Interdisciplinary cardiovascular and thoracic surgery最新文献

Objectives: To compare the extent of pleural inflammation and fibrosis induced by autologous blood vs talc pleurodesis in an exploratory experimental model and evaluate effects of postoperative non-steroidal anti-inflammatory analgesics on pleurodesis formation.

Methods: Twenty-eight Sprague Dawley rats underwent intrapleural instillation of autologous blood on one side and talc on the contralateral side. They were sacrificed at 2, 4, 6, 15, or 30 days for macroscopic and histopathological analysis. Eight animals in the late euthanasia groups received oral Ibuprofen postoperatively. A pathologist, who was blinded to the interventions assessed all animals for macroscopic adhesions in the chest as well as microscopic evaluation for inflammation and fibrosis.

Results: We found no significant differences between autologous blood and talc regarding macroscopic adhesion scores, or grading of inflammation and fibrosis. The inflammatory response peaked earlier after autologous blood compared with talc. Fibrosis progressively increased after both interventions. Ibuprofen reduced inflammation and fibrosis in both types of pleurodesis. Statistically significant reductions in fibrosis were seen after 15 days in the talc group (P = .008) and after 30 days in the autologous blood group (P = .024).

Conclusions: Autologous blood and talc pleurodesis induce comparable inflammatory responses and fibrosis in this experimental model suggesting that the mechanism of autologous blood patch for prolonged air leakage is not just a mechanical plug effect. Ibuprofen reduced all inflammatory responses after both interventions suggesting that non-steroidal anti-inflammatory drugs may impair pleurodesis formation.

Objectives: This study assessed the prognostic impact of cardiovascular injuries in patients with isolated chest trauma primarily involving the respiratory system.

Methods: We retrospectively reviewed the Japan Trauma Data Bank records (2004-2019). Patients with isolated chest trauma were categorized into the respiratory or cardiovascular injury group according to the highest abbreviated injury scale score. The effect of cardiovascular injuries in the respiratory injury group was analysed using a multivariable logistic regression analysis.

Results: Among the 8048 patients in the respiratory injury group, those with minor cardiac injury had a higher mortality rate than those without (15% vs 7%; P = .027); those with severe vascular injury (most commonly thoracic aorta) had a 76% mortality rate. The multivariable analysis indicated older age (adjusted odds ratio [adjOR]: 1.01, 95% CI: 1.00-1.01, P = .016), penetrating injury (adjOR: 2.19, 95% confidence interval [CI]: 1.40-3.43, P = .002), higher new injury severity score (adjOR: 3.89, 95% CI: 3.16-4.78, P < .001), coexistence of cardiac (adjOR: 2.68, 95% CI: 1.51-4.76, P < .001) or vascular injuries (adjOR: 3.36, 95% CI: 1.93-5.83, P < .001), and tracheobronchial injuries (adjOR: 2.10, 95% CI: 1.15-3.82, P = .015) with the highest abbreviated injury scale scores were significantly associated with increased odds of in-hospital mortality.

Conclusions: Minor cardiac or severe vascular injuries significantly increased mortality in patients with isolated chest trauma primarily involving the respiratory system. Assessment of both respiratory and coexisting cardiovascular injuries is essential for clinical management.

Objectives: Mitral regurgitation (MR) represents the most common valvular heart disease (VHD) in the Western world. While transcatheter mitral valve repair (M-TEER) is the leading interventional treatment for surgically high-risk patients, transcatheter mitral valve implantation (TMVI) is reserved for selected patients with unsuitable anatomy for M-TEER. This review aims to summarize our institutional experience with transapical TMVI using the Tendyne valve (Abbott Vascular, CA, USA), focusing on interdisciplinary preoperative, intraoperative, and postoperative management strategies.

Methods: We conducted a narrative review of current literature on TMVI with the Tendyne system and integrated it with a comprehensive analysis of our interdisciplinary clinical experience. Data were collected regarding patient selection, imaging protocols, procedural techniques, and postoperative care.

