JTCVS open最新文献_第10页

Marfan and Loeys-Dietz aortic phenotype: A potential tool for diagnosis and management Marfan 和 Loeys-Dietz 主动脉表型：诊断和管理的潜在工具

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.015

Luigi Lovato MD , Mariano Cefarelli MD, PhD , Luca Di Marco MD, PhD , Daniel Arcioni MD , Giada Tortora MD, PhD , Ada Dormi Mth D Biostatistical , Nicolò Schicchi MD , Elisabetta Mariucci MD, PhD , Marco Di Eusanio MD, PhD , Davide Pacini MD, PhD , Rossella Fattori MD, PhD

Objective

In heritable aortic diseases, different vascular involvement may occur with potential variable implications in aortic dilation/dissection risk. This study aimed to analyze the aortic anatomy of individuals with Marfan syndrome and Loeys-Dietz syndrome to identify possible morphological differences.

Methods

Computed tomography and magnetic resonance imaging of the thoracoabdominal aorta from the proximal supra-aortic vessels to the femoral bifurcation level of 114 patients with Marfan and Loeys-Dietz syndromes and 20 matched control subjects were examined. Aortic diameters, areas, length, and tortuosity were measured in different aortic segments using specific vessel analysis software.

Results

Patients with Marfan syndrome showed a higher prevalence of ascending aorta and aortic root dilation (P = .011), larger and longer aortic roots (P = .013) with pear-shaped phenotype, larger isthmus/descending aorta diameter ratio (P = .015), and larger suprarenal aorta and iliac arteries. Patients with Loeys-Dietz syndrome showed longer indexed segments and a significantly longer arch (P = .006) with type 2/3 arch prevalence (P = .097). Measurement ratios analysis provided cut-off values (aortic root to ascending aorta length/aortic root diameter, aortic root/sinotubular junction, aortic root/ascending aorta diameter) differentiating patients with Marfan syndrome from patients with Loeys-Dietz syndrome, even in the early stage of the disease.

Conclusions

Both syndromes show peculiar anatomic patterns at different aortic levels irrespective of aortic dilation and disease severity. These features may represent the expression of different genetic mutations on aortic development, with a potential impact on prognosis and possibly contributing to better management of the diseases. The systematic adoption of whole body imaging with magnetic resonance or computed tomography should always be considered, because they allow a complete vascular assessment with practical indicators of differential diagnosis.

目的在遗传性主动脉疾病中，可能会出现不同的血管受累情况，从而对主动脉扩张/离断风险产生潜在的不同影响。本研究旨在分析马凡氏综合征和洛伊-迪茨氏综合征患者的主动脉解剖结构，以确定可能存在的形态学差异。方法对 114 名马凡氏综合征和洛伊-迪茨氏综合征患者以及 20 名匹配的对照组受试者的胸腹主动脉（从近端主动脉上血管到股骨分叉水平）进行计算机断层扫描和磁共振成像检查。结果显示，马凡氏综合征患者的升主动脉和主动脉根部扩张率较高（P = .011），主动脉根部较大且较长（P = .013），呈梨形表型，峡部/降主动脉直径比较大（P = .015），肾上主动脉和髂动脉较大。Loeys-Dietz综合征患者的指数节段更长，弓明显更长（P = .006），2/3型弓的发病率更高（P = .097）。测量比率分析提供了临界值（主动脉根部至升主动脉长度/主动脉根部直径、主动脉根部/细支交界处、主动脉根部/升主动脉直径），可将马凡氏综合征患者与洛伊-狄茨综合征患者区分开来，即使在疾病的早期阶段也是如此。这些特征可能代表了不同基因突变对主动脉发育的影响，对预后有潜在影响，并可能有助于更好地治疗疾病。应始终考虑系统性地采用磁共振或计算机断层扫描进行全身成像，因为它们可以进行全面的血管评估，并提供实用的鉴别诊断指标。

{"title":"Marfan and Loeys-Dietz aortic phenotype: A potential tool for diagnosis and management","authors":"Luigi Lovato MD , Mariano Cefarelli MD, PhD , Luca Di Marco MD, PhD , Daniel Arcioni MD , Giada Tortora MD, PhD , Ada Dormi Mth D Biostatistical , Nicolò Schicchi MD , Elisabetta Mariucci MD, PhD , Marco Di Eusanio MD, PhD , Davide Pacini MD, PhD , Rossella Fattori MD, PhD","doi":"10.1016/j.xjon.2024.03.015","DOIUrl":"10.1016/j.xjon.2024.03.015","url":null,"abstract":"<div><h3>Objective</h3><p>In heritable aortic diseases, different vascular involvement may occur with potential variable implications in aortic dilation/dissection risk. This study aimed to analyze the aortic anatomy of individuals with Marfan syndrome and Loeys-Dietz syndrome to identify possible morphological differences.</p></div><div><h3>Methods</h3><p>Computed tomography and magnetic resonance imaging of the thoracoabdominal aorta from the proximal supra-aortic vessels to the femoral bifurcation level of 114 patients with Marfan and Loeys-Dietz syndromes and 20 matched control subjects were examined. Aortic diameters, areas, length, and tortuosity were measured in different aortic segments using specific vessel analysis software.</p></div><div><h3>Results</h3><p>Patients with Marfan syndrome showed a higher prevalence of ascending aorta and aortic root dilation (<em>P</em> = .011), larger and longer aortic roots (<em>P</em> = .013) with pear-shaped phenotype, larger isthmus/descending aorta diameter ratio (<em>P</em> = .015), and larger suprarenal aorta and iliac arteries. Patients with Loeys-Dietz syndrome showed longer indexed segments and a significantly longer arch (<em>P</em> = .006) with type 2/3 arch prevalence (<em>P</em> = .097). Measurement ratios analysis provided cut-off values (aortic root to ascending aorta length/aortic root diameter, aortic root/sinotubular junction, aortic root/ascending aorta diameter) differentiating patients with Marfan syndrome from patients with Loeys-Dietz syndrome, even in the early stage of the disease.</p></div><div><h3>Conclusions</h3><p>Both syndromes show peculiar anatomic patterns at different aortic levels irrespective of aortic dilation and disease severity. These features may represent the expression of different genetic mutations on aortic development, with a potential impact on prognosis and possibly contributing to better management of the diseases. The systematic adoption of whole body imaging with magnetic resonance or computed tomography should always be considered, because they allow a complete vascular assessment with practical indicators of differential diagnosis.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 223-240"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000950/pdfft?md5=23e6f3501be154863946e302aabaf4a2&pid=1-s2.0-S2666273624000950-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The anatomic repair of recurrent aortic arch obstruction in children and adolescents 儿童和青少年主动脉弓复发性阻塞的解剖修复术

