Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.06.015
Elizabeth L. Norton MD , Kanika Kalra MD , Robert A. Guyton MD
Tricuspid valve surgery is associated with a high risk of new permanent pacemaker implantation. Tension on annular tissue by placement of a circular valve in a very noncircular annulus may cause conduction abnormalities. To address this, a triangular piece of pericardium was sewn to the prosthesis sewing ring, extending the sewing ring into the corner of the annulus between the septal and anterior leaflets, visibly relieving tension in the region of the atrioventricular node in five patients. A sewing ring extension of the prosthesis should be explored during tricuspid valve replacement to potentially reduce the risk of conduction system impairment.
{"title":"Tricuspid Valve Replacement With a Sewing Ring Extender to Address Conduction Abnormalities","authors":"Elizabeth L. Norton MD , Kanika Kalra MD , Robert A. Guyton MD","doi":"10.1016/j.atssr.2025.06.015","DOIUrl":"10.1016/j.atssr.2025.06.015","url":null,"abstract":"<div><div>Tricuspid valve surgery is associated with a high risk of new permanent pacemaker implantation. Tension on annular tissue by placement of a circular valve in a very noncircular annulus may cause conduction abnormalities. To address this, a triangular piece of pericardium was sewn to the prosthesis sewing ring, extending the sewing ring into the corner of the annulus between the septal and anterior leaflets, visibly relieving tension in the region of the atrioventricular node in five patients. A sewing ring extension of the prosthesis should be explored during tricuspid valve replacement to potentially reduce the risk of conduction system impairment.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1067-1069"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645714","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.05.008
Suk Ho Sohn MD, PhD , Kyung Hwan Kim MD, PhD , Yoonjin Kang MD, PhD , Jae Woong Choi MD, PhD , Seung Hyun Lee MD, PhD , Sung Ho Shinn MD, PhD , Jae Suk Yoo MD, PhD
Background
This study compared the early and midterm outcomes of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in a real-world entire population in Korea.
Methods
During 5 years from June 2015 to May 2019, 1468 patients underwent primary isolated transfemoral TAVI and 3897 patients underwent primary isolated SAVR in Korea. Early and midterm clinical outcomes were compared between the groups, and propensity score-matched analysis was also performed to balance between the groups. Subgroup analyses were performed by dividing the overall cohort into 6 age-subgroups of <65, 65 to 69, 70 to 74, 75 to 79, 80 to 84, and ≥85 years. Follow-up was 100% complete. Median follow-up duration was 2.5 years in the TAVI group and 3.0 years in the SAVR group.
Results
There was no difference in periprocedural mortality between the groups in the overall cohort (3.2% in TAVI vs 3.5% in SAVR, P =.66), whereas SAVR demonstrated higher periprocedural mortality in the matched cohort (2.9% in TAVI vs 5.6% in SAVR, P =.003). Cumulative incidence of all-cause mortality was not significantly different between TAVI and SAVR in the matched cohort (hazard ratio, 0.96; 95% CI, 0.79-1.16; P =.64), and was also not significantly different in every matched age-subgroup. Other midterm clinical outcomes, including stroke, endocarditis, and reintervention, were comparable between the groups, whereas the cumulative incidence of permanent pacemaker implantation was significantly higher in TAVI.
Conclusions
TAVI and SAVR demonstrated comparable midterm survival in the real-world entire population from 2015 to 2019 in Korea. Comparable midterm survival was also demonstrated between all age-subgroups.
