JTCVS open最新文献

英文中文

Should We Wait Until the Morning? 我们应该等到早上吗？

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.06.002

Ye In Christopher Kwon, Barry Gibney, Z.A. Hashmi

引用次数: 0

Management of aortoesophageal fistula primarily using esophageal preservation 主要通过食管保留治疗主动脉食管瘘

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.04.004

Alexander Mills DO , Akiko Tanaka MD, PhD , Ashley Dawson MD , Robert Hetz MD , Holly Smith MD , Michael Lopez DO , Hazim Safi MD , Anthony Estrera MD

Objective

Aortoesophageal fistula is a rare, life-threatening condition. There is no consensus regarding the surgical management of the esophagus in this condition.

Methods

We retrospectively evaluated 13 patients diagnosed with aortoesophageal fistulas at a single institution from 2003 to 2021. Descriptive statistics were used to analyze patient characteristics, operative characteristics, and patient outcomes. Kaplan–Meier survival analysis was performed.

Results

Patients’ mean age was 63.5 years, and 6 (46.2%) were female. The most common presenting symptoms were hemoptysis/hematemesis (69.2%), chest/back pain (46.2%), and fever (38.5%). Twelve patients (92.3%) had a history of aortic procedures. The median time between the index operation and repair of the secondary aortoesophageal fistula in the 12 patients was 5 months. The index operation was a thoracic endovascular aortic repair in 10 of 12 patients (83.3%). Eleven patients (84.6%) underwent primary esophageal repair with flap coverage (omentum or muscle). One of these patients needed an esophagectomy within 1 year. The primary surgical management of the aorta was graft excision and replacement, aside from 1 patient who underwent primary repair. The 30-day survival was 69.2%, and 1-year and 5-year survivals were 31.7%. There were no recurrent infections at the esophageal fistula site.

Conclusions

Aortoesophageal fistula remains a rare condition, but its case numbers have increased with thoracic endovascular aortic repair. It continues to be a difficult condition to manage and has a high fatality rate. Esophageal-preserving surgery may be a safe and less-invasive option for patients with a small defect.

目的主动脉食管瘘是一种罕见的危及生命的疾病。方法我们回顾性评估了 2003 年至 2021 年在一家医疗机构确诊的 13 例主动脉食管瘘患者。我们使用描述性统计来分析患者特征、手术特征和患者预后。结果患者的平均年龄为 63.5 岁，其中 6 例（46.2%）为女性。最常见的首发症状是咯血/吐血（69.2%）、胸痛/背痛（46.2%）和发热（38.5%）。12名患者（92.3%）有主动脉手术史。这12名患者从接受手术到修复继发性主动脉食管瘘的中位时间为5个月。12名患者中有10名（83.3%）的手术是胸腔内主动脉血管修补术。11名患者（84.6%）接受了皮瓣覆盖（网膜或肌肉）的初级食管修复术。其中一名患者在 1 年内需要进行食管切除术。主动脉的主要手术治疗方法是移植物切除和置换，只有一名患者接受了初级修复术。30 天存活率为 69.2%，1 年和 5 年存活率为 31.7%。结论食管主动脉瘘仍然是一种罕见疾病，但随着胸腔内主动脉血管修复术的开展，其病例数有所增加。食管主动脉瘘仍然是一种难以治疗的疾病，而且死亡率很高。对于缺损较小的患者来说，保留食管的手术可能是一种安全、创伤较小的选择。

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引用次数: 0

Costal margin reconstruction for slipping rib syndrome: Outcomes of more than 500 cases and advancements beyond earlier sutured repair technique 肋骨滑移综合征的肋缘重建术：500 多例病例的结果和早期缝合修复技术的进步

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.007

Adam J. Hansen MD, Jeremiah Hayanga MD, MPH, Alper Toker MD, Vinay Badhwar MD

Objectives

To evaluate results of sutured repair for slipping rib syndrome (SRS), identify failure points, and discuss technique modifications to improve outcomes through costal margin reconstruction (CMR).

Methods

Patients undergoing repair of SRS between February 2019 and February 2024 at an academic referral institution were retrospectively analyzed. Pain scores, quality of life, pain medication use, and reoperations were evaluated pre- and postoperatively at 1 and 6 months. In patients failing sutured repair we identified specific failure points and devised a new CMR technique to overcome them. Subsequent CMR patients were followed at 1, 6, 12, 18, and 24 months using the same outcome measures.

