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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Request AccessHidden Port Site Incision for Robotic Foregut and Hepatopancreatobiliary Operation: A Cosmetically Superior Approach.
Journal of theWhile the widespread adoption of minimally invasive surgery has led to improved cosmesis for abdominal operations, visible scars on the abdomen may...
Is histological confirmation necessary to avoid futile resections? Comparative of four university hospitals.
Cardiothoracic SurgeryThere is no consensus in the literature on preoperative histological analysis for lung cancer. The objective of this study was to assess four diagnostic models used in different hospitals with differing practices regarding preoperative histological diagnosis and the consequences in terms of unnecessary surgery and futile major resection.
We carried out a retrospective observational study collected from four university hospitals in Spain over 3 years (January 2019 to December 2021). We included all patients with a confirmed diagnosis of primary lung cancer and any patients with suspected primary lung cancer who had undergone surgery. All patients underwent CT and PET/CT scans. Each multidisciplinary committee was free to choose whether to perform flexible bronchoscopic or transthoracic lung biopsy. Decisions concerning whether to perform intraoperative sample analysis, the surgical approach and the type of resection were left to the surgical team.
We included a total of 1642 patients. The use of flexible endoscopy and its diagnostic performance varied substantially between hospitals (range: 23.8%-79.3% and 25%-60.7%, respectively); and the same was observed for transthoracic biopsy and its performance (range: 16.9%-82.3% and 64.6%-97%, respectively). Regarding major resection surgery (lobectomy or more extensive resection), the lowest rate was observed in hospital C (1%) and the highest in hospital B (2.8%), with between-hospital differences not reaching significance (p = 0.173).
The rate of histological sampling before lung cancer surgery still varies between hospitals. In spite of very diverse multidisciplinary management, the rate of futile lobectomy is not significantly higher in hospitals with lower rates of preoperative histological analysis.
Patient-specific ascending aortic intervention criteria.
Cardiothoracic SurgeryAscending aortic aneurysms pose a different risk to each patient. We aim to provide personalized risk stratification for such patients based on sex, age, body surface area, and aneurysm location (root vs ascending).
Root and ascending diameters, and adverse aortic events (dissection, rupture, death) of ascending thoracic aortic aneurysm patients were analyzed. Aortic diameter was placed in context vis-a-vis the normal distribution in the general population with similar sex, age, and BSA, by conversion to z scores. These were correlated of major adverse aortic events, producing risk curves with 'hinge points' of steep risk, constructed separately for the aortic root and mid ascending aorta.
1162 patients were included. Risk curves unveiled generalized thresholds of z = 4 for the aortic root, and z = 5 for the mid ascending aorta. These correspond to individualized thresholds of less than the standard criterion of 5.5 cm in the vast majority of patients. Indicative results include a 75 year-old typical male with 2.1 m2 body surface area, who was found to be at increased risk of adverse events if root diameter exceeds 5.15 cm, or mid ascending exceeds 5.27 cm. An automated calculator is presented which identifies patients at high risk of adverse events based on sex, age, height, weight, and root and ascending size.
This analysis exploits a large sample of aneurysmal patients, demographic features of the general population, pre-dissection diameter, discrimination of root and supracoronary segments, and statistical tools to extract thresholds of increased risk tailor-made for each patient.
Scheduled Follow-Up and Association with Emergency Department Use and Readmission after Trauma.
American College of SurgeonsAfter traumatic injury, 13-14% of patients utilize the emergency department (ED) and 11% are readmitted within 30 days. Decreasing ED visits and readmission represents a target for quality improvement. This cohort study evaluates risk factors for ED visits and readmission after trauma, focusing on outpatient follow-up.
We conducted a retrospective chart review of adult trauma admissions from 1/1/2018-12/31/2021. Our primary exposure was outpatient follow-up, our primary outcome was ED use, and our secondary outcome was readmission. Multivariable logistic regression evaluated the association between primary exposure and outcomes, adjusting for factors identified on unadjusted analysis.
