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

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: We aimed to compare the midterm outcomes of the no-touch saphenous vein graft (NT-SVG) as a second conduit with those of other graft types.

Methods: We retrospectively reviewed 549 consecutive patients who underwent multivessel isolated coronary artery bypass grafting (CABG) with ≥2 distal anastomoses between 2002 and 2024. Five conduit groups for non-LAD grafting were analyzed: in situ internal thoracic artery (ITA), free ITA, conventional saphenous vein graft (cSVG), NT-SVG, and right gastroepiploic artery (rGEA). We analyzed conduit-specific patency and propensity score-matched patency between cSVG and NT-SVG.

Results: The mean age was 68.6 ± 9.5 years, and 74% were men. Off-pump CABG was performed in 60.5% of cases, with a mean of 3.3 ± 0.9 distal anastomoses. Hospital mortality was 1.5%. Notably, the 5- and 10-year survival rates were 85.9% and 74.1%, respectively. Among 794 non-LAD grafts, the NT-SVG demonstrated a 5-year patency of 96.4%, which was significantly higher than that of cSVG (89.5%, p = 0.05) and rGEA (87.2%, p = 0.04), and equivalent to in situ ITA (94.4%) and free ITA (95.0%). The propensity score-matched analysis further demonstrated superior graft patency with the NT-SVG.

Conclusions: The NT-SVG achieves a 5-year patency comparable to that of ITA grafts and superior to that of cSVG and rGEA, suggesting its potential as a promising option for non-LAD revascularization, pending further validation.

Purpose: The aim of this study was to evaluate the impact of intercostal nerve cryoablation on postoperative pain, opioid usage, and lung expansion after open aortic repair via left thoracotomy.

Methods: This retrospective study included 62 patients who underwent aortic repair via left thoracotomy between 2017 and 2023. Patients were divided into cryoablation (n = 32) and non-cryoablation (n = 30) groups. Pain was assessed using the Numerical Rating Scale (NRS), and lung volume was measured using computed tomography 1 week postoperatively.

Results: The cryoablation group showed significantly lower mean NRS scores (1.7 vs. 2.4, p <0.01) and lower opioid consumption (6.2% vs. 56.6%, p <0.01). The left lung volume ratio was significantly higher in the cryoablation group (72.3% vs. 62.4%, p = 0.05).

Conclusions: Intercostal nerve cryoablation effectively reduces postoperative pain and opioid consumption and enhances pulmonary expansion after left thoracotomy. This technique may offer a favorable analgesic option in thoracic aortic surgery.

Purpose: The study investigated the importance of left ventricular volume assessment before primary repair in asymptomatic tetralogy of Fallot (TOF) patients.

Methods: Forty-two asymptomatic TOF patients who underwent preoperative cardiac catheterization at a median age of 4.7 months interquartile range [IQR], 4.0-5.3) between 2013 and 2023 were enrolled. Asymptomatic TOF was defined as room air oxygen saturation ≥85% without duct-dependent circulation. Left ventricular end-diastolic volume (LVEDV) as a percentage of predicted normal (LVEDV%N) was measured using the single-plane area-length method. Correlation with echocardiographic parameters was assessed.

Results: The median LVEDV%N was 107% (IQR, 87.5-139.5). Five patients (11.6%) had LVEDV%N ≤80%. One patient with the lowest LVEDV%N (62%) underwent a modified Blalock-Taussig shunt instead of primary repair. The remaining four patients had a small pulmonary valve annulus (PVA) (Z-score -4.2 to -6.6) and underwent transannular patch repair. Seven additional patients underwent transannular patch repair due to total conal ventricular septal defect (n = 5) or patent ductus arteriosus with small PVA (n = 2). LVEDV%N showed a weak correlation with 1-month echocardiographic parameters (R² = 0.27-0.347).

Conclusions: Left ventricular volume assessment prior to primary repair is essential in asymptomatic TOF patients. There were cases with small LV for whom primary repair was deferred, or whose PVA was also small; therefore, transannular patch repair was selected.

