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Discussion to: Noncomplex ventricular arrhythmia associated with higher freedom from recurrent ectopy at 1 year after mitral repair surgery 讨论到:非复杂性室性心律失常与二尖瓣修复手术后 1 年内复发性异位发生率较高有关。
Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.04.015
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引用次数: 0
National trends, safety, and effectiveness of minimally invasive concomitant chest wall resection for locally advanced lung cancer 局部晚期肺癌微创同期胸壁切除术的全国趋势、安全性和有效性
Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.016
Shawn Purnell MD , Ayham Odeh MD , Richard Freeman MD, MBA , Wissam Raad MD, FACS , Elliot Servais MD, FACS , Zaid Abdelsattar MD, MS, FACS

Objective

Concomitant chest wall resection for locally advanced lung cancer is traditionally performed via an open approach. The safety and effectiveness of minimally invasive approaches for chest wall resections are unknown.

Methods

We used the National Cancer Database to identify patients undergoing lobectomy/bi-lobectomy with concomitant chest wall resection from 2010 to 2020. We stratified patients into those undergoing a minimally invasive resection (video-assisted thoracoscopic surgery [VATS]/robotic) or open, while accounting for conversions. We also compared VATS with robotic approaches. The main outcomes were length of stay, mortality, readmissions, and overall survival. We used multivariable, Kaplan-Meier and Cox proportional models to identify associations.

Results

Of 2837 patients, 756 procedures (26.6%) were started minimally invasive, of which 23.1% were robotic. There were 237 (31.3%) conversions. Patients undergoing a minimally invasive operation were similar in terms of age (65.2 ± 9.8 years vs 66.0 ± 9.9 years), sex, race, tumor histology, and location (all P > .05) but had smaller cancers (5.4 ± 2.6 cm vs 6.2 ± 4.3 cm; P < .001) compared with those undergoing open. They also had shorter length of stay (8.6 ± 7.6 days vs 9.7 ± 9.3 days; P < .001) but similar unadjusted 90-day mortality (8.2% vs 8.0%; P = .999). Neoadjuvant therapy was associated with less minimally invasive approaches (adjusted odds ratio, 0.69; P ≤ .001). Larger cancers were associated with less minimally invasive operations and greater rates of conversions. However, the robotic approach was associated with lower conversion rates than VATS across all tumor sizes. Overall survival was equivalent.

Conclusions

The use of minimally invasive approaches to concomitant chest wall resection is increasing. Although conversions to open are common, this approach is safe and is associated with shorter hospital stays. Overall survival is equivalent to the open approach.

目的局部晚期肺癌的胸壁同期切除术传统上是通过开放式方法进行的。方法我们利用国家癌症数据库识别了 2010 年至 2020 年期间接受肺叶切除术/双叶切除术并同时接受胸壁切除术的患者。我们将患者分为接受微创切除术(视频辅助胸腔镜手术 [VATS]/机器人手术)或开放手术的患者,同时考虑了转换手术。我们还比较了视频辅助胸腔镜手术和机器人手术。主要结果包括住院时间、死亡率、再入院率和总生存率。我们使用了多变量、Kaplan-Meier 和 Cox 比例模型来确定两者之间的关联。有 237 例(31.3%)患者转为微创手术。接受微创手术的患者在年龄(65.2 ± 9.8 岁 vs 66.0 ± 9.9 岁)、性别、种族、肿瘤组织学和位置(均为 P >.05)方面相似,但与接受开放手术的患者相比,他们的癌细胞更小(5.4 ± 2.6 cm vs 6.2 ± 4.3 cm; P <.001)。他们的住院时间也较短(8.6 ± 7.6 天 vs 9.7 ± 9.3 天;P < .001),但未经调整的 90 天死亡率相似(8.2% vs 8.0%;P = .999)。新辅助治疗与较少的微创方法有关(调整后的几率比为0.69;P≤.001)。较大的癌症与较少的微创手术和较高的转换率有关。然而,在所有大小的肿瘤中,机器人方法的转换率均低于VATS方法。结论同时进行胸壁切除术的微创方法越来越多。虽然转为开胸手术的情况很常见,但这种方法很安全,而且住院时间较短。总生存率与开放式方法相当。
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引用次数: 0
Quality of life, psychological states, and personality traits in patients with pectus excavatum 乳突患者的生活质量、心理状态和个性特征
Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.013
Kohei Matsuda MD , Daisuke Fujisawa MD , Kyohei Masai MD , Naoki Miyazaki , Shigeki Suzuki MD , Yu Okubo MD , Kaoru Kaseda MD , Keisuke Asakura MD , Tomoyuki Hishida MD , Hisao Asamura MD

