Annals of thoracic surgery short reports最新文献

英文中文

Trends in Surgery for Endocarditis: 15-Year Experience From a Statewide Quality Collaborative 心内膜炎手术的趋势：15年的全国质量合作经验

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.021

Ahmet Can Topcu MD , Patricia F. Theurer MSN , Chang He MS , Melissa J. Clark MSN , Jason P. Hecht PharmD , Dimitrios Apostolou MD , Alessandro Vivacqua MD , Charles L. Willekes MD , Andrew L. Pruitt MD , Richard L. Prager MD , Francis D. Pagani MD, PhD

Background

During the past 2 decades, there has been a rise in endocarditis-related hospitalizations and overall health care expenditures in the United States. The objectives of this study were to assess trends in number of cardiac surgical procedures in which endocarditis was the indication for operation and to characterize the demographics and outcomes of patients receiving cardiac surgical procedures for endocarditis.

Methods

This was a retrospective, multicenter investigation of prospectively collected data from a statewide database of adults undergoing open valvular surgical operations for the treatment of endocarditis in Michigan from January 2008 through June 2022. Trends in patient characteristics, endocarditis cause, and surgical outcomes were analyzed by Cochran-Armitage trend test.

Results

In 2008, 3.8% of all valvular operations were performed for endocarditis, with the incidence increasing to 8.9% in 2022 (P < .001). Mortality rates decreased during the study period, from 13.6% in 2008 to 9.0% in 2022, but the trend was not statistically significant (P = .4). There was no discernible trend in the rate of health care–associated endocarditis cases.

Conclusions

Between 2008 and 2022, surgical valvular operations for endocarditis have steadily increased in Michigan without significant changes in operative mortality rates, patient characteristics, operative risk profile, or incidence of health care–associated endocarditis.

背景：在过去的20年里，美国心内膜炎相关的住院治疗和总体医疗保健支出有所上升。本研究的目的是评估以心内膜炎为手术指征的心脏外科手术数量的趋势，并描述因心内膜炎接受心脏外科手术的患者的人口统计学特征和结果。方法：本研究是一项回顾性、多中心调查，前瞻性收集了密歇根州2008年1月至2022年6月期间接受开放式瓣膜手术治疗心内膜炎的成年人的全州数据库数据。采用Cochran-Armitage趋势检验分析患者特征、心内膜炎病因和手术结果的趋势。结果2008年心内膜炎发生率为3.8%，2022年上升至8.9% （P < 0.001）。死亡率在研究期间有所下降，从2008年的13.6%降至2022年的9.0%，但趋势无统计学意义（P = 0.4）。与医疗保健相关的心内膜炎病例的发生率没有明显的趋势。结论：2008年至2022年间，密歇根州心内膜炎的瓣膜手术稳步增加，手术死亡率、患者特征、手术风险概况或医疗保健相关心内膜炎的发生率均无显著变化。

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引用次数: 0

Factors Associated With Next-Day Discharge After Pulmonary Lobectomy 肺叶切除术后次日出院的相关因素

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.006

Anuj Shah MD , Ray Chihara MD, PhD , Warren Naselsky MD , Edward A. Graviss PhD, MPH , Min P. Kim MD

Background

As surgical treatment of lung cancer continues to improve, the focus is now on improving patient outcomes. We aimed to determine the factors that play a role in discharge the day after pulmonary lobectomy.

Methods

We performed a retrospective cohort study of patients who underwent lobectomy. We compared outcomes between patients who were discharged the next day and those who had longer hospital stays. Logistic regression modeling was performed to determine the characteristics associated with next-day discharges.

Results

There were 591 patients who underwent lobectomy performed by 5 surgeons, of whom 270 (45.7%) were male with a median age of 69 years. Most patients underwent surgery by the da Vinci Xi robotic system (n = 491 [83.1%]), and 72 (12%) were discharged the next day. Patients who were discharged the next day had significantly fewer complications (6.9% vs 34.9%; P < .01), without a difference in the 30-day readmission rate (6.9% vs 7.3%; P = 1) or 30-day mortality (0% vs 0.4%; P =1). Multivariate logistic regression showed that surgeon (odds ratio, 3.60; 95% CI, 1.94-6.66) and the da Vinci Xi robotic approach (odds ratio, 9.79; 95% CI, 2.25-42.61) were 2 modifiable independent predictors of next-day discharge.