本研究比较了经导管主动脉瓣植入术（TAVI）和外科主动脉瓣置换术（SAVR）在韩国真实人群中的早期和中期结果。方法2015年6月至2019年5月，韩国共有1468例原发性分离性经股TAVI患者和3897例原发性分离性SAVR患者。比较两组患者的早期和中期临床结果，并进行倾向评分匹配分析以平衡两组之间的差异。亚组分析将整个队列分为6个年龄亚组，分别为65岁、65岁至69岁、70岁至74岁、75岁至79岁、80岁至84岁和≥85岁。随访100%完成。TAVI组中位随访时间为2.5年，SAVR组中位随访时间为3.0年。结果在整个队列中，两组患者的围手术期死亡率无差异（TAVI组为3.2%，SAVR组为3.5%,P = 0.66），而匹配队列中SAVR组的围手术期死亡率更高（TAVI组为2.9%，SAVR组为5.6%,P = 0.003）。在匹配队列中，TAVI和SAVR的全因死亡率累积发生率无显著差异（风险比0.96;95% CI, 0.79-1.16; P = 0.64），在每个匹配的年龄亚组中也无显著差异。其他中期临床结果，包括卒中、心内膜炎和再干预，在两组之间具有可比性，而永久性起搏器植入的累积发生率在TAVI中明显更高。结论：2015年至2019年，stavi和SAVR在韩国真实人群中表现出相当的中期生存率。所有年龄亚组的中期生存率也具有可比性。
{"title":"National Midterm Outcomes of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement","authors":"Suk Ho Sohn MD, PhD , Kyung Hwan Kim MD, PhD , Yoonjin Kang MD, PhD , Jae Woong Choi MD, PhD , Seung Hyun Lee MD, PhD , Sung Ho Shinn MD, PhD , Jae Suk Yoo MD, PhD","doi":"10.1016/j.atssr.2025.05.008","DOIUrl":"10.1016/j.atssr.2025.05.008","url":null,"abstract":"<div><h3>Background</h3><div>This study compared the early and midterm outcomes of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in a real-world entire population in Korea.</div></div><div><h3>Methods</h3><div>During 5 years from June 2015 to May 2019, 1468 patients underwent primary isolated transfemoral TAVI and 3897 patients underwent primary isolated SAVR in Korea. Early and midterm clinical outcomes were compared between the groups, and propensity score-matched analysis was also performed to balance between the groups. Subgroup analyses were performed by dividing the overall cohort into 6 age-subgroups of <65, 65 to 69, 70 to 74, 75 to 79, 80 to 84, and ≥85 years. Follow-up was 100% complete. Median follow-up duration was 2.5 years in the TAVI group and 3.0 years in the SAVR group.</div></div><div><h3>Results</h3><div>There was no difference in periprocedural mortality between the groups in the overall cohort (3.2% in TAVI vs 3.5% in SAVR, <em>P</em> =.66), whereas SAVR demonstrated higher periprocedural mortality in the matched cohort (2.9% in TAVI vs 5.6% in SAVR, <em>P</em> =.003). Cumulative incidence of all-cause mortality was not significantly different between TAVI and SAVR in the matched cohort (hazard ratio, 0.96; 95% CI, 0.79-1.16; <em>P</em> =.64), and was also not significantly different in every matched age-subgroup. Other midterm clinical outcomes, including stroke, endocarditis, and reintervention, were comparable between the groups, whereas the cumulative incidence of permanent pacemaker implantation was significantly higher in TAVI.</div></div><div><h3>Conclusions</h3><div>TAVI and SAVR demonstrated comparable midterm survival in the real-world entire population from 2015 to 2019 in Korea. Comparable midterm survival was also demonstrated between all age-subgroups.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1045-1050"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645709","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.06.023
David Niehaus BS , Michael Javorski MD , Elliot Kay MD , Abigail Rhoades PharmD , Hilary Raidt PharmD , Rob Dowling MD
Heparin is the primary anticoagulant used for cardiopulmonary bypass and requires reversal to prevent postoperative bleeding. Protamine sulfate is the only United States Food and Drug Administration–approved heparin reversal agent and therefore is routinely used after cardiopulmonary bypass. Severe intraoperative protamine reactions are infrequent but may preclude full heparin reversal. Andexanet alfa has demonstrated effective in vitro heparin reversal, but clinical use has not been reported. We review the preclinical data on andexanet alfa as a heparin reversal agent and report a clinical case of andexanet alfa infusion, with complete laboratory and clinical evidence of heparin reversal.
