Interdisciplinary cardiovascular and thoracic surgery最新文献

Introduction: Maintenance of donor lung pressure is recommended to maintain inflation pressures of 12-15 mm Hg. This is particularly important given graft transportation in aircraft, due to the inevitable pressure changes.

Case: We describe a case of a donor lung preservation system which maintained proper airway pressure during sudden cabin pressure loss requiring emergent landing.

Discussion: The donor lungs were implanted without complication. Post-transplant course was notable for primary graft dysfunction (PGD) grade 1 at 24 hours, grade 2 at 48 hours, and grade 1 at 72 hours. At 3 months post-transplant, the patient has had no respiratory complications and has been noted to be doing well.

Objectives: Selective pulmonary artery perfusion with blood flow occlusion (SPAP-BFO), an experimental endovascular technique, has shown potential to enhance pulmonary drug delivery to the lung. Therefore, it becomes a potential minimally invasive technique for lung cancer and pulmonary metastases. Prior studies predominantly used animal models which do not adequately replicate human vascular anatomy, leaving the clinical feasibility of SPAP-BFO underexplored. To address this gap, we developed a patient-specific 3D model of the human venous system to evaluate the technical feasibility of SPAP-BFO.

Methods: A 1:1 scale 3D model of the human venous system was developed and printed based on CT scans of a patient. This model was connected to a perfusion system to simulate blood flow, enabling testing of the catheterization procedure under realistic clinical conditions. Two commercially available balloon catheters, Coda (Cook) and Reliant (Medtronic), were selected based on length and balloon diameter, and their feasibility of reaching and occluding the left and right pulmonary arteries were assessed.

Results: The model effectively simulated human anatomy and blood flow, allowing for both visual and fluoroscopic assessment of the procedure. Both Coda and Reliant catheters successfully reached the target location, when introduced via the femoral vein, and occluded the left and right pulmonary arteries without physically blocking contralateral flow or extending beyond the first bifurcation.

Conclusions: This patient-specific 3D model provided a valuable platform to evaluate the clinical feasibility of SPAP-BFO. The Coda and Reliant balloon catheters demonstrated effective occlusion of the pulmonary arteries, supporting their potential use in SPAP-BFO procedures.

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.

Objectives: Sex differences in outcomes after transcatheter aortic valve implantation (TAVI) remain incompletely understood. Earlier studies described a "sex paradox," with women experiencing more procedural complications but similar or superior survival compared with men. However, most data derive from earlier device generations, and contemporary evidence is limited.

Methods: We retrospectively analysed all patients with severe aortic stenosis who underwent TAVI at the University Hospital of Angers between January 2012 and December 2023. Clinical and procedural characteristics were collected from a dedicated database. Propensity-score matching (1:1) was performed to account for baseline differences. The primary end-point was 30-day mortality.

Results: A total of 2718 patients underwent TAVI, of whom 49.1% were women. Women were older but had fewer comorbidities than men. After matching (1320 pairs), procedural duration was similar, but women more often required alternative access and received self-expandable valves. Thirty-day mortality did not differ between sexes, but all-cause mortality was significantly higher in men (P < .01). Women had a greater incidence of postoperative stroke, particularly in low-risk patients, whereas men had higher rates of acute renal failure and pacemaker implantation. The survival probability was higher for women in overall population and in low- and intermediate-risk patients.

Conclusions: In this large, contemporary cohort, women experienced more strokes, whereas men had higher all-cause mortality and conduction-related complications. These findings underscore persistent sex-specific differences in TAVI outcomes and highlight the need for tailored procedural strategies.

The patient was diagnosed with unguarded tricuspid orifice (UGTO), functional pulmonary atresia, and left pulmonary artery hypoplasia. In view of the severe right ventricular dysfunction, the staged single ventricular palliation procedure was selected. The surgical procedure on Starnes operation and left pulmonary artery augmentation was performed one month after birth. As left pulmonary artery stenosis was diagnosed, secondly, the bidirectional cavopulmonary shunt with additional systemic to pulmonary shunt and intrapulmonary patch septation and left pulmonary artery augmentation with in-situ pericardium were performed. Despite the necessity for additional balloon dilation and surgical blunt dilation, the total cavopulmonary connection operation was ultimately performed, resulting in the successful implementation of staged single-ventricle palliation in conjunction with left pulmonary artery rehabilitation.

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 analyzed 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 underwent 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 = .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 reduce 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 = .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 3 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 one or more of the following failure-to-rescue complications: acute renal failure, respiratory complications (prolonged ventilation >24 h, 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 < .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 = .035) and failure-to-rescue (OR 3.64, 95% CI 1.33-9.98, P = .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.