Conclusions

The next-day discharge after pulmonary lobectomy was safe. Patients operated on by experienced surgeons using the da Vinci Xi robot were more likely to be discharged the following day. Gaining experience in performing robotic lobectomy may help ensure safe, next-day discharge after pulmonary lobectomy.

随着肺癌手术治疗的不断改进，现在的重点是改善患者的预后。我们的目的是确定影响肺叶切除术后出院的因素。方法对接受肺叶切除术的患者进行回顾性队列研究。我们比较了第二天出院的患者和住院时间较长的患者之间的结果。进行逻辑回归建模以确定与次日出院相关的特征。结果591例患者经5位外科医生行肺叶切除术，其中男性270例（45.7%），中位年龄69岁。大多数患者使用达芬奇Xi机器人系统进行手术（n = 491[83.1%]）， 72例（12%）患者于次日出院。第二天出院的患者并发症明显减少（6.9% vs 34.9%; P < 0.01）， 30天再入院率（6.9% vs 7.3%; P =1）或30天死亡率（0% vs 0.4%; P =1）无差异。多因素logistic回归分析显示，外科手术（优势比3.60,95% CI 1.94 ~ 6.66）和da Vinci Xi机器人入路（优势比9.79,95% CI 2.25 ~ 42.61）是次日出院的2个可修改的独立预测因素。结论肺叶切除术后次日出院安全。由经验丰富的外科医生使用达芬奇Xi机器人进行手术的患者更有可能在第二天出院。获得执行机器人肺叶切除术的经验可能有助于确保肺叶切除术后第二天的安全出院。

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引用次数: 0

Infective Endocarditis With a Giant Vegetation on the Tricuspid Valve With a Congenital Ventricular Septal Defect in a 63-Year-Old Patient 感染性心内膜炎伴三尖瓣巨大赘生物合并先天性室间隔缺损一例

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.019

Hande İştar MD , Buğra Harmandar MD

Infective endocarditis is an infection of the endocardial tissue of the heart, primarily affecting the cardiac valves. Of various causes, untreated or undiagnosed congenital heart defects are known contributors. This report presents the case of a 63-year-old man with infective endocarditis of the tricuspid valve associated with an uncorrected ventricular septal defect. We describe our elderly patient who underwent successful surgical repair, including tricuspid valve reconstruction and closure of the ventricular septal defect, after a long life uncomplicated by severe pulmonary hypertension.

感染性心内膜炎是一种心脏内膜组织的感染，主要影响心脏瓣膜。在各种原因中，未经治疗或未确诊的先天性心脏缺陷是已知的原因。本文报告一例63岁男性三尖瓣感染性心内膜炎合并未矫正的室间隔缺损。我们描述了我们的老年患者成功的手术修复，包括三尖瓣重建和室间隔缺损关闭后，长期生活无严重肺动脉高压并发症。

引用次数: 0

Outcome of Transfer Time Difference From Diagnosis to Operation Room in Acute Type A Aortic Dissection Complicated by Malperfusion 急性A型主动脉夹层合并灌注不良从诊断到手术室转移时差的观察

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.05.015

Chikashi Nakai MD , Andrew Ku MD , Yuan Haw Wu MD , Junyi Liu BS , Nikhil Azhagiri BS , Eduardo Danduch MD , Saeed Tarabichi MD , Li Zhang MD , Sanjay Samy MD

Background

There are few reports of time effect for postoperative outcomes in patients with acute type A aortic dissection (ATAAD) complicated by malperfusion syndrome (MPS), especially transfer time difference from diagnosis to operation room (OR). To elucidate whether time between diagnosis and OR might be a significant factor, this study evaluated surgical outcomes of ATAAD complicated by MPS.