Results

Four hundred forty-nine patients underwent repair. Two hundred forty-one patients underwent sutured repair with revision required in 66. Median time to revision was 14 months. CMR was developed and performed in 247 patients. In CMR patients, preoperative mean pain score of 7.5 out of 10 dropped postoperatively to 4.0, 2.5, 1.9, 1.3, and 0.9 at 1, 6, 12, 18, and 24 months, respectively (P < .001). Mean quality of life of 38% improved to 73%, 83%, 88%, 93%, and 95% at the same intervals (P < .001). Preoperatively, 29% of patients chronically used opioid medications. Opioid use dropped postoperatively to 11%, 4%, 4%, 0%, and 0% at the same intervals. Use of nonopioid medications followed a similar pattern. One CMR patient required full revision.

Conclusions

SRS is a debilitating, but correctable disorder. Improved pain and quality of life, reduction in chronic opioid use, and freedom from revision surgery suggest that CMR should be considered the standard operation for SRS.

目的评估肋骨滑脱综合征（SRS）缝合修复术的效果，确定失败点，并讨论通过肋缘重建（CMR）来改善疗效的技术改造方法。在术前和术后 1 个月和 6 个月对疼痛评分、生活质量、止痛药物使用和再次手术进行评估。在缝合修复失败的患者中，我们确定了特定的失败点，并设计了一种新的 CMR 技术来克服这些失败点。随后，我们在 1、6、12、18 和 24 个月对 CMR 患者进行了随访，并采用了相同的结果测量方法。241 名患者接受了缝合修复，其中 66 人需要进行翻修。中位修复时间为 14 个月。247名患者进行了CMR检查。在 CMR 患者中，术前平均疼痛评分为 7.5 分（满分 10 分），术后 1、6、12、18 和 24 个月分别降至 4.0、2.5、1.9、1.3 和 0.9 分（P < .001）。38%的患者的平均生活质量在相同的时间间隔内分别提高到73%、83%、88%、93%和95%（P < .001）。术前，29% 的患者长期使用阿片类药物。术后，阿片类药物的使用率分别降至 11%、4%、4%、0% 和 0%。非阿片类药物的使用情况与此类似。一名 CMR 患者需要进行全面翻修。疼痛和生活质量的改善、长期阿片类药物使用的减少以及免于翻修手术表明，CMR 应被视为 SRS 的标准手术。

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引用次数: 0

Defining resectability: When do you try to take it out? 定义可拆除性：何时取出？

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.012

Harry Etienne MD, PhD , Bianca Battilana MM , Jonathan Spicer MD, PhD , Raphael S. Werner MD, MSc , Isabelle Opitz MD

引用次数: 0

Mesenteric malperfusion syndrome is the game changer in acute aortic dissection 肠系膜灌注不良综合征是急性主动脉夹层的转折点

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.014

Koray Ak MD, PhD

引用次数: 0

Discussion to: 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 讨论到：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.2024.04.011

引用次数: 0

Nationwide analysis of case volume and outcomes in cardiac surgery during the COVID-19 pandemic COVID-19 大流行期间全国心脏外科病例量和结果分析

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.02.024

Jean-Luc A. Maigrot BS , Guangjin Zhou PhD , Siran M. Koroukian PhD , Aaron J. Weiss MD, PhD , A. Marc Gillinov MD , Faisal Bakaeen MD , Lars G. Svensson MD, PhD , Edward G. Soltesz MD, MPH

引用次数: 0

Timeliness of surgery for early-stage lung cancer: Patient factors and predictors 早期肺癌手术的及时性：患者因素和预测因素

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.02.019

Jeffrey Zhu MSPH , Sydney Kantor MBA , Jiafang Zhang MS , Rowena Yip PhD, MPH , Raja M. Flores MD , Claudia I. Henschke PhD, MD , David F. Yankelevitz MD

Objectives

Time-to-treatment initiation is an important consideration for patients undergoing thoracic surgery for early-stage lung cancer because delays have the potential to adversely affect outcomes. This study seeks to quantify time-to-treatment initiation for patients with clinical stage I lung cancer, explore patient factors and predictors that lead to an increased time-to-treatment initiation, and compare surgeon perception of appropriate time-to-treatment initiation to the results.

