD , Vidyasagar Kalahasti MD , Ashley M. Lowry MS , Eugene H. Blackstone MD , Lars G. Svensson MD, PhD , Eric E. Roselli MD

Objective

After aortic coarctation repair, patients may develop peri-anastomotic aneurysms or recoarctation requiring reintervention. We describe the spectrum of late coarctation repair–associated complications, repair strategies, and outcomes.

Methods

From 1999 to 2023, 145 patients (mean age 38 ± 16 years, 66% male) underwent reintervention for recoarctation (74, 51%), aneurysm (28, 19%), pseudoaneurysm (19, 13%), and other indications (24, 16%) at a median of 29 years after initial repair. Survival and freedom from repeat reintervention were estimated with the Kaplan–Meier method. Median follow-up was 7.9 years.

Results

Open and hybrid repair were performed in 38 and 18 cases, respectively, whereas most patients underwent endovascular repair with bare metal stents or covered stent-grafts (89, 61%). Open repairs involved 16 aorto-aortic bypasses, 12 interposition grafts, 6 conventional elephant trunk repairs, and 4 others. Hybrid repairs involved 13 frozen elephant trunks and 5 others. Operative mortality was 2.1%, whereas major adverse events including stroke (3, 2.3%), spinal cord injury (1, 0.7%), and acute kidney injury requiring dialysis (3, 2.3%) were uncommon. Average peak transcoarctation gradients decreased from 29 to 3 mm Hg postoperatively in the recoarctation group. Estimated freedom from repeat reintervention at 1, 5, 10, and 15 years was 87%, 80%, 75%, and 70%, respectively. Estimated survival at these intervals was 97%, 96%, 91%, and 84%, respectively.

Conclusions

Coarctation repair–associated complications are varied and complex, but can be managed with open, hybrid, and endovascular techniques tailored to the individual patient's pathology, morphology, and coexisting lesions with favorable outcomes at dedicated aortic centers.

目的主动脉缩窄修复后，患者可能发生吻合口周围动脉瘤或再狭窄，需要再次介入治疗。我们描述了晚期缩窄修复相关的并发症、修复策略和结果。方法1999年至2023年，145例患者（平均年龄38±16岁，男性66%）在初次修复后的中位时间为29年，接受了再修补（74,51%）、动脉瘤（28,19%）、假性动脉瘤（19,13%）和其他适应症（24,16%）的再干预治疗。用Kaplan-Meier法估计患者的生存率和避免重复再干预的自由度。中位随访时间为7.9年。结果开放修复和混合修复分别为38例和18例，而大多数患者采用裸金属支架或覆盖支架移植进行血管内修复（89,61%）。开放修复包括16例主动脉-主动脉搭桥、12例间置移植物、6例常规象鼻修复和4例其他修复。混合修复涉及13条冷冻象鼻和其他5条。手术死亡率为2.1%，而主要不良事件包括中风（3.2.3%）、脊髓损伤（1.0.7%）和需要透析的急性肾损伤（3.2.3%）并不常见。术后再狭窄组的平均峰狭窄梯度从29毫米汞柱下降到3毫米汞柱。估计1年、5年、10年和15年再次干预的自由度分别为87%、80%、75%和70%。这些区间的估计生存率分别为97%、96%、91%和84%。结论缩窄修复相关并发症多种多样且复杂，但可以根据患者的病理、形态和共存病变情况，采用开放、混合和血管内技术进行治疗，并在专门的主动脉中心获得良好的结果。

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引用次数: 0

Staged, blood-sparing management of postmyocardial infarction ventricular septal rupture in a Jehovah's Witness

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2026-02-01 Epub Date: 2025-12-03 DOI: 10.1016/j.xjtc.2025.102173

Yuichiro Fukumoto MD , Chiaki Aichi MD , Yusuke Imamura MD , Mototsugu Tamaki MD , Yasuhide Okawa MD , Hisao Suda MD, PhD , Hideki Kitamura MD, PhD

