Interdisciplinary cardiovascular and thoracic surgery最新文献

Objectives: Extended arch replacement (EAR) and hemiarch replacement (HAR) are surgical options for type A acute aortic dissection (AAD). However, the effectiveness of EAR compared with HAR, particularly in elderly patients, remains unclear owing to its invasiveness and complications. This study aimed to compare the postoperative outcomes of EAR and HAR in elderly patients with type A AAD.

Methods: This retrospective cohort study used data from the Shizuoka Kokuho Database, a prefecture-wide, multi-institutional administrative claims database managed by the Shizuoka Prefectural Government. We identified patients aged ≥60 years with type A AAD who underwent HAR or EAR between April 2012 and September 2022. Propensity score matching (PSM) was employed to balance the baseline characteristics between the groups. The primary outcome was all-cause mortality. The secondary outcome included the incidence of reoperation for bleeding.

Results: A total of 774 patients were included (174 undergoing EAR and 600 undergoing HAR). After PSM, 167 matched pairs were analysed. Kaplan-Meier curves revealed no significant differences in survival between both procedures (log-rank test, P = .739). Cox proportional hazards analysis also revealed no significant differences in all-cause mortality between the EAR and HAR groups (hazard ratio: 1.08, 95% confidence interval: 0.70-1.66). However, the incidence of reoperation for bleeding was higher in the EAR group than in the HAR group (20 [12.0%] vs 7 [4.2%], P = .012).

Conclusions: Although no statistically significant difference in postoperative mortality was observed between EAR and HAR, the incidence of reoperation for bleeding was higher in the EAR group. Therefore, the indication for EAR in elderly patients with type A AAD should be considered with caution.

Objectives: To report an initial experience with a novel off-the-shelf single branched thoracic aortic stent graft preserving various aortic arch vessels.

Methods: Our study is a retrospective cohort analysis of the largest European case series to date. We treated twenty patients for various aortic arch and descending pathology in the year 2024 and 2025.

Results: Twenty patients underwent successful implantation of the thoracic branched endoprosthesis (TBE) in the aortic arch and descending thoracic aorta. The sidebranch was applied to preserve the left subclavian artery in 17 patients, the innominate artery in two and the left carotid artery in one patient. Patients were treated for saccular arch aneurysms, chronic type B dissections with progressive dilatation, type 1a endoleaks after TEVAR, degenerative thoracic aneurysms, localized type A dissections or a first stage Crawford type II thoraco-abdominal aneurysm repair followed by a subsequent visceral branched endoprosthesis. The median follow-up period was six (1-12) months and technical results were satisfying. All TBE stentgrafts were implanted in the desired position with a patent branch on computed tomography angiography (CT-A) scan six weeks postoperatively. There was no in-hospital or 30-day mortality. Unfortunately, two patients suddenly died seven and eight weeks postoperatively of unknown causes. CT-A scan at six weeks showed no abnormalities concerning the aorta or TBE in both patients.

Conclusions: The present study demonstrates satisfying technical results with the GORE TBE which was successfully implanted for multiple indications of aortic arch or descending pathology. Longer follow-up and larger series are needed for verification.

This brief communication follows 5 individuals who underwent en bloc removal of the sternum and insertion of a customized 3-dimensonal printed implant. This paper focuses on the materials and operative techniques that were adopted to reconstruct and fit each of these sternums. A total of 5 patients underwent this procedure. Three of the patients were women who suffered from sternal damage due to oligometastasis from breast cancer. Another patient developed a metastasis from a thyroid cancer, and the final patient suffered from a chondrosarcoma of the sternum. All 5 operations were performed by 1 cardiothoracic surgeon. Of note, the surgical materials used by this surgeon shifted from titanium to StarPore over the course of performing the 5 operations. StarPore is a porous high-density polyethylene implant that can be customized to the patient. The main limitations of this implant are cost, potential delay to the operation and limited cases/evidence. With only a few cases of sternal reconstruction by 3D printing documented to date, this case series provides an important body of literature. This brief communication discusses the materials used and the operative technique that is most appropriate when reconstructing a sternum.

Objectives: To provide a European-focused overview of the role of patient advocacy groups in shaping surgical lung cancer care, highlighting their contributions to multidisciplinary care, equitable access, psycho-social support, and patient-centred research.

Methods: We conducted a narrative review of the major European and national lung cancer advocacy organizations, integrating perspectives from patient leaders and thoracic surgeons. The analysis focused on initiatives directly impacting thoracic surgery and perioperative care, with attention to education, prevention, survivorship, and research advocacy.

Results: Multiple advocacy organizations have significantly influenced lung cancer care with relevance to surgery. Oncogene Cancer Research (UK) promotes transparent information and shared decision-making around surgical options across all disease stages. Women Against Lung Cancer in Europe delivers large-scale initiatives such as European Program for ROutine testing of Patients with Advanced lung cancer, expanding molecular testing and psycho-social support across several European countries. The Israeli Lung Cancer Foundation secured national low-dose CT screening and mandatory multidisciplinary team review for early-stage patients. In Greece, FairLife launched the BREATH program, providing structured psycho-social support integrated with surgical pathways. Longkanker Nederland advances shared decision-making through national decision aids, patient-reported outcomes, and guideline development. ALK Positive UK develops tailored education for patients and clinicians, addressing the impact of biomarker status on surgical pathways. At the European level, Lung Cancer Europe drives large-scale surveys, awareness campaigns, and collaborations with European Society of Thoracic Surgery to embed patient perspectives into surgical discussions.