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.04.007

Michaela Kreuzer MD , Eva Sames-Dolzer MD , Melanie Klapper BSc , Andreas Tulzer MD , Roland Mair MD , Fabian Seeber MD , Gregor Gierlinger MD , Dalibor Saric MD , Rudolf Mair MD

Objective

Surgery for recurrent aortic arch obstruction is highly challenging and publications are rare. The aim of this retrospective, single-center study was to evaluate mortality, complications, and reintervention rate after an anatomic repair.

Methods

Between 1999 and 2022, in total 946 operations on the aortic arch were performed at the Children's Heart Center Linz. In 39 cases, the indication was a recurrent or residual aortic arch obstruction or coarctation in a patient aged 18 years or younger. This is our study cohort. The aorta was reconstructed by a direct anastomosis/autograft in 20 patients, patch in 17 patients, and interposition graft in 2 adolescents. In 32 procedures, cardiopulmonary bypass with whole body perfusion was employed, in 4, antegrade cerebral perfusion was employed, in 2, a left heart bypass was employed, and in 1 no cardiopulmonary bypass was used.

Results

Median (Q1, Q3) age at operation was 253 days (100, 2198 days), weight 7.5 kg (4.5, 17.8 kg). Median cardiopulmonary bypass time was 177 minutes (115, 219 minutes), crossclamp time 73 minutes (49, 102 minutes). Three infants died during the hospital stay: 1 with Williams syndrome, 1 with hypoplastic left heart syndrome, and 1 with heterotaxia. There was no death due to an arch complication. The main complications were 1 neurologic injury after postoperative resuscitation (Williams syndrome) and 1 permanent recurrent laryngeal nerve paralysis. During the follow-up period of median 8.1 years (2.6, 12 years) 1 re-reintervention on the aortic arch was necessary.

Conclusions

Sophisticated reoperations on the aortic arch could be performed safely. In children, the growth potential of all segments of the aorta could be sustainably preserved by avoiding interposition or extra-anatomic bypass grafts.

目的主动脉弓复发性梗阻的手术极具挑战性，发表的论文很少。这项回顾性单中心研究旨在评估解剖修复术后的死亡率、并发症和再介入率。方法1999年至2022年间，林茨儿童心脏中心共进行了946例主动脉弓手术。其中有 39 例手术的适应症是 18 岁或以下患者的主动脉弓复发性或残余阻塞或闭塞。这就是我们的研究队列。20名患者通过直接吻合/自体移植重建了主动脉，17名患者通过补片重建了主动脉，2名青少年通过间置移植重建了主动脉。32例手术采用了全身灌注的心肺旁路，4例采用了逆行脑灌注，2例采用了左心旁路，1例未采用心肺旁路。心肺旁路时间中位数为177分钟（115，219分钟），交叉钳夹时间为73分钟（49，102分钟）。3 名婴儿在住院期间死亡：1 名患有威廉姆斯综合征，1 名患有左心发育不全综合征，1 名患有异位畸形。没有婴儿因足弓并发症死亡。主要并发症是术后复苏后的1例神经损伤（威廉姆斯综合征）和1例永久性喉返神经麻痹。在中位 8.1 年（2.6-12 年）的随访期间，有 1 例主动脉弓再次手术。结论主动脉弓复杂的再手术可以安全地进行，儿童主动脉所有节段的生长潜力都可以通过避免插管或解剖外旁路移植得到持续保持。