2,266 patients met inclusion criteria, with an 11.3% ED visit rate and 4.1% readmission rate. Attending follow-up did not have a significant association with ED visits (OR 0.99, 95% CI 0.99-2.01, p=0.05) or readmission rates (OR 1.68, 95% CI 0.95-2.99, p=0.08). Significant associations with ED use included non-white race, depression, anxiety, substance use disorder, discharge disposition, and being discharged with lines or drains. Significant associations with readmission included depression, anxiety, and discharge disposition.
Emphasizing outpatient follow-up in trauma patients is not an effective target to decrease ED use or readmission. Future studies should focus on supporting patients with mental health comorbidities and investigating interventions to optimally engage with trauma patients after hospital discharge.
Comparison of modified del nido and custodiol® cardioplegia in minimally invasive mitral valve surgery.
Cardiothoracic SurgeryIn this study, we evaluated if modified Del Nido cardioplegia delivers comparable cardiac protection in comparison to Custodiol® in patients undergoing isolated minimally invasive mitral valve repair.
From 01/2018 to 10/2021 all patients undergoing non emergent isolated minimally invasive mitral valve repair were included in this study. The cardioplegia was chosen at the surgeons' discretion. The primary end-points of this study were peak postoperative cardiac enzyme levels. Secondary end-points were in-hospital mortality, hospital stay, occurrence of cardiac arrhythmias, pacemaker implantations, postoperative lactate and sodium levels and postoperative incidence of renal failure requiring dialysis.
A total of 355 patients were included in this study. The mean age of patients was 57. After propensity score matching, a total of 156 pairs were identified. There was no difference in cross-clamp time between both groups. Postoperative Creatine kinase levels were higher in patients receiving Custodiol® on the 1st and 2nd postoperative day. CK-MB levels were higher in patients receiving Custodiol® on the 2nd postoperative day (0.5 ± 0.2 µmol/L*s vs 0.4 ± 0.1 µmol/L*s; p < 0.001). Postoperative Troponin T concentrations were similar between both groups. Maximum lactate concentrations were higher in patients receiving Custodiol on the day of surgery (2.4 ± 1.9 mmol/L vs 2.0 ± 1.1 mmol/L; p = 0.04). The overall hospital stay was longer in patients receiving Del Nido cardioplegia (10.6 ± 3.2 days vs 8 ± 4.1 days; p < 0.01).
Modified Del Nido cardioplegia based on Ionosteril® solution offers equivalent protection compared to Custodiol® for isolated minimally invasive mitral valve repair.
On-X aortic valve replacement patients treated with low dose warfarin and low dose aspirin.
European Journal of Heart FailureTo assess if warfarin targeted to INR 1.8 (range 1.5-2.0) is safe for all patients with an On-X aortic mechanical valve.
This prospective, observational registry follows patients receiving warfarin targeted at an INR of 1.8 (range 1.5-2.0) plus daily aspirin (75-100 mg) after On-X aortic valve replacement. The primary end-point is a composite of thromboembolism, valve thrombosis, and major bleeding. Secondary end-points include the individual rates of thromboembolism, valve thrombosis, and major bleeding, as well as the composite in subgroups of home or clinic-monitored INR and risk categorization for thromboembolism. The control was the patient group randomized to standard-dose warfarin (INR 2.0-3.0) plus daily aspirin 81 mg from the PROACT trial.
A total of 510 patients were enrolled at 23 centers in the UK, United States, and Canada. Currently, the median follow-up duration is 3.4 years, and median achieved INR is 1.9. The primary composite end-point rate in the low INR patients is 2.31% vs 5.39% (95% confidence interval 4.12%-6.93%) per patient-year in the PROACT control group, constituting a 57% reduction. Results are consistent in subgroups of home or clinic-monitored, and high-risk patients, with reductions of 56%, 57%, and 57%, respectively. Major and total bleeding are decreased by 85% and 73%, respectively, with similar rates of thromboembolic events. No valve thrombosis occurred.
Interim results suggest that warfarin targeted at an INR of 1.8 (range 1.5-2.0) plus aspirin is safe and effective in patients with an On-X aortic mechanical valve with or without home INR monitoring.
Durable left ventricular assist device explantation following recovery in paediatric patients: Determinants and outcome after explantation.