Conclusions: Patient advocacy is increasingly shaping thoracic surgery in Europe, bridging gaps in communication, equity, and research. By collaborating with advocacy organizations, surgeons can deliver more integrated, communicative, and patient-centred care, ensuring that surgical innovation aligns with the lived experiences and priorities of patients.

Objectives: Hybrid operating rooms (HORs) incorporating robotic C-arm systems facilitate concurrent localization and resection of small pulmonary nodules, albeit with significant cost barriers. Contemporary mobile 3 D C-arm systems may provide superior soft tissue visualization with enhanced economic viability and accessibility. This prospective single-arm clinical pilot trial was designed to assess the technical feasibility, clinical efficacy, and procedural safety of employing mobile 3 D C-arm technology for single-stage localization and excision of small pulmonary nodules.

Methods: Patients presenting with small and/or deep-seated lung tumors necessitating preoperative localization were eligible for inclusion. Two distinct mobile 3 D C-arm systems (Cios Spin and Ziehm Vision RFD 3 D) were employed. The primary end-points included the rate of successful tumour localization and the time required to complete the localization procedure. Secondary end-points encompassed perioperative complications and radiation exposure.

Results: The study cohort included 41 patients with lung tumors measuring a median diameter of 7.30 mm (interquartile range [IQR]: 5.00-9.20 mm) and a median depth of 10.00 mm (IQR: 2.00-18.00 mm). Successful localization was achieved in 40 patients, yielding a success rate of 97.6%. In one case, inadequate lesion visualization using the mobile 3 D C-arm necessitated localization in a hybrid operating room. The mean localization time was 27.17 ± 10.38 min, and the median radiation exposure was 531.04 μGy m2 (IQR: [297.12-870.98] μGy m2). All patients were successfully discharged, with a median postoperative hospital stay of 3 days (IQR: 3-3 days).

Conclusions: Our results support the technical feasibility, clinical efficacy, and procedural safety of mobile 3 D C-arm systems for single-stage localization and resection of small pulmonary nodules.

Clinical trial registration number: ClinicalTrials.gov identifier: NCT04974632.

Objectives: Advances in imaging have expanded options for diagnosis and therapy, including wedge resection of small pulmonary nodules. Cone-beam computed tomography (CBCT) can substitute for hybrid operating rooms (ORs) to identify impalpable nodules. We report the initial clinical use of a portable CBCT system (Cios Spin, Siemens, Germany) for intraoperative localization of small pulmonary nodules.

Methods: Four patients (3 men, 1 woman; mean age, 68.3 years) with peripheral nodules were included. Under general anaesthesia, an initial pre-scan confirmed that the lesion was within the field of view. Thoracoscopic surgery was initiated, and a surgical clip was placed on the visceral pleura at the site predicted from preoperative computed tomography (CT) to be closest to the tumour. During surgery, the C-arm was removed and later repositioned for intraoperative scanning.

Results: All nodules, 1.4-cm ground-glass, 2.0-cm part-solid, and two 0.7-cm, were clearly visualized, with image quality comparable to preoperative CT. The portable system accommodated table flexion and lateral decubitus positioning. No complications occurred, and radiation exposure, measured in one case, was acceptable.

Conclusions: To our knowledge, this is the first report to demonstrate that portable CBCT enables accurate, flexible, and real-time intraoperative localization of pulmonary nodules without requiring a hybrid OR.

Objectives: Atrial functional mitral regurgitation (MR) lacks well-defined treatment guidelines. Medical therapy alone is insufficient, and either TEER (transcatheter edge-to-edge) or surgery is recommended. Short- and long-term comparative outcomes remain unclear. We aim to address this gap using available data.

Methods: We performed a meta-analysis of studies examining the outcomes of surgery and/or transcatheter edge-to-edge. MEDLINE, EMBASE, and the Cochrane Library were assessed. The incidence rate of late severe MR was the primary outcome. A random model was performed. Leave-one-out, subgroup, and meta-regression analyses were conducted.

Results: Thirty-two studies (1923 patients); 20 in surgery (1166) vs 12 in TEER (757), were selected. TEER patients were, on average, 10 years older, with twice the rate of New York Heart Association Classification (NYHA) III/IV symptoms and more than double the Society of Thoracic Surgeons Risk (STS) score. At a weighted mean follow-up of 3.2 years, compared to isolated transcatheter, surgery was associated with decreased incidence of late severe MR (2.53 vs 6.66 events per 100 person-years, P-interaction = .03), late all-cause mortality (3.00 vs 8.84, P-interaction = .024), late heart failure hospitalization (4.44 vs 17.03, P-interaction < .01), and late NYHA III/IV (2.98 vs 22.47, P-interaction < .01). However, significantly better long-term outcomes associated with surgery showed high heterogeneity. There were no differences in early all-cause mortality, early cardiac-specific mortality, late cardiac-specific mortality, postprocedural morbidities, or atrial diameter. On meta-regression, preprocedural heart failure (β = 0.0224, P < .01) and coronary artery disease (β = 0.0294, P < .00001) were linked to increased late severe MR. Older age, hypertension, mitral valve replacement, and associated aortic valve surgery were linked to increased late all-cause mortality.

