JTCVS Techniques最新文献

英文中文

Hemi-Commando with aortic homograft and atrioventricular septal defect repair for recurrent triple valve endocarditis 采用主动脉同源移植和房室间隔缺损修补术治疗复发性三瓣心内膜炎的 Hemi-Commando

IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2024-10-01 DOI: 10.1016/j.xjtc.2024.07.021

Gabe Weininger MD, Hanjay Wang MD, Y. Joseph Woo MD

引用次数: 0

Clinical utility of artificial intelligence–augmented endobronchial ultrasound elastography in lymph node staging for lung cancer 人工智能增强支气管内超声弹性成像在肺癌淋巴结分期中的临床应用

IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2024-10-01 DOI: 10.1016/j.xjtc.2024.06.024

Yogita S. Patel BSc , Anthony A. Gatti PhD , Forough Farrokhyar MPhil, PhD , Feng Xie PhD , Waël C. Hanna MDCM, MBA

Objective

Endobronchial ultrasound elastography produces a color map of mediastinal lymph nodes, with the color blue (level 60) indicating stiffness. Our pilot study demonstrated that predominantly blue lymph nodes, with a stiffness area ratio greater than 0.496, are likely malignant. This large-scale study aims to validate this stiffness area ratio compared with pathology.

Methods

This is a single-center prospective clinical trial where B-mode ultrasound and endobronchial ultrasound elastography lymph node images were collected from patients undergoing endobronchial ultrasound transbronchial needle aspiration for suspected or diagnosed non–small cell lung cancer. Images were fed to a trained deep neural network algorithm (NeuralSeg), which segmented the lymph nodes, identified the percent of lymph node area above the color blue threshold of level 60, and assigned a malignant label to lymph nodes with a stiffness area ratio above 0.496. Diagnostic statistics and receiver operating characteristic analyses were conducted. NeuralSeg predictions were compared with pathology.

Results

B-mode ultrasound and endobronchial ultrasound elastography lymph node images (n = 210) were collected from 124 enrolled patients. Only lymph nodes with conclusive pathology results (n = 187) were analyzed. NeuralSeg was able to predict 98 of 143 true negatives and 34 of 44 true positives, resulting in an overall accuracy of 70.59% (95% CI, 63.50-77.01), sensitivity of 43.04% (95% CI, 31.94-54.67), specificity of 90.74% (95% CI, 83.63-95.47), positive predictive value of 77.27% (95% CI, 64.13-86.60), negative predictive value of 68.53% (95% CI, 64.05-72.70), and area under the curve of 0.820 (95% CI, 0.758-0.883).

Conclusions

NeuralSeg was able to predict nodal malignancy based on endobronchial ultrasound elastography lymph node images with high area under the receiver operating characteristic curve and specificity. This technology should be refined further by testing its validity and applicability through a larger dataset in a multicenter trial.

目的支气管内超声弹性成像可生成纵隔淋巴结的彩色图，蓝色（60 级）表示僵硬度。我们的试点研究表明，以蓝色为主的淋巴结（硬度面积比大于 0.496）很可能是恶性的。这是一项单中心前瞻性临床试验，从因疑似或确诊为非小细胞肺癌而接受支气管内超声经支气管针吸术的患者身上收集 B 型超声和支气管内超声弹性成像淋巴结图像。图像被输入到训练有素的深度神经网络算法（NeuralSeg）中，该算法对淋巴结进行分割，识别超过 60 级蓝色阈值的淋巴结面积百分比，并对僵硬度面积比超过 0.496 的淋巴结贴上恶性标签。进行了诊断统计和接收者操作特征分析。结果从124名入选患者中收集了B型超声和支气管内超声弹性成像淋巴结图像（n = 210）。只分析了有确诊病理结果的淋巴结（n = 187）。NeuralSeg 能够预测 143 个真阴性淋巴结中的 98 个和 44 个真阳性淋巴结中的 34 个，总体准确率为 70.59%（95% CI，63.50-77.01），灵敏度为 43.04%（95% CI，31.94-54.67），特异性为 90.74%（95% CI，83.63-95.47），阳性预测值为 77.27%（95% CI，64.13-86.60），阴性预测值为 90.74%（95% CI，83.63-95.47）。结论NeuralSeg能根据支气管内超声弹性成像淋巴结图像预测结节恶性程度，接收者操作特征曲线下面积大，特异性高。这项技术应在多中心试验中通过更大的数据集测试其有效性和适用性，从而进一步完善。

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引用次数: 0

The devil is in the details 细节决定成败

IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2024-10-01 DOI: 10.1016/j.xjtc.2024.06.017