{"title":"The anatomic repair of recurrent aortic arch obstruction in children and adolescents","authors":"Michaela Kreuzer MD , Eva Sames-Dolzer MD , Melanie Klapper BSc , Andreas Tulzer MD , Roland Mair MD , Fabian Seeber MD , Gregor Gierlinger MD , Dalibor Saric MD , Rudolf Mair MD","doi":"10.1016/j.xjon.2024.04.007","DOIUrl":"10.1016/j.xjon.2024.04.007","url":null,"abstract":"<div><h3>Objective</h3><p>Surgery for recurrent aortic arch obstruction is highly challenging and publications are rare. The aim of this retrospective, single-center study was to evaluate mortality, complications, and reintervention rate after an anatomic repair.</p></div><div><h3>Methods</h3><p>Between 1999 and 2022, in total 946 operations on the aortic arch were performed at the Children's Heart Center Linz. In 39 cases, the indication was a recurrent or residual aortic arch obstruction or coarctation in a patient aged 18 years or younger. This is our study cohort. The aorta was reconstructed by a direct anastomosis/autograft in 20 patients, patch in 17 patients, and interposition graft in 2 adolescents. In 32 procedures, cardiopulmonary bypass with whole body perfusion was employed, in 4, antegrade cerebral perfusion was employed, in 2, a left heart bypass was employed, and in 1 no cardiopulmonary bypass was used.</p></div><div><h3>Results</h3><p>Median (Q1, Q3) age at operation was 253 days (100, 2198 days), weight 7.5 kg (4.5, 17.8 kg). Median cardiopulmonary bypass time was 177 minutes (115, 219 minutes), crossclamp time 73 minutes (49, 102 minutes). Three infants died during the hospital stay: 1 with Williams syndrome, 1 with hypoplastic left heart syndrome, and 1 with heterotaxia. There was no death due to an arch complication. The main complications were 1 neurologic injury after postoperative resuscitation (Williams syndrome) and 1 permanent recurrent laryngeal nerve paralysis. During the follow-up period of median 8.1 years (2.6, 12 years) 1 re-reintervention on the aortic arch was necessary.</p></div><div><h3>Conclusions</h3><p>Sophisticated reoperations on the aortic arch could be performed safely. In children, the growth potential of all segments of the aorta could be sustainably preserved by avoiding interposition or extra-anatomic bypass grafts.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 215-222"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001098/pdfft?md5=349a1529717a397cad498ff4d211b527&pid=1-s2.0-S2666273624001098-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A cardiothoracic surgery interest group starter kit for medical students from the Thoracic Surgery Medical Student Association 胸外科医学生协会心胸外科兴趣小组医学生入门套件

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.003

Andrew D. Vogel MS , Ahmet Bilgili BS , Betemariam Sharew BA , Allen Kuncheria BS , Kenny Nguyen BS , John A. Treffalls BS , Zachary Brennan DO , Dominic Emerson MD , Tyler J. Wallen DO , Ibrahim Sultan MD , Jeffery P. Jacobs MD

引用次数: 0

A surgical armamentarium for correcting systolic anterior motion with re-repair rather than replacement 通过再修复而非置换术矫正收缩压前移的手术武器库

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.010

Whitney Fu MD, Catherine Wagner MD, Gurnoordeep Pawar BS, Nicolas Ceniza BS, Matthew A. Romano MD, Gorav Ailawadi MD, MBA, Steven F. Bolling MD, Michigan Mitral Research Group

引用次数: 0

Reply: Suit yourself: Tailoring treatment to malperfusion in acute type A aortic dissection 答复请自便：根据急性 A 型主动脉夹层的灌注不良情况调整治疗方法

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.04.016

James A. Brown MD, MS , Ibrahim Sultan MD

引用次数: 0

Reply: How to define oversizing or undersizing of frozen elephant trunk 答复：如何定义场效应晶体管的过大或过小？

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.04.001

Yuichiro Kitada MD , Homare Okamura MD, PhD

引用次数: 0

Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and stroke 左心房阑尾关闭术对早期和长期死亡率及中风影响的系统回顾和荟萃分析。

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.02.022

Mariusz Kowalewski MD, PhD , Michał Święczkowski MD , Łukasz Kuźma MD, PhD , Bart Maesen MD, PhD , Emil Julian Dąbrowski MD , Matteo Matteucci MD , Jakub Batko MD, PhD , Radosław Litwinowicz MD, PhD , Adam Kowalówka MD, PhD , Wojciech Wańha MD, PhD , Federica Jiritano MD, PhD , Giuseppe Maria Raffa MD, PhD , Pietro Giorgio Malvindi MD, PhD , Luigi Pannone MD , Paolo Meani MD, PhD , Roberto Lorusso MD, PhD , Richard Whitlock MD, PhD , Mark La Meir MD, PhD , Carlo de Asmundis MD, PhD , James Cox MD, PhD , Piotr Suwalski MD, PhD

Objective

Left atrial appendage closure (LAAC) concomitant to heart surgery in patients with underlying atrial fibrillation (AF) has gained attention because of long-term reduction of thromboembolic complications. As of mortality benefits in the setting of non-AF, data from both observational studies and randomized controlled trials are conflicting.

Methods

On-line databases were screened for studies comparing LAAC versus no LAAC concomitant to other heart surgery. End points assessed were all-cause mortality and stroke at early and longest-available follow-up. Subgroup analyses stratified on preoperative AF were performed. Risk ratios (RR) with 95% CIs served as primary statistics.

Results

Electronic search yielded 25 studies (N = 660 [158 patients]). There was no difference between LAAC and no LAAC in terms of early mortality. In the overall population analysis, LAAC reduced long-term mortality (RR, 0.86; 95% CI, 0.74-1.00; P = .05; I² = 88%), reduced early stroke risk by 19% (RR, 0.81; 95% CI, 0.72-0.93; P = .002; I² = 57%), and reduced late stroke risk by 13% (RR, 0.87; 95% CI, 0.84-0.90; P < .001; I² = 58%). Subgroup analysis showed lower mortality (RR, 0.85; 95% CI, 0.72-1.01; P = .06; I² = 91%), short-, and long-term stroke risk reduction only in patients with preoperative AF (RR, 0.81; 95% CI, 0.71-0.93; P = .003; I² = 71% and RR, 0.87; 95% CI, 0.84-0.91; P < .001; I² = 70%, respectively). No benefit of LAAC in patients without AF was found.

