The latest medical research on Cardiothoracic Surgery

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about cardiothoracic surgery gathered by our medical AI research bot.

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Preoperative percutaneous needle indigo carmine and lipiodol mixture marking in lung segmentectomy.

European Journal of Heart Failure

For successful nodule localization and appropriate surgical margin distances in pulmonary segmentectomy for patients with lung malignancies, the effectiveness and feasibility of preoperative marking using an indigo carmine and lipiodol mixture remain unclear.

Patients who underwent thoracoscopic pulmonary segmentectomy with (marking group, n = 69) and without (non-marking group, n = 265) preoperative marking at our institution from January 2013 to March 2020 were retrospectively reviewed and compared in terms of surgical outcomes. All markings were performed using a fine needle to percutaneously inject an indigo carmine and lipiodol mixture under the guidance of computed tomography fluoroscopy.

Successful localization was achieved in 66 (96%) patients, of whom 62 (94%) underwent dye pigmentation and four (6%) underwent intraoperative fluoroscopy. On images, the marking group showed a significantly longer distance between the lung surface and tumour (mm, 9 (1-17) vs 0 (0-10); p < 0.01) and smaller maximum tumour size (mm, 16 (11-21) vs 17 (13-23); p = 0.03) and consolidation tumour ratio (0.4 (0.3-1) vs 0.8 (0.4-1); p < 0.01) than the non-marking group. Both groups had comparable operative outcomes, perioperative complications, pulmonary function changes, and surgical margin distances (mm, 20 (15-21) vs 20 (15-20); p = 0.96) without any local recurrence on the surgical margin. Propensity score-matching analysis also showed similar findings for both groups.

Thoracoscopic pulmonary segmentectomy with preoperative marking using an indigo carmine and lipiodol mixture may be an acceptable therapeutic option for small malignancies located deep lung parenchyma.

Pulmonary artery banding as adjunct therapy for ventricular recovery after ALCAPA-repair: a case report.

European Journal of Heart Failure

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly commonly associated with seve...

Reoperative Aortic Valve Replacement After Bio-Bentall using a Double Sewing Ring Technique.

European Journal of Heart Failure

We report an 89-year-old hemodialysis patient with a structural valve deterioration following a Bentall-de Bono operation with a tissue valve using...

Lung Transplantation Long-term Survival is Worse in Patients Who Have Undergone Previous Cardiac Surgery.

European Journal of Heart Failure

Approximately 10% of lung transplant recipients have had previous cardiothoracic surgery. We sought to determine if previous surgery affects outcomes after lung transplant at a national level.

The United Network for Organ Sharing database was analyzed from 2005-2019 to include adult patients who underwent lung transplant who had previous cardiac surgery, and previous thoracic surgery. T-test and chi-squared analysis was used to compare perioperative outcomes. Long-term survival comparison was performed using the Kaplan-Meier method in an unadjusted and propensity matched analysis.

Out of 24,784 lung transplants, 691 (2.7%) had previous cardiac surgery and 1,321 (6.5%) had previous thoracic surgery. Operative mortality was worse in previous cardiac surgery 42(6.1%) versus no previous cardiac surgery 740(3.1%), p < 0.001, and in previous thoracic surgery 65(4.9%) versus no previous thoracic surgery 717(3.1%), p < 0.001. The previous thoracic surgery group had more primary graft failure and treated rejection during the first-year post-transplant. There was no difference in stroke, dialysis, intubation and extracorporeal membrane oxygenation at 72 hours. Long-term survival was significantly worse for lung transplant patients who had undergone previous cardiac surgery (median 3.8 vs 6.3 years, p < 0.001) due to an increase in cardiovascular deaths (p = 0.008) and malignancy (p = 0.043). However, there was no difference in previous thoracic surgery (median 6.6 vs 6.1 years, p = 0.337).

Previous cardiac surgery prior to lung transplant results in worse survival related to cardiovascular death and malignancies. Previous thoracic surgery worsens perioperative outcomes but does not affect long term survival.

Simple open-heart surgery protocol for sickle-cell disease patients: a retrospective cohort study comparing patients undergoing mitral valve surgery.