Cardiothoracic SurgeryMyocardial recovery in children supported by a durable left ventricular assist device is a rare, but highly desirable outcome since it could potentially eliminate the need for cardiac transplantation and its lifelong need for immunosuppressant therapy and risk of complications. However, experience in this specific outcome is very limited.
All patients <19 y supported by a durable left ventricular assist device from the European Registry for Patients with Mechanical Circulatory Support database were included. Participating centres were approached for additional follow-up data after explantation. Associated factors for explantation due to myocardial recovery were explored using Cox proportional hazard models.
The incidence of recovery in children supported by a durable left ventricular assist device was 11.7% (52/445; med duration of support 122.0 days). Multivariable analyses showed BSA (HR 0.229 CI 0.093-0.565, p = 0.001) and a primary diagnosis of myocarditis (HR 4.597 CI 2.545-8.303, p < 0.001) to be associated with recovery. Left ventricular end-diastolic diameter in children with myocarditis was not associated with recovery. Of 46 patients (88.5%), follow-up after recovery could be obtained. Sustained myocardial recovery was reported in 33/46 (71.7%) at the end of follow-up (28/33 > 2 y). In 6/46 (11.4%) transplantation was performed (in 5 after ventricular assist device reimplantation). Death occurred in 7/46 (15.2%).
Myocardial recovery occurs in a substantial portion of the durable left ventricular assist device-supported paediatric patients and sustainable recovery is seen in around three-quarters of them. Even children with severely dilated ventricles due to myocarditis can show recovery. Clinicians should be attentive to (developing) myocardial recovery. These results can be used to develop internationally approved paediatric weaning guidelines.
Increased utilization of the hybrid procedure is not associated with improved early survival for newborns with hypoplastic left heart syndrome: a single center experience.
Cardiothoracic SurgeryThe primary objectives were to examine utilization of the Hybrid vs. the Norwood procedure for patients with hypoplastic left heart syndrome (HLHS) or variants and the impact on hospital mortality. The Hybrid procedure was first used at our institution in 2004.
Review of all subjects undergoing the Norwood or Hybrid procedure between 1/1/1984 and 12/31/2022. The study period was divided into 8 eras: era 1, 1984 to 1988; era 2, 1989 to 1993; era 3, 1994 to 1998; era 4, 1999 to 2003; era 5, 2004 to 2008; era 6, 2009 to 2014; era 7, 2015 to 2018; and era 8, 2019 to 2022. The primary outcome was in-hospital mortality. Mortality rates were computed using standard binomial proportions with 95% confidence intervals. Rates across eras were compared using an ordered logistic regression model with and adjusted using the Tukey-Kramer post-hoc procedure for multiple comparisons. In the risk modeling phase, logistic regression models were specified and tested.
The Norwood procedure was performed in 1,899 subjects, and the Hybrid procedure in 82 subjects. Use of the Hybrid procedure increased in each subsequent era, reaching 30% of subjects in era 8. After adjustment for multiple risk factors, use of the Hybrid procedure was significantly and positively associated with hospital mortality.
Despite the increasing use of the Hybrid procedure, overall mortality for the entire cohort has plateaued. After adjustment for risk factors, use of the Hybrid procedure was significantly and positively associated with mortality compared to the Norwood procedure.
Twenty-five years' experience with isolated bicuspid aortic valve repair: impact of commissural orientation.
Cardiothoracic SurgeryRepair of the bicuspid aortic valve has evolved in the past 25 years. The aim of this study was to review and analyze the long-term durability of isolated BAV repair with particular focus on commissural orientation (CO).
All patients who underwent bicuspid aortic valve repair for severe aortic regurgitation between 10/1998 and 12/2022 were included. The study group consists of all patients operated after 2009 ie, since CO modification. The control group includes patients who were operated before 2009. Commissural orientation was classified as symmetric, asymmetric, and very asymmetric.
Overall, 594 adult patients (93% male; mean age 42 years) were included. At 15 years, survival was 94.8% (SD : 2.2); freedom from reoperation was 86.8% (SD : 2.3). Freedom from AI≥II was 70.8% (SD : 4.7) at 15 years. Modification of commissural orientation by sinus plication was performed in 200 (33.7%) instances. Using competing risks analysis, the absence of eH measurement (P = 0.018), very asymmetric CO (P = 0.028), the presence of calcification (P < 0.001), the use of pericardial patch (P < 0.001), the use of subcommissural sutures (P < 0.001), and preoperative endocarditis (P = 0.005) were identified as independent predictors for reoperation. Follow-up was 97% complete (4228 patient-years); mean follow-up was 7 years (SD : 5).