Results: Utilizing the Tendyne valve, TMVI addresses symptomatic moderate-to-severe or severe MR in patients unsuitable for conventional surgery or M-TEER. Successful outcomes require thorough patient selection, including assessment of mitral annular calcification, absence of intracardiac thrombus, low left ventricular outflow tract (LVOT) obstruction risk, and optimal annular sizing. Multimodal imaging, particularly transoesophageal echocardiography and cardiac computed tomography, is essential for procedural planning and execution. TMVI is performed under general anaesthesia with intraoperative transoesophageal guidance and haemodynamic monitoring to minimize complications such as LVOT obstruction, bleeding, and valve malposition. Postoperative management emphasizes haemodynamic stabilization, bleeding control, and surveillance for paravalvular leaks or device dysfunction.

Conclusions: TMVI with the Tendyne valve provides a viable and effective treatment for selected patients with symptomatic relevant MR. Optimal outcomes are dependent on meticulous interdisciplinary collaboration, advanced imaging protocols, and comprehensive perioperative management.

Objectives: This study evaluates the haemodynamic performance of a novel hybrid configuration-Valve-in-MHV-where a CoreValve transcatheter heart valve is implanted within the annulus of a composite valved graft after leaflet removal.

Methods: In vitro testing was performed using left heart mock loop combined with backlight particle image velocimetry. Three configurations were assessed: (i) mechanical heart valve (MHV), (ii) CoreValve THV, and (iii) Valve-in-MHV. Flow parameters were measured at cardiac outputs of 3 and 5 L/min.

Results: At 5 L/min, the Valve-in-MHV showed the highest PG (15.5 mmHg) and TKE (0.53 m2/s2), compared to the THV (10.9 mmHg, 0.31 m2/s2) and MHV (11.5 mmHg, 0.26 m2/s2). Effective orifice area was smallest for the Valve-in-MHV (1.44 cm2). The Valve-in-MHV generated a more physiological central jet than the MHV, but with increased turbulence and higher peak velocities (up to 2.66 m/s).

Conclusions: Examining the mechanistic implications of Valve-in-MHV may offer valuable insights into the likelihood of adverse effects such as leaflet thrombosis and the development of pronounced pressure gradients in patients who are candidates for Valve-in-MHV.

Objectives: Haemodynamic studies have demonstrated the excellent performance of rapid deployment (RD) valves. This retrospective single-centre study aimed to compare early and medium-term outcomes of RD bioprostheses versus conventional stented valves in patients with small aortic annuli.

Methods: We included patients who underwent isolated or combined surgical aortic valve replacement (SAVR) with Magna Ease (ME) and Intuity (Edwards Lifesciences, Irvine, CA) sizes 19 and 21 at our institution between June 2016 and March 2022. Follow-up was conducted through scheduled visits and echocardiograms at the study site, or via telephonic interviews with patients and/or referring cardiologists. A propensity score weighting analysis was performed to account for baseline differences between the 2 cohorts.

Results: A total of 666 consecutive patients underwent SAVR with the 2 devices. ME was implanted in 367 patients (55.1%) and Intuity in 299 (44.9%). ME size 19 or 21 was used in 105 patients (35.1%), and Intuity size 19 or 21 in 115 patients (31.3%). Our study population comprised 220 patients. There were no significant differences in postoperative complications. Intuity demonstrated significantly lower gradients overall (mean gradients: 12 mmHg vs 16 mmHg, P < 0.001) and for size 21 (mean gradients: 12 mmHg vs 15 mmHg, P < 0.001). Mid-term survival and rehospitalization rates were similar between the 2 devices (5-year rehospitalization rate: 17% ME vs 20.9% Intuity, P = 0.57; 5-year survival: 81.9% ME vs 88% Intuity, P = 0.761).

Conclusions: In patients with small aortic annuli, RD bioprostheses provide superior haemodynamic outcomes compared to conventional stented valves. However, perioperative outcomes, mid-term survival, and rehospitalization rates are similar between the 2 devices.

Objectives: Occult pneumothorax is increasingly diagnosed in trauma patients due to widespread use of computed tomography (CT), yet its optimal management remains controversial. This study aimed to identify clinical and radiological predictors of deterioration requiring tube thoracostomy and to develop a predictive model to guide management decisions.

