JTCVS Techniques最新文献

英文中文

Variation in and deviation from protective ventilation during lung surgery 肺手术中保护性通气的变化和偏离

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-28 DOI: 10.1016/j.xjtc.2025.10.010

Matthew C. So MD , Camila Machado de Souza MD, PhD , Gordon Buduhan MD, MSc , Sadeesh K. Srinathan MD, MSc , Lawrence Tan MDCM , Biniam Kidane MD, MSc

Background

One-lung ventilation (OLV) is used for most lung resections. Protective ventilation strategies aim to limit volutrauma, atelectrauma, and barotrauma to reduce postoperative pulmonary complications (PPCs). We aimed to describe patterns in ventilatory strategies used during OLV, identify factors that affect these strategies, and investigate their relationship with PPCs.

Methods

Consecutive eligible patients undergoing lung surgery at a tertiary thoracic center were enrolled in this prospective cohort study. Real-time data capture of intraoperative ventilation parameters was performed. Complications were assessed prospectively using the validated Ottawa Thoracic Morbidity and Mortality classification system. Univariate statistics were described regarding adherence to low tidal volume (V_T), airway pressures, and positive end-expiratory pressure (PEEP). Multivariable regression models interrogated the relationships between PPCs (outcome variable), patient factors, and ventilatory parameters (predictor variables).

Results

A total of 225 patients were included. The median V_T, PEEP, driving pressure, and plateau pressure were 6.4 mL/kg, 5 cmH₂O, 9.5 cmH₂O, and 15.3 cmH₂O, respectively. The percentage of surgeries within defined protective limits (V_T < 5 mL/kg, PEEP ≥5 cmH₂O, driving pressure ≤15 cmH₂O, and plateau pressure ≤25 cmH₂O) at least 75% of the OLV time were 7.5%, 86.7%, 67.4%, and 55.8%, respectively. An increased proportion of time with peak inspiratory pressure >25 cmH₂O (odds ratio [OR], 3.62; 95% confidence interval [CI], 1.15-12.03; P = .0302) and duration of OLV (OR, 3.44; 95% CI, 1.88-6.65; P = .00011) were associated with PPCs.

Conclusions

Adherence to lung-protective ventilation recommendations was low. Higher peak inspiratory pressure is associated with PPCs, supporting barotrauma during OLV as a culprit. This is a target for quality assessment and knowledge translation efforts.

背景：肺内通气（OLV）用于大多数肺切除术。保护性通气策略旨在限制容量创伤、肺不张创伤和气压创伤，以减少术后肺部并发症（PPCs）。我们的目的是描述OLV期间使用的通气策略模式，确定影响这些策略的因素，并研究它们与PPCs的关系。方法本前瞻性队列研究纳入了在三级胸科中心接受肺部手术的连续符合条件的患者。实时采集术中通气参数数据。采用经验证的渥太华胸椎发病率和死亡率分类系统对并发症进行前瞻性评估。单变量统计描述了低潮气量（VT）、气道压力和呼气末正压（PEEP）的依从性。多变量回归模型探讨了PPCs（结果变量）、患者因素和通气参数（预测变量）之间的关系。结果共纳入225例患者。中位VT、PEEP、驱动压和平台压分别为6.4 mL/kg、5 cmH2O、9.5 cmH2O和15.3 cmH2O。在至少75%的OLV时间内（VT < 5 mL/kg, PEEP≥5 cmH2O，驱动压≤15 cmH2O，平台压≤25 cmH2O）的手术比例分别为7.5%,86.7%，67.4%和55.8%。吸入压力峰值达到25 cmH2O的时间比例增加（优势比[OR]， 3.62； 95%可信区间[CI]， 1.15-12.03; P = 0.0302）和OLV持续时间（优势比[OR]， 3.44; 95% CI, 1.88-6.65; P = 0.00011）与PPCs相关。结论肺保护性通气建议的依从性较低。较高的峰值吸气压力与PPCs有关，支持OLV期间的气压创伤是罪魁祸首。这是质量评估和知识转化工作的目标。