Methods

Time-to-treatment initiation was determined for patients enrolled in the Mount Sinai Initiative for Early Lung Cancer Research on Treatment study who underwent surgical resection for clinical stage I lung cancer between March 2016 and December 2021. The following dates were determined: (1) date of first suspicious radiologic imaging, (2) date of first biopsy, and (3) date of surgery. A total of 15 thoracic surgeons who participated in the Mount Sinai Initiative for Early Lung Cancer Research on Treatment were assessed on their perception on time-to-treatment initiation.

Results

For 638 patients, median time from first suspicious imaging findings to biopsy was 40 days, biopsy to surgery was 37 days, and suspicious imaging to surgery was 84 days. Significant factors that resulted in longer time-to-treatment initiation in the multivariate analysis were African American or Black race (P = .005), vascular disease (P = .01), and median household income less than $75,000 (P = .04). Although the surgeon's perception was that the average time from biopsy to surgery was 28 days, it was longer for 63.5% of participants; surgeon perception of maximum time between diagnosis and surgery was 84 days and longer for 28.7% of participants.

Conclusions

Patient factors such as race, income, and comorbidities were found to have differences in time-to-treatment initiation. Delays to surgery exceeded the expectations of thoracic surgeons.

目的对于接受胸腔镜手术治疗的早期肺癌患者来说，开始治疗的时间是一个重要的考虑因素，因为延误治疗可能会对预后产生不利影响。本研究旨在量化临床 I 期肺癌患者开始治疗的时间，探索导致开始治疗时间延长的患者因素和预测因素，并比较外科医生对适当开始治疗时间的认知和结果。方法对 2016 年 3 月至 2021 年 12 月期间参加西奈山早期肺癌治疗研究倡议（Mount Sinai Initiative for Early Lung Cancer Research on Treatment）研究并接受临床 I 期肺癌手术切除的患者确定开始治疗的时间。确定了以下日期：（1）首次可疑放射成像日期；（2）首次活检日期；（3）手术日期。共有 15 名胸外科医生参与了西奈山肺癌早期治疗研究计划，他们对开始治疗时间的看法接受了评估。结果在 638 名患者中，从首次可疑影像学检查结果到活检的中位时间为 40 天，活检到手术的中位时间为 37 天，可疑影像学检查结果到手术的中位时间为 84 天。在多变量分析中，非裔美国人或黑人种族（P = .005）、血管疾病（P = .01）和家庭收入中位数低于 75,000 美元（P = .04）是导致开始治疗时间延长的重要因素。虽然外科医生认为从活检到手术的平均时间为 28 天，但 63.5% 的参与者认为时间更长；外科医生认为从诊断到手术的最长时间为 84 天，28.7% 的参与者认为时间更长。手术延迟时间超出了胸外科医生的预期。

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引用次数: 0

The effect of treatment timing on repeat revascularization in patients with stable ischemic heart disease 治疗时机对稳定型缺血性心脏病患者重复血管重建的影响

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.04.009

Sean Hardiman PhD, MHA , Guy Fradet MD, MSc , Lisa Kuramoto MSc , Michael Law PhD , Simon Robinson MB, ChB, MD , Boris Sobolev PhD

Objectives

In patients with stable ischemic heart disease, there is no evidence for the effect of revascularization treatment timing on the need for repeat procedures. We aimed to determine if repeat revascularizations differed among patients who received coronary artery bypass graft surgery after the time recommended by physicians compared with those who had timely percutaneous coronary intervention.

Methods

We identified 25,520 British Columbia residents 60 years or older who underwent first-time nonemergency revascularization for angiographically proven, stable left main or multivessel ischemic heart disease between January 1, 2001, and December 31, 2016. We estimated unadjusted and adjusted cumulative incidence functions for repeat revascularization, in the presence of death as a competing risk, after index revascularization or last staged percutaneous coronary intervention for patients undergoing delayed coronary artery bypass grafting compared with timely percutaneous coronary intervention.