Interactive Cardiovascular and Thoracic Surgery

Sickle-cell disease (SCD) patients are considered to be at high risk from open-heart surgery. This study assessed the role of a simple sickling-prevention protocol.

Perioperative non-specific and SCD-specific morbidity and 30-day mortality are investigated in a retrospective cohort study on patients undergoing isolated mitral valve surgery. Patients with and without SCD were compared. In the SCD cohort, a bundle of interventions was applied to limit the risk of sickling: 'on-demand' transfusions to keep haemoglobin levels of around 7-8 g/dl, cardiopulmonary bypass with higher blood flow and perfusion temperature, close monitoring of acid-base balance and oxygenation.

20 patients with and 40 patients without SCD were included. At baseline only preoperative haemoglobin levels differed between cohorts (8.1 vs 11.8 g/dl, p < 0.001). Solely SCD-patients received preoperative transfusions (45.0%). Intraoperative transfusions were significantly larger in SCD-patients during cardiopulmonary bypass (priming: 300 vs 200 ml; entire length: 600 vs 300 ml, and 20 vs 10 ml/kg). SCD-patients had higher perfusion temperatures during cardiopulmonary bypass (34.7 vs 33.0 °C, p = 0.01) with consequently higher pharyngeal temperature, both during cooling (34.1 vs 32.3 °C, p = 0.02) and rewarming (36.5 vs 36.2 °C, p = 0.02). No mortality occurred, and non-SCD-specific complications were comparable between groups, but one SCD-patient suffered from perioperative cerebrovascular accident with seizures, and another had evident haemolysis.

SCD-patients may undergo open-heart surgery for mitral valve procedures with an acceptable risk profile. Simple but thoughtful perioperative management, embracing 'on-demand' transfusions and less aggressive cardiopulmonary bypass cooling is feasible and probably efficacious.

Basic Principles of cardiothoracic surgery training: A Position Paper by the EACTS Residents Committee.

Interactive Cardiovascular and Thoracic Surgery

Across Europe there are significant variations in the fundamental structure and content of cardiothoracic surgery (CTS) training programmes. Previous efforts have been made to introduce a Unified European Training System which outlined the fundamentals of the ideal programme and supported a paradigm shift from an apprenticeship to a competency-based model. This paper's goal was to define key structural, administrative and executive details of such a programme in order to lay the foundations for the standardization of cardiothoracic surgical training across Europe.

The European Association for Cardiothoracic Surgery (EACTS) Residents Committee had previously conducted a residents' training survey across Europe in 2020. Training curricula from the twelve most represented countries across Europe were either searched online or obtained from the countries' national trainee representative and reviewed by the committee. Information was collated and placed into one of the following categories to develop the position paper: 1) selection of eligible candidates, 2) guidance for an outcome-based syllabus, 3) documentation and evaluation of training progress, 4) mandatory rotations and training courses, 5) number of independent or assisted cases, and 6) requirements and quality assurance of teachers.

An independent professional body should promote an outcome-based syllabus and take responsibility for the training programme's quality assurance. Trainees should be selected on merit by an open and transparent process. Training should be delivered within a defined period and supervised by an appointed training committee to ensure its implementation. This committee should review the trainees progression regularly, provide feedback and offer trainees the opportunity to experience various training environments and trainers. A common electronic portal be used by trainees to record their agreed objectives and to evidence their completion. Trainees should regularly attend specialty relevant courses and conferences to promote professional and academic development. The end of training is reached when the formal requirements of the training programme are met and the trainee is able to perform at the level expected of a day-one independent surgeon.

This paper defines the key structural, administrative, and executive principles for cardiothoracic surgery training. Programmes are encouraged to review and modify their training curricula, if necessary, to ensure the delivery of high-quality, standardized, outcome-orientated CTS training across Europe.

AVNeo Improves Early Hemodynamics In Regurgitant Bicuspid Aortic Valves Compared To Aortic Valve Repair.

Interactive Cardiovascular and Thoracic Surgery

Calcified or fibrotic cusps in patients with bicuspid aortic valves and aortic regurgitation complicate successful AV-repair. AVNeo with autologous pericardium offers an alternative treatment to prosthetic valve replacement. We compared patients with regurgitant bicuspid valves undergoing AV-repair or AVNeo.