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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 : 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

Commentary: Dura lex sed lex, or when posterior is not so posterior 注释：硬脑膜是硬脑膜，或者当后部不是那么后部时

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-24 DOI: 10.1016/j.xjtc.2025.10.007

Jerome Soquet MD, PhD

引用次数: 0

Thoracoscopic resection of torsion of the right middle lobe after right lower lobectomy: A case report 右下肺叶切除术后胸腔镜治疗右中肺叶扭转1例

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-24 DOI: 10.1016/j.xjtc.2025.10.006

Sota Yoshimine MD, PhD, Yosuke Matsuura MD, PhD, Mitsue Kawahara MD, Ayumi Suzuki MD, PhD, Junji Ichinose MD, PhD, Masayuki Nakao MD, PhD, Mingyon Mun MD, PhD

引用次数: 0

Percutaneous suspension technique for thymectomy and superior vena cava replacement without sternotomy in a patient with thymic carcinoma: Case report 经皮悬吊技术治疗胸腺癌患者胸腺切除术和上腔静脉置换术不开胸骨：1例报告

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-24 DOI: 10.1016/j.xjtc.2025.10.008

Xiao-Han Jin MD , Hao-Ji Yan MD , Bing-Shi Liu MD , Ji-Er Ma MD , Jun-Min Zhu MD , Jun-Jie Wang MD , Zhi-Qiang Deng MD , Yi-Chen Liu MD , Yi-Xin Sun MD , Jin-Lan Zhao MD , Long-Qi Chen MD, PhD , Dong Tian MD, PhD

引用次数: 0

Precision myectomy: Real-time on-pump intracardiac echocardiography for resection in patients with thin septa 精确子宫内膜切除术：实时无泵心内超声心动图切除薄隔膜患者

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-24 DOI: 10.1016/j.xjtc.2025.09.037

Katherine G. Phillips MD , Robert G. Nampi MD , Mark V. Sherrid MD , Daniele Massera MD , Yuhe Xia BS , Muhamed Saric MD, PhD , Eugene Grossi MD , Pedro Colon BS , Joshua A. Scheinerman MD , Daniel G. Swistel MD

Objective

During septal myectomy, once the heart is arrested and drained of blood on cardiopulmonary bypass, transesophageal echocardiography can no longer assess septal thickness. In the present study, we evaluated the effectiveness of on-pump intracardiac echocardiography (OPIE) for real-time intraoperative septal thickness assessment in patients with preoperative thickness ≤2.0 cm. Our hypothesis was that OPIE measurements would be conconcordant with the pre- and postcardiopulmonary bypass transesophageal echocardiography measurements that are at present the primary operative guides.

Methods

We retrospectively reviewed patients with hypertrophic cardiomyopathy and septal thickness ≤2.0 cm on transthoracic echocardiography who underwent septal myectomy from July 2017 to July 2024. The OPIE probe was introduced into the left-ventricular chamber during cardioplegic arrest, with repeated measurements to assess the depth and adequacy of resection. Septal thickness was evaluated pre-myectomy using transthoracic echocardiography, cardiac magnetic resonance imaging, transesophageal echocardiography, and OPIE. Lin's concordance correlation coefficients and Bland-Altman analyses were used to evaluate agreement between modalities.

Results

A total of 220 patients were included with preoperative thickness ≤2.0, 56 of whom underwent myectomy with OPIE guidance. Preresection transesophageal echocardiography and OPIE demonstrated the strongest agreement of all the imaging modalities (Lin's concordance correlation coefficient, 0.81; 95% CI, 0.72-0.88), with minimal bias (−0.73) and the narrowest limits of agreement (−3.76, +2.31]. OPIE-derived resection thickness estimates were tightly clustered. In the OPIE cohort, there was 1 ventricular septal defect (1.8%) and no 30-day mortality.

