Multiple arterial grafting (MAG) is associated with improved long-term outcomes. However, there are limited data on the benefit of total arterial revascularization (TAR).Retrospective study of adult patients with multive...Multiple arterial grafting (MAG) is associated with improved long-term outcomes. However, there are limited data on the benefit of total arterial revascularization (TAR).Retrospective study of adult patients with multivessel disease undergoing isolated coronary artery bypass grafting (CABG) in three centers between January 1, 2009, and December 31, 2023. Patients were grouped according to the revascularization strategy (TAR vs. MAG). The primary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE). The cumulative incidence of MACCE was plotted using Kaplan Meier (KM) curves. The hazard ratio (HR) for TAG versus MAG was calculated using multivariate Cox models.Our cohort included 2,791 patients. About 1,048 (37.55%) underwent TAR and 1,743 (62.45%) underwent MAG, of whom 2,434 (87.21%) were male. Mean age was 61.6 ± 9.8 years in the TAR and 62.1 ± 9.1 years in the MAG. Median follow-up time was 101 months. The cumulative incidence of the primary outcome was 48.57% in the TAR and 42.4% in the MAG group. After multivariable adjustment, TAR had an HR of 1.05, 95% CI (0.93-1.18) for the primary outcome ( = 0.25). The mortality rate was 28.72% in the TAR and 23.06% in the MAG group.TAR showed no benefit over MAG at midterm follow-up.
To assess the efficacy of preoperative full aortic computed tomography (CT) to reduce complications during surgical aortic valve replacement (SAVR).A single-center retrospective study examined all SAVR procedures from 20...To assess the efficacy of preoperative full aortic computed tomography (CT) to reduce complications during surgical aortic valve replacement (SAVR).A single-center retrospective study examined all SAVR procedures from 2013 to 2015, comparing outcomes between surgeries planned with CT and those without. The study assessed how CT imaging adapted surgical methods, including cannulation and the possibility of switching from SAVR to interventional therapy. The analysis primarily focused on the occurrence of in-hospital complications.Out of 359 patients analyzed, those who received presurgical CT ( = 305, complications = 53; 17%; EuroSCORE = 1.8) had fewer in-hospital complications compared with the non-CT group ( = 54, complications = 17; 32%; EuroSCORE = 1.8), with a statistically significant difference ( = 0.016). Patients in the CT group had a 15% absolute risk reduction and a number needed to treat of 7 to avoid one in-hospital complication.CT is associated with reduced in-hospital complications in SAVR patients and could enhance patient outcomes when used in preoperative planning. This supports the recommendation for incorporating CT into routine preoperative assessment to enable personalized surgical strategies, potentially including a shift to transcatheter treatments when indicated.
Minimally invasive repair of pectus excavatum (MIRPE) creates an iatrogenic communication between the pleural cavities, known as a "buffalo chest." Patients with pectus excavatum are also at increased risk of spontaneous...Minimally invasive repair of pectus excavatum (MIRPE) creates an iatrogenic communication between the pleural cavities, known as a "buffalo chest." Patients with pectus excavatum are also at increased risk of spontaneous pneumothorax due to congenital apical blebs. When these two conditions coexist, the risk of bilateral spontaneous pneumothorax becomes potentially life-threatening. This study aims to evaluate the incidence and characteristics of spontaneous pneumothorax following MIRPE, with particular attention to the presence and role of congenital blebs.We retrospectively reviewed patients who underwent MIRPE between 2005 and 2024 to identify cases of spontaneous pneumothorax. Only cases occurring at least 1 month postoperatively and unrelated to intraoperative thoracoscopy were included. Patients were followed for at least 10 months. We analyzed laterality, clinical presentation, presence of blebs, treatment, and outcomes. A systematic literature review was also conducted to explore the relationship between buffalo chest, pneumothorax, and pectus excavatum.Among 795 patients, 7 developed spontaneous pneumothorax: 4 unilateral, 3 bilateral. In six cases, blebs were identified and treated with thoracoscopic bullectomy and pleurodesis. Two patients with bilateral pneumothorax experienced cardiac arrest: one recovered after emergency drainage; the other died in a peripheral hospital, where blebs were suspected but not confirmed. The literature review identified nine similar cases in five reports.Bilateral spontaneous pneumothorax after MIRPE can be a life-threatening emergency due to the buffalo chest. Patients and families should be informed of this rare but serious risk to enable early recognition and prompt treatment. Preoperative detection of apical blebs may help reduce this risk.