{"title":"Use of Andexanet Alfa to Reverse Heparin After Cardiopulmonary Bypass","authors":"David Niehaus BS , Michael Javorski MD , Elliot Kay MD , Abigail Rhoades PharmD , Hilary Raidt PharmD , Rob Dowling MD","doi":"10.1016/j.atssr.2025.06.023","DOIUrl":"10.1016/j.atssr.2025.06.023","url":null,"abstract":"<div><div>Heparin is the primary anticoagulant used for cardiopulmonary bypass and requires reversal to prevent postoperative bleeding. Protamine sulfate is the only United States Food and Drug Administration–approved heparin reversal agent and therefore is routinely used after cardiopulmonary bypass. Severe intraoperative protamine reactions are infrequent but may preclude full heparin reversal. Andexanet alfa has demonstrated effective in vitro heparin reversal, but clinical use has not been reported. We review the preclinical data on andexanet alfa as a heparin reversal agent and report a clinical case of andexanet alfa infusion, with complete laboratory and clinical evidence of heparin reversal.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1146-1147"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645954","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.06.001
Allison N. Moore MD , Meera Mathur MS , Catherine G. Pratt MD, MS , Christy Pinkston MS , Shesh Rai PhD , Ralph C. Quillin III MD , Robert M. Van Haren MD, MSPH
Background
Mandatory smoking cessation before surgical resection for lung cancer may worsen racial disparities, increasing barriers to treatment without a proven risk reduction in postoperative complications. This study compares postoperative complications regarding current and former smoking status of patients undergoing lung cancer resection.
Methods
Study data were drawn from the National Lung Screening Trial. Inclusion criteria included lung cancer diagnosis and pretreatment staging or IA, IB, IIA, or IIB. These patients were stratified by self-reported current or former smoking status.
Results
Of 862 patients from the National Lung Screening Trial who met inclusion criteria, 45% (n = 379) had former smoking status and 55% (n = 483) had current smoking status. Those with current smoking status were more often racial minorities (10.7% vs 5.0%; P = .005), were younger (62.9 vs 64.5 years; P < .001), had squamous cell carcinoma (28.0% vs 24.5%; P = .03), and had less heart disease (12.4% [n = 60] vs 17.4% [n = 66]; P = .04) Current smoking status was associated with increased moderate/major complications (P = .04) but not all complications (P = .06). There was no difference in mortality rates between current and former smoking status patients (4.3% vs 2.4%; P = .12).
Conclusions
Current smoking status is associated with increased risk of moderate/major complications after lung cancer resection; however, there was no difference in mortality rate. Surgeons should offer smoking cessation, although requiring cessation before surgical resection may worsen racial disparities by limiting access to surgery.
背景：肺癌手术切除前强制戒烟可能会加剧种族差异，增加治疗的障碍，而没有证明可以减少术后并发症的风险。本研究比较了肺癌切除术患者当前和既往吸烟状况的术后并发症。方法研究数据来自国家肺筛查试验。纳入标准包括肺癌诊断和预处理分期或IA、IB、IIA或IIB。这些患者根据自我报告的当前或以前吸烟状况进行分层。结果在862例符合纳入标准的国家肺筛查试验患者中，45% （n = 379）有既往吸烟史，55% （n = 483）有当前吸烟史。目前吸烟的人群多为少数种族（10.7% vs 5.0%; P = 0.005），年龄较小（62.9 vs 64.5岁；P = 0.001），患有鳞状细胞癌（28.0% vs 24.5%; P = 0.03），心脏病发生率较低（12.4% [n = 60] vs 17.4% [n = 66]; P = 0.04）。目前吸烟与中度/重度并发症增加相关（P = 0.04），但并非所有并发症（P = 0.06）。目前和曾经吸烟的患者的死亡率没有差异（4.3% vs 2.4%; P = .12）。结论当前吸烟状况与肺癌切除术后中/重度并发症风险增加相关；然而，死亡率没有差异。外科医生应该提供戒烟服务，尽管在手术切除前要求戒烟可能会限制手术的机会，从而加剧种族差异。