Desiree Steimer MD, Michael T. Jaklitsch MD, Scott J. Swanson MD

引用次数: 0

Laparoscopic robotic-assisted transhiatal thoracic duct ligation for refractory chylothorax 腹腔镜机器人辅助经腹胸导管结扎术治疗难治性乳糜胸

IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2024-10-01 DOI: 10.1016/j.xjtc.2024.08.013

Adin Reisner MD , Subroto Paul MD , Paul C. Lee MD , Matthew L. Inra MD

引用次数: 0

Minimally invasive complex neochordal reconstruction for mitral valve regurgitation 二尖瓣反流的微创复杂新软骨重建术

IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2024-10-01 DOI: 10.1016/j.xjtc.2024.05.012

Ryaan EL-Andari MD, Jimmy Kang MD, Sabin Bozso MD, PhD, Michael Moon MD, Jeevan Nagendran MD, PhD

引用次数: 0

The development of direct 3-dimensional printing of patient-specific mitral valve in soft material for simulation and procedural planning 开发直接三维打印患者特异性二尖瓣软材料，用于模拟和程序规划

IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2024-10-01 DOI: 10.1016/j.xjtc.2024.06.008

Shokoufeh Cheheili Sobbi MD , Milou Pauli BSc , Marvin Fillet BSc , Jos G. Maessen MD, PhD , Peyman Sardari Nia MD, PhD

Objectives

Replicating 3-dimensional prints of patient-specific mitral valves in soft materials is a cumbersome and time-consuming process. The aim of this study was to develop a method for a direct 3-dimensional printing of patient-specific mitral valves in soft material for simulation-based training and procedural planning.

Methods

A process was developed based on data acquisition using 3-dimensional transesophageal echocardiography Cartesian Digital Imaging and Communication of Medicine format, image processing using software (Vesalius3D, Blender, Meshlab, Atum3D Operation Station), and 3-dimensional printing using digital light processing, an additive manufacturing process based on photopolymer resins. Experiments involved adjustment of 3 variables: curing times, model thinness, and lattice structuring during the printing process. Printed models were evaluated for suitability in physical simulation by an experienced mitral valve surgeon.

Results

Direct 3-dimensional printing of a patient's mitral valve in soft material was completed within a range of 1.5 to 4.5 hours. Prints with postcuring times of 5, 7, 10, and 15 minutes resulted in increased stiffness. The mitral valves with 2.0-mm and 2.4-mm thinner leaflets felt more flexible without tear of the sutures through the material. The addition of lattice structures made the prints more compliant and better supported suturing.

Conclusions

Direct 3-dimensional printing of a realistic and flexible patient-specific mitral valve was achieved within a few hours. A combination of thinner leaflets, reduced curing time, and lattice structures enabled the creation of a realistic patient-specific mitral valve in soft material for physical simulation.

目的在软性材料中复制患者特异性二尖瓣的三维打印是一个繁琐且耗时的过程。方法采用三维经食道超声心动图笛卡尔数字成像和医学交流格式进行数据采集，使用软件（Vesalius3D、Blender、Meshlab、Atum3D Operation Station）进行图像处理，并使用基于光聚合物树脂的添加剂制造工艺--数字光处理进行三维打印。实验涉及调整三个变量：固化时间、模型薄度和打印过程中的晶格结构。由一位经验丰富的二尖瓣外科医生对打印模型的物理模拟适用性进行了评估。结果用软材料直接三维打印病人的二尖瓣在 1.5 到 4.5 小时内完成。打印后固化时间分别为 5、7、10 和 15 分钟，从而增加了硬度。厚度为 2.0 毫米和 2.4 毫米的二尖瓣瓣叶感觉更灵活，缝合线不会撕裂材料。结论直接三维打印逼真、灵活的患者特异性二尖瓣瓣膜在几小时内就能完成。结合更薄的瓣叶、更短的固化时间和格子结构，可以用软材料制作出逼真的患者特异性二尖瓣，用于物理模拟。

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引用次数: 0

A simplified approach to robotic tracheal resection 机器人气管切除术的简化方法

IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2024-10-01 DOI: 10.1016/j.xjtc.2024.06.022

David Rice MB, BCh , Mohanad Elsheikh MD , Elena Potylchansky MD

引用次数: 0

Short-term outcomes of robotic left ventricular patch ventriculoplasty for significant mitral annular calcification 机器人左心室补片脑室成形术治疗严重二尖瓣环钙化的短期疗效

IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2024-10-01 DOI: 10.1016/j.xjtc.2024.06.016

Noritsugu Naito MD, PhD, Didier F. Loulmet MD, Michael Dorsey MD, Xun Zhou MD, Eugene A. Grossi MD

Objective

Surgical management of mitral annular calcification remains challenging. Our institution pursued a strategy of total mitral annular calcification resection with pericardial patch reconstruction of the left ventricle when primary atrioventricular groove closure was not possible. We present the short-term outcomes derived after implementing this strategy.