Conclusions

Concomitant LAAC was associated with reduced stroke rates at early and long-term and possibly reduced all-cause mortality at the long-term follow-up but the benefits were limited to patients with preoperative AF. There is not enough evidence to support routine concomitant LAAC in non-AF settings.

目的对有潜在心房颤动（房颤）的患者进行心脏手术的同时进行左心房附壁关闭术（LAAC），因其可长期减少血栓栓塞并发症而备受关注。至于在非房颤情况下死亡率的益处，观察性研究和随机对照试验的数据并不一致。方法在线数据库中筛选了比较其他心脏手术同时进行 LAAC 与不进行 LAAC 的研究。评估终点为早期和最长随访时间内的全因死亡率和中风。根据术前房颤进行了分组分析。结果通过电子检索获得了 25 项研究（N = 660 [158 名患者]）。就早期死亡率而言，LAAC与无LAAC没有差异。在总体人群分析中，LAAC 降低了长期死亡率（RR，0.86；95% CI，0.74-1.00；P = .05；I2 = 88%），早期卒中风险降低了 19%（RR，0.81；95% CI，0.72-0.93；P = .002；I2 = 57%），晚期卒中风险降低了 13%（RR，0.87；95% CI，0.84-0.90；P <；.001；I2 = 58%）。亚组分析显示，仅术前有房颤的患者死亡率较低（RR，0.85；95% CI，0.72-1.01；P = .06；I2 = 91%），短期和长期卒中风险降低（分别为RR，0.81；95% CI，0.71-0.93；P = .003；I2 = 71%和RR，0.87；95% CI，0.84-0.91；P < .001；I2 = 70%）。结论伴随 LAAC 可降低早期和长期卒中率，并可能降低长期随访时的全因死亡率，但获益者仅限于术前有房颤的患者。没有足够的证据支持在非房颤情况下常规同时使用 LAAC。

{"title":"Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and stroke","authors":"Mariusz Kowalewski MD, PhD , Michał Święczkowski MD , Łukasz Kuźma MD, PhD , Bart Maesen MD, PhD , Emil Julian Dąbrowski MD , Matteo Matteucci MD , Jakub Batko MD, PhD , Radosław Litwinowicz MD, PhD , Adam Kowalówka MD, PhD , Wojciech Wańha MD, PhD , Federica Jiritano MD, PhD , Giuseppe Maria Raffa MD, PhD , Pietro Giorgio Malvindi MD, PhD , Luigi Pannone MD , Paolo Meani MD, PhD , Roberto Lorusso MD, PhD , Richard Whitlock MD, PhD , Mark La Meir MD, PhD , Carlo de Asmundis MD, PhD , James Cox MD, PhD , Piotr Suwalski MD, PhD","doi":"10.1016/j.xjon.2024.02.022","DOIUrl":"10.1016/j.xjon.2024.02.022","url":null,"abstract":"<div><h3>Objective</h3><p>Left atrial appendage closure (LAAC) concomitant to heart surgery in patients with underlying atrial fibrillation (AF) has gained attention because of long-term reduction of thromboembolic complications. As of mortality benefits in the setting of non-AF, data from both observational studies and randomized controlled trials are conflicting.</p></div><div><h3>Methods</h3><p>On-line databases were screened for studies comparing LAAC versus no LAAC concomitant to other heart surgery. End points assessed were all-cause mortality and stroke at early and longest-available follow-up. Subgroup analyses stratified on preoperative AF were performed. Risk ratios (RR) with 95% CIs served as primary statistics.</p></div><div><h3>Results</h3><p>Electronic search yielded 25 studies (N = 660 [158 patients]). There was no difference between LAAC and no LAAC in terms of early mortality. In the overall population analysis, LAAC reduced long-term mortality (RR, 0.86; 95% CI, 0.74-1.00; <em>P</em> = .05; <em>I</em><sup>2</sup> = 88%), reduced early stroke risk by 19% (RR, 0.81; 95% CI, 0.72-0.93; <em>P</em> = .002; <em>I</em><sup>2</sup> = 57%), and reduced late stroke risk by 13% (RR, 0.87; 95% CI, 0.84-0.90; <em>P</em> < .001; <em>I</em><sup>2</sup> = 58%). Subgroup analysis showed lower mortality (RR, 0.85; 95% CI, 0.72-1.01; <em>P</em> = .06; <em>I</em><sup>2</sup> = 91%), short-, and long-term stroke risk reduction only in patients with preoperative AF (RR, 0.81; 95% CI, 0.71-0.93; <em>P</em> = .003; <em>I</em><sup>2</sup> = 71% and RR, 0.87; 95% CI, 0.84-0.91; <em>P</em> < .001; <em>I</em><sup>2</sup> = 70%, respectively). No benefit of LAAC in patients without AF was found.</p></div><div><h3>Conclusions</h3><p>Concomitant LAAC was associated with reduced stroke rates at early and long-term and possibly reduced all-cause mortality at the long-term follow-up but the benefits were limited to patients with preoperative AF. There is not enough evidence to support routine concomitant LAAC in non-AF settings.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 131-163"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000585/pdfft?md5=c21d11a31c91a61dd45c5196fcb5b057&pid=1-s2.0-S2666273624000585-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140267941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Treatment strategies and outcomes following acute type A aortic dissection repair in patients with bicuspid and tricuspid aortic valves: A meta-analysis 二尖瓣和三尖瓣主动脉瓣患者急性 A 型主动脉夹层修复术后的治疗策略和疗效：元分析