Thorac Cardiovasc Surg
· 2026 Mar · PMID 40957606
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Simulation-based thoracic surgery training is increasingly incorporating physical models to enhance traditional learning methods. Conventional box trainers, though useful for basic skills, often lack anatomical accuracy...Simulation-based thoracic surgery training is increasingly incorporating physical models to enhance traditional learning methods. Conventional box trainers, though useful for basic skills, often lack anatomical accuracy and tactile feedback, limiting their relevance for complex procedures like thoracoscopic lung resection. High-fidelity 3D-printed lung models offer realistic anatomy and procedural flow, but their educational impact remains underexplored.Fifty-two surgical residents without prior thoracoscopic experience were randomly assigned to a high-fidelity lung model group or a conventional Fundamentals of Laparoscopic Surgery (FLS) box trainer group. All participants completed a baseline thoracic anatomy test and received standardized educational materials. The lung model group received structured simulation training on procedural anatomy and operative steps, while the FLS group practiced fundamental laparoscopic tasks. After training, participants repeated the anatomy test and performed a thoracoscopic lung wedge resection in a live animal model. Performance was assessed using the Objective Structured Assessment of Technical Skill (OSATS) and a 5-point confidence scale.A total of 52 surgical residents participated in the study, with 26 assigned to the high-fidelity lung model group and 26 to the FLS trainer group. Baseline anatomy scores were similar between groups (65.42 ± 6.10 vs. 66.12 ± 5.92; = 0.710). Posttraining, the lung model group showed greater gains in anatomy comprehension (87.60 ± 4.75 vs. 78.19 ± 5.54; < 0.001), higher OSATS scores (19.18 ± 2.43 vs. 15.41 ± 2.41; < 0.001), and increased confidence (3.13 ± 0.61 vs. 2.27 ± 0.68; = 0.002).High-fidelity 3D-printed lung models significantly enhance anatomical understanding, thoracoscopic skills, and confidence compared with conventional box trainers. These results support integrating anatomically accurate simulation into thoracic surgical education to improve both cognitive and psychomotor outcomes.
Thorac Cardiovasc Surg
· 2026 Jan · PMID 40935159
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Primary palmar hyperhidrosis (PPH) causes excessive hand sweating, impacting daily activities and quality of life. Endoscopic thoracic sympathectomy (ETS), including ganglionectomy, is a common treatment, but the risk of...Primary palmar hyperhidrosis (PPH) causes excessive hand sweating, impacting daily activities and quality of life. Endoscopic thoracic sympathectomy (ETS), including ganglionectomy, is a common treatment, but the risk of compensatory hyperhidrosis (CH) remains a concern. This study compares unilateral versus bilateral T3 ganglionectomy, focusing on differences in CH occurrence and patient satisfaction.We retrospectively analyzed 118 patients who underwent either unilateral or bilateral T3 ganglionectomy for PPH at our institution from November 2023 to January 2025. Data on patient characteristics and surgical outcomes were extracted from electronic medical records. Patient satisfaction and incidence of CH were assessed at postoperative 3 months.Of the 118 patients with severe PPH, 77 underwent bilateral T3 ganglionectomy, and 41 received unilateral T3 ganglionectomy. No significant differences in baseline characteristics were observed between the groups. Postoperative satisfaction was higher in the unilateral group, with 93% reporting being "very satisfied" compared with 61% in the bilateral group ( < 0.001). The unilateral group also had fewer incidences of CH, with 80% reporting no CH, while 43% of the bilateral group experienced mild CH ( = 0.007). The most common areas affected by CH were the back, thighs, chest, abdomen, and hips. In the unilateral group, 7.5% showed improvement in contralateral sweating, with 22% necessitating contralateral ganglionectomy.This study is the first to compare the effectiveness and incidence of CH between unilateral and bilateral ETS for PPH. Our results show that 93% of unilateral ETS patients reported high satisfaction, compared with 61% in the bilateral group. Eighty percent of the unilateral group experienced no CH, while only 43% in the bilateral group reported mild CH. Statistically significant differences were observed in both satisfaction scores ( < 0.001) and CH occurrence ( = 0.007), suggesting unilateral ETS may provide better symptom relief with fewer adverse effects. Compared with prior studies, our cohort showed improved bilateral ETS outcomes, with only 48% developing CH. These findings indicate that unilateral ETS may be preferred for patients seeking higher satisfaction and reduced risk of CH, though further long-term studies are needed to confirm such results.
BACKGROUND: DeBakey type I aortic dissection requires circulatory arrest during arch reconstruction, putting the brain at risk. In resource-limited