Interdisciplinary cardiovascular and thoracic surgery最新文献

Objectives: The use of telemedicine has gained importance in patient care since the COVID-19 pandemic. This study aimed to compare the acceptance of telemedicine in lung cancer patients undergoing thoracic surgery or oncological therapy.

Methods: Consecutive lung cancer patients, either post-surgery (n = 100) or after oncological therapy (n = 100), were prospectively surveyed between May 2024 and March 2025 at the Asklepios Lung Clinic Gauting, Germany. A 67-item questionnaire covering perceived advantages and disadvantages of telemedicine, personal preferences, and the willingness to use telemedicine was employed.

Results: Demographic and clinical characteristics were similar in the surgical and oncological groups (median age 70/66 years, 52/44% females, respectively). Both groups showed a similar attitude towards telemedicine, regardless of education, age, sex, tumour stage, or treatment. Overall, 69% of surgical and 55% of oncological patients were unaware of existing telemedicine services. The majority would accept video/phone consultations for initial assessments, incapacity certificates, and follow-up, although 40% of patients were concerned about the quality of the patient-physician relationship. Perceived advantages were reduced waiting times and infection risk. Among medical specialties, telemedicine was most accepted for General Practice (50%). Compared to a population-based cohort, patients expressed less concern about misdiagnoses and data privacy.

Conclusions: Lung cancer patients expressed specific preferences regarding telemedicine, without major differences between surgical and oncological patients. They perceived advantages in its use for follow-up, saving time, and reducing infection risk. These findings can help guide a focused and well-accepted implementation of telemedicine into clinical practice.

Objectives: Conventional annuloplasty rings used in mitral valve repair (MVr) are made of metal or synthetic polymers, which may increase infection risk. This study aimed to develop a mitral annuloplasty ring using decellularised tissue and evaluate its ability to suppress regurgitation in a degenerative mitral regurgitation (DMR) model.

Methods: A 4 mm diameter annuloplasty ring was created using decellularized bovine tendon. Porcine mitral valve complexes (including the annulus, leaflets, chordae tendineae, and papillary muscles) were obtained from a slaughterhouse. The annulus was enlarged by 4 mm, and the two chordae tendineae of the posterior leaflet (P2) were severed. The DMR model, integrated into a pulsatile flow simulator, was repaired using a commercial-Physio II, Colvin-Galloway (CG) Future, Tailor band, and a decellularised tendon-based ring. Regurgitation control and effective mitral valve area (MVA) were compared (n = 6 for each group).

Results: The regurgitation rate of the DMR model was 52.3 ± 3.4%, consistent with severe MR. Post-MVr with each ring, the regurgitation rates were 14.9 ± 3.1% (Physio II), 14.5 ± 1.1% (CG Future), 16.4 ± 1.7% (Tailor band), and 15.5 ± 3.0% (decellularised tendon-based biological ring). All of these rates were significantly reduced, with no significant differences among them. Effective MVA was comparable across groups: 2.46 ± 0.28 cm2 (Physio II), 2.33 ± 0.54 cm2 (CG Future), 2.28 ± 0.12 cm2 (Tailor band), and 2.27 ± 0.53 cm2 (decellularised tendon-based biological ring).

Conclusions: The decellularised tendon-based annuloplasty ring demonstrated functional performance comparable to that of current mitral annuloplasty devices.

Objectives: Large Language Models (LLMs) are generative-AI which generate text output like a human conversation. We wanted to assess the ability of LLMs to answer patient's questions and benchmark their output using a Best Evidence Topic (BET).

Methods: We asked LLMs whether Robot-assisted Thoracic Surgery (RATS) or Video-assisted Thoracoscopic Surgery (VATS) lobectomy had better perioperative outcomes for postoperative pain, length of hospital stay (LOS) and mortality. A BET was constructed according to a structured protocol for the same questions. An initial search yielded 324 papers, 12 represented best evidence.

Results: LLM outputs are almost instantaneous while a BET took many hours of searching a database for relevant evidence. However, current iterations and models of LLMs did not provide relevant outputs, suffered from hallucinations and could be restricted by copyright and paywall issues. The BET, on the other hand, was tailored to the scenario by specialist human oversight and therefore more reliable and nuanced.

Conclusions: There were no major differences between RATS and VATS lobectomy for T1cN0M0 NSCLC apart from shorter LOS following RATS. Current LLMs may not be entirely reliable for answering clinical questions. An LLM-BET protocol could be used as a standardised process to compare LLM outputs for different clinical scenarios, each benchmarked with a BET. It can also be used to analyse outputs of different models of current and future LLMs.

Objectives: This study aims to investigate the first 90 days alive and out of hospital (DAOH90) following enhanced recovery thoracoscopic segmentectomy versus lobectomy.

