Interdisciplinary cardiovascular and thoracic surgery最新文献

Objectives: Transcatheter aortic valve-in-valve is frequently performed in degenerated surgical valves. Notably, in small-sized surgical valves, bioprosthetic valve fracturing can improve the functional results of the transcatheter heart valve (THV). Therefore, this study aimed to investigate the impact of an expandable surgical valve on the functional improvement of 2 THV models.

Methods: An Inspiris Resilia (21 mm) and 2 different THV models-the self-expanding Evolut-PRO and the balloon-expandable SAPIEN 3 (each 23 and 26 mm)-were used for hydrodynamic testing at 4 different circulatory conditions in a pulse duplicator. Mean pressure gradient (MPG), effective orifice area (EOA), geometric orifice area (GOA), minimal internal diameter (MID), and pin-wheeling index (PWI) of the THVs were analysed before and after expansion of the Inspiris Resilia with a non-compliant balloon (6 atm). Leaflet kinematics were evaluated by high-speed video recording. The internal and external diameters of Inspiris Resilia were measured with a calliper gauge. Fluoroscopic images were recorded.

Results: The Inspiris Resilia showed 2 mm enlarged internal and external stent diameters after expansion, which are fluoroscopically visible. EOA and MPG of the THVs as valve-in-valve did not change significantly after the expansion of the Inspiris Resilia. However, the Inspiris Resilia expansion improved leaflet kinematics, resulting in an increased GOA and a decreased PWI of the THVs as valve-in-valve.

Conclusions: The expansion of the Inspiris Resilia enlarged the stent diameter, resulting in improved leaflet kinematics of the THVs as valve-in-valve. These findings may be helpful for valve-in-valve interventions, especially in small-sized surgical valves.

Objectives: This study develops a visual scoring system based on chest computed tomography (CT) findings to assess donor lung function and explores its use for brain-dead donors.

Methods: We conducted a retrospective cohort study of 151 donors after brain death managed by our local Organ Procurement Organization from January 1 to June 30, 2024. A multidisciplinary team developed a chest CT evaluation protocol based on Fleischner Society guidelines. Lung lesions were scored lobe-by-lobe for statistical analysis.

Results: Of 151 potential donors, 56 (37.09%) underwent lung transplantation. Transplanted lungs had a higher proportion of blood type O, better oxygenation index, lower C-reactive protein and procalcitonin level, and lower CT scores compared to non-transplanted lungs. A higher total lung score (TLS) was strongly and negatively associated with lung utilization (OR 0.643, P < .001). ROC curve analysis indicated good discriminative ability for the TLS alone (AUC = 0.803). Our findings establish that chest CT visual scoring is a valuable univariable tool for assessing lungs from brain-dead donors. Based on the CT scoring results, the overall utilization rate of potential lung lobes reached 79.22%.

Conclusions: In the evaluation of donor lungs, a high TLS demonstrates a significant negative univariable association with lung utilization rates and exhibits good univariable diagnostic accuracy. The TLS has the potential to serve as a powerful and practical screening tool for donor lung assessment. Our findings suggest that chest CT visual scoring holds potential importance in assessing lungs from brain-dead donors and provides meaningful insights into the evaluation of donor lung lobes. However, further studies with larger sample sizes are required to explore these findings in greater depth.

Objectives: We analysed our long-term experience with heart transplantation (Htx) utilizing 3 different cardioplegic solutions.

Methods: During a 20-year period, 538 adult individuals underwent isolated Htx at our institution. Ten cases in which the Organ Care System TransMedics Inc was utilized were excluded, resulting in a final cohort of 528 individuals. Patients were stratified into 3 groups according to the donor heart cardioplegic solution: Celsior (n = 301; reference group), HTK-Custodiol (n = 88), and St Thomas (n = 139). Mean follow-up period was 6.2 ± 5.5 years (maximum 20 years).

