Interdisciplinary cardiovascular and thoracic surgery最新文献

Thymic hyperplasia with lymphoepithelial sialadenitis-like features (LESA-like TH) is a rare benign thymic lesion sometimes associated with autoimmune diseases or mucosa-associated lymphoid tissue lymphoma. A 47-year-old man was incidentally found to have 2 anterior mediastinal masses. Contrast-enhanced computed tomography (CT) showed irregularly walled cysts, and positron emission tomography-CT demonstrated partial fluorodeoxyglucose (FDG) uptake. A total thymectomy was performed, and histopathology confirmed LESA-like TH. This is the first report to document both imaging-visible multiplicity and FDG avidity in LESA-like TH, which broadens the recognized imaging spectrum of this rare thymic lesion.

Left-handed cardiac surgery has been a rising topic. Training necessities pertaining to left-handed cardiac surgery education and mentorship are crucial to this group of surgeons. Through initiatives of experienced left-handed cardiac surgeons in association with the EACTS, a left-handed learning lab at the EACTS annual meeting was developed. This skills lab training is dedicated to offering left-handed surgeons a space which offers both technical development and career networking. In this short communication, we detail lessons learned and future insights into left-handed cardiac surgery education through hands-on training.

Objectives: Chronic kidney disease requiring dialysis significantly increases the risks of coronary artery disease. However, there is limited data on this high-risk patient population requiring coronary artery bypass grafting. Using a UK national registry, we investigated the impact of preoperative dialysis on in-hospital mortality and early morbidity in patients undergoing coronary artery bypass graft (CABG).

Methods: A retrospective analysis of National Adult Cardiac Surgery Audit data between January 1996, 2, and March 31, 2019, identified patients who underwent first-time isolated CABG. Propensity matching was performed to balance the baseline characteristics between dialysis and non-dialysis patients, yielding 633 matched pairs. We evaluated trends in CABG among dialysis patients and EuroSCORE 2 performance in predicting in-hospital mortality (calibration, discrimination, and clinical utility).

Results: There was a steep increase in CABG operations in dialysis patients after 2011. EuroSCORE 2 showed poor calibration, discrimination, and minimal clinical benefit in predicting mortality in dialysis cases. Dialysis patients exhibited a significantly higher in-hospital mortality rate (7.9% vs 2.1%, P < .001) than non-dialysis patients. The dialysis patients had longer median hospital stays (12 vs 9 days, P < .001) and a higher rate of return to the theatre for bleeding (5.5% vs 2.7%, P = .034). We found no difference in postoperative neurological deficit rates between the 2 cohorts. The odds ratio of in-hospital mortality for the dialysis vs non-dialysis patients was 4.62, P < .001, 95% (CI: 2.54-8.4). Significant predictors of mortality in the dialysis CABG cohort included advanced age (OR: 2.48), New York Heart Association class IV (OR: 3.06), and pulmonary hypertension (OR: 11.91).

Conclusions: There has been an overall increase in coronary artery bypass operations performed in renal dialysis-dependent patients in the UK. Preoperative chronic dialysis is associated with considerable in-hospital mortality, return to theatre for bleeding and prolonged hospital stay. EuroSCORE 2 has poor predictive performance in this patient cohort.

Objectives: The arterial switch operation (ASO) is the standard treatment for transposition of the great arteries (TGA), requiring robust myocardial protection due to the neonatal myocardium's vulnerability to ischaemia. This study compares the myocardial protective efficacy of Custodiol, Del Nido, and cold intermittent blood cardioplegia in neonates undergoing ASO.

Methods: We retrospectively analysed 133 neonates with TGA undergoing ASO (2013-2024) at 4 Turkish centres, grouped by cardioplegia: cold blood (n = 47), Custodiol (n = 44), or Del Nido (n = 42). Outcomes included aortic cross-clamp and cardiopulmonary bypass times, troponin I, CK-MB, inotropic support, and ventilation duration.

Results: Custodiol and Del Nido had shorter cross-clamp (70.4 (8.5) vs 68.7 (7.9) vs 78.2 (9.1) minutes, P < .001) and bypass times (P = .004), lower troponin I (4.2 (1.3) vs 4.0 (1.5) vs 6.8 (1.9) ng/mL, P < .001), reduced inotropic needs (P < .001), and shorter ventilation/intensive care unit stays (P ≤ .010). Mortality was similar (P = .47).

Conclusions: Custodiol and Del Nido cardioplegia strategies provided favourable outcomes compared to cold blood cardioplegia in neonates undergoing ASO, with implications for optimizing myocardial protection protocols in this population.

Objectives: Cardiac myxomas are rare primary heart tumours, most commonly originating in the left atrium. A smaller proportion occurs in the left ventricle, where they are even more uncommon and present unique diagnostic and therapeutic challenges. This systematic review aims to characterize the clinical features, management strategies, and outcomes of left ventricular cardiac myxomas.

Methods: A systematic search of the PubMed database was conducted to identify articles published up to May 2025. A total of 174 cases of surgically treated left ventricular myxomas were included. Data were extracted on patient demographics, tumour characteristics, surgical approaches, and follow-up outcomes.

Results: Patients showed a broad geographic distribution, with the highest number of cases reported from the United States. The mean age was 38.2 ± 20.37 years, with a slight female predominance (48.9%). Tumours were most commonly attached to the left ventricular wall (43.7%) and inter-ventricular septum (25.3%). Complete surgical excision was achieved in 92.5% of cases and was strongly associated with survival; nearly all patients with complete resection survived, compared to only 20% among those without. Overall postoperative survival was high (83.9%), with a low mortality rate (2.9%). Survival rates were comparable across genders and age groups, although paediatric patients had a slightly higher mortality rate (9.1%).