Methods

Between October 2013 and June 2024, 159 patients with ATAAD underwent emergent aortic repair; 54.7% (87/159) presented with MPS, 45.3% (72/159) without MPS. Of 87 patients with MPS, 69.0% (60/87) were transferred to the OR within 150 minutes from initial diagnosis (immediate repair), whereas 31.0% (27/87) were transferred to the OR after 150 minutes (late repair).

Results

In the MPS group, there was a significant difference in 30-day mortality rate between immediate and late repair, 20.0% (12/60) vs 48.1% (13/27; P < .01). Mean follow-up time was 33.0 ± 35.8 months. Cumulative survival rate in 5 years of patients with MPS was 64.6% for immediate repair and 46.1% for late repair. A significant difference was noted in long-term outcome between the groups (P = .03), whereas there was no difference in the non-MPS group (P = .11). On multivariable Cox regression analysis, age >65 years, cardiac tamponade, and late aortic repair were associated with increased long-term mortality (P = .02, .02, and <.01).

Conclusions

Immediate transfer from diagnosis to OR significantly improved long-term outcome in patients with ATAAD complicated by MPS. Older age and preoperative cardiac tamponade worsened long-term mortality in this cohort.

背景关于急性A型主动脉夹层（ATAAD）合并灌注不良综合征（MPS）患者术后预后的时间效应报道较少，尤其是从诊断到手术室（OR）的转移时差。为了阐明诊断到OR之间的时间是否可能是一个重要因素，本研究评估了ATAAD合并MPS的手术结果。方法2013年10月至2024年6月，159例ATAAD患者行急诊主动脉修复术；54.7%（87/159）有MPS， 45.3%（72/159）无MPS。87例MPS患者中，69.0%（60/87）的患者在首次诊断后150分钟内（即刻修复）转至手术室，而31.0%（27/87）的患者在150分钟后（晚期修复）转至手术室。结果MPS组即刻修复与后期修复30天死亡率分别为20.0%（12/60）和48.1% (13/27;P < 0.01)，差异有统计学意义。平均随访时间33.0±35.8个月。MPS患者5年累积生存率即刻修复为64.6%，晚期修复为46.1%。两组间的长期预后有显著差异（P = .03），而非mps组无差异（P = .11）。在多变量Cox回归分析中，年龄>；65岁、心脏填塞和主动脉修复晚期与长期死亡率增加相关（P = 0.02, P = 0.05）。02和<；.01)。结论ATAAD合并MPS患者从诊断立即转至OR可显著改善长期预后。在这个队列中，年龄较大和术前心脏填塞加重了长期死亡率。

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引用次数: 0

Aorto–Superior Mesenteric Artery Bypass in Type A Aortic Dissection Complicated by Mesenteric Malperfusion: Reperfusion-First Strategy 主动脉-肠系膜上动脉旁路治疗合并肠系膜灌注不良的A型主动脉夹层：再灌注优先策略

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.05.010

Yosuke Ueno MD , Masanori Hirota MD, PhD , Takaaki Yamada MD , Shintaro Kazama MD , Kosuke Onaka MD , Hiroki Yamazaki MD , Takashi Takano MD , Tasuku Kadowaki MD , Hiromasa Nakamura MD, PhD , Hiroki Yamaguchi MD, PhD

Mesenteric malperfusion represents one of the most fatal complications associated with acute aortic dissection. We successfully treated a patient with complicated type A aortic dissection and superior mesenteric artery (SMA) obstruction. Before central aortic repair, a 6-mm ringed expanded polytetrafluoroethylene graft was anastomosed to the SMA to achieve initial reperfusion of ischemic mesentery. Central aortic repair was performed under circulatory arrest with the support of cardiopulmonary bypass. The inflow of the graft was redirected to the side branch of the quadrifurcated graft, thus effectively establishing the aorto–superior mesenteric artery bypass. This reperfusion-first strategy proves to be safe and beneficial in patients with mesenteric malperfusion.