We retrospectively analyzed patients with regurgitant bicuspid valves undergoing AV- repair or AVNeo. We focused on residual regurgitation, pressure gradients and effective orifice area, determined preoperatively and at discharge.

AV-repair was performed in 61 patients (mean age: 43.2 ± 11.3 years years) and AVNeo in 22 (45.7 ± 14.1). Prior to the operation patients of the AV-repair group showed severe regurgitation in 38 cases (62.3%) and moderate in 23 (37.6%); in the AV-Neo-group all patients exhibited severe regurgitation. Postoperatively, 57 patients (93.4%) patients had no or mild regurgitation after AV-repair and 21 (95.4%) after AVNeo. In AVNeo- patients, peak (10.6 ± 3.1 mmHg vs 22.7 ± 11 mmHg mmHg, p < 0.001) and mean pressure gradients (5.9 ± 2 mmHg mmHg vs 13.8 ± 7.3 mmHg mmHg, p < 0.001) were significantly lower and the orifice area significantly larger (2.9 ± 0.8 cm2 vs 1.9 ± 0.7 cm2, p < 0.001) compared to repair.

Compared to AV-repair, patients AVNeo showed lower mean pressure gradients and larger orifice areas at discharge. The functional result was not different.

Long-term survival of single versus bilateral internal mammary artery grafting in patients under 70.

Interactive Cardiovascular and Thoracic Surgery

As definitive data from randomized controlled trials comparing the effect on long-term survival of using single or bilateral internal mammary artery grafting are not yet available, observational studies allow for long-term follow-up in large and representative populations, which might complement the information potentially derived from randomized trials. To compare long-term survival in patients under 70 years of age undergoing single or bilateral internal mammary artery grafting.

Retrospective analysis of 3384 consecutive patients under 70 years undergoing primary isolated coronary artery bypass surgery, performed from 2000 to 2015, in a Portuguese level III Hospital. We identified 2176 and 1208 patients from the study population that underwent single and bilateral internal mammary artery grafting, respectively. The primary end-point was all-cause mortality at ten years. We employed inverse probability weighting to restrict confounding by indication.

The mean age of the study population was 59.4 (± 7.6) years, and 567 (16.8%) were females. Inverse probability weighting was effective in eliminating differences in all significant baseline characteristics. Follow-up was 99.88% complete. The median follow-up time was 12.82 (interquartile range, 9.65, 16.74) years: The primary end-point of all-cause mortality at ten years occurred in 463 patients (21.3%) and 166 (13.7%) in the single and bilateral internal mammary artery grafting group, respectively (hazard ratio, 0.78; 95% CI, 0.66 to 0.92; p = 0.004).

Bilateral internal mammary grafting is associated with lower long-term mortality than single internal mammary grafting. Moreover, this survival benefit comes at no increased perioperative morbidity or mortality cost.

Neointimal hyperplasia in systemic-to-pulmonary shunts of children with complex cyanotic congenital heart disease.

European Journal of Heart Failure

Neointimal hyperplasia might affect systemic-to-pulmonary shunt failure in infants with complex cyanotic congenital heart disease.The aim of this study was to elucidate histopathologic changes of polytetrafluorethylene shunts and to determine whether increased neointimal formation is associated with early interventions comprising balloon dilatation, stent implantation and shunt revision. Further, we intended to identify clinical factors associated with increased neointimal proliferation.

Removed shunts were processed for histopathological analysis. Slides were stained with Hematoxylin/Eosin and Richardson. Immunohistochemistry was performed with anti-alpha-smooth muscle-actin and anti-CD68. Non-parametric analysis and univariable regressions were performed to identify clinical factors associated with neointimal hyperplasia and shunt stenosis.

Fifty-seven shunts (39 modified Blalock-Taussig anastomosis, 8 right-ventricle to pulmonary-artery anastomosis, 10 central shunts) were analyzed. Area of neointimal proliferation within the shunt was in median 0.75 mm2 [Interquartile range, 0.3 -1.57 mm2] and relative shunt stenosis in median 16.7% [Interquartile range, 6.7-30.8%].Neointimal hyperplasia and shunt stenosis correlated with each other and were significantly greater in the group that required early interventions and shunt revision.Univariable linear regression identified smaller shunt size and lower acetylsalicylic acid dosage as factors to be associated with greater neointimal proliferation and shunt stenosis.

