Interdisciplinary cardiovascular and thoracic surgery最新文献

We present the case of a 72-year-old man with symptomatic severe aortic regurgitation and moderate aortic stenosis, and an annular diameter of 30 mm, exceeding the recommended range for sutureless Perceval valve implantation. To reduce the annular size to allow implantation of the Perceval XL valve, an annular plication technique was employed, involving three horizontal mattress sutures placed at the interleaflet triangles. A totally endoscopic approach via right mini-thoracotomy was utilized. Postoperative echocardiography confirmed excellent valve positioning and no paravalvular leak. The patient recovered uneventfully and remained asymptomatic with good prosthesis function at the 3-year follow-up. This case demonstrated that annular plication enables the safe use of the Perceval valve in patients with a mildly oversized annulus and may expand its applicability in minimally invasive settings.

Objectives: The comparative benefits of 3-dimensional (3D) versus 2-dimensional (2D) video-assisted thoracic surgery (VATS) for oesophageal cancer remain uncertain. This meta-analysis aims to assess the efficacy and safety profiles of 3D and 2D VATS procedures in the management of oesophageal cancer.

Methods: A comprehensive literature search was conducted utilizing the PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for studies published up to August 2025. Eligible studies were those comparing the efficacy and safety profiles of 3D versus 2D VATS. For data synthesis, continuous variables were evaluated using standardized mean differences (SMD), while dichotomous outcomes were assessed with odds ratios (ORs); all effect measures are reported with 95% confidence intervals (CIs) and corresponding P-values.

Results: Eight studies involving 1273 patients (608 undergoing 3D VATS and 665 undergoing 2D VATS) demonstrated that the 3D VATS approach was associated with significantly decreased intraoperative blood loss (-2.27; 95% CI: -3.45 to -1.09; P < .05) and reduced operative duration (-0.65; 95% CI: -1.15 to -0.16; P < .05) compared to the 2D technique. However, no statistically significant differences were observed between the 2 groups in terms of postoperative drainage time, postoperative hospitalization duration, total postoperative drainage volume, incidence of postoperative complications, and number of lymph node dissection.

Conclusions: This meta-analytic study demonstrates that potential clinical benefits of 3D VATS over the 2D approach for oesophageal cancer resection, such as decreased intraoperative blood loss and reduced operative duration.

We report a case of simplified surgical conversion from a prior mechanical composite valved conduit to a bioprosthetic aortic valve using a leaflet fracture technique. A 69-year-old man presented with progressive heart failure 7 years after aortic root replacement for bicuspid aortic stenosis and root aneurysm. Imaging revealed severe prosthetic valve stenosis and suspected pannus formation. Given significant comorbidities, a simplified approach was chosen to avoid full root re-replacement. Following redo sternotomy and graft incision, the mechanical valve leaflets were fractured and removed. A Foley balloon inserted into the left ventricular outflow tract prevented leaflet embolization. Pannus excision revealed a hypertrophic subvalvular septum, prompting a septal myectomy. A 23-mm bioprosthetic valve was implanted above the retained mechanical housing using interrupted mattress sutures. The patient's postoperative course was uneventful, and echocardiography confirmed good valve function. This case highlights the utility of leaflet fracture as a safe and efficient option in high-risk reoperative settings and underscores the added benefit of direct subvalvular visualization for detecting underlying anatomic contributors to prosthetic dysfunction not detected preoperatively.

Objectives: Increased aortic angulation (AA) is anatomically challenging during transcatheter aortic valve implantation (TAVI) and may affect procedural outcomes. This study evaluates the clinical and procedural impact of AA in contemporary TAVI procedures.

Methods: This retrospective single-centre observational study included 509 consecutive patients undergoing transfemoral TAVI between January 2021 and December 2024. The primary end-point was device success according to VARC-3 criteria. Secondary endpoints included technical success, early safety at 30 days, procedural time, fluoroscopy time, contrast volume, paravalvular regurgitation (PVR), and permanent pacemaker implantation (PPI). Multivariable logistic and linear regression models were used to assess the association between AA (in degrees) and clinical outcomes. Receiver operating characteristic (ROC) and spline regression analyses were used to evaluate potential threshold effects.

Results: Device success at discharge was achieved in 89.4% (455/509) of patients, technical success in 96.3% (490/509), and early safety at 30 days in 75.6% (385/509). Aortic angulation did not significantly influence device success (adjusted odds ratio [aOR]: 0.974, 95% CI: 0.938-1.012, P = .175), technical success (aOR 1.034; 95% CI 0.980-1.091; P = .22), or early safety (aOR: 0.994, 95% CI: 0.968-1.020, P = .633). Similarly, no association was observed between AA and PPI (aOR 1.016; 95% CI 0.984-1.050; P = .34) and PVR. However, AA significantly correlated with increased fluoroscopy times (coefficient: 0.073, SE: 0.026; P = .006) and greater contrast usage (coefficient: 0.406, SE: 0.194; P = .037).

Conclusions: While higher AA increased procedural imaging demand, it did not adversely affect device performance or clinical safety outcomes after TAVI. Importantly, outcomes remained consistent across prosthesis types.

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.

Objectives: Acute Type A aortic dissection (ATAAD) repair is a high-risk procedure with significant in-hospital mortality. This study evaluates the impact of implementing an On-call Specialist Aortic Rota on ATAAD repair outcomes.

Methods: Retrospective analysis of prospectively collected data for all ATAAD repairs performed in our centre between January 2015 and October 2023 (n = 406). In September 2020, an On-Call Specialist Aortic Rota was introduced, requiring surgeons to perform at least 10 major aortic cases and 4 ATAAD repairs annually. Outcomes were compared between the pre-Rota (Group A) and post-Rota (Group B) implementation groups.

Results: Preoperative characteristics were similar between groups (mean age 59.7 ± 14 years, 68% male). In multivariable analysis, rota implementation was associated with lower in-hospital mortality (adjusted OR 0.60; 95% CI, 0.36-1.00; P = .049). Unadjusted mortality was 25% pre-Rota vs 16% post-Rota (P = .033). Group B had a higher rate of aortic root replacement (44% vs 35%, P = .008), lower ascending aorta and hemiarch replacement (40% vs 53%, P = .013) and showed a trend towards more extensive distal aortic repairs: total arch replacement (27% vs 20%, P = .139) and frozen elephant trunk (20% vs 14%, P = .171). Postoperative complications, including permanent stroke (7.9% vs 9.3%, P = .250) and continuous renal replacement therapy (9.8% vs 12.3%, P = .196), were comparable between groups, while tracheostomy rates were significantly lower in Group B (5.2% vs 9.7%, P = .036).

Conclusions: The period after introducing an On-Call Specialist Aortic Rota was associated with lower in-hospital mortality (adjusted OR 0.60; 95% CI, 0.36-1.00) and accompanied by a practice-pattern shift towards more extensive repairs. Given the observational design and potential for residual confounding and calendar-time bias, these findings should be viewed as associative rather than causal and require confirmation in multicentre studies with longer follow-up.

Clinical trial registry number: CEU/2019/11118.

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.

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.