Interdisciplinary cardiovascular and thoracic surgery最新文献

Objectives: Acute type A aortic dissection (ATAAD) carries high mortality, with emergency surgery being the cornerstone of treatment. The German Registry for Acute Type A Aortic Dissection (GERAADA)-score is advocated in guidelines to predict 30-day mortality after ATAAD surgery. This study investigates its performance in a Dutch cohort, with an emphasis on malperfusion definitions, age groups, and sex.

Methods: Adults undergoing emergency surgery for ATAAD at 5 Dutch centres (2007-2024) were included in a multicentre database. External validation of the GERAADA-score was performed with these data, using discrimination (area under the curve [AUC]) and calibration (Brier score, Hosmer-Lemeshow test, and calibration plots). A logistic regression with GERAADA variables was fitted on the study population, and assumptions were checked. Subgroup analyses were conducted based on sex, age groups, and malperfusion definitions (including imaging and clinical definitions).

Results: A total of 1,146 patients underwent emergency surgery for ATAAD. Observed early mortality was 16.9% (n = 194). Of 1,130 patients included in the external validation cohort, 92.2% had low-intermediate risk (GERAADA-score ≤ 30%). The GERAADA-score showed moderate discrimination (AUC = 0.649, 95% confidence interval = 0.604-0.694), with a higher AUC for younger patients (50-59 years). The malperfusion definition including ischaemia confirmed by imaging showed the best discriminative power. Calibration was good (Hosmer-Lemeshow, P = .754, Brier score = 0.131). Logistic regression identified age, catecholamine use, ventilation support, and coronary and peripheral malperfusion as independent risk factors for 30-day mortality, with signs of multicollinearity between preoperative catecholamine use and resuscitation.

Conclusions: In the Dutch setting, the GERAADA-score demonstrated moderate discriminative power and good calibration across relevant subgroups. Adaptations of the GERAADA-score, including conducting a haemodynamic instability variable, may be considered to avoid redundant predictions and boost reproducibility.

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: This study evaluates intermediate-term survival and valve-related complications in patients undergoing minimally invasive surgical aortic valve replacement (MI-SAVR) using rapid-deployment (RD) valves compared with those receiving transfemoral transcatheter aortic valve replacement (TF-TAVR) after propensity-matched analysis.

Methods: All consecutive patients treated with either isolated MI-SAVR with an RD valve or TF-TAVR at a single cardiac-surgery centre were retrospectively reviewed. A propensity score was created, and exact matching was applied after the maximum propensity score difference. Nearest-neighbour matching was conducted with a caliper of 0.2 standard deviations of the logit of the propensity score, without replacement and with a 1:1 matching ratio.

Results: From April 2011 to June 2022, 926 patients underwent either isolated MI-SAVR with an RD valve (n = 400) or TF-TAVR (n = 526). After propensity score matching, the final cohort (n = 366) included 183 matched pairs. Operative mortality was 0% after MI-SAVR compared with 3.3% (n = 6) following TF-TAVR (P = .03). Perioperative stroke occurred in 2.7% (n = 5, MI-SAVR) vs 2.2% (n = 4, TF-TAVR, P = 1). At 3 years, MI-SAVR was associated with significantly lower rates of paravalvular leakage (2.2% vs 13.8%, P < .001), new pacemaker implantations (6.6% vs 14.8%, P = .01) and a composite end-point of thromboembolic and major bleeding events (7.2% vs 12.7%, P = .025). No difference between aortic valve re-interventions and stroke was identified between groups. Survival at 1- and 3-year follow-up was 98% and 88% (MI-SAVR) and 88% and 67% (TF-TAVR) respectively (P < .001). EuroScore II emerged as an independent predictor of mortality (HR 1.12 [1.02, 1.23], P = .014).

Conclusions: Minimally invasive SAVR with RD-valves could represent a treatment modality to TF-TAVR for severe AS in an older, low-risk patient cohort. In our retrospective cohort study, MI-SAVR was linked to improved survival and lower rates of permanent pacemaker implantation and paravalvular leakage.

A neonate who underwent corrective surgery for cardiac-type total anomalous pulmonary venous connection (TAPVC) was suspected of having a pseudoaneurysm of the left ventricular (LV) free wall on transthoracic echocardiography (TTE) on postoperative day 11. Emergency surgery was performed the following day, revealing LV rupture due to a congenital partial defect of the LV free wall. The defect was successfully repaired using double-patch closure reinforced with BioGlue. The postoperative course was uneventful. This case highlights that left ventricular rupture may occur due to an unrecognized congenital defect after neonatal cardiac surgery, particularly in conditions such as TAPVC, where the left ventricle is underfilled preoperatively.

Objectives: This study evaluates the nationwide outcome of single-vessel left anterior descending artery (LAD) revascularization through median sternotomy in the Netherlands and to analyse the impact of the surgical technique (off-pump versus on-pump).

Methods: A retrospective multicentre cohort study was conducted, including 2592 patients who underwent isolated coronary artery bypass surgery for single-vessel LAD disease from 2013 to 2022. Data were obtained from the Netherlands Heart Registration (NHR) database. The study analysed postoperative 30 days and 1 year mortality, postoperative complications, and 5-year postoperative outcome. Propensity score matching (PSM) was used to adjust for baseline differences between the off-pump (OPCAB) and on-pump (ONCAB) groups.

Results: In the total cohort, 30-day mortality was 0.9%, with a 1-year mortality of 1.9%. The distribution of surgical technique was stable during the study period (60% OPCAB and 40% ONCAB). After PSM, there was less need for perioperative blood transfusions with OPCAB (7.0% versus 16.5%, P < .001). There was no significant difference in 30-day mortality (0.7% versus 0.6%, P = .762) and 1-year mortality (1.5% versus 1.6%, P = .932) between OPCAB and ONCAB. The Kaplan-Meier analysis demonstrated significant difference in target vessel reintervention (TVR) in favour for ONCAB (P = .028) but no difference in survival.

Conclusions: Single-vessel LAD revascularization through median sternotomy in the Netherlands shows good procedural outcomes, comparable for both OPCAB and ONCAB. These data might serve as a benchmark for future studies on minimally invasive revascularization.

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: We report a rare case of a 52-year-old woman with a recurrent intimal sarcoma adjacent to the mitral prosthesis in the left atrium. She had previously undergone initial surgery for mitral valve intimal sarcoma at age 48.

Methods: At this presentation, we resected a 25-mm tumour as well as the surrounding lesions. Cryoablation was applied using cryoICE on all resection margins and the posterior mitral annulus.

Results: The use of a malleable probe facilitated the redo surgery. The patient has remained alive for more than 5 years following the initial operation and for 11 months after the subsequent redo surgery.

Conclusion: Cryoablation may play an important role in improving surgical radicality in cardiac sarcoma.

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: 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 decellularized 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 2 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 decellularized 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% (decellularized 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 (decellularized tendon-based biological ring).

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

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.