Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia最新文献

Purpose: The superior septal approach offers improved mitral valve exposure compared to the right-sided left atriotomy or transseptal approach. However, the risk of postoperative sinus node dysfunction remains controversial, with limited data in the context of right mini-thoracotomy.

Methods: This retrospective study included 155 patients (64 women; mean age, 60.8 ± 13.4 years) who underwent mitral valve surgery via right mini-thoracotomy between November 2016 and August 2023. Indications included degenerative mitral regurgitation (94.8%) and mitral stenosis (5.2%). Patients were divided into 2 groups: the conventional minimally invasive mitral valve surgery (CM) group (n = 47), using the right-sided left atriotomy, and the drawer-case technique (DCT) group (n = 108), using the superior septal approach. Demographic, intraoperative, and outcome data were analyzed.

Results: Baseline characteristics were similar between groups. There were no significant differences in valve repair techniques or postoperative echocardiographic findings. Postoperative junctional rhythm occurred in 6 patients (CM group) and 21 patients (DCT group); all patients with preoperative sinus rhythm returned to sinus rhythm postoperatively.

Conclusion: The superior septal approach does not increase the risk of persistent junctional rhythm in right mini-thoracotomy and is a safe and effective option for mitral valve surgery.

Compared with the conventionally harvested saphenous vein graft, the no-touch saphenous vein graft, in which manipulation and tension are minimized and intraluminal dilatation is avoided during vein harvest, has shown better-preserved luminal endothelium and improved patency rates after coronary artery bypass grafting. This review article will detail and summarize the relevant literature on the no-touch saphenous vein in coronary artery bypass grafting.

Left atrial mitral valve chorda (LAMVC) is a rare congenital cardiac anomaly. The abnormal tissue band, like a mitral valve chorda, is attached to the left atrial wall on one side and mostly to the mitral valve leaflet on the other side and the band sometimes disturbs the mitral leaflet motion, followed by mitral regurgitation (MR). We encountered a case with a LAMVC which originated from a papillary muscle and attached to the posterior mitral annulus over the posterior leaflet and caused MR due to restricted mitral leaflet motion.

We report a rare case of the independent coexistence of lung cancer and organizing pneumonia (OP) in different lobes of the right lung in a 67-year-old man with a history of left upper lobectomy. Computed tomography revealed a lesion consistent with OP in the right upper lobe and a suspicious shadow in the right lower lobe, which was diagnosed as squamous cell carcinoma via bronchoscopic biopsy. The patient underwent right lower lobectomy and partial resection of the right upper lobe under left one-lung ventilation. Empirical corticosteroids were administered preoperatively, followed by a brief postoperative course for 3 days after pathological confirmation of OP to reduce complications such as bronchial fistula, then transitioned to macrolide therapy for 3 months. Fourteen months postoperatively, OP had not recurred, although bone metastases developed and responded well to chemoradiotherapy. This case highlights the need for individualized perioperative management in patients with complex pulmonary pathology.

Purpose: In totally endoscopic off-pump left atrial appendage (LAA) closure and surgical ablation, securing the operative field is sometimes difficult in some patients because of a narrow working space caused by an elevated diaphragm or ventricles. In this study, we aimed to investigate the effectiveness of a method that facilitates securing the operative field using an artificial pneumothorax.

Methods: We analyzed 71 consecutive patients who underwent totally endoscopic off-pump LAA closure and bilateral pulmonary vein isolation. The factors contributing to the reduction in operative time were examined. The patients were divided into the following 2 groups according to whether or not an artificial pneumothorax was used: Group C comprised 24 patients without an artificial pneumothorax and Group A comprised 47 patients with an artificial pneumothorax.

Results: There were no hospital deaths or major complications. The operative time was significantly shorter in Group A (108 ± 26 minutes) than in Group C (198 ± 77 minutes) (p <0.0001).

Conclusions: In totally endoscopic off-pump LAA closure and surgical ablation, an artificial pneumothorax may be useful in reducing the operative time.

Primary pulmonary sarcoma is a rare disease and is much less common than lung cancer among tumors arising from pulmonary cysts. We report the case of a female patient who showed multifocal cysts in the left S9-10. Follow-up computed tomography (CT) revealed that the cyst tended to regress, but the solid component of the cyst wall continued to thicken, growing to a 10-cm-diameter tumor. Thoracoscopic left lower lobectomy was performed to diagnose and treat the cystic lung lesions. For the pathology of the pulmonary cystic lesion, it was marked by solid tumors composed of proliferative atypical spindle cells, with some trapped bronchial tissue. Based on the imaging and pathological findings, the diagnosis was primary pulmonary sarcoma arising from the pulmonary cyst. The present case highlights that, even when a pulmonary cyst appears to shrink, careful follow-up and timely surgical consideration are warranted if cyst wall thickening is observed.