Objective

The quality of life (QOL) and psychological states of patients with pectus excavatum (PE) have yet to be well understood. This study aimed to evaluate the health-related QOL (HRQOL), psychological states, and personality traits of patients with PE, alongside the associations of these factors with the severity of PE.

Methods

A cross-sectional evaluation was prospectively performed in patients scheduled to undergo PE repair surgery between July 2019 and April 2021. The primary outcome was the patients’ HRQOL, and the secondary outcomes were depression, social anxiety, self-efficacy, and personality traits.

Results

In total, 129 patients were subjected to analyses. Patients' HRQOL had a lower role component summary score (mean ± standard deviation: 41.8 ± 12.8, P < .001) than the general population controls. Patients' HRQOL had a significantly better physical component summary (54.0 ± 10.4, P < .001) and mental component summary (53.3 ± 8.8, P < .001) than that of the general population. Fourteen patients' (10.9%) and 56 patients' (43.4%) scores indicated the presence of depression and social anxiety disorder, respectively. Patients’ self-efficacy (46.1 ± 11.4, P, .001) and level of extraversion (46.5 ± 11.8, P < .001) were lower than those of the general population. No significant correlation was found between the severity of PE and these scores.

Conclusions

Our study revealed that patients with PE had decreased social-role QOL, depressive tendencies, increased social anxiety, lower self-efficacy, and introversion. No correlation between the severity of PE and the patients’ psychological outcomes leads us to conclude that surgical implications of PE should not be decided solely by a physical index.

目的:人们尚未充分了解乳房下垂(PE)患者的生活质量(QOL)和心理状态。本研究旨在评估PE患者的健康相关QOL(HRQOL)、心理状态和人格特质,以及这些因素与PE严重程度的关系。方法对2019年7月至2021年4月期间计划接受PE修复手术的患者进行前瞻性横断面评估。主要结果是患者的 HRQOL,次要结果是抑郁、社交焦虑、自我效能感和人格特质。与普通对照组相比,患者的 HRQOL 的角色成分总分较低(平均值 ± 标准差:41.8 ± 12.8,P < .001)。与普通人群相比,患者的 HRQOL 的身体部分总分(54.0 ± 10.4,P < .001)和精神部分总分(53.3 ± 8.8,P < .001)明显更高。14名患者(10.9%)和56名患者(43.4%)的得分分别表明他们患有抑郁症和社交焦虑症。患者的自我效能感(46.1 ± 11.4,P,.001)和外向程度(46.5 ± 11.8,P < .001)均低于普通人群。结论我们的研究显示,PE 患者的社会角色 QOL 下降、抑郁倾向、社交焦虑增加、自我效能感降低、性格内向。PE 的严重程度与患者的心理结果之间没有相关性,因此我们得出结论,PE 的手术影响不应仅由生理指标来决定。
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引用次数: 0
Young infants with symptomatic tetralogy of Fallot: Shunt or primary repair? 患有症状性法洛氏四联症的幼儿:分流术还是初次修复术?
Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.04.003
Xin Tao Ye MD , Soichiro Henmi MD, PhD , Edward Buratto MBBS, PhD , Mitchell C. Haverty MS , Can Yerebakan MD , Tyson Fricke MBBS, PhD , Christian P. Brizard MD, MS , Yves d’Udekem MD, PhD , Igor E. Konstantinov MD, PhD

Objectives

The optimal treatment strategy for symptomatic young infants with tetralogy of Fallot (TOF) is unclear. We sought to compare the outcomes of staged repair (SR) (shunt palliation followed by second-stage complete repair) versus primary repair (PR) at 2 institutions that have exclusively adopted each strategy.