Conclusions

OPIE is a reliable tool for intraoperative assessment of septal thickness, particularly in patients with mild hypertrophy.

目的在室间隔肌切除术中，一旦心脏停搏和体外循环放血，经食管超声心动图就不能再评估室间隔厚度。在本研究中，我们评估了非泵心内超声心动图（OPIE）对术前厚度≤2.0 cm的患者术中间隔厚度实时评估的有效性。我们的假设是，OPIE测量值将与目前主要的手术指南——经食管超声心动图测量值相一致。方法回顾性分析2017年7月至2024年7月行室间隔肌切除术的肥厚型心肌病患者，经胸超声心动图显示室间隔厚度≤2.0 cm。在心脏骤停期间，将OPIE探针引入左心室，反复测量以评估切除的深度和充分性。使用经胸超声心动图、心脏磁共振成像、经食管超声心动图和OPIE评估肌切除术前的间隔厚度。使用Lin的一致性相关系数和Bland-Altman分析来评估模式之间的一致性。结果共纳入术前厚度≤2.0的患者220例，其中56例在OPIE指导下行肌瘤切除术。经食管超声心动图和OPIE在所有成像方式中表现出最强的一致性（Lin’s一致性相关系数，0.81;95% CI, 0.72-0.88），偏差最小（- 0.73），一致性最小（- 3.76,+2.31）。opie导出的切除厚度估计是紧密聚类的。在OPIE队列中，有1例室间隔缺损（1.8%），无30天死亡率。结论sopie是术中评估鼻中隔厚度的可靠工具，尤其适用于轻度肥厚患者。

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引用次数: 0

A novel quasi-homogeneous supercooling approach expands preservation time for donor hearts 一种新的准均匀过冷方法延长了供体心脏的保存时间

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-21 DOI: 10.1016/j.xjtc.2025.10.005

Kai Xing PhD , Junhao Li MS , Wei Wang PhD , Zhi Huang PhD , Wei Wang PhD , Hongjie Shi PhD , Yuan Chang PhD , Xiao Chen PhD , Shun Liu MD , Xingchao Du PhD , Zhenghao Guo MS , Peiyuan Li PhD , Yuqi An MS , Chenghao Li MS , Mengda Xu PhD , Yixuan Sheng PhD , Kang Liu PhD , Jinping Liu PhD , Jiangping Song PhD

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A novel total transcatheter-based palliation before Yasui repair for type B interrupted aortic arch with left ventricular outflow tract obstruction B型主动脉弓中断伴左室流出道梗阻的一种新型全经导管缓解方法

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-18 DOI: 10.1016/j.xjtc.2025.10.004

Nataliya Bahatyrevich MD, MS , Pournika Muniyandi MD , Frank Ing MD , Mohammad Alnoor MD , Gary W. Raff MD , Timothy J. Pirolli MD

引用次数: 0

First-reported case of successful sequential coronary artery bypass grafting with combined bilateral lung-liver transplantation 序贯冠状动脉旁路移植术联合双侧肺肝移植成功首例报道

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-16 DOI: 10.1016/j.xjtc.2025.09.035

James L. Rogers BS , Brandon S. Petree MD , Kelly L. Mishra MD , Kara K. Siegrist MD , John W. Stokes MD , Anna-Maria Eid MD , Eric N. Quintana MD , Aditi Balakrishna MD , Matthew Bacchetta MD, MBA , David Erasmus MD , Shakirat Salvador MD , Tarek S. Absi MD , Seth J. Karp MD , Martin I. Montenovo MD, MMHC, FACS , Konrad Hoetzenecker MD, PhD

引用次数: 0

Mitral valve surgery with concomitant Y-incision aortic annular enlargement 二尖瓣手术合并y形切口主动脉环扩大

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2025-10-16 DOI: 10.1016/j.xjtc.2025.10.003

Busra Cangut MD, MS, Marc Titsworth BS, Sarah A. Chen MD, MA, Aditya Sridhar BS, Bo Yang MD, PhD

引用次数: 0

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