{"title":"Does Smoking Status Have an Impact on Postoperative Complications After Lung Cancer Resection? An Analysis of the National Lung Screening Trial","authors":"Allison N. Moore MD , Meera Mathur MS , Catherine G. Pratt MD, MS , Christy Pinkston MS , Shesh Rai PhD , Ralph C. Quillin III MD , Robert M. Van Haren MD, MSPH","doi":"10.1016/j.atssr.2025.06.001","DOIUrl":"10.1016/j.atssr.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Mandatory smoking cessation before surgical resection for lung cancer may worsen racial disparities, increasing barriers to treatment without a proven risk reduction in postoperative complications. This study compares postoperative complications regarding current and former smoking status of patients undergoing lung cancer resection.</div></div><div><h3>Methods</h3><div>Study data were drawn from the National Lung Screening Trial. Inclusion criteria included lung cancer diagnosis and pretreatment staging or IA, IB, IIA, or IIB. These patients were stratified by self-reported current or former smoking status.</div></div><div><h3>Results</h3><div>Of 862 patients from the National Lung Screening Trial who met inclusion criteria, 45% (n = 379) had former smoking status and 55% (n = 483) had current smoking status. Those with current smoking status were more often racial minorities (10.7% vs 5.0%; <em>P</em> = .005), were younger (62.9 vs 64.5 years; <em>P</em> < .001), had squamous cell carcinoma (28.0% vs 24.5%; <em>P</em> = .03), and had less heart disease (12.4% [n = 60] vs 17.4% [n = 66]; <em>P</em> = .04) Current smoking status was associated with increased moderate/major complications (<em>P</em> = .04) but not all complications (<em>P</em> = .06). There was no difference in mortality rates between current and former smoking status patients (4.3% vs 2.4%; <em>P</em> = .12).</div></div><div><h3>Conclusions</h3><div>Current smoking status is associated with increased risk of moderate/major complications after lung cancer resection; however, there was no difference in mortality rate. Surgeons should offer smoking cessation, although requiring cessation before surgical resection may worsen racial disparities by limiting access to surgery.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 834-838"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645967","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.05.014
Mohammed Abed MD, MPH , Erik Beckmann MD , Miho Fukui MD, PhD , Vinayak N. Bapat MD
{"title":"Giant Thrombus on the Face of WATCHMAN FLX Device","authors":"Mohammed Abed MD, MPH , Erik Beckmann MD , Miho Fukui MD, PhD , Vinayak N. Bapat MD","doi":"10.1016/j.atssr.2025.05.014","DOIUrl":"10.1016/j.atssr.2025.05.014","url":null,"abstract":"","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1159-1160"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645998","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.04.003
Marisa Sewell MD , Mitchka Mohammadi MS , Michael Kilbourne MD , Gary Grunkemeier PhD , Paul Schipper MD , Julie Doberne MD, PhD , Ruchi Thanawala MD, MS
Background
COVID-19 accelerated the adaptation of telemedicine in surgical practice. Audio-only telemedicine utilization is rare; however, this may be more accessible than video for many patients. There are limited data examining the feasibility of this technology in the preoperative setting.
Methods
We conducted a single institution review of patients evaluated for thoracic surgery oncologic indications from 2018 to 2022. Patients were stratified into phone- and office-based assessment on the type of their first preoperative visit. Primary outcomes were rate of day of surgery cancellation and postoperative length of stay.
Results
Overall, 741 patients met the inclusion criteria, including 374 in-person and 367 via telemedicine. The distribution of patients residing in the same county as our institution did not change based on type of preoperative visit (15% vs 17%, P = .550). Additionally, the rate of day of surgery cancellation did not differ between in office and phone-based groups (2% [7 of 374] and 3% [11 of 367], P = .910). Patients in the telemedicine group did have a higher number of preoperative visits compared with the in-office group (1.0 visits vs 1.4 visits, P < .001). There was no difference in postoperative length of stay (P = .600).
Conclusions
This single institution study of patients undergoing thoracic surgery for malignancy demonstrates that patients can feasibly undergo an audio-only preoperative visit without increasing the rate of day of surgery cancellation or length of stay. This technology should remain an option for surgical patients going forward.