Mitral annular calcifications have been known to increase complexity during mitral valve replacement (MVR). Standard procedure requires decalcification followed by reconstruction of the mitral annulus prior to placing the prosthesis. While this is the ideal technique, it is not feasible in every patient due to the associated risks. The mere attempt at valve replacement without proper annular decalcification has been associated with a high incidence of periprosthetic leak which complicates the postoperative course and has been associated with increased morbidity and mortality. With the advances in transcatheter therapy, postoperative periprosthetic regurgitation can be managed with devices and primary transcatheter valve implantation could be alternative to standard valve replacement; however, these alternate strategies are not without its own limitations and drawbacks. In the current report, we present a novel strategy to be used in a select group of patients with severe but non-circumferential annular calcifications to prevent/minimize periprosthetic regurgitation during MVR. This involves placing a patch over the posteriorly located calcium bar, thus minimizing tension on the posterior suture line and contain any periprosthetic regurgitation if to develop. This modification has been performed in a total of nine cases with acceptable early results.

Purpose: This study evaluated the prognostic significance of the controlling nutritional status/creatine kinase score (CNKS), a composite index derived from the controlling nutritional status (CONUT) score and creatine kinase (CK) level, in patients with interstitial pneumonia awaiting lung transplantation (LT).

Methods: We retrospectively analyzed 202 patients with interstitial pneumonia who were registered for LT between January 2014 and July 2023. CNKS was calculated using CK levels and the CONUT (derived from albumin level, lymphocyte count, and cholesterol level).

Results: Among the 202 patients, 130 (64.4%) were alive, while 72 (35.6%) had died at the time of analysis. Among the surviving patients, 79 (39.1%) underwent cadaveric LT, and 51 (25.2%) remained on the waiting list. A high CNKS (n = 72 [35.6%]) was significantly associated with a lower body mass index (P <0.001), a shorter 6-minute walk distance (P <0.001), and lower forced vital capacity (P = 0.006) compared with a low CNKS (n = 130 [64.4%]). The results of the multivariate analysis showed that CNKS was a significant independent prognostic factor for survival during the waiting period (P = 0.031).

Conclusion: CNKS represents a promising prognostic marker, potentially useful in selecting lung transplant candidates and guiding nutritional and rehabilitative interventions during the pretransplant period.

Purpose: Reimplanting the radial artery in the left internal thoracic artery as a composite graft allows total arterial revascularization (TAR) without aortic manipulation. The limitation of this strategy is the length of the radial artery required to reach distal right coronary artery (RCA) branches. Our analysis focuses on the feasibility of this strategy.

Methods: A total of 169 patients underwent TAR using the radial artery in a composite grafting configuration. Length of the radial artery, number of sequential anastomoses, heart size, target location, length of the arm, patient height, body surface area, and flow in the composite graft were prospectively collected.

Results: The mean length of the radial artery was 18.02 cm. Patients with a mean length of the radial artery of 15.9 cm needed an extension of the radial artery with another conduit to reach the RCA distal branches. When T-configuration is used, the length of the radial artery should be 0.53 cm per sequential anastomosis to reach the RCA distal branches.

Conclusions: Our study shows that an average length of 18.02 cm of radial artery is needed to reach targets on the RCA distal branches in composite grafting. In T-configuration, we need 0.53 cm more length per anastomosis to achieve TAR.

Purpose: We aimed to investigate the effects of initial abdominal aortic aneurysm (AAA) diameter on aneurysmal sac expansion/shrinkage, endoleaks, and reintervention postelective simple endovascular aneurysm repair (EVAR).

Methods: Overall, 228 patients monitored for >1 year after EVAR were analyzed. Male and female participants with initial AAA diameters <55 mm and <50 mm, respectively, composed the small group (group S), while those with initial AAA diameters ≥55 mm (men) and ≥50 mm (women) composed the large group (group L). Aneurysmal sac expansion of 10 mm and/or reintervention during follow-up (composite event) and its related factors were evaluated.

Results: The 5-year freedom from composite event rate was significantly higher in group S (92.4 ± 2.8%) than that in group L (79.1 ± 4.9%; P <0.01). Multivariate analysis revealed AAA diameters before EVAR in group S (hazard ratio, 0.38; 95% confidence interval, 0.18-0.81; P = 0.01) and type II endoleak (T2EL) at discharge (hazard ratio, 2.83; 95% confidence interval, 1.29-6.20; P <0.01) as factors associated with the composite event. The freedom from composite event rate decreased to 51 ± 13% at 5 years in group L with T2EL.

Conclusions: Group S had high freedom from composite event rate; in group L, the rate decreased to 51% at 5 years with T2EL at discharge.