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.02.020

Tomonari Shimoda MD , Yujiro Yokoyama MD , Hisato Takagi MD, PhD , Toshiki Kuno MD, PhD , Shinichi Fukuhara MD

Background

There is no consensus regarding the strategies for repairing acute type A aortic dissection (ATAAD) in patients with bicuspid aortic valve (BAV). This meta-analysis aimed to compare the treatment strategies and outcomes of ATAAD repair between patients with BAV and those with tricuspid aortic valve (TAV).

Methods

A systematic review of databases were performed from inception through March 2023. The primary outcome of interest was all-cause mortality, with a minimum follow-up of 1 year. The secondary outcomes of interest included ratios of performed procedures and rate of distal aortic reoperation. Data were extracted, and pooled analysis was performed using a random-effects model.

Results

Eight observational studies including a total of 3701 patients (BAV, n = 349; TAV, n = 3352) were selected for a meta-analysis. Concerning proximal aortic procedures, BAV patients exhibited a higher incidence of necessary root replacement (odds ratio [OR], 6.53; 95% confidence interval [CI], 3.84 to 11.09; P < .01). Regarding distal aortic procedures, extended arch replacement was performed less frequently in BAV patients (OR, 0.69; 95% CI, 0.49 to 0.99; P = .04), whereas hemiarch procedure rates were comparable in the 2 groups. All-cause mortality was lower in the BAV group (hazard ratio, 0.68; 95% CI, 0.50 to 0.92; P = .01). Distal aortic reoperation rates were comparable in the 2 groups.

Conclusions

This study highlights distinct procedural patterns in ATAAD patients with BAV and TAV. Despite differing baseline characteristics, BAV patients exhibited superior survival compared to TAV patients, with comparable distal aortic reoperation rates. These findings may be useful for decision making regarding limited versus extended aortic arch repair.

背景关于修复双尖瓣主动脉瓣（BAV）患者急性A型主动脉夹层（ATAAD）的策略尚未达成共识。本荟萃分析旨在比较双主动脉瓣患者和三尖瓣主动脉瓣（TAV）患者的治疗策略和 ATAAD 修复的结果。主要研究结果为全因死亡率，随访时间至少为 1 年。次要研究结果包括手术比例和远端主动脉再手术率。结果8项观察性研究共纳入3701名患者（BAV，n = 349；TAV，n = 3352）进行荟萃分析。就近端主动脉手术而言，BAV 患者进行必要的主动脉根部置换的发生率更高（几率比 [OR]，6.53；95% 置信区间 [CI]，3.84 至 11.09；P < .01）。在主动脉远端手术方面，BAV患者较少进行扩弓置换术（OR，0.69；95% CI，0.49 至 0.99；P = .04），而两组患者的半弓手术率相当。BAV组的全因死亡率较低（危险比为0.68；95% CI为0.50至0.92；P = .01）。两组患者的远端主动脉再手术率相当。尽管基线特征不同，BAV 患者的存活率高于 TAV 患者，但远端主动脉再手术率相当。这些发现可能有助于就有限主动脉弓修复与扩大主动脉弓修复做出决策。

{"title":"Treatment strategies and outcomes following acute type A aortic dissection repair in patients with bicuspid and tricuspid aortic valves: A meta-analysis","authors":"Tomonari Shimoda MD , Yujiro Yokoyama MD , Hisato Takagi MD, PhD , Toshiki Kuno MD, PhD , Shinichi Fukuhara MD","doi":"10.1016/j.xjon.2024.02.020","DOIUrl":"10.1016/j.xjon.2024.02.020","url":null,"abstract":"<div><h3>Background</h3><p>There is no consensus regarding the strategies for repairing acute type A aortic dissection (ATAAD) in patients with bicuspid aortic valve (BAV). This meta-analysis aimed to compare the treatment strategies and outcomes of ATAAD repair between patients with BAV and those with tricuspid aortic valve (TAV).</p></div><div><h3>Methods</h3><p>A systematic review of databases were performed from inception through March 2023. The primary outcome of interest was all-cause mortality, with a minimum follow-up of 1 year. The secondary outcomes of interest included ratios of performed procedures and rate of distal aortic reoperation. Data were extracted, and pooled analysis was performed using a random-effects model.</p></div><div><h3>Results</h3><p>Eight observational studies including a total of 3701 patients (BAV, n = 349; TAV, n = 3352) were selected for a meta-analysis. Concerning proximal aortic procedures, BAV patients exhibited a higher incidence of necessary root replacement (odds ratio [OR], 6.53; 95% confidence interval [CI], 3.84 to 11.09; <em>P</em> < .01). Regarding distal aortic procedures, extended arch replacement was performed less frequently in BAV patients (OR, 0.69; 95% CI, 0.49 to 0.99; <em>P</em> = .04), whereas hemiarch procedure rates were comparable in the 2 groups. All-cause mortality was lower in the BAV group (hazard ratio, 0.68; 95% CI, 0.50 to 0.92; <em>P</em> = .01). Distal aortic reoperation rates were comparable in the 2 groups.</p></div><div><h3>Conclusions</h3><p>This study highlights distinct procedural patterns in ATAAD patients with BAV and TAV. Despite differing baseline characteristics, BAV patients exhibited superior survival compared to TAV patients, with comparable distal aortic reoperation rates. These findings may be useful for decision making regarding limited versus extended aortic arch repair.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 9-30"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266627362400055X/pdfft?md5=335b6bf1280c8c974a01e9c4e042a3e4&pid=1-s2.0-S266627362400055X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140275835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-term outcomes of heart transplantation in adults with congenital heart disease: The impact of single-ventricle versus biventricular physiology 先天性心脏病成人心脏移植的长期疗效：单心室与双心室生理学的影响