新冠肺炎疫情加速了远程医疗在外科实践中的应用。纯音频远程医疗的利用很少；然而，对于许多患者来说，这可能比视频更容易获得。关于该技术在术前可行性的研究数据有限。方法：我们对2018年至2022年接受胸外科肿瘤适应症评估的患者进行了单机构回顾。根据患者第一次术前就诊的类型，对患者进行电话和办公室评估。主要结局为手术取消天数和术后住院时间。结果741例患者符合纳入标准，其中现场就诊374例，远程就诊367例。与我们机构居住在同一县的患者分布没有因术前就诊类型而改变（15% vs 17%, P = 0.550）。此外，手术取消率在办公室组和电话组之间没有差异（2%[374例中的7例]和3%[367例中的11例]，P = .910）。远程医疗组的患者术前就诊次数确实高于门诊组（1.0次vs 1.4次，P < .001）。术后住院时间差异无统计学意义（P = 0.600）。结论：这项针对恶性胸外科患者的单机构研究表明，患者可以在不增加手术取消天数或住院时间的情况下进行仅听诊。这项技术应该继续成为外科手术患者的一种选择。
{"title":"Extending the Reach of Thoracic Surgical Oncology With Telehealth","authors":"Marisa Sewell MD , Mitchka Mohammadi MS , Michael Kilbourne MD , Gary Grunkemeier PhD , Paul Schipper MD , Julie Doberne MD, PhD , Ruchi Thanawala MD, MS","doi":"10.1016/j.atssr.2025.04.003","DOIUrl":"10.1016/j.atssr.2025.04.003","url":null,"abstract":"<div><h3>Background</h3><div>COVID-19 accelerated the adaptation of telemedicine in surgical practice. Audio-only telemedicine utilization is rare; however, this may be more accessible than video for many patients. There are limited data examining the feasibility of this technology in the preoperative setting.</div></div><div><h3>Methods</h3><div>We conducted a single institution review of patients evaluated for thoracic surgery oncologic indications from 2018 to 2022. Patients were stratified into phone- and office-based assessment on the type of their first preoperative visit. Primary outcomes were rate of day of surgery cancellation and postoperative length of stay.</div></div><div><h3>Results</h3><div>Overall, 741 patients met the inclusion criteria, including 374 in-person and 367 via telemedicine. The distribution of patients residing in the same county as our institution did not change based on type of preoperative visit (15% vs 17%, <em>P</em> = .550). Additionally, the rate of day of surgery cancellation did not differ between in office and phone-based groups (2% [7 of 374] and 3% [11 of 367], <em>P</em> = .910). Patients in the telemedicine group did have a higher number of preoperative visits compared with the in-office group (1.0 visits vs 1.4 visits, <em>P</em> < .001). There was no difference in postoperative length of stay (<em>P</em> = .600).</div></div><div><h3>Conclusions</h3><div>This single institution study of patients undergoing thoracic surgery for malignancy demonstrates that patients can feasibly undergo an audio-only preoperative visit without increasing the rate of day of surgery cancellation or length of stay. This technology should remain an option for surgical patients going forward.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1166-1170"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646000","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.04.014
Jose I. Ortiz De Elguea-Lizarraga MD , Benjamin Mason BS , Junji Tsukagoshi MD , Alexis N. Davis MD , Mitchell W. Cox MD , Andre Y. Son MD , Abe DeAnda MD
Open thoracoabdominal aortic aneurysm (TAAA) repair remains the gold standard for patients with connective tissue disorders. Traditionally, repair of these aneurysms is conducted through a single thoracotomy often requiring rib resection or excessive retraction and resulting in postoperative pain and complications. This report presents the case of a 47-year-old woman with Loeys-Dietz syndrome who required an extent V TAAA repair. A single-incision double-thoracotomy approach was performed. This technique is believed to improve outcomes with less postoperative pain and to provide better exposure with a more expeditious procedure overall.