肠系膜灌注不良是急性主动脉夹层最致命的并发症之一。我们成功地治疗了一例复杂的a型主动脉夹层和肠系膜上动脉梗阻。在中央主动脉修复前，将6mm环形扩张聚四氟乙烯移植物吻合于SMA，实现缺血肠系膜的初始再灌注。中央主动脉修复是在循环停止和体外循环支持下进行的。移植物的流入被重新定向到四分叉移植物的侧支，从而有效地建立了主动脉-肠系膜上动脉旁路。在肠系膜灌注不良患者中，这种再灌注优先策略被证明是安全有益的。

引用次数: 0

Never Fear, the Robot Is Here: Robotic Resection for a Giant Thymoma 别怕，机器人来了：机器人切除巨大胸腺瘤

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.020

Alison S. Baskin MD , Andrew D. Wisneski MD , Kirk D. Jones MD , Johannes R. Kratz MD , David M. Jablons MD

Thymomas are rare anterior mediastinal tumors that can grow large, compressing important thoracic structures. Complete surgical excision remains the “gold standard.” Whereas median sternotomy has traditionally been used, minimally invasive techniques are becoming increasingly favored. Recent studies highlight the safety and efficacy of robotic thymectomy; however, “large” tumors described in the literature have averaged 6 to 8 cm. We present the case of a 68-year-old woman with a 13-cm thymoma resected entirely robotically. Use of various port configurations and enhanced maneuverability of robotic platform instruments enabled adequate visualization and safe dissection. This case highlights that tumor size alone should not preclude robotic thymectomy.

胸腺瘤是一种罕见的前纵隔肿瘤，它可以生长得很大，压迫重要的胸部结构。完全的手术切除仍然是“黄金标准”。虽然传统上采用正中胸骨切开术，但微创技术正日益受到青睐。最近的研究强调了机器人胸腺切除术的安全性和有效性；然而，文献中描述的“大”肿瘤平均为6至8厘米。我们提出的情况下，68岁的妇女与13厘米胸腺瘤完全切除机器人。使用各种端口配置和增强的机器人平台仪器的可操作性，可以实现充分的可视化和安全的解剖。该病例强调，肿瘤大小本身不应排除机器人胸腺切除术。

引用次数: 0

Concomitant Tricuspid Annuloplasty During Mitral Surgery: Becoming an Unpopular Practice? 二尖瓣手术中合并三尖瓣环成形术：成为不受欢迎的做法？

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.024

Alex M. Wisniewski MD, MSc , Ashley Chipoletti BS , Raymond J. Strobel MD, MSc , Anthony V. Norman MD, MSc , Jared P. Beller MD , Leora T. Yarboro MD , John Kern MD , Mohammed Quader MD , Nicholas R. Teman MD , Kenan W. Yount MD, MBA

Background

Concomitant tricuspid annuloplasty (TA) during surgery for degenerative mitral regurgitation remains debated. A recent Cardiothoracic Surgical Trials Network trial demonstrated a reduction in tricuspid regurgitation with concomitant TA, with no mortality or quality of life benefit and a significantly higher risk of permanent pacemaker placement. We sought to quantify the rate of TA in eligible patients after publication of these trial results.

Methods

Using a regional collaborative, we identified all patients between 2017 and 2023 with degenerative mitral regurgitation undergoing mitral valve repair or replacement. We included only those patients with moderate tricuspid regurgitation. Those with endocarditis, primary tricuspid regurgitation, severe tricuspid regurgitation, or an undocumented degree of tricuspid regurgitation were excluded. Our time event was the trial publication date. A 1-month washout period before and after the time of publication was used to account for change in surgeon practice.

Results

We identified 204 patients who met inclusion criteria, with 57 patients (27.9%) undergoing surgery in the posttrial period. The rate of tricuspid repair in the pretrial group was 45.6% compared with 26.3% in the posttrial group (P = .01). Baseline demographics and comorbidities between the groups were similar. All postoperative outcomes, including operative mortality, were similar (P > .05).

Conclusions

In a comparative group of patients with moderate tricuspid regurgitation undergoing mitral valve surgery, there was a significant decrease in concomitant tricuspid valve interventions after the Cardiothoracic Surgical Trials Network trial publication.