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.04.006

Alice V. Vinogradsky BA , Stephanie N. Nguyen MD , Krushang Patel MD , Matthew Regan MS , Kelly M. Axsom MD , Matthew J. Lewis MD , Gabriel Sayer MD , Nir Uriel MD, MSc , Yoshifumi Naka MD, PhD , Andrew B. Goldstone MD, PhD , Koji Takeda MD, PhD

Objective

Congenital heart disease is a risk factor for mortality after orthotopic heart transplantation; however, the impact of preoperative circulation type and primary congenital heart disease diagnosis remains poorly delineated.

Methods

We retrospectively reviewed patients with adult congenital heart disease aged 16 years or more who underwent orthotopic heart transplantation at our institution between 2008 and 2022. Patients were categorized as having single-ventricle or biventricular circulation. The primary end point was 5-year post-transplant survival.

Results

Sixty-one patients with adult congenital heart disease (single-ventricle: n = 26 [42.6%], biventricular: n = 35 [57.4%]) underwent orthotopic heart transplantation at 33.7 [interquartile range, 19.1-48.7] years. The most common congenital heart disease diagnosis was hypoplastic left heart syndrome (n = 11, 42.3%) in the single-ventricle group and congenitally corrected transposition of the great arteries (n = 7, 20.0%) in the biventricular group. Twenty-four patients previously underwent Fontan palliation. At transplant, patients in the single-ventricle group were younger (18.5 [interquartile range, 17.6-32.3] years vs 45.0 [interquartile range, 33.0-52.2] years, P < .001) and more likely to have biopsy-proven cirrhosis (46.2% vs 14.3%, P = .01) and protein-losing enteropathy (42.3% vs 2.9%, P < .001). Patients in the single-ventricle group also had longer bypass times (223.4 ± 65.3 minutes vs 187.4 ± 59.5 minutes, P = .03) and longer durations of mechanical ventilatory support (3.5 [interquartile range, 2.0-6.0] days vs 1.0 [interquartile range, 1.0-2.0] days, P < .001). Operative mortality was comparable (11.5% vs 8.6%, P = 1). Median follow-up was 6.0 [interquartile range, 2.4-10.0] years. Five-year survival was worse in the single-ventricle group (66.0% ± 10.0% vs 91.3% ± 4.8%, P = .03), as was freedom from major rejection (58.3% ± 10.2% vs 84.0% ± 6.6%, P = .02). In univariable analysis, hypoplastic left heart syndrome and Fontan circulation were risk factors for post-transplant mortality (hypoplastic left heart syndrome: hazard ratio, 5.0, P < .001; Fontan: hazard ratio, 3.5, P = .03).

Conclusions

Adult patients with congenital heart disease undergoing heart transplant with single-ventricle physiology experienced a more complicated post-transplant course, with worse long-term survival and freedom from rejection. Multicenter studies are required to guide orthotopic heart transplantation decision-making in this complex cohort.

方法我们回顾性研究了2008年至2022年期间在我院接受心脏移植手术的16岁及以上成人先天性心脏病患者。患者被分为单心室或双心室循环。结果61例成人先天性心脏病患者（单心室：26例[42.6%]，双心室：35例[57.4%]）在33.7[四分位间范围，19.1-48.7]岁时接受了正位心脏移植手术。最常见的先天性心脏病诊断是单心室组的左心发育不全综合征（n = 11，42.3%）和双心室组的先天性矫正性大动脉转位（n = 7，20.0%）。24名患者曾接受过丰坦姑息术。移植时，单心室组患者更年轻（18.5 [四分位数间距，17.6-32.3] 岁 vs 45.0 [四分位数间距，33.0-52.2] 岁，P < .001），更有可能患有活检证实的肝硬化（46.2% vs 14.3%，P = .01）和蛋白丢失性肠病（42.3% vs 2.9%，P < .001）。单心室组患者的旁路时间更长（223.4 ± 65.3 分钟 vs 187.4 ± 59.5 分钟，P = .03），机械通气支持时间更长（3.5 [四分位间范围，2.0-6.0] 天 vs 1.0 [四分位间范围，1.0-2.0] 天，P < .001）。手术死亡率相当（11.5% vs 8.6%，P = 1）。中位随访时间为 6.0 [四分位间范围，2.4-10.0] 年。单心室组的五年存活率较低（66.0% ± 10.0% vs 91.3% ± 4.8%，P = .03），无严重排斥反应的存活率也较低（58.3% ± 10.2% vs 84.0% ± 6.6%，P = .02）。在单变量分析中，左心发育不全综合征和Fontan循环是导致移植后死亡的危险因素（左心发育不全综合征：危险比，5.0，P = .001；Fontan：危险比，3.5，P = .03）。需要进行多中心研究，以指导这一复杂群体的正位心脏移植决策。