Methods

We performed propensity score-matched comparison of 143 infants under 4 months of age who underwent shunt palliation at one institution between 1993 and 2021 with 122 infants who underwent PR between 2004 and 2018 at another institution. The primary outcome was mortality. Secondary outcomes were postoperative complications, durations of perioperative support and hospital stays, and reinterventions. Median follow-up was 8.3 years (interquartile range, 8.1-13.4 years).

Results

After the initial procedure, hospital mortality (shunt, 2.8% vs PR, 2.5%; P = .86) and 10-year survival (shunt, 95%; 95% confidence interval [CI], 90%-98% vs PR, 90%; 95% CI, 81%-95%; P = .65) were similar. The SR group had a greater risk of early reinterventions but similar rates of late reinterventions. Propensity score matching yielded 57 well-balanced pairs. In the matched cohort, the SR group had similar freedom from reintervention (55%; 95% CI, 39%-68% vs 59%; 95% CI, 43%-71%; P = .85) and greater survival (98%; 95% CI, 88%-99.8% vs 85%; 95% CI, 69%-93%; P = .02) at 10 years, as the result of more noncardiac-related mortalities in the PR group.

Conclusions

In symptomatic young infants with TOF operated at 2 institutions with exclusive treatment protocols, the SR strategy was associated with similar cardiac-related mortality and reinterventions as the PR strategy at medium-term follow-up.

目标法洛氏四联症(TOF)无症状幼婴的最佳治疗策略尚不明确。我们试图在两家完全采用分期修复(SR)(分流姑息后进行第二阶段完全修复)与初次修复(PR)策略的机构中比较两者的治疗效果。方法我们对 1993 年至 2021 年期间在一家机构接受分流姑息治疗的 143 名 4 个月以下婴儿与 2004 年至 2018 年期间在另一家机构接受 PR 治疗的 122 名婴儿进行了倾向评分匹配比较。主要结果是死亡率。次要结果是术后并发症、围手术期支持和住院时间以及再干预。中位随访时间为 8.3 年(四分位间范围为 8.1-13.4 年)。结果首次手术后,住院死亡率(分流,2.8% vs PR,2.5%;P = .86)和 10 年生存率(分流,95%;95% 置信区间 [CI],90%-98% vs PR,90%;95% CI,81%-95%;P = .65)相似。SR 组早期再干预的风险更大,但晚期再干预的比例相似。倾向评分匹配产生了 57 对平衡良好的配对。在匹配队列中,SR 组的再干预率相似(55%;95% CI,39%-68% vs 59%;95% CI,43%-71%;P = .85),10 年后的存活率更高(98%;95% CI,88%-99.8% vs 85%;95% CI,69%-93%;P = .02),这是因为 PR 组的非心脏相关死亡率更高。结论 对于在两家机构接受手术并采用独家治疗方案的有症状的年幼 TOF 婴儿,在中期随访时,SR 策略与 PR 策略具有相似的心脏相关死亡率和再干预率。
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引用次数: 0
Multifactorial considerations in frozen elephant trunk selection and treatment strategies for acute type A aortic dissection 急性 A 型主动脉夹层的冰冻象鼻干选择和治疗策略的多因素考虑
Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.008
Yang Yu MD, PhD, Lu Liu MD, Enyi Shi MD, PhD, Tianxiang Gu MD, PhD
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引用次数: 0
Value of nutritional indices in predicting survival free from pump replacement and driveline infections in centrifugal left ventricular assist devices 营养指标在预测离心式左心室辅助装置免于更换泵和传动系统感染的存活率方面的价值
Pub Date : 2024-06-01 DOI: 10.1016/j.xjon.2024.03.017
Fabian Jimenez Contreras MD , Bret L. Pinsker MD , Jason N. Katz MD, MHS , Stuart D. Russell MD , Jacob Schroder MD , Benjamin Bryner MD , Alexander H. Gunn MD , Krunal Amin MD , Carmelo Milano MD

Objective

There is a paucity of data assessing the impact of nutritional status on outcomes in patients supported with the HeartMate 3 (HM3) left ventricular assist device (LVAD).