Methods

A single-institution retrospective analysis included patients with significant mitral annular calcification undergoing totally endoscopic robotic mitral valve surgery between October 2009 and August 2023. Mitral valve repair was performed in patients with sufficient posterior leaflet length. Patients requiring pericardial patch ventriculoplasty were compared with those in whom primary atrioventricular groove closure was possible (non–pericardial patch ventriculoplasty).

Results

Of 1441 patients who underwent totally endoscopic mitral valve surgery, 217 (15.1%) presented with significant mitral annular calcification. Pericardial patch ventriculoplasty was performed in 69 patients (31.8%). Patients undergoing non–pericardial patch ventriculoplasty were significantly younger than patients undergoing pericardial patch ventriculoplasty (63.4 vs 67.8 years, P = .01). Mitral valve repair was conducted in 145 patients (98.0%) in the non–pericardial patch ventriculoplasty group versus 56 patients (81.2%) in the pericardial patch ventriculoplasty group (P < .01). The median postoperative length of stay was significantly shorter in the non–pericardial patch ventriculoplasty group (3 vs 5 days, P < .01). There was no significant difference in postoperative stroke (0.7% vs 2.9%, P = .50) or 30-day mortality (1.4% vs 1.4%, P = 1.00). Three-year survival was comparable between the groups (97.4% vs 93.7%, P = .52).

Conclusions

Totally endoscopic robotic mitral valve repair is a safe and feasible technique for the management of mitral annular calcification with promising results at 3 years. Patients who required atrioventricular groove pericardial patch reconstruction had similar outcomes to those in whom primary closure was possible.

目的二尖瓣环钙化的手术治疗仍然具有挑战性。在无法进行原发性房室沟关闭术的情况下，我们的医疗机构采用了二尖瓣环钙化全切除术，同时进行左心室心包补片重建的策略。我们介绍了实施该策略后的短期疗效。方法一项单一机构的回顾性分析纳入了2009年10月至2023年8月期间接受全内镜机器人二尖瓣手术的二尖瓣环显著钙化患者。对有足够后叶长度的患者进行二尖瓣修复。结果在接受全内镜二尖瓣手术的1441名患者中，有217人（15.1%）出现二尖瓣环明显钙化。69名患者（31.8%）接受了心包修补心室成形术。接受非心包补片脑室成形术的患者明显比接受心包补片脑室成形术的患者年轻（63.4 岁 vs 67.8 岁，P = .01）。非心包补片脑室成形术组有 145 名患者（98.0%）进行了二尖瓣修复术，而心包补片脑室成形术组有 56 名患者（81.2%）进行了二尖瓣修复术（P <.01）。非心包补片脑室成形术组的术后中位住院时间明显短（3 天 vs 5 天，P < .01）。术后中风（0.7% 对 2.9%，P = .50）或 30 天死亡率（1.4% 对 1.4%，P = 1.00）无明显差异。结论全内镜机器人二尖瓣修复术是治疗二尖瓣环钙化的一种安全可行的技术，3年后效果良好。需要房室沟心包补片重建的患者与可以进行初次关闭术的患者结果相似。

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引用次数: 0

Expansion bone allografts for anterior chest wall reconstruction after persistent sternal nonunion 扩张骨异体移植用于持续性胸骨不连后的前胸壁重建

IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2024-10-01 DOI: 10.1016/j.xjtc.2024.07.013

Kenan A. Shawwaf MD, Kristen A. Sell-Dottin MD, Juan M. Farina MD, Rawan M. Zeineddine MD, Jesse J. Lackey CSFA, Dawn E. Jaroszewski MD, MBA

引用次数: 0

Piezoelectric-assisted aortic valve repair 压电辅助主动脉瓣修复术

IF 1.7 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques

Pub Date : 2024-10-01 DOI: 10.1016/j.xjtc.2024.06.009

Cristina Barbero MD, PhD , Marco Pocar MD, PhD , Antonio Spitaleri MD , Dario Brenna MD , Giacomo Maraschioni MD , Sergio Trichiolo MD , Michele La Torre MD , Mauro Rinaldi MD

引用次数: 0

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