{"title":"Long-term outcomes of heart transplantation in adults with congenital heart disease: The impact of single-ventricle versus biventricular physiology","authors":"Alice V. Vinogradsky BA , Stephanie N. Nguyen MD , Krushang Patel MD , Matthew Regan MS , Kelly M. Axsom MD , Matthew J. Lewis MD , Gabriel Sayer MD , Nir Uriel MD, MSc , Yoshifumi Naka MD, PhD , Andrew B. Goldstone MD, PhD , Koji Takeda MD, PhD","doi":"10.1016/j.xjon.2024.04.006","DOIUrl":"10.1016/j.xjon.2024.04.006","url":null,"abstract":"<div><h3>Objective</h3><p>Congenital heart disease is a risk factor for mortality after orthotopic heart transplantation; however, the impact of preoperative circulation type and primary congenital heart disease diagnosis remains poorly delineated.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed patients with adult congenital heart disease aged 16 years or more who underwent orthotopic heart transplantation at our institution between 2008 and 2022. Patients were categorized as having single-ventricle or biventricular circulation. The primary end point was 5-year post-transplant survival.</p></div><div><h3>Results</h3><p>Sixty-one patients with adult congenital heart disease (single-ventricle: n = 26 [42.6%], biventricular: n = 35 [57.4%]) underwent orthotopic heart transplantation at 33.7 [interquartile range, 19.1-48.7] years. The most common congenital heart disease diagnosis was hypoplastic left heart syndrome (n = 11, 42.3%) in the single-ventricle group and congenitally corrected transposition of the great arteries (n = 7, 20.0%) in the biventricular group. Twenty-four patients previously underwent Fontan palliation. At transplant, patients in the single-ventricle group were younger (18.5 [interquartile range, 17.6-32.3] years vs 45.0 [interquartile range, 33.0-52.2] years, <em>P < .</em>001) and more likely to have biopsy-proven cirrhosis (46.2% vs 14.3%<em>, P = .</em>01) and protein-losing enteropathy (42.3% vs 2.9%<em>, P < .</em>001). Patients in the single-ventricle group also had longer bypass times (223.4 ± 65.3 minutes vs 187.4 ± 59.5 minutes<em>, P = .</em>03) and longer durations of mechanical ventilatory support (3.5 [interquartile range, 2.0-6.0] days vs 1.0 [interquartile range, 1.0-2.0] days<em>, P < .</em>001). Operative mortality was comparable (11.5% vs 8.6%, <em>P</em> = 1). Median follow-up was 6.0 [interquartile range, 2.4-10.0] years. Five-year survival was worse in the single-ventricle group (66.0% ± 10.0% vs 91.3% ± 4.8%<em>, P = .</em>03), as was freedom from major rejection (58.3% ± 10.2% vs 84.0% ± 6.6%<em>, P = .</em>02). In univariable analysis, hypoplastic left heart syndrome and Fontan circulation were risk factors for post-transplant mortality (hypoplastic left heart syndrome: hazard ratio, 5.0<em>, P < .</em>001; Fontan: hazard ratio, 3.5, <em>P = .</em>03).</p></div><div><h3>Conclusions</h3><p>Adult patients with congenital heart disease undergoing heart transplant with single-ventricle physiology experienced a more complicated post-transplant course, with worse long-term survival and freedom from rejection. Multicenter studies are required to guide orthotopic heart transplantation decision-making in this complex cohort.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 257-274"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001086/pdfft?md5=c1ab72bdf11563cf3c7b3eda601d2e4d&pid=1-s2.0-S2666273624001086-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140785907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes of single- versus multi-port video-assisted thoracoscopic surgery: Data from a multicenter randomized controlled trial of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer 单孔与多孔视频辅助胸腔镜手术的疗效：视频辅助胸腔镜手术与开胸手术治疗肺癌的多中心随机对照试验数据

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.02.025

Eric Lim MD , Rosie A. Harris MSc , Tim Batchelor Bsc (Hons), MBChB, FRCS , Gianluca Casali MEDGB , Rakesh Krishnadas MD , Sofina Begum MD , Simon Jordan MD , Joel Dunning MD , Ian Paul MD , Michael Shackcloth MD , Sarah Feeney RN , Vladimir Anikin MD , Niall Mcgonigle MD , Hazem Fallouh MD , Luis Hernandez MD , Franscesco Di Chiara MD , Dionisios Stavroulias MD , Mahmoud Loubani MD , Syed Qadri MD , Vipin Zamvar MD , Chris A. Rogers PhD

Objectives

Surgery through a single port may be less painful because access is supplied by 1 intercostal nerve or more painful because multiple instruments are used in 1 port. We analyzed data collected from the video-assisted thoracoscopic surgery group of a randomized controlled trial to compare differences in pain up to 1 year.

Methods

Groups were compared in a prespecified exploratory analysis using direct (regression) and indirect comparison (difference with respect to thoracotomy). In-hospital visual analogue scale pain scores were used, and analgesic ratios were calculated. After discharge, pain was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaires-Core 30 scores up to 1 year.