Methods

Patients ≥18 years of age who underwent HM3 LVAD implantation between 2015 and 2020 were identified from a single tertiary care center. The primary outcome assessed was death or device replacement. A secondary outcome of driveline infection was also evaluated. Kaplan-Meier survival analysis and a multivariate Cox-proportional hazards model were used to identify predictors of outcome.

Results

Of the 289 patients identified, 94 (33%) experienced a primary outcome and 96 (33%) a secondary outcome during a median follow-up time of 2.3 years. Independent predictors of the primary outcome included peripheral vascular disease (hazard ratio [HR], 3.40; 95% confidence interval [CI], 1.66-6.97, P < .01), diabetes mellitus (HR, 0.46; 95% CI, 0.27-0.80, P < .01), body mass index ≥40 kg/m2 (HR, 2.63 per 1 kg/m2 increase; 95% CI, 1.22-5.70, P < .05), preoperative creatinine level (HR, 1.86 per 1 mg/dL increase; 95% CI, 1.31-2.65, P < .01), and preoperative prognostic nutritional index (PNI) score (HR, 0.88 per 1-point increase; 95% CI, 0.81-0.96, P < .01). Independent predictors of driveline infection included age at the time of implantation (HR, 0.97; 95% CI, 0.96-0.99, P < .01) and diabetes mellitus (HR, 1.79; 95% CI, 1.17-2.73, P < .01).

Conclusions

Preoperative PNI scores may independently predict mortality and the need for device replacement in patients with HM3 LVAD. Routine use of the PNI score during preoperative evaluation and, when possible, supplementation to PNI >33, may be of value in this population.