Purpose: This study aimed to summarize 8-year clinical outcomes for patients who underwent transcatheter aortic valve replacement (TAVR) with the J-Valve system and evaluate the long-term durability and hemodynamic performance of the valve.

Methods: Between July 2014 and June 2015, 21 patients underwent transapical TAVR with the J-Valve system. Systematic clinical and echocardiographic follow-up was conducted on 18 patients for up to 8 years.

Results: Eight years post-TAVR with the J-Valve system, the all-cause mortality rate was 16.7%, with no prosthesis failures or thrombosis. Moderate to severe valve deterioration was observed in 50% of patients with aortic stenosis (AS), whereas no such deterioration was noted in patients with pure aortic regurgitation (PAR). At 8 years following TAVR, the effective orifice area measured 2.27 ± 0.50 cm² in patients with PAR and 1.35 ± 0.38 cm² in those with AS. Additionally, patients with AS exhibited a mean pressure gradient of 17.90 ± 10.61 mmHg. Over 8 years, PAR patients experienced a significant reduction in left ventricular end-diastolic diameter from 61.50 ± 2.08 mm to 48.67 ± 7.23 mm (p < 0.001), whereas AS patients showed no significant change.

Conclusion: The J-Valve system demonstrates favorable long-term outcomes in TAVR, with excellent durability and hemodynamic performance in PAR patients.

The scarcity of leaflet tissue and restricted systolic motion remain challenges in mitral valve repair. In addition to functional or secondary mitral regurgitation, atrial functional mitral regurgitation, characterized by chronic atrial fibrillation, preserved left ventricular function, and atriogenic leaflet tethering, exacerbates leaflet scarcity, complicating mitral valve repair. To address this, we introduce the "elbow patch repair," a novel technique using an autologous pericardium overlay patch to reinforce the posterior mitral valve leaflet. A 65-year-old male patient with chronic atrial fibrillation and severe mitral regurgitation consistent with atrial functional mitral regurgitation underwent the "elbow patch repair" combined with annuloplasty and neochordae placement. This approach effectively managed posterior mitral valve leaflet deficiency and restored the coaptation surface. The "elbow patch repair" offers a straightforward and effective solution for leaflet shortage in atrial functional mitral regurgitation and select cases of Carpentier Class IIIb. Further studies are needed to assess its long-term durability.

Severe subcutaneous emphysema that is refractory to chest tube drainage can result in significant patient discomfort, airway compromise, and hemodynamic instability. Various interventional approaches, including subcutaneous drain insertion and the blowhole technique, with or without negative pressure wound therapy (NPWT), have been proposed to manage this condition. In this case series, we describe 10 patients who developed severe subcutaneous emphysema following surgery or pneumothorax and were treated using the blowhole technique, with or without NPWT. A Wound Protector/Retractor XXS or LapProtector was used to maintain the patency of the blowhole, facilitating continuous decompression. In cases with more extensive emphysema, the application of NPWT led to rapid respiratory improvement, thereby enabling additional invasive interventions to address the underlying pulmonary air leak. These findings highlight the potential utility of a structured approach incorporating NPWT for the management of severe subcutaneous emphysema, particularly in cases refractory to conventional chest tube drainage.

Purpose: Cryoprecipitate has been covered by Japanese national health insurance since 2020 for cardiopulmonary bypass (CPB)-induced hypofibrinogenemia. This study evaluated the clinical efficacy of in-house cryoprecipitate use in patients undergoing CPB.

Methods: A total of 1357 patients were divided into 2 groups before and after cryoprecipitate introduction in February 2020 (Group A, n = 685; Group B, n = 672). Propensity score matching also compared 205 pairs between transfused patients in Group A (Group A', n = 597) and those receiving cryoprecipitate in Group B (Group B', n = 222).

Results: Cryoprecipitate was used in 222 patients (37%) in Group B. While overall transfusion rates did not differ significantly, postoperative red blood cell (20% vs 13%, p <0.01) and platelet concentrate (PC) (35% vs 12%, p <0.01) use were significantly lower in Group B. In the matched cohorts, including ~70% undergoing aortic surgery, postoperative PC use was significantly reduced in Group B' (26% vs 18%, p = 0.04).

Conclusions: In-house cryoprecipitate use was associated with reduced postoperative PC transfusion, particularly in aortic surgery involving prolonged CPB and deep hypothermic circulatory arrest. A cryoprecipitate-centered hemostatic strategy, supplementing multiple coagulation factors beyond fibrinogen, may be effective in complex CPB procedures.