Interdisciplinary cardiovascular and thoracic surgery最新文献

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: 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: Large-scale comparative data on the perioperative safety of robotic-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery in Asia are limited. We compared the perioperative outcomes of these 2 approaches for lung cancer.

Methods: This retrospective study used data from the Diagnostic Procedure Combination database in Japan. We included 47 541 patients who underwent lobectomy or segmentectomy for lung cancer from 2018 to 2021 and performed multivariable analyses.

Results: Among 47 541 patients, 2835 underwent robotic-assisted thoracoscopic surgery. Perioperative mortality did not differ significantly between groups (incidence rate ratio, 1.71; 95% CI, 0.88-3.33). Robotic-assisted surgery was associated with longer anaesthesia time and a higher incidence of mechanical ventilation postoperatively (incidence rate ratio, 1.96; 95% CI, 1.36-2.81), although the absolute difference was small (Marginal risk difference, +0.52 percentage points; 95% CI, +0.14 to +0.91). No significant differences were observed in other major complications, reoperation, or hospital stay.

Conclusions: In this large, real-world Japanese cohort including the early experience with robotic surgery, overall perioperative safety was comparable between robotic-assisted and video-assisted thoracoscopic surgery, although a statistically significant but small absolute increase in postoperative ventilation was observed with the robotic approach. This association remained robust across a series of sensitivity analyses. However, it is likely influenced by unmeasured confounding. Future prospective studies should investigate specific procedural factors, including anaesthetic management and patient selection, to optimize outcomes.

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.

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.

Objectives: To assess the application of preoperative indocyanine green (ICG) near-infrared (NIR) fluorescence imaging in video-assisted thoracoscopic surgery (VATS) for posterior mediastinal neurogenic tumors.

Methods: We present a case of a 66-year-old female with a T3-adjacent posterior mediastinal tumor. She received intravenous ICG (5 mg/kg) 24 hours before surgery. Intraoperative NIR imaging was used to identify the tumor and nearby nerves during VATS.

Results: ICG fluorescence clearly delineated the tumor margins and visualized the adjacent sympathetic and intercostal nerves. This guided the complete resection of the tumor, which extended into the intervertebral foramen, with no postoperative complications. Pathology confirmed a schwannoma.

Discussion: ICG NIR imaging offers enhanced intraoperative visualization for complex posterior mediastinal tumors. It aids in distinguishing tumor from normal tissue and identifying key nerves, thereby facilitating complete resection while minimizing the risk of iatrogenic injury. This technique shows promise for managing "dumbbell" tumors via a minimally invasive approach.

Conclusion: Preoperative ICG injection is a useful adjunct in VATS for posterior mediastinal tumors, improving the delineation of tumor borders and neural structures to enhance surgical precision and safety.

Objectives: Tricuspid regurgitation (TR) is commonly encountered in patients with left-sided valve disease and often progresses postoperatively if left unaddressed. While mitral valve replacement (MVR) alone may improve left heart parameters, concomitant tricuspid ring annuloplasty (TRA) might prevent right-sided deterioration.

Methods: This retrospective study analysed 129 patients undergoing MVR between 2016 and 2019. Patients were divided into 2 groups: isolated MVR (n = 71) and MVR + TRA (n = 58). Long-term echocardiographic outcomes were compared, including LVDD, LVSD, LVEF, LA diameter, IVS thickness, pulmonary flow rate, PAP, and TI degree.

Results: Both the groups showed regression in left heart dimensions postoperatively; however, left ventricular ejection fraction (LVEF) significantly decreased in the MVR-only group (P < .001) while it remained stable in the MVR + TRA group (P =0.598). Severe tricuspid insufficiency occurred in 12% (95% CI 5%-21%) of patients undergoing isolated MVR and 0% (95% CI 0%-6 ) of those undergoing MVR + TRA (P < .001). The mean difference in the change of pulmonary artery pressure (ΔPAP) between the groups was 12.0 mmHg (95% CI 6.5-17.3, P = .002), and both pulmonary artery pressure and left atrial diameter significantly decreased postoperatively in the MVR + TRA group.

Conclusions: Performing TRA during MVR surgery offers significant protective effects against TI progression and right heart overload. Even in cases with mild TI but annular dilation, simultaneous TRA may be a rational and beneficial strategy to ensure long-term cardiac stability.

Objectives: As transcatheter aortic valve replacement (TAVR) expands to lower-risk populations, understanding contemporary patterns of complications requiring surgical intervention remains critical. This study examines the incidence, predictors, and outcomes of major TAVR complications.

Methods: The National Inpatient Sample (2016-2021) was queried to identify adult patients undergoing TAVR. Major complications were defined as surgical aortic valve replacement, coronary artery bypass grafting, aortic intervention, pericardial drainage, VA-ECMO, cardiac repair, or diagnosis of aortic dissection/rupture. Multivariable logistic regression identified predictors of complications and failure-to-rescue.

Results: Among 383 395 TAVRs, 4685 (1.2%) experienced major complications. Overall in-hospital mortality was 1.3%. Mortality was 26.0% in patients with major complications versus 1.0% without (P < .001). Stroke rates were also higher in patients with major complications (7.5% versus 1.8%, P < .001). Complications were associated with longer length of stay (8 vs 2 days) and higher hospital costs ($79,302 vs $45,469). Independent predictors of complications included age <65 (OR 2.27), bicuspid aortic valve (OR 1.79), thoracic aortic aneurysm (OR 1.49) and female sex (OR 1.24), while elective admission was protective (OR 0.51). Among patients with complications, VA-ECMO cannulation (OR 10.36), cardiac chamber repair (OR 3.14), and aortic dissection/rupture (OR 1.68) were strongest predictors of mortality.

Conclusions: While the proportion of TAVR patients experiencing surgical emergencies has remained stable over time, the overall prevalence is increasing with the growth of TAVR, and these complications are associated with an in-hospital mortality rate of greater than 25%. Younger age, female sex, bicuspid valve, and thoracic aneurysm are associated with increased risk of major complications.