Isolated bicuspid aortic valve repair leads to good survival and durability in all morphologic types if cusp repair is guided by effective height, suture annuloplasty is performed, and CO is modified using sinus plication in asymmetrical valves. Very asymmetrical valves may should be treated with a lower threshold for replacement.
Mid-term outcomes of right ventricular papillary muscle approximation for severe functional tricuspid regurgitation.
Cardiothoracic SurgeryRecurrence of tricuspid regurgitation after tricuspid annuloplasty can occur in cases where a dilated right ventricle exists and subsequent leaflet tethering follows. We previously reported a new technique of the right ventricular papillary muscle approximation for functional tricuspid regurgitation associated with leaflet tethering. The objective of this study is to elucidate the mid-term outcomes and evaluate the durability of right ventricular papillary muscle approximation.
Between January 2014 and March 2023, we applied right ventricular papillary muscle approximation in 20 patients of advanced functional tricuspid regurgitation with severe leaflet tethering. The indication of the technique was severe TR with leaflet tethering height >8mm, and/or a right ventricular end-diastolic diameter >45mm. The patients were followed up with echocardiography before discharge and at annual interval thereafter.
There was no perioperative mortality. In the echocardiography performed before discharge, tricuspid regurgitation was decreased to mild or less in 85%, and a significant improvement in right ventricular end-diastolic diameter and tethering height were achieved (53 mm to 45 mm, and 11.1 mm to 4.4 mm, respectively). Furthermore, during the median 3-year follow-up period, tricuspid regurgitation was kept controlled mild or less in 80% of the cases.
Right ventricular papillary muscle approximation is considered to be a safe, effective and durable technique as an additional approach for tricuspid annuloplasty.
Outcome after extracorporeal membrane oxygenation therapy in norwood patients before the bidirectional glenn operation.
Cardiothoracic SurgeryPatients after the Norwood procedure are prone to postoperative instability. Extracorporeal membrane oxygenation (ECMO) can help to overcome short-term organ failure. This retrospective single-center study examines ECMO weaning, hospital discharge and long-term-survival after ECMO-therapy between Norwood and bidirectional Glenn (BDG) palliation as well as risk factors for mortality.
In our institution over 450 Norwood procedures have been performed. Since the introduction of ECMO-therapy, 306 Norwood operations took place between 2007 and 2022, involving ECMO in 59 cases before BDG. In 48.3% of cases, ECMO was initiated intraoperatively post-Norwood. Patient outcomes were tracked and mortality risk factors were analyzed using uni- and multivariable testing.
ECMO-therapy after Norwood (median duration: 5d; range: 0-17d), saw 31.0% installed under CPR. Weaning was achieved in 46 children (78.0%), with 55.9% discharged home after a median of 45 [36; 66] days. Late-death occurred in 3 patients after 27, 234, and 1541 days. Currently, 30 children are in a median 4.8 year [3.4; 7.7] follow-up. At the time of inquiry, 1 patient awaits BDG, 6 are at stage II palliation, Fontan was completed in 22, and 1 was lost to follow-up post-Norwood. Risk factor analysis revealed dialysis (p < 0.001), cerebral lesions (p = 0.026), longer ECMO duration (p = 0.002), cardiac indication, and lower body weight (p = 0.038) as mortality-increasing factors. The 10-year survival rate after ECMO therapy was 51.1% [95% CI : 37.1-63.5%].
ECMO-therapy in critically ill patients after the Norwood operation may significantly improve survival of a patient cohort otherwise forfeited and give the opportunity for successful future-stage operations.
Glenn shunt as a rescue strategy for acute right ventricular failure after right ventricular myocardial infarction.
Cardiothoracic SurgeryWe present a case of a 52-year old woman with cardiogenic shock (CS) with refractory right ventricular (RV) failure due to spontaneous dissection o...