Results: The rate of severe primary graft dysfunction (PGD) was 10.2% in the HTK-Custodiol group, significantly higher than the reference group (4.5%; P < .040). Overall, in-hospital mortality was 12.9%: 13.6% in the HTK-Custodiol group and 12.9% in the St Thomas group, comparable to the reference group (P = .803 and P = .924). Survival at 1, 5, and 12 years in the Celsior and HTK-Custodiol groups was 82.6 ± 2.2% vs 85.2±3.8%, 79.4 ± 2.4% vs 82.1 ± 4.3%, and 66.8 ± 3.3% vs 62.9 ± 7.3%, respectively (P = .706). Survival at 1, 5, and 12 years in the St Tomas group was 81.5 ± 3.4%, 71.9 ± 4.1%, and 65.5 ± 5.2%, respectively, comparable to the reference group (P = .640). Post-transplant rejection rate was similar among the groups.

Conclusions: The use of HTK-Custodiol solution was associated with a significantly higher incidence of PGD when compared to Celsior solution, although this data had no impact on in-hospital mortality. Long-term survival and post-transplant rejection were comparable among the 3 groups. HTK-Custodiol solution should be used with caution for preservation of donor hearts.

Erb approval number: 215-29042020; May 5, 2020.

Objectives: This retrospective study investigated whether phrenic nerve repair with intercostal nerve graft affects postoperative diaphragmatic motion and respiratory function after thoracic tumour resection.

Methods: We included 11 consecutive patients (reconstruction group: n = 8; nonreconstruction group: n = 3) who underwent thoracic tumour resection with phrenic nerve removal between October 2023 and March 2025. In the reconstruction group, the intercostal and phrenic nerves were connected end-to-end using 5-0 or 6-0 Prolene sutures. Postoperative respiratory function, inspiratory/expiratory diaphragm movement distance (IEDD), and inspiratory/expiratory lung area (IEA) ratio on chest X-ray were measured using SYNAPSE VINCENT and compared between the 2 groups.

Results: No significant differences in age, sex, and side of phrenic nerve resected were observed between the 2 groups. IEDD ≥10 mm within 1 month postoperatively was seen in 4 (50%) patients in the reconstruction group. Mean IEDD on X-ray was 19.8 mm vs 4.1 mm (P = .013) at 1-3 months and 19.8 mm vs 4.4 mm (P = .031) at 4-6 months for the reconstruction and nonreconstruction groups, respectively. Mean IEA ratios were 1.16 vs 1.04 (P = .026) at 1-3 months and 1.19 vs 1.05 (P = .031) at 4-6 months, respectively. Postoperative respiratory function showed higher %VC (78% vs 56%, P = .008) and %FEV1 (72% vs 45%, P < .001) in the reconstruction group at 4-6 months.

Conclusions: Phrenic nerve repair with intercostal nerve graft mitigated diaphragmatic dysfunction and maintained postoperative respiratory function after phrenic nerve resection.

Clinical registration number: 2024 Eki-102.

Objectives: We aimed to describe the anatomical distance between the mitral annulus and the left circumflex coronary artery (LCX) using multiplanar reconstruction (MPR) of transoesophageal echocardiography (TEE) images and to investigate its association with mitral annular disjunction (MAD).

Methods: A single-centre retrospective cohort study included 54 patients who underwent mitral valve repair for mitral regurgitation between January 2020 and July 2021. We measured the distance between the mitral annulus and the LCX (ML distance) using MPR of intraoperative TEE images. As an exploratory analysis, we compared the ML distance between patients with MAD (group D: N = 11) and those without (group N: N = 43).

Results: The LCX was closest to the mitral annulus at 70-90 degrees counterclockwise from the anteroposterior axis. No cases of LCX injury were observed. MAD was most frequently observed at P1, and all patients in group D had disjunction at P1. The minimum ML distance was significantly shorter in group D than in group N (3.2 [1.1] mm in group D, and 4.9 [2.1] mm in group N). Overall, the ML distance was shorter in group D than in group N, and was significantly shorter at 70-100 degrees.

Conclusions: MPR of intraoperative TEE images is a less invasive and useful tool to detect patients with a short ML distance. The area of the closest distance from the mitral annulus to the LCX is near the anterolateral commissure, especially in patients with MAD.

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: 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: 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.