背景：手术治疗退行性二尖瓣反流时是否同时行三尖瓣环成形术（TA）仍有争议。最近的一项心胸外科试验网络试验表明，合并TA可以减少三尖瓣反流，没有死亡率或生活质量方面的好处，但放置永久性起搏器的风险明显更高。在这些试验结果发表后，我们试图量化符合条件的患者的TA率。方法通过区域合作，我们确定了2017年至2023年间所有行二尖瓣修复或置换术的退行性二尖瓣反流患者。我们只纳入了中度三尖瓣反流的患者。排除心内膜炎、原发性三尖瓣反流、严重三尖瓣反流或未记录三尖瓣反流程度的患者。我们的时间事件是试验发布日期。在发表之前和之后的1个月的洗脱期用于解释外科医生实践的变化。结果我们确定了204例符合纳入标准的患者，其中57例（27.9%）在试验后期接受了手术。试验前组三尖瓣修复率为45.6%，试验后组为26.3% （P = 0.01）。两组之间的基线人口统计学和合并症相似。包括手术死亡率在内的所有术后结果相似（P > 0.05）。结论在一组接受二尖瓣手术的中度三尖瓣反流患者中，在心胸外科试验网络试验发表后，合并三尖瓣干预的患者显著减少。

{"title":"Concomitant Tricuspid Annuloplasty During Mitral Surgery: Becoming an Unpopular Practice?","authors":"Alex M. Wisniewski MD, MSc , Ashley Chipoletti BS , Raymond J. Strobel MD, MSc , Anthony V. Norman MD, MSc , Jared P. Beller MD , Leora T. Yarboro MD , John Kern MD , Mohammed Quader MD , Nicholas R. Teman MD , Kenan W. Yount MD, MBA","doi":"10.1016/j.atssr.2025.06.024","DOIUrl":"10.1016/j.atssr.2025.06.024","url":null,"abstract":"<div><h3>Background</h3><div>Concomitant tricuspid annuloplasty (TA) during surgery for degenerative mitral regurgitation remains debated. A recent Cardiothoracic Surgical Trials Network trial demonstrated a reduction in tricuspid regurgitation with concomitant TA, with no mortality or quality of life benefit and a significantly higher risk of permanent pacemaker placement. We sought to quantify the rate of TA in eligible patients after publication of these trial results.</div></div><div><h3>Methods</h3><div>Using a regional collaborative, we identified all patients between 2017 and 2023 with degenerative mitral regurgitation undergoing mitral valve repair or replacement. We included only those patients with moderate tricuspid regurgitation. Those with endocarditis, primary tricuspid regurgitation, severe tricuspid regurgitation, or an undocumented degree of tricuspid regurgitation were excluded. Our time event was the trial publication date. A 1-month washout period before and after the time of publication was used to account for change in surgeon practice.</div></div><div><h3>Results</h3><div>We identified 204 patients who met inclusion criteria, with 57 patients (27.9%) undergoing surgery in the posttrial period. The rate of tricuspid repair in the pretrial group was 45.6% compared with 26.3% in the posttrial group (<em>P</em> = .01). Baseline demographics and comorbidities between the groups were similar. All postoperative outcomes, including operative mortality, were similar (<em>P</em> > .05).</div></div><div><h3>Conclusions</h3><div>In a comparative group of patients with moderate tricuspid regurgitation undergoing mitral valve surgery, there was a significant decrease in concomitant tricuspid valve interventions after the Cardiothoracic Surgical Trials Network trial publication.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1035-1039"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Aortic Root Replacement in Patients With Ventricular Septal Defect 主动脉根部置换术治疗室间隔缺损

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.025

Ryota Takahashi MD , Hiroshi Munakata MD, PhD , Kenji Okada MD, PhD , Taro Hayashi MD, PhD , Tatsuichiro Seto MD, PhD , Hisao Suda MD, PhD , Yutaka Okita MD, PhD

Background

Aortic root replacement in patients with ventricular septal defect (VSD) requires a modified surgical technique.

Methods

Between 2000 and 2022, 12 patients with aortic regurgitation and VSD underwent an operation. Their age at operation was 31.8 (SD 19.9) years. The VSD was patent in 5 patients and spontaneously or surgically closed in 7 patients. The location of the VSD was subarterial in 6 patients, perimembranous in 5, and muscular in 1 patient. The aortic valve was tricuspid in 8 patients, bicuspid in 2, and unicuspid in 2. Eight patients also had annuloaortic ectasia.

