Interdisciplinary cardiovascular and thoracic surgery最新文献

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: To determine whether CT within 6 months after total arch replacement (TAR) with a frozen elephant trunk (FET) for chronic aortic dissection predicts mid-term outcomes and informs the timing of distal treatment.

Methods: We analysed 56 consecutive patients who underwent TAR with FET at 2 centres (2009-2022) and had evaluable 6-month postoperative CT. Early remodelling was defined as the change from baseline to 6 months in the maximal outer-to-outer diameter of the proximal descending thoracic aorta at Level A (Ishimaru zone 3, 20 mm distal to the left subclavian artery, measured on centreline-orthogonal reconstructions). Patients were classified as early positive remodelling (EPR; no increase or a decrease) or early negative remodelling (ENR; ≥1-mm increase). Prespecified outcomes were distal aortic reintervention, distal stent graft-induced new entry (dSINE), and overall survival.

Results: Mean follow-up was 5.4 years (standard deviation 3.7). Distal reintervention was required in 36/56 patients (64%). At 5 years, freedom from distal reintervention was higher with EPR than with ENR (44.6% vs 6.2%; P = .003). dSINE occurred in 26/56 patients (46.4%); 5-year dSINE-free survival was 65.1% (95% CI, 39.6-81.9) with EPR versus 18.2% (95% CI 5.9-35.2) with ENR (P = .008). Overall, 5-year survival for the cohort was 80.0% (95% CI 64.7-89.2). Among ENR patients, 5-year survival was 0% with conservative management versus 40.5% with distal intervention (P < .001); within EPR, 5-year survival was 65.9% with conservative management versus 85.7% with reintervention (P = .210).

Conclusions: A 6-month CT provides simple, actionable risk stratification after TAR with FET for chronic aortic dissection. Absence of EPR identifies a high-risk subgroup (ENR) that warrants closer surveillance and timely distal intervention, optimizing follow-up intensity and treatment timing.

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: Preoperative left atrial (LA) strain parameters measured by 2-dimensional speckle tracking echocardiography have been used to predict postoperative atrial fibrillation (POAF) after cardiac surgery. The aim of this meta-analysis was to determine whether preoperative LA strain parameters predict POAF after cardiac surgery.

Methods: PubMed, Embase, Cochrane database, and Google Scholar were searched manually until January 31, 2025. Studies where preoperative LA strain was used to predict POAF following cardiac surgery in adults were considered. Reviews, case series, case reports, and studies where patients were in preoperative atrial fibrillation were excluded.

Results: Twenty-four observational studies involving 2242 patients were included. Preoperative LA reservoir strain was significantly lower in patients with POAF vs those without POAF (standardized mean difference [SMD] -2.37; 95% confidence interval [CI] -3.87 to -0.88; I2 = 94.5%). Preoperative LA conduit (SMD -0.73; 95% CI, -1.06 to -0.39; I2 = 41.5%) and contraction (SMD -1.04; 95% CI, -1.81 to -0.27; I2 = 92.2%) strain were significantly lower in patients with POAF while preoperative LA reservoir, conduit, and contraction strain rates were not different in patients with POAF vs no POAF. Meta regression for heterogeneity in reservoir strain was significant for gender, vendor platform, and filling pressures (E/e'). The cut-off value of LA reservoir strain for predicting POAF was 22 to 25% (area under curve 0.69, specificity 0.679 [95% CI, 0.645 to 0.711], sensitivity 0.713 [95% CI, 0.675 to 0.743]).

Conclusions: Preoperative LA reservoir, conduit, and contraction strain predict POAF in adults undergoing cardiac surgery.

Prospero registration no: CRD42024606011.

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.