Methods: A retrospective analysis for consecutive thoracoscopic segmentectomies and lobectomies for clinical stage IA1-2 non-small cell lung cancer (cIA1-2 NSCLC) was performed between January 2018 and March 2024. All factors contributing to reduced DAOH90 were analysed individually. The association between surgical extent and DAOH90 was assessed using a multivariable logistic regression model. Sensitivity analyses were performed after propensity score matching.

Results: Of 720 patients, 591 underwent lobectomy and 129 segmentectomy. Compared with lobectomy, patients undergoing segmentectomy had poorer lung function and exercise capacity, more comorbidities, slightly longer operative duration, and less blood loss. The median DAOH90 was 1 day longer after segmentectomy than lobectomy (87 vs 86 days, p = 0.049). Air leak > 1 day (38.3% vs 40.0%), pneumonia (13.3% vs 18.3%), and pain (13.3% vs 23.3%) were important reasons to reduced DAOH90, all occurring more frequently in the lobectomy group. Social factors (37.5% vs 25.8%) were also a predominant cause in both groups, particularly after segmentectomy. Other causes were less common. In multivariable analysis, lobectomy (vs segmentectomy, OR 1.44, p = 0.048) was identified as an independent predictor of shorter DAOH90, along with body mass index, lung function, and cardiac comorbidity. The results of the sensitivity analysis were consistent with these findings.

Conclusions: Following an enhanced recovery thoracoscopic protocol, segmentectomy for well-selected patients with cIA1-2 NSCLC may result in longer DAOH and less postoperative complications compared to lobectomy.

Objectives: In February 2024, a nationwide resident resignation occurred in South Korea that persisted for more than one and a half years and caused unprecedented disruptions in teaching hospitals. This study evaluated the clinical and socioeconomic impact of resident absence on cardiovascular surgery at a tertiary teaching hospital.

Methods: We retrospectively reviewed 681 patients who underwent open-heart or aortic surgery between February 20 and November 30, 2023 (before resident absence) and in 2024 (resident absence). Each year was divided into three periods (Q1, Q2, and Q3) for temporal comparison. The primary outcomes were 30-day mortality, failure-to-rescue complications and failure-to-rescue. Failure-to-rescue was defined as in-hospital mortality after more than one of the following failure-to-rescue complications: acute renal failure, respiratory complications (prolonged ventilation >24 hours, pneumonia or tracheostomy), stroke, reoperation, life-threatening arrhythmia, postoperative myocardial infarction or culture-positive sepsis. Multivariable logistic regression was performed to identify independent risk factors.

Results: When comparing 2023 Q1 with 2024 Q1, surgical volume decreased from 154 to 65 cases (-58%) and did not return to 2023 Q1 baseline. Compared with the 2023 group, the median surgical waiting time of the 2024 group increased from 17[IQR: 8-28] to 36[IQR: 20-58] days (p < 0.001). Resident absence was not a risk factor for 30-day mortality but was an independent risk factor for both failure-to-rescue complications (OR 1.50, 95% CI 1.03-2.19, p = 0.035) and failure-to-rescue (OR 3.64, 95% CI 1.33-9.98, p = 0.012).

Conclusions: The nationwide resignation of residents revealed the structural vulnerability of South Korea's healthcare system, which relies heavily on residents' workforce. Surgical capacity decreased, waiting times increased, and rescue outcomes deteriorated. The resident-dependent healthcare system requires reform, with teaching hospitals treating residents primarily as trainees rather than as inexpensive labour.

Objectives: For surgical repair of acute type I aortic dissection, total arch replacement (TAR) with a frozen elephant trunk (FET) has been known to result in better long-term remodelling of a residual false lumen. This study was designed to investigate the impact of the elephant trunk by comparing long-term remodelling features among different extents and strategies of aortic replacement.

Methods: We conducted a single-centre retrospective analysis of patients who underwent surgical repair for acute type I aortic dissection from January 2004 to June 2022. Patients were categorized based on the surgical strategy employed: non-TAR, conventional TAR, TAR with a classic elephant trunk (CET) and TAR-FET. The primary outcomes were positive remodelling of the residual false lumen and composite aortic events, with secondary outcomes focusing on early postoperative results.

Results: A total of 327 patients were included. TAR, when combined with the insertion of an ET, whether it was stented or not, significantly promoted favourable aortic remodelling (P < .001). Compared with TAR-CET, the FET group tended towards faster false lumen thrombosis and regression, albeit without a significant difference in ultimate remodelling rates; 1-year and 5-year rates of proximal descending false lumen thrombosis were 85.4% (95% confidence interval [CI], 69.2-100) and 90.3% (95% CI, 75.9-100), respectively, after TAR-FET; additionally, these aforementioned rates were 65.7% (95% CI, 54.7-76.6) and 81.9% (95% CI, 71.8-91.9), respectively, after TAR-CET. No significant differences were observed in early postoperative outcomes or overall survival.

Conclusions: The favourable remodelling of the residual false lumen after TAR-FET shown in this study is in line with results from previous studies. CET might be a reasonable alternative to FET according to the individual patient risk profiles and institutional logistics situation.