Results

The VSDs were closed using a patch in 4 patients and directly closed in 1 patient. The aortic root procedures were valve-sparing reimplantation in 7 patients, root remodeling in 1, basal ring annuloplasty in 1, basal ring annuloplasty with sinutubular junction annuloplasty in 1, and a Ross procedure in 1 patient. Additional cusp repair was required in 9 patients. No early deaths occurred. The postoperative follow-up periods were 5.3 (3.4) years. Two patients died, and 1 underwent aortic valve replacement 4 years postoperatively. Survival was 91.7 (8.0)% at 5 years and 68.8 (20.7)% at 10 years. Freedom from aortic valve reoperation was 88.9 (10.5)% at 10 years.

Conclusions

Valve-sparing root reimplantation in patients with annuloaortic ectasia and VSD may require a special first row suture line. Patients with prolapsed cusps may require resuspension or cusp extension. The Ross operation can be an alternative for patients with severely deformed aortic cusps.

背景：室间隔缺损（VSD）患者的主动脉根置换术需要一种改良的手术技术。方法2000年至2022年间，对12例主动脉瓣反流合并室间隔缺损患者进行手术治疗。手术年龄31.8岁（SD 19.9）。5例VSD未闭，7例自发或手术闭合。6例VSD位于动脉下，5例位于膜周，1例位于肌肉。8例主动脉瓣为三尖瓣，2例为二尖瓣，2例为单尖瓣。8例患者也有主动脉环扩张。结果4例采用补片缝合，1例采用直接缝合。7例患者的主动脉根部手术为保留瓣膜再植，1例患者为根重塑，1例患者为基环成形术，1例患者为基环成形术合并窦管结成形术，1例患者为罗斯手术。9例患者需要额外的尖端修复。没有发生过早死亡。术后随访5.3年（3.4年）。2例死亡，1例术后4年行主动脉瓣置换术。5年生存率为91.7%(8.0)%，10年生存率为68.8(20.7)%。10年主动脉瓣再次手术的成功率为88.9（10.5%）。结论环主动脉扩张合并室间隔缺损患者保留瓣根再植术可能需要特殊的第一排缝线。鼻尖脱垂的患者可能需要心肺复苏或鼻尖延长。罗斯手术是主动脉瓣严重畸形患者的另一种选择。

{"title":"Aortic Root Replacement in Patients With Ventricular Septal Defect","authors":"Ryota Takahashi MD , Hiroshi Munakata MD, PhD , Kenji Okada MD, PhD , Taro Hayashi MD, PhD , Tatsuichiro Seto MD, PhD , Hisao Suda MD, PhD , Yutaka Okita MD, PhD","doi":"10.1016/j.atssr.2025.06.025","DOIUrl":"10.1016/j.atssr.2025.06.025","url":null,"abstract":"<div><h3>Background</h3><div>Aortic root replacement in patients with ventricular septal defect (VSD) requires a modified surgical technique.</div></div><div><h3>Methods</h3><div>Between 2000 and 2022, 12 patients with aortic regurgitation and VSD underwent an operation. Their age at operation was 31.8 (SD 19.9) years. The VSD was patent in 5 patients and spontaneously or surgically closed in 7 patients. The location of the VSD was subarterial in 6 patients, perimembranous in 5, and muscular in 1 patient. The aortic valve was tricuspid in 8 patients, bicuspid in 2, and unicuspid in 2. Eight patients also had annuloaortic ectasia.</div></div><div><h3>Results</h3><div>The VSDs were closed using a patch in 4 patients and directly closed in 1 patient. The aortic root procedures were valve-sparing reimplantation in 7 patients, root remodeling in 1, basal ring annuloplasty in 1, basal ring annuloplasty with sinutubular junction annuloplasty in 1, and a Ross procedure in 1 patient. Additional cusp repair was required in 9 patients. No early deaths occurred. The postoperative follow-up periods were 5.3 (3.4) years. Two patients died, and 1 underwent aortic valve replacement 4 years postoperatively. Survival was 91.7 (8.0)% at 5 years and 68.8 (20.7)% at 10 years. Freedom from aortic valve reoperation was 88.9 (10.5)% at 10 years.</div></div><div><h3>Conclusions</h3><div>Valve-sparing root reimplantation in patients with annuloaortic ectasia and VSD may require a special first row suture line. Patients with prolapsed cusps may require resuspension or cusp extension. The Ross operation can be an alternative for patients with severely deformed aortic cusps.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1051-1055"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Accidental Ammo: Lawn Mower Catapulted Ballistic Leading to Left Ventricular Impalement 意外弹药：割草机弹射弹道导致左心室穿刺