{"title":"Single-Incision Double Thoracotomy for Open Thoracoabdominal Aortic Aneurysm Repair: Case Report and New Technique","authors":"Jose I. Ortiz De Elguea-Lizarraga MD , Benjamin Mason BS , Junji Tsukagoshi MD , Alexis N. Davis MD , Mitchell W. Cox MD , Andre Y. Son MD , Abe DeAnda MD","doi":"10.1016/j.atssr.2025.04.014","DOIUrl":"10.1016/j.atssr.2025.04.014","url":null,"abstract":"<div><div>Open thoracoabdominal aortic aneurysm (TAAA) repair remains the gold standard for patients with connective tissue disorders. Traditionally, repair of these aneurysms is conducted through a single thoracotomy often requiring rib resection or excessive retraction and resulting in postoperative pain and complications. This report presents the case of a 47-year-old woman with Loeys-Dietz syndrome who required an extent V TAAA repair. A single-incision double-thoracotomy approach was performed. This technique is believed to improve outcomes with less postoperative pain and to provide better exposure with a more expeditious procedure overall.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 993-996"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646026","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}
Surgical treatment of secondary pneumothorax caused by pulmonary aspergilloma often makes it difficult to close the fistula. We herein report a surgical case of pneumothorax in an 85-year-old man with a fungus ball in a cavity of the right lung S3. A fungus mass protruded into the thoracic cavity from the lung fistula, and the surrounding tissue was thickened by inflammatory changes. We tried to close the defect by filling it with pericardial fat tissue and suturing. After the operation, the air leak disappeared immediately, and there was no recurrence of pneumothorax. This method is an effective and practical treatment.
{"title":"Pericardial Fat Plombage for Secondary Pneumothorax Caused by Pulmonary Aspergilloma","authors":"Masaya Sogabe MD , Kentaro Minegishi MD, PhD , Keigo Sudo MD , Fumie Osuga MD , Takaya Sato MD , Shunsuke Endo MD, PhD , Hiroyoshi Tsubochi MD, PhD","doi":"10.1016/j.atssr.2025.06.009","DOIUrl":"10.1016/j.atssr.2025.06.009","url":null,"abstract":"<div><div>Surgical treatment of secondary pneumothorax caused by pulmonary aspergilloma often makes it difficult to close the fistula. We herein report a surgical case of pneumothorax in an 85-year-old man with a fungus ball in a cavity of the right lung S3. A fungus mass protruded into the thoracic cavity from the lung fistula, and the surrounding tissue was thickened by inflammatory changes. We tried to close the defect by filling it with pericardial fat tissue and suturing. After the operation, the air leak disappeared immediately, and there was no recurrence of pneumothorax. This method is an effective and practical treatment.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 883-885"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646050","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.05.004
Jessica M. Carducci BSN , Andrew C. Chang MD , Kiran H. Lagisetty MD , Richard Kwon MD , Jules Lin MD , Rishindra M. Reddy MD, MBA
Background
Peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) are 2 common treatments for achalasia. Endoluminal functional lumen imaging probe (EndoFLIP; Medtronic) technology allows for real-time esophagogastric junction measurements intraoperatively before and after myotomy. We hypothesize that POEM would result in improved distensibility over LHM given its longer myotomy length.
Methods
A retrospective cohort study of prospectively collected data from consecutive patients with achalasia who underwent either POEM or LHM at a single-center tertiary care center between 2018 and 2019 was performed. Premyotomy and postmyotomy EndoFLIP measurements and outcomes such as length of stay and 30-day readmissions were compared using χ2 and t tests.
Results
Data from 65 patients with achalasia were included (19 LHM and 46 POEM), and 57 patients were excluded for lack of EndoFLIP data. The POEM cohort was significantly older (P < .001), with no other significant demographic differences. Average pre-LHM and post-LHM distensibility (1.22 [SD 0.5] and 3.64 [1.14], respectively) represented a mean 198% ( 41%) increase. Pre-POEM and post-POEM distensibility measurements (1.73 [1.41] and 4.1 [2], respectively), demonstrated a mean 137% (39%) increase (P = .95). The esophagogastric junction diameter increased by 73% (42%) and 49% (41%) in LHM and POEM, respectively (P = .07). There was no significant difference in length of stay (P = .06) or 30-day readmissions (P = .17).
Conclusions
Similar increases in EndoFLIP measurements were seen intraoperatively during POEM and LHM. Longer-term quality of life data should be used to correlate with EndoFLIP measurements to understand the benefits of myotomy.