Results

From July 2015 to February 2019, we randomized 503 participants. After excluding 50 participants who did not receive lobectomy, surgery was performed using a single port in 42 participants (predominately by a single surgeon), multiple ports in 166 participants, and thoracotomy in 245 participants. No differences were observed in-hospital between single- and multiple-port video-assisted thoracoscopic surgery when modeled using a direct comparison, mean difference of −0.24 (95% CI, −1.06 to 0.58) or indirect comparison, mean difference of −0.33 (−1.16 to 0.51). Mean analgesic ratio (single/multiple port) was 0.75 (0.64 to 0.87) for direct comparison and 0.90 (0.64 to 1.25) for indirect comparison. After discharge, pain for single-port video-assisted thoracoscopic surgery was lower than for multiple-port video-assisted thoracoscopic surgery (first 3 months), and corresponding physical function was higher up to 12 months.

Conclusions

There were no consistent differences for in-hospital pain when lobectomy was undertaken using 1 or multiple ports. However, better pain scores and physical function were observed for single-port surgery after discharge.

目的通过单个端口进行手术可能因由一根肋间神经提供通道而减少疼痛，也可能因在一个端口使用多种器械而增加疼痛。我们分析了一项随机对照试验中视频辅助胸腔镜手术组收集的数据，以比较长达 1 年的疼痛差异。方法在预先指定的探索性分析中，使用直接比较（回归）和间接比较（与开胸术的差异）对各组进行比较。采用院内视觉模拟量表疼痛评分，并计算镇痛比率。出院后，使用欧洲癌症研究和治疗组织生活质量问卷--核心 30 评分对疼痛进行评估，直至 1 年。在排除50名未接受肺叶切除术的参与者后，42名参与者采用单孔手术（主要由一名外科医生实施），166名参与者采用多孔手术，245名参与者采用开胸手术。通过直接比较（平均差异为-0.24（95% CI，-1.06 至 0.58））或间接比较（平均差异为-0.33（-1.16 至 0.51）），未观察到单孔和多孔视频辅助胸腔镜手术在院内的差异。直接比较的平均镇痛比值（单孔/多孔）为 0.75（0.64 至 0.87），间接比较的平均镇痛比值为 0.90（0.64 至 1.25）。出院后，单孔视频辅助胸腔镜手术的疼痛低于多孔视频辅助胸腔镜手术（前3个月），相应的身体功能在12个月内更高。然而，单孔手术出院后的疼痛评分和身体功能更好。

{"title":"Outcomes of single- versus multi-port video-assisted thoracoscopic surgery: Data from a multicenter randomized controlled trial of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer","authors":"Eric Lim MD , Rosie A. Harris MSc , Tim Batchelor Bsc (Hons), MBChB, FRCS , Gianluca Casali MEDGB , Rakesh Krishnadas MD , Sofina Begum MD , Simon Jordan MD , Joel Dunning MD , Ian Paul MD , Michael Shackcloth MD , Sarah Feeney RN , Vladimir Anikin MD , Niall Mcgonigle MD , Hazem Fallouh MD , Luis Hernandez MD , Franscesco Di Chiara MD , Dionisios Stavroulias MD , Mahmoud Loubani MD , Syed Qadri MD , Vipin Zamvar MD , Chris A. Rogers PhD","doi":"10.1016/j.xjon.2024.02.025","DOIUrl":"https://doi.org/10.1016/j.xjon.2024.02.025","url":null,"abstract":"<div><h3>Objectives</h3><p>Surgery through a single port may be less painful because access is supplied by 1 intercostal nerve or more painful because multiple instruments are used in 1 port. We analyzed data collected from the video-assisted thoracoscopic surgery group of a randomized controlled trial to compare differences in pain up to 1 year.</p></div><div><h3>Methods</h3><p>Groups were compared in a prespecified exploratory analysis using direct (regression) and indirect comparison (difference with respect to thoracotomy). In-hospital visual analogue scale pain scores were used, and analgesic ratios were calculated. After discharge, pain was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaires-Core 30 scores up to 1 year.</p></div><div><h3>Results</h3><p>From July 2015 to February 2019, we randomized 503 participants. After excluding 50 participants who did not receive lobectomy, surgery was performed using a single port in 42 participants (predominately by a single surgeon), multiple ports in 166 participants, and thoracotomy in 245 participants. No differences were observed in-hospital between single- and multiple-port video-assisted thoracoscopic surgery when modeled using a direct comparison, mean difference of −0.24 (95% CI, −1.06 to 0.58) or indirect comparison, mean difference of −0.33 (−1.16 to 0.51). Mean analgesic ratio (single/multiple port) was 0.75 (0.64 to 0.87) for direct comparison and 0.90 (0.64 to 1.25) for indirect comparison. After discharge, pain for single-port video-assisted thoracoscopic surgery was lower than for multiple-port video-assisted thoracoscopic surgery (first 3 months), and corresponding physical function was higher up to 12 months.</p></div><div><h3>Conclusions</h3><p>There were no consistent differences for in-hospital pain when lobectomy was undertaken using 1 or multiple ports. However, better pain scores and physical function were observed for single-port surgery after discharge.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"19 ","pages":"Pages 296-308"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000949/pdfft?md5=a26bc67800c5e8425b43fb22f19f6484&pid=1-s2.0-S2666273624000949-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141325252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0