Conclusions: This systematic review represents the most comprehensive analysis to date of surgically treated left ventricular myxomas. The findings highlight the importance of complete excision in achieving favourable outcomes and highlight demographic and geographic patterns that can inform clinical suspicion, surgical planning, and patient counselling.

Objectives: To compare postoperative outcomes between hydrogel-coated chest drains (HCDs) and conventional non-coated drains (NCDs) in patients undergoing general thoracic surgery, using a propensity score-matched analysis.

Methods: This retrospective multi-institutional study included adult patients who underwent thoracic surgery across 4 European centres between February and September 2022. Patients were grouped according to drain type (HCD vs NCD), and a propensity score-matched analysis was performed to account for 16 preoperative and intraoperative covariates. The primary outcome was length of postoperative hospital stay (LOS). Secondary outcomes included in-hospital complications, intensive care unit (ICU) admission, chest drain reinsertion, readmission, duration of drainage, and in-hospital mortality. Subgroup analysis was performed in patients undergoing anatomical lung resections.

Results: A total of 773 patients were included (HCD n = 362; NCD n = 411). After matching, 724 patients were analysed. HCD use was associated with a significantly shorter LOS (average treatment effect of the treated population -1.87 days; 95% CI -3.04 to -0.695; P = .002), lower odds of ICU admission (odds ratio [OR] 0.29; 95% CI 0.16-0.53; P < .001), and lower in-hospital complication rates (OR 0.38; 95% CI 0.26-0.55; P < .001). Rates of pneumonia (5.2% vs 13.4%; P = .001), atrial fibrillation (2.2% vs 9.0%; P < .001), and retained pleural effusion (0.8% vs 3.6%; P = .015) were significantly lower in the HCD group. There were no significant differences in drain duration, readmission, or mortality. In the anatomical resection subgroup, HCDs were similarly associated with reduced LOS and complications.

Conclusions: Hydrogel-coated drains are associated with fewer postoperative complications and shorter hospital stay compared to conventional drains, particularly in anatomical lung resections. These findings support further prospective evaluation to define the role of HCDs in routine thoracic surgical practice.

Objectives: Lung volume reduction surgery (LVRS) is guided by strict selection criteria from the National Emphysema Treatment Trial (NETT) to minimize risk and optimize outcomes. However, emerging evidence suggests that rigid cutoffs may exclude patients who could benefit. This study aimed to identify beyond-criteria patients undergoing LVRS and compare their outcomes with standard-criteria patients.

Methods: This single-centre retrospective analysis of a prospectively maintained database included all LVRS procedures from August 2019 until November 2024. Patients were classified as beyond-criteria if they met two or more of the following: age ≥ 75 years, body mass index (BMI) < 18.5 kg/m2, forced expiratory volume in 1 second (FEV1) < 20%pred, diffusing capacity for carbon monoxide (DLCO) < 20%pred, 6-minute walk distance (6MWD) < 140 m, homogeneous emphysema, systolic pulmonary arterial pressure (sPAP) > 35 mmHg, or prior thoracic interventions. Complications (Clavien-Dindo) and functional outcomes were assessed at 3, 6, and 12 months.

Results: Twenty-one procedures were performed in 18 beyond-criteria patients versus 227 procedures in 191 standard-criteria patients. Among beyond-criteria patients: age ≥ 75 years (n = 3), BMI < 18.5 kg/m2 (n = 10), FEV1 < 20%pred (n = 5), DLCO < 20%pred (n = 1), 6MWD < 140 m (n = 1), homogeneous emphysema (n = 3), sPAP > 35 mmHg (n = 12), and prior thoracic intervention (n = 7). Complication rates were comparable (38% vs. 42%, P = .819 [95% CI, 0.93-1.10]), as were prolonged air leaks and hospital stay. One 30-day LVRS-related death (0.4%) occurred in the standard group. Functional and quality of life measures improved in both groups.

Conclusions: Beyond-criteria patients can be considered for LVRS when guided by careful multidisciplinary evaluation, with meaningful improvement in experienced centers.

Objectives: Mechanical valve replacement is often used as the therapeutic option in valvular heart surgery in children. Evidence suggests that this should change to provide optimal long-term survival for this growing population. We reviewed our current practice in valve repair in congenital heart disease and analysed its outcomes.

Methods: A total of 90 patients (30 semilunar valve and 60 atrioventricular [AV] valve) underwent valve repair between September 2020 and December 2024. Operative data and follow-up information were gathered retrospectively. Kaplan-Meier calculations were used for survival and freedom from reoperation analysis. Cox regression analysis was used to assess risk factors for mortality (single ventricle physiology, age and weight at time of surgery, bicuspid aortic valve, and complexity of repair). Complexity of repair was defined as the application of 3 or more repair techniques.

Results: Estimated survival at 12 months for semilunar and AV valve groups was 95.2% and 95%, respectively. Estimated freedom from reoperation at 12 months for repair of semilunar and AV valves was 95.8% and 95.6%, respectively. Single ventricle morphology (HR [hazard ratio], 5.2; 95% confidence interval [CI], 1.3-20.8; P = .0198) and younger age at time of surgery (HR, 0.7; 95% CI, 0.6-0.9; P = .0223) were associated with increased risk of mortality.

Conclusions: Valve repair in congenital heart disease provides reliable early outcomes in this complex population. The worst outcomes are expected in patients with single ventricle requiring surgery in early life.