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.06.010

Marvi Tariq MD , Eva Ingram MD , Kendra Douglas DO , Sasha Still MD

Penetrating cardiac injury is highly lethal due to the risk of exsanguination and cardiac tamponade, making timely diagnosis and treatment crucial. We present a rare case of cardiac impalement with a chain-link fence segment treated by surgical removal.

穿透性心脏损伤有出血和心包填塞的危险，具有很高的致死率，及时诊断和治疗至关重要。我们报告一例罕见的心脏刺穿与链环栅栏段手术切除治疗。

引用次数: 0

Protocol-Driven Perioperative Management of Ischemic Cardiomyopathy in a Community Hospital Setting 社区医院缺血性心肌病围手术期治疗方案驱动

Annals of thoracic surgery short reports

Pub Date : 2025-12-01 DOI: 10.1016/j.atssr.2025.04.025

Katherine Slusarz PA-C , Brock Daughtry DO , Jeremy London MD , Andrew Papoy MD

Background

We describe our experience using a defined protocol for the selection, classification, and treatment of patients with ischemic cardiomyopathy (ICM) undergoing coronary artery bypass grafting (CABG), with or without additional procedures, in a nonacademic setting with expected limited resources and support staff.

Methods

From December 2021 to December 2023, 25 patients with an ejection fraction of ≤0.44 due to ICM requiring CABG were assigned to a treatment algorithm based on the preoperative classification for CABG with no device (n = 9), balloon pump (n = 2), or direct centrifugal pump (n = 14) placed in the operating room.

Results

Preliminary data of all patients with surgically revascularized ICM using the defined protocol demonstrated a predicted average risk of mortality of 8.455% vs our mortality rate of 4%, whereas the average predicted risk of morbidity and mortality was 27.7%, with our 30-day morbidity and mortality of 24%. Subgroup analysis of the 3 patient categories: moderately depressed, low risk; moderately depressed, high risk; and severely depressed; shows better-than-expected outcomes when compared with predictions.

Conclusions

In a community hospital setting, experience using a defined protocol to select and manage patients with ICM undergoing CABG reduced morbidity and mortality compared with predicted outcomes. This is a practical method of managing high-risk CABG patients with the expected limitations of a community hospital.

背景：我们描述了我们的经验，在非学术环境下，在资源和支持人员有限的情况下，使用一种明确的方案来选择、分类和治疗接受冠状动脉旁路移植术（CABG）的缺血性心肌病（ICM）患者，有或没有额外的手术。方法2021年12月至2023年12月，选取25例因ICM需要冠状动脉搭桥导致射血分数≤0.44的患者，根据术前冠状动脉搭桥分级，分别在手术室内放置无装置（n = 9）、球囊泵（n = 2）或直接离心泵（n = 14）进行治疗。结果采用该方案的所有手术血运重建ICM患者的初步数据显示，预测的平均死亡风险为8.455%，而我们的死亡率为4%，而平均预测的发病率和死亡率为27.7%，我们的30天发病率和死亡率为24%。3类患者亚组分析：中度抑郁、低危；中度抑郁，高危；严重抑郁；与预测相比，显示出好于预期的结果。结论在社区医院环境中，与预测结果相比，使用明确的方案选择和管理接受CABG的ICM患者可降低发病率和死亡率。这是一种实用的方法来管理高风险的冠脉搭桥患者的预期限制在社区医院。

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引用次数: 0

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