引用次数: 0

Left-right commissural aortic root enlargement facilitates valve-in-valve transcatheter aortic valve implantation: A computed tomographic analysis 左、右联合主动脉根部扩大有利于经导管瓣内瓣植入：计算机断层分析

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2026-02-01 Epub Date: 2025-10-30 DOI: 10.1016/j.xjtc.2025.10.014

Jahangir H. Charania MD , Logan Atkinson MD , Sorush Rokui MD, MSE , Daniel R. Wong MD, MPH

Objective

Aortic root enlargement (ARE) at the left-right (LR) commissure may mitigate risk of coronary obstruction during future valve-in-valve (VinV) transcatheter aortic valve implantation (TAVI) by creating space for blood flow behind the LR surgical valve strut into the adjacent sinuses. We analyzed computed tomography (CT) scans after LR ARE to determine theoretical candidacy for future VinV TAVI.

Methods

All patients undergoing LR ARE and bioprosthetic surgical aortic valve replacement (SAVR) between February 2023 and November 2024 were reviewed retrospectively. Postoperative CT scans were analyzed, modeling for both balloon-expandable (BEV) and self-expanding (SEV) valves. Risk of coronary obstruction was based on virtual transcatheter valve to coronary (VTC) and sinotubular junction (VTSTJ) distances, and measurements of the LR ARE patch.

Results

There were 32 patients (62% female, 44% inpatient) who had LR ARE with bioprosthetic SAVR, including 22% with a concomitant Y ARE. There was no 30-day mortality or stroke. Postoperative mean gradient was 5.5 mm Hg. Overall, 85% of valves were 23 or 25 mm, representing upsizing by 1.7 ± 0.7 sizes. The patch was 26.2 ± 4.7 mm tall, with 6.2 ± 2.4 mm of space behind the LR strut. If a SEV were used, 94% would be safe for VinV TAVI with low risk of coronary obstruction; if balloon inflation were needed during TAVI (such as for BEV), 77% could have safe VinV TAVI.

Conclusions

In this CT analysis, LR ARE carried low risk of coronary obstruction for future VinV TAVI and may benefit patients undergoing bioprosthetic SAVR.

目的：在左右（LR）连接处的主动脉根部扩大（ARE）可以通过为LR手术瓣膜支撑后的血流创造空间，从而降低未来瓣中瓣（VinV）经导管主动脉瓣植入（TAVI）时冠状动脉阻塞的风险。我们分析了LR ARE后的计算机断层扫描（CT），以确定未来VinV TAVI的理论候选性。方法回顾性分析2023年2月至2024年11月接受LR ARE和生物假体手术主动脉瓣置换术（SAVR）的患者。分析术后CT扫描，对球囊膨胀性（BEV）和自膨胀性（SEV）瓣膜进行建模。冠状动脉阻塞的风险是基于虚拟经导管瓣膜到冠状动脉（VTC）和窦管交界处（VTSTJ）的距离，以及LR ARE贴片的测量。结果32例LR ARE合并生物假体SAVR患者（女性62%，住院患者44%），其中22%合并Y ARE。没有30天死亡率或中风。术后平均梯度为5.5 mm Hg。总体而言，85%的瓣膜为23或25 mm，增大了1.7±0.7个尺寸。贴片高26.2±4.7 mm，在LR支柱后面有6.2±2.4 mm的空间。如果使用SEV， 94%的viv TAVI是安全的，冠状动脉阻塞的风险较低；如果在TAVI期间需要气球膨胀（例如BEV）， 77%的人可以获得安全的VinV TAVI。结论本CT分析显示，LR ARE对未来vvtavi冠脉阻塞的风险较低，可能有利于接受生物假体SAVR的患者。

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引用次数: 0

Retrograde intraluminal balloon occlusion for redo descending or thoracoabdominal aortic repair via left thoracotomy 逆行腔内球囊闭塞术经左开胸重降或胸腹主动脉修复