Results

After adjustment with inverse probability of treatment weights, at 3 years, patients who underwent delayed coronary artery bypass grafting had a statistically significant lower cumulative incidence of a repeat revascularization compared with patients who received timely percutaneous coronary intervention (4.84% delayed coronary artery bypass grafting, 12.32% timely percutaneous coronary intervention; subdistribution hazard ratio, 0.16, 95% CI, 0.04-0.65).

Conclusions

Patients who undergo delayed coronary artery bypass grafting have a lower cumulative incidence of repeat revascularization than patients who undergo timely percutaneous coronary intervention. Patients who want to wait to receive coronary artery bypass grafting will see the benefit of lower repeat revascularization over percutaneous coronary intervention unaffected by a delay in treatment.

目标在稳定型缺血性心脏病患者中，没有证据表明血管重建治疗时机对重复手术的需求有影响。我们旨在确定在医生建议的时间后接受冠状动脉旁路移植手术的患者与及时接受经皮冠状动脉介入治疗的患者相比，重复血管再通的情况是否有所不同。方法我们确定了 25520 名 60 岁或以上的不列颠哥伦比亚省居民，他们在 2001 年 1 月 1 日至 2016 年 12 月 31 日期间因血管造影证实的稳定型左主干或多支血管缺血性心脏病接受了首次非急诊血管再通治疗。与及时接受经皮冠状动脉介入治疗的患者相比，我们估算了延迟接受冠状动脉旁路移植术的患者在指数血管重建或最后一次分期经皮冠状动脉介入治疗后，在死亡作为竞争风险的情况下，重复血管重建的未调整和调整累积发病率函数。结果经治疗权重逆概率调整后，3 年后，与及时接受经皮冠状动脉介入治疗的患者相比，接受延迟冠状动脉旁路移植术的患者重复血管再通的累积发生率有显著统计学意义（4.结论与及时接受经皮冠状动脉介入治疗的患者相比，接受延迟冠状动脉旁路移植术的患者重复血管再通的累积发生率较低。希望等待接受冠状动脉搭桥术的患者将看到，与经皮冠状动脉介入治疗相比，延迟治疗带来的重复血管再通发生率较低的益处不受影响。

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引用次数: 0

Effects of implantation height on the performance of a redo transcatheter aortic valve replacement using a balloon-expandable valve 植入高度对使用球囊扩张瓣膜的重做经导管主动脉瓣置换术性能的影响

JTCVS open

Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.02.021

Huang Chen PhD , Milad Samaee PhD , Pradeep Yadav MD , Vinod Thourani MD , Lakshmi Prasad Dasi PhD

Objective

The use of the transcatheter aortic valve in low-risk patients might lead to a second intervention due to the deterioration of the first 1. Understanding the implantation height is key to an effective redo transcatheter aortic valve replacement treatment.

Methods

The effects of implantation height on the performance of a balloon-expandable valve within a self-expandable valve were assessed using hemodynamic testing and particle image velocimetry. The hemodynamic performances, leaflet kinematics, and turbulent shear stresses were measured and compared.

Results

When a second balloon-expandable valve was positioned at varying heights relative to the first self-expandable valve, the leaflet motion of the first valve transitioned from free opening and closing to overhanging, and eventually to being entirely pinned to the stent, forming a neo-skirt. When the leaflets of the self-expandable valve could move freely, a decrease in regurgitation fraction was observed, but with an increased pressure gradient across the valve. Flow visualization indicated that the overhanging leaflets disrupted the flow, generating a higher level of turbulence.

Conclusions

This study suggests that the overhanging leaflets should be avoided, whereas the other 2 scenarios should be carefully evaluated based on an individual patient's anatomy and the cause of failure of the first valve.

方法采用血流动力学测试和粒子图像测速仪评估了植入高度对自扩张瓣内球囊扩张瓣性能的影响。结果当第二个球囊扩张瓣膜相对于第一个自体扩张瓣膜以不同高度定位时，第一个瓣膜的瓣叶运动从自由开闭过渡到悬垂，最终完全固定在支架上，形成一个新裙边。当自扩张瓣膜的瓣叶可以自由运动时，反流率下降，但瓣膜上的压力梯度增加。本研究表明，应避免使用悬垂瓣叶，而其他两种情况则应根据患者的解剖结构和第一个瓣膜失效的原因进行仔细评估。

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