Conclusions: Surgery and isolated transcatheter edge-to-edge repair showed comparable short-term outcomes, with surgery appearing more effective long-term; however, due to study limitations and heterogeneity, these findings are hypothesis-generating and require validation through prospective studies.

Clinical registration number: PROSPERO website: CRD42024504022.

Objectives: The management of asymptomatic aortic stenosis (AS) is controversial. We perform a meta-analysis of reconstructed individual patient data to compare conservative treatment versus transcatheter or surgical aortic valve replacement (TAVR or SAVR) in asymptomatic AS.

Methods: PubMed/MEDLINE, Web of Science, Scopus, and Cochrane CENTRAL were systematically searched, through 25th September 2025, to identify any observational or randomized controlled studies that comply with our inclusion criteria. Our primary outcomes were short cardiovascular and non-cardiovascular mortality as well as long-term mortality. We combined aggregate data meta-analysis for dichotomous outcomes using incidence rate ratio (IRR) with reconstructed time-to-event data derived from published Kaplan-Meier curves using validated algorithms.

Results: Seventeen studies were included. Overall, AVR was associated with a significantly lower risk of all-cause mortality compared with conservative management (IRR = 0.43; 95% CI, 0.32-0.57; P < .001). Cardiovascular mortality was also significantly reduced with AVR (IRR = 0.47; 95% CI, 0.29-0.75; P < .01; I2 = 62%). The risk of heart failure hospitalization was markedly lower among AVR recipients (IRR = 0.39; 95% CI, 0.22-0.67; P < .01), with consistent benefit across study designs. AVR was further associated with a substantial reduction in sudden cardiac death (IRR = 0.13; 95% CI, 0.04-0.48; P < .01) and myocardial infarction (IRR = 0.11; 95% CI, 0.04-0.31; P = .03). The risk of stroke was not significantly different between groups (IRR = 0.77; 95% CI, 0.58-1.02; P = .07). Reconstructed Kaplan-Meier analyses demonstrated durable long-term survival benefit with AVR, consistent across surgical and transcatheter approaches.

Conclusions: Patients with asymptomatic AS, managed with either SAVR or TAVR, were associated with lower short- and long-term mortality compared to conservative management.

Aortic valve commissural avulsion is an exceptionally rare and often underdiagnosed cause of aortic regurgitation. We report a 30-year-old male with severe chronic aortic regurgitation and a mildly dilated aortic root, in whom intraoperative inspection revealed spontaneous avulsion of the right-noncoronary commissure. The patient underwent valve-sparing aortic root replacement using a combined approach: remodelling root replacement with external annuloplasty according to the Lansac technique, and targeted commissural reinforcement based on David principles. Postoperative and 6-month imaging showed stable root geometry, good leaflet coaptation, mild central regurgitation, and improved left ventricular function. This case highlights the diagnostic value of multimodality imaging and illustrates that tailored application of established valve-sparing techniques can achieve durable repair in rare commissural lesions.

Objectives: Neoadjuvant chemo-immunotherapy is associated with oncologic benefits in patients undergoing resection for locally advanced non-small cell lung cancer (NSCLC). We assessed patient-reported physical and psychological symptoms following neoadjuvant chemo-immunotherapy and surgery compared to stage-equivalent patients who were operated during the same period without neodjuvant treatment.

Methods: All consecutive patients submitted to lung resection for clinical stage II and III NSCLC between March 2023 and December 2024 and alive at the time of the interview were approached for the study. Their patient-reported symptoms were assessed using the Non-Small Cell Lung Cancer Symptom Assessment Questionnaire (NSCLC-SAQ) and their psychological distress was assessed using the Hospital Anxiety and Depression Scale (HADS).

Results: Of the 138 patients initially screened, 82 completed the survey. Median time from surgery to the interview was 13.9 months. There was no difference in total NSCLC-SAQ score between patients undergoing upfront surgery (S) and surgery after neoadjuvant chemo-immunotherapy (CT-IO) (P = .64). Chemo-immunotherapy was not independently associated with total NSCLC-SAQ score after multivariable regression analysis. The average anxiety and depression scores were also similar between the 2 groups. Finally, a similar proportion of patients in the 2 groups reported to have symptoms similar or better than before starting treatment.

Conclusions: Our findings show in a real clinical practice setting that neoadjuvant chemo-immunotherapy is not negatively associated with patient-reported physical or psychological symptoms in the medium to long-term follow-up compared to surgery alone. These results can be used as information tool during patients' counselling.