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2026-02-01 Epub Date: 2025-12-13 DOI: 10.1016/j.xjtc.2025.102187

Kyokun Uehara MD, PhD , Mikage Inada MD , Masatomo Hayashi MD , Taku Shirakami MD , Makoto Takehara MD , Hiroyuki Hara MD , Mamoru Hamuro MD , Takashi Tsuji MD , Yoshio Arai MD, PhD

引用次数: 0

Berlin cannulation with an outflow interposition graft—a versatile technique 柏林插管与流出间置移植物-一种通用技术

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2026-02-01 Epub Date: 2025-10-15 DOI: 10.1016/j.xjtc.2025.09.036

Richard C. Tang MD , Junsang Cho MD , Yishay Orr MD, PhD , Jeffrey S. Heinle MD , Hari P. Tunuguntla MD, MPH , Sebastian C. Tume MD , Jun Teruya MD, DSc , Iki Adachi MD

Objective

The Berlin Heart EXCOR VAD is increasingly used to support more complex patients with heart failure. To accommodate variable arterial anatomy, a modified outflow with a long interposition graft connected to an “apical” cannula is an attractive alternative to the conventional, rigid “arterial” cannula.

Methods

We conducted a single-center retrospective review of consecutive patients who underwent Berlin cannulation using this novel technique between September 2020 and May 2025.

Results

Fifty consecutive patients were identified. Median (range) age, weight, and body surface area at implantation were 0.7 (9 days-10.4) years, 7.8 (3.1-21.7) kg, and 0.4 (0.21-0.86) m², respectively. Underlying etiologies were congenital heart disease (26, 52%, of which 22 are single ventricle) and cardiomyopathy (24, 48%). Graft material was expanded polytetrafluoroethylene in 43 (86%) and Dacron in 7 (14%). Target outflow vessel was native aorta in 34 (68%), neoaorta in 11 (22%), and main pulmonary artery in 5 (10%). Favorable outcomes were achieved in 41 (82%): transplant for 30, ongoing support for 8, and explantation for myocardial recovery for 3, whereas 9 (18%) patients died. Significant hemolysis occurred in 7 (14%) patients, 4 of whom had Dacron grafts, 2 of whom required surgical reintervention. Subsequently, expanded polytetrafluoroethylene became the material of choice because of its smooth internal surface, which may reduce shear stress in the setting of high stroke volume from the EXCOR pump.

Conclusions

The long interposition graft technique offers versatility and flexibility to the VAD outflow. Selection of optimal graft material and size may need attention for improved outcomes.

目的：Berlin Heart EXCOR VAD越来越多地用于支持更复杂的心力衰竭患者。为了适应可变的动脉解剖结构，改良的流出物与连接到“根尖”插管的长插入移植物是传统的刚性“动脉”插管的一个有吸引力的选择。方法：我们对2020年9月至2025年5月期间使用这种新技术进行柏林插管的连续患者进行了单中心回顾性研究。结果确认了50例患者。植入时的中位（范围）年龄、体重和体表面积分别为0.7（9天-10.4）岁、7.8 (3.1-21.7)kg和0.4 (0.21-0.86)m2。潜在病因为先天性心脏病（26.52%，其中22例为单心室）和心肌病（24.48%）。接枝材料为膨胀聚四氟乙烯43例（86%），涤纶7例（14%）。靶流出血管为原主动脉34例（68%），新主动脉11例（22%），肺动脉主动脉5例（10%）。41例（82%）患者获得了良好的结果：30例移植，8例持续支持，3例心肌恢复移植，而9例（18%）患者死亡。7例（14%）患者出现明显溶血，其中4例行涤纶移植物，2例需要手术再干预。随后，膨胀聚四氟乙烯成为首选材料，因为它的内表面光滑，可以减少EXCOR泵的高冲程体积设置中的剪切应力。结论长间位移植物技术对VAD流出具有通用性和灵活性。选择最佳的移植物材料和大小可能需要注意改善结果。

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