{"title":"The Role of Intraoperative Functional Lumen Imaging in Peroral Endoscopic Myotomy and Laparoscopic Heller Myotomy","authors":"Jessica M. Carducci BSN , Andrew C. Chang MD , Kiran H. Lagisetty MD , Richard Kwon MD , Jules Lin MD , Rishindra M. Reddy MD, MBA","doi":"10.1016/j.atssr.2025.05.004","DOIUrl":"10.1016/j.atssr.2025.05.004","url":null,"abstract":"<div><h3>Background</h3><div>Peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) are 2 common treatments for achalasia. Endoluminal functional lumen imaging probe (EndoFLIP; Medtronic) technology allows for real-time esophagogastric junction measurements intraoperatively before and after myotomy. We hypothesize that POEM would result in improved distensibility over LHM given its longer myotomy length.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of prospectively collected data from consecutive patients with achalasia who underwent either POEM or LHM at a single-center tertiary care center between 2018 and 2019 was performed. Premyotomy and postmyotomy EndoFLIP measurements and outcomes such as length of stay and 30-day readmissions were compared using χ<sup>2</sup> and <em>t</em> tests.</div></div><div><h3>Results</h3><div>Data from 65 patients with achalasia were included (19 LHM and 46 POEM), and 57 patients were excluded for lack of EndoFLIP data. The POEM cohort was significantly older (<em>P</em> < .001), with no other significant demographic differences. Average pre-LHM and post-LHM distensibility (1.22 [SD 0.5] and 3.64 [1.14], respectively) represented a mean 198% ( 41%) increase. Pre-POEM and post-POEM distensibility measurements (1.73 [1.41] and 4.1 [2], respectively), demonstrated a mean 137% (39%) increase (<em>P</em> = .95). The esophagogastric junction diameter increased by 73% (42%) and 49% (41%) in LHM and POEM, respectively (<em>P</em> = .07). There was no significant difference in length of stay (<em>P</em> = .06) or 30-day readmissions (<em>P</em> = .17).</div></div><div><h3>Conclusions</h3><div>Similar increases in EndoFLIP measurements were seen intraoperatively during POEM and LHM. Longer-term quality of life data should be used to correlate with EndoFLIP measurements to understand the benefits of myotomy.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 918-923"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646060","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.06.013
Neelesh Bagrodia MD , Peter J. Kneuertz MD , Nicholas J. Pastis MD , Desmond M. D’Souza MD , Robert E. Merritt MD, MBA , Ioana Baiu MD, MPH
Schwannomas are benign peripheral nerve sheath tumors with characteristic imaging features and low avidity on positron emission tomography (PET). Transformation into malignant peripheral nerve sheath tumors (MPNSTs) is rare (<0.3%), but it typically manifests with invasive, large (>5 cm), PET-avid, heterogeneous tumors. Although schwannomas may be monitored or excised, MPNSTs require aggressive systemic treatment. We present 2 intrathoracic schwannomas with discordant radiologic and pathologic findings, highlighting the preoperative diagnostic uncertainty. These cases emphasize the critical role of multidisciplinary evaluation in guiding management when high PET avidity suggests malignancy despite benign pathologic features.
{"title":"Too Hot? Don’t Believe Me, Just Watch: Highly Positron Emission Tomography–Avid Thoracic Schwannomas","authors":"Neelesh Bagrodia MD , Peter J. Kneuertz MD , Nicholas J. Pastis MD , Desmond M. D’Souza MD , Robert E. Merritt MD, MBA , Ioana Baiu MD, MPH","doi":"10.1016/j.atssr.2025.06.013","DOIUrl":"10.1016/j.atssr.2025.06.013","url":null,"abstract":"<div><div>Schwannomas are benign peripheral nerve sheath tumors with characteristic imaging features and low avidity on positron emission tomography (PET). Transformation into malignant peripheral nerve sheath tumors (MPNSTs) is rare (<0.3%), but it typically manifests with invasive, large (>5 cm), PET-avid, heterogeneous tumors. Although schwannomas may be monitored or excised, MPNSTs require aggressive systemic treatment. We present 2 intrathoracic schwannomas with discordant radiologic and pathologic findings, highlighting the preoperative diagnostic uncertainty. These cases emphasize the critical role of multidisciplinary evaluation in guiding management when high PET avidity suggests malignancy despite benign pathologic features.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 954-958"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646068","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}
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