方法从一家三级医疗中心确定了在 2015 年至 2020 年期间接受 HM3 LVAD 植入术的年龄≥18 岁的患者。评估的主要结果是死亡或设备更换。此外,还评估了传动系感染这一次要结果。结果 在中位随访时间为 2.3 年的 289 例患者中,94 例(33%)出现主要结局,96 例(33%)出现次要结局。主要结果的独立预测因素包括外周血管疾病(危险比 [HR],3.40;95% 置信区间 [CI],1.66-6.97,P < .01)、糖尿病(HR,0.46;95% CI,0.27-0.80,P < .01)、体重指数≥40 kg/m2(HR,2.63;95% CI,1.22-5.70,P < .05)、术前肌酐水平(HR,每增加 1 mg/dL 增加 1.86;95% CI,1.31-2.65,P < .01)和术前预后营养指数(PNI)评分(HR,每增加 1 分增加 0.88;95% CI,0.81-0.96,P < .01)。结论 术前 PNI 评分可独立预测 HM3 LVAD 患者的死亡率和设备更换需求。在术前评估中常规使用 PNI 评分,并在可能的情况下补充 PNI >33,可能对这一人群有价值。
{"title":"Value of nutritional indices in predicting survival free from pump replacement and driveline infections in centrifugal left ventricular assist devices","authors":"Fabian Jimenez Contreras MD ,&nbsp;Bret L. Pinsker MD ,&nbsp;Jason N. Katz MD, MHS ,&nbsp;Stuart D. Russell MD ,&nbsp;Jacob Schroder MD ,&nbsp;Benjamin Bryner MD ,&nbsp;Alexander H. Gunn MD ,&nbsp;Krunal Amin MD ,&nbsp;Carmelo Milano MD","doi":"10.1016/j.xjon.2024.03.017","DOIUrl":"10.1016/j.xjon.2024.03.017","url":null,"abstract":"<div><h3>Objective</h3><p>There is a paucity of data assessing the impact of nutritional status on outcomes in patients supported with the HeartMate 3 (HM3) left ventricular assist device (LVAD).</p></div><div><h3>Methods</h3><p>Patients ≥18 years of age who underwent HM3 LVAD implantation between 2015 and 2020 were identified from a single tertiary care center. The primary outcome assessed was death or device replacement. A secondary outcome of driveline infection was also evaluated. Kaplan-Meier survival analysis and a multivariate Cox-proportional hazards model were used to identify predictors of outcome.</p></div><div><h3>Results</h3><p>Of the 289 patients identified, 94 (33%) experienced a primary outcome and 96 (33%) a secondary outcome during a median follow-up time of 2.3 years. Independent predictors of the primary outcome included peripheral vascular disease (hazard ratio [HR], 3.40; 95% confidence interval [CI], 1.66-6.97, <em>P</em> &lt; .01), diabetes mellitus (HR, 0.46; 95% CI, 0.27-0.80, <em>P</em> &lt; .01), body mass index ≥40 kg/m<sup>2</sup> (HR, 2.63 per 1 kg/m<sup>2</sup> increase; 95% CI, 1.22-5.70, <em>P</em> &lt; .05), preoperative creatinine level (HR, 1.86 per 1 mg/dL increase; 95% CI, 1.31-2.65, <em>P</em> &lt; .01), and preoperative prognostic nutritional index (PNI) score (HR, 0.88 per 1-point increase; 95% CI, 0.81-0.96, <em>P</em> &lt; .01). Independent predictors of driveline infection included age at the time of implantation (HR, 0.97; 95% CI, 0.96-0.99, <em>P</em> &lt; .01) and diabetes mellitus (HR, 1.79; 95% CI, 1.17-2.73, <em>P</em> &lt; .01).</p></div><div><h3>Conclusions</h3><p>Preoperative PNI scores may independently predict mortality and the need for device replacement in patients with HM3 LVAD. Routine use of the PNI score during preoperative evaluation and, when possible, supplementation to PNI &gt;33, may be of value in this population.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001037/pdfft?md5=f03889c7d804c5b6dc86a6f0101433ca&pid=1-s2.0-S2666273624001037-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140774685","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
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
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 ,&nbsp;Mariano Cefarelli MD, PhD ,&nbsp;Luca Di Marco MD, PhD ,&nbsp;Daniel Arcioni MD ,&nbsp;Giada Tortora MD, PhD ,&nbsp;Ada Dormi Mth D Biostatistical ,&nbsp;Nicolò Schicchi MD ,&nbsp;Elisabetta Mariucci MD, PhD ,&nbsp;Marco Di Eusanio MD, PhD ,&nbsp;Davide Pacini MD, PhD ,&nbsp;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":null,"pages":null},"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
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 ,&nbsp;Eva Sames-Dolzer MD ,&nbsp;Melanie Klapper BSc ,&nbsp;Andreas Tulzer MD ,&nbsp;Roland Mair MD ,&nbsp;Fabian Seeber MD ,&nbsp;Gregor Gierlinger MD ,&nbsp;Dalibor Saric MD ,&nbsp;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":null,"pages":null},"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
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
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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
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
{"title":"A surgical armamentarium for correcting systolic anterior motion with re-repair rather than replacement","authors":"Whitney Fu MD,&nbsp;Catherine Wagner MD,&nbsp;Gurnoordeep Pawar BS,&nbsp;Nicolas Ceniza BS,&nbsp;Matthew A. Romano MD,&nbsp;Gorav Ailawadi MD, MBA,&nbsp;Steven F. Bolling MD,&nbsp;Michigan Mitral Research Group","doi":"10.1016/j.xjon.2024.03.010","DOIUrl":"10.1016/j.xjon.2024.03.010","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000895/pdfft?md5=bbcc623140b42fd29d34a5dd050e3e65&pid=1-s2.0-S2666273624000895-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403439","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
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