Objectives: Older patients are more prone to postoperative morbidity and mortality after mitral valve (MV) surgery. Minimally invasive MV surgery (MIMVS) is increasingly adopted worldwide, with a potential benefit in the elderly. This study compares short-term and mid-term outcomes in patients above 70 years, undergoing MIMVS versus median sternotomy (MST), in a nationwide registry.

Methods: All patients above 70 years undergoing primary elective MV surgery (±tricuspid valve [TV] surgery, atrial septal defect closure, rhythm surgery) between 2013 and 2021 were included. All data were extracted from the Netherlands Heart Registration. Primary outcomes were short-term morbidity, mortality, and 5-year survival.

Results: In total, 1418 patients were included (MST n = 797, MIMVS n = 621). No statistically significant differences in baseline characteristics were found. Median Logistic EuroSCORE I was 6.3 [4.7-8.5] vs 6.0 [4.6-8.5], P = .27 for MST and MIMVS, respectively. Mitral valve repair (77.7% vs 64.7% P < .001) and concomitant TV surgery (43.9% vs 18.2%, P < .001) was more frequently performed in MST. Lower 30-day mortality was observed in MIMVS (0.6% [n = 4] vs 2.5% [n = 21], P = .01). Furthermore, the incidence of pneumonia, prolonged intubation, readmission to intensive care unit, kidney failure, and new-onset arrhythmia were lower for MIMVS. No difference in 5-year survival was found (MST: 89.1 ± 4.6% vs MIMVS: 91.6 ± 4.7% Log-Rank P = .51).

Conclusions: Minimally invasive MV surgery in patients above 70 years may be associated with lower 30-day mortality and incidence of postoperative complications compared with sternotomy.

Objectives: Neoadjuvant therapy (NAT) significantly improves the pathologic complete response (pCR) rates in patients with locally advanced esophageal squamous cell carcinoma (ESCC). Emerging evidence suggests that patients with pCR may experience favourable outcomes and could be considered for active surveillance strategies to delay surgery. This study aims to develop a clinical-radiomics model to predict pCR after NAT in ESCC.

Methods: We retrospectively enrolled 236 patients with locally advanced ESCC who received NAT at our centre and randomly assigned them to training and test cohorts (3:2 ratio). Radiomics features were extracted from tumour regions segmented on post-NAT contrast-enhanced computed tomography (CT) scans. After feature selection, a predictive model integrating radiomics and clinical variables was developed using logistic regression and visualized as a nomogram. Model performance was evaluated using area under the curve (AUC), accuracy, sensitivity, and specificity.

Results: The clinical-radiomics model achieved an AUC of 0.91 (95% confidence interval [CI]: 0.86-0.95), accuracy of 0.84, sensitivity of 0.89, and specificity of 0.81 in the training cohort, and an AUC of 0.84 (95% CI: 0.76-0.92), accuracy of 0.78, sensitivity of 0.84, and specificity of 0.74 in the test cohort. Calibration curves demonstrated good agreement between predicted and observed outcomes, and decision curve analysis confirmed the model's clinical utility.

Conclusions: The clinical-radiomics model accurately predicts pCR following NAT in ESCC and may guide personalized treatment strategies.

Objectives: To investigate the application of a mechanical side-to-side oesophagogastric anastomosis in the reconstruction of the digestive tract of beagles after an oesophagectomy.

Methods: Eighteen beagles were randomly divided into 3 groups: the hand-sewn (HS) group, the linear-stapled anastomosis in the oesophagus and anterior portion of the stomach (LESA) group and the linear-stapled anastomosis in the oesophagus and the posterior portion of the stomach (LESP) group. The gastro-oesophageal reflux, anastomotic area, anastomotic bursting pressure and the breaking strength in the beagles at 1 week and 12 weeks after the operations were compared. The histopathological morphology was observed using haematoxylin-eosin staining and Masson staining, and the expression of the vascular endothelial growth factor (VEGF) was detected by immunohistochemical analysis.

Results: At 1 and 12 weeks after the operation, the percentage of gastro-oesophageal reflux time and the longest reflux time in the HS group and the LESP group were higher than those in the LESA group (P < .05). The anastomotic areas in the HS group were significantly smaller than those in the LESA and LESP groups at 1 and 12 weeks postoperatively (P < .05); there were no differences in the anastomotic areas in the LESA and LESP groups. At 1 and 12 weeks postoperatively, the bursting pressure and breaking strength of the anastomosis, the collagen-fibre area ratio and VEGF positive expression in the LESA group were significantly higher than those in the HS group (P < .05).

Conclusions: The mechanical side-to-side oesophagogastric anastomosis of the oesophagus and the anterior wall of the stomach can reduce the occurrence of gastro-oesophageal reflux, increase the bursting pressure and breaking strength, promote collagen fibre and VEGF expression, to promote healing of the anastomosis.