This case report presents an instance of pleural epithelioid hemangioendothelioma (EHE), a vascular tumour with an incidence of less than 1% among vascular tumors. The patient, a 43-year-old man, presented with a right-sided pleural effusion, longstanding neck and shoulder pain, and worsening pleuritic chest pain. Initial imaging revealed a left infra-clavicular soft tissue mass, pleural thickening, and pulmonary nodules suggestive of metastases. Despite inconclusive initial biopsies, immunohistochemistry and an international pathology review confirmed EHE, characterized by CAMTA1 expression and WWTR1 CAMTA1 fusion. The pleural involvement indicated metastatic disease, leading to a poor prognosis. Treatment with the MEK inhibitor trametinib was initiated, but the patient died within 3 months. This case underscores the diagnostic challenges of EHE due to its rarity and variable clinical presentation, which often delays diagnosis until advanced stages. The report highlights the aggressive nature of pleural EHE and the lack of standardized treatments, emphasizing the need for early recognition.

Surgical resection improves prognosis for thymic carcinoma. Recent phase II trials have indicated the efficacy of immune checkpoint inhibitor therapy in unresectable disease. Here, we report a case of salvage surgery following immune checkpoint inhibitor therapy for an initially unresectable, locally advanced thymic carcinoma in a 67-year-old woman. Computed tomography revealed an anterior mediastinal mass and enlarged anterior mediastinal lymph nodes, diagnosed as an unresectable thymic epithelial tumour, due to suspected invasion into the left main pulmonary artery. Thoracoscopic biopsy confirmed the diagnosis of squamous cell carcinoma with high programmed cell death-ligand 1 expression (90%-100%). Following definitive chemoradiotherapy, the patient received durvalumab, which reduced the primary tumour size and resolved lymphadenopathy, without immune-related adverse events. Salvage surgery was performed without invasion of the great vessels. The patient remained disease-free at 2 years postoperatively. Salvage surgery following immune checkpoint inhibitor therapy may be a viable treatment option for thymic carcinoma with high programmed cell death-ligand 1 expression.

Objectives: We aimed to determine whether high-sensitivity cardiac troponin I (hs-cTnI) thresholds associated with increased 30-day mortality isolated coronary artery bypass grafting (CABG) differed between those undergoing off-pump (OPCAB) and on-pump (ONCAB) CABG.

Methods: We conducted a subanalysis of patients who underwent isolated CABG in the Vascular Events in Surgery Patients Cohort Evaluation (VISION) Cardiac Surgery Study. Cox regression was used to determine the hazard ratios (HRs) for mortality based on postoperative day 1 log-transformed hs-cTnI adjusted by EuroSCORE II, with OPCAB versus ONCAB as an interaction term. HRs were modelled as a function of hs-cTnI, and the lowest troponin associated with HR ≥ 1.00 was identified for each group.

Results: Of the original VISION cohort, 6505 patients underwent isolated CABG (OPCAB = 1141, ONCAB = 5364). Median hs-cTnI after CABG was 2446 ng/L (interquartile range [IQR] 1164-5654), and lower after OPCAB (640 ng/L [264-1689]) than ONCAB (2972 ng/L [1536-6448], P < .001). There were no differences in 30-day mortality between OPCAB and ONCAB (1.7% vs 1.4%, P = .5). Increased log-peak hs-cTnI was associated with greater mortality after CABG (adjusted HR = 1.7 [95% CI, 1.4-2.1]). The hs-cTnI threshold associated with HR ≥ 1.00 for isolated CABG was 6549 ng/L (95% CI, 3609-8381). OPCAB versus ONCAB had a significant interaction effect on the association between hs-cTnI and mortality (interaction P = .002). The hs-cTnI threshold associated with mortality after OPCAB was ≥4708 ng/L (95% CI, 581-7177), compared to ≥6806 ng/L (95% CI, 4001-13 993) after ONCAB.

Conclusions: The clinically significant hs-cTnI threshold after CABG associated with an increased risk of 30-day mortality above the baseline is substantially higher than defined by current guidelines, but lower in patients undergoing OPCAB compared to ONCAB.