In infants with complex cyanotic congenital heart disease, neointimal hyperplasia in systemic-to-pulmonary shunts is associated with early interventions comprising balloon dilatation, stent implantation and shunt revision. Smaller shunt size and lower aspirin dosage are associated with increased neointimal proliferation.

Mediastinitis after Cryopreserved allograft tracheal transplantation treated by Major omentum transposition.

European Journal of Heart Failure

A 56-year-old female presented with an extended adenoid cystic carcinoma of the entire trachea. She underwent a 12-cm fully-circumferential trachea...

Statistical primer: An introduction to the application of linear mixed-effects models in cardiothoracic surgery outcomes research-a case study using homograft pulmonary valve replacement data.

European Journal of Heart Failure

The emergence of big cardio-thoracic surgery datasets that include not only short-term and long-term discrete outcomes but also repeated measurements over time, offers the opportunity to apply more advanced modeling of outcomes. This article presents a detailed introduction to developing and interpreting linear mixed-effects models for repeated measurements in the setting of cardiothoracic surgery outcomes research.

A retrospective dataset containing serial echocardiographic measurements in patients undergoing surgical pulmonary valve replacement (PVR) from 1986 to 2017 in Erasmus MC was used to illustrate the steps of developing a linear mixed-effects model for clinician-researchers.

Essential aspects of constructing the model are illustrated with the dataset including theories of linear mixed-effects models, missing values, collinearity, interaction, nonlinearity, model specification, results interpretation, and assumptions evaluation. A comparison between linear regression models and linear mixed-effects models is done to elaborate on the strengths of linear mixed-effects models. An R script is provided for the implementation of the linear mixed-effects model.

Linear mixed-effects models can provide evolutional details of repeated measurements and give more valid estimates compared to linear regression models in the setting of cardio-thoracic surgery outcomes research.

Systematic review and Meta-analysis comparing low-flow duration of extracorporeal and conventional cardiopulmonary resuscitation.

Interactive Cardiovascular and Thoracic Surgery

After cardiac arrest, a key factor determining survival outcomes is low-flow duration. Our aims were to determine the relation of survival and low-flow duration of extracorporeal cardiopulmonary resuscitation and conventional cardiopulmonary resuscitation and if these two therapies have different short term survival curves in relation to low-flow duration.

We searched Embase, Medline, Web of Science, and Google Scholar from inception up to April 2021. A linear mixed effect model was used to describe the course of survival over time, based on study-specific and time-specific aggregated survival data.

We included 42 observational studies reporting on 1,689 extracorporeal cardiopulmonary resuscitation and 375,751 conventional cardiopulmonary resuscitation procedures. Of the included studies, 25 included adults, 13 included children, and four included both. In adults, survival curves decline rapidly over time (extracorporeal cardiopulmonary resuscitation 37.2%-29.8%-23.8%-19.1% versus conventional cardiopulmonary resuscitation-shockable 36.8%-7.2%-1.4%-0.3% for 15-30-45-60 min low-flow, respectively). extracorporeal cardiopulmonary resuscitation was associated with a statistically significant slower decline in survival than conventional cardiopulmonary resuscitation with initial shockable rhythms (conventional cardiopulmonary resuscitation-shockable). In children, survival curves decline rapidly over time (extracorporeal cardiopulmonary resuscitation 43.6%-41.7%-39.8%-38.0% versus CCPR-shockable 48.6%-20.5%-8.6%-3.6% for 15-30-45-60 min low-flow, respectively). extracorporeal cardiopulmonary resuscitation was associated with a statistically significant slower decline in survival than conventional cardiopulmonary resuscitation-shockable.

The short-term survival of extracorporeal cardiopulmonary resuscitation and conventional cardiopulmonary resuscitation-shockable patients both decline rapidly over time, in adults as well as in children. This decline of short-term survival in relation to low-flow duration in extracorporeal cardiopulmonary resuscitation was slower than in conventional cardiopulmonary resuscitation.

Prospero: CRD42020212480, 02-10-2020.