Methods: In this retrospective single-centre study, 166 patients with blunt trauma-associated occult pneumothorax were analyzed. Clinical and radiological variables-including subcutaneous emphysema, haemothorax volume, pneumothorax size, mechanical ventilation, and rib fractures-were evaluated for association with delayed tube thoracostomy. A weighted multivariable logistic regression model addressed class imbalance, and model performance was assessed using receiver operating characteristic (ROC) analysis.

Results: Of 166 patients, 17 (10.2%) required delayed tube thoracostomy. Subcutaneous emphysema (odds ratio [OR] 20.10, P = .001) and mechanical ventilation (OR 17.30, P = .002) were the strongest independent predictors of deterioration. Haemothorax volume also showed a significant association (OR 1.06, P = .045). Other factors, including pneumothorax size, rib fractures, age, and sex, were not predictive. The predictive model demonstrated excellent discrimination (area under the curve [AUC] = 0.97), suggesting potential for clinical risk stratification.

Conclusions: Physiological indicators such as subcutaneous emphysema and mechanical ventilation are superior to anatomical parameters in predicting deterioration among patients with occult pneumothorax. Our findings support a selective management strategy and highlight the utility of predictive modelling to guide tube thoracostomy decisions. Prospective multicentre studies are warranted to validate these results.

Surgical repair of ventricular septal defects (VSDs) with straddling atrioventricular (AV) valve chordae is challenging due to the risk of disrupting valve integrity. We report the successful use of a dual-patch technique in a 5-month-old girl (6.1 kg) with Down syndrome, presenting with a large inlet VSD, secundum atrial septal defect (ASD), and straddling chordae involving both AV valves. Ventricular septal defects closure was performed via right atriotomy using 2 glutaraldehyde-treated autologous pericardial patches placed on the superior and inferior septal margins, encasing the chordae without division. Mitral and tricuspid valve clefts were repaired, and the ASD was closed primarily. Postoperative echocardiography showed no residual VSD and only mild AV valve regurgitation. This approach preserved valvular geometry and avoided conduction disturbance. The dual-patch technique offers a physiologic and conservative solution when conventional VSD repair is precluded by straddling chordae. It avoids chordal translocation or reimplantation, maintaining the native architecture and function of the AV valves.

Objectives: To evaluate whether digital drainage systems reduce chest tube duration and hospital stay following anatomical lung resection in a resource-limited healthcare setting.

Methods: This retrospective study, approved by the institutional ethics committee (Approval No. 30491514.3.0000.0065), compared digital and conventional water seal drainage systems in a public hospital in Brazil. Outcomes included chest tube duration and hospital stay. Propensity score matching (PSM) was applied to control for confounding variables.

Results: A total of 388 patients were included (67.8% smokers, mean age 63.8 years). After PSM, 85 matched pairs, no significant differences were observed in most demographic and clinical variables. Lobectomies were more frequent in the conventional group (100% vs 85.9%, P < 0.001). After paired statistical analysis using the Wilcoxon signed-rank test showed no significant differences in chest tube drainage time (4.2 vs 4.4 days, P = 0.397) or hospital stay duration (4.9 vs 5.2 days, P = 0.745).

Conclusions: In a resource-constrained setting, digital drainage systems are feasible and may support clinical decision-making through precise air leak quantification. However, no significant differences were observed in key outcomes when compared to conventional drainage, warranting further investigation into cost-effectiveness and broader implementation strategies.

This article reports a rare case of a 66-year-old female patient. The patient was admitted to the hospital due to multiple episodes of syncope over 5 days and was diagnosed with a possible congenital coronary artery-pulmonary artery fistula and ruptured coronary artery aneurysm. After admission, the patient received treatments including pericardiocentesis drainage and was subsequently transferred to the cardiac surgery department for operation. During surgery, a giant coronary artery aneurysm and multiple fistulous openings were discovered and successfully managed through a series of surgical procedures. The patient recovered well postoperatively with no residual fistulas or aneurysms. In this case, the combination of a giant coronary artery aneurysm with a coronary artery-pulmonary artery fistula is extremely rare, and the patient survived aneurysm rupture and cardiac tamponade before successfully undergoing surgery, providing valuable clinical experience for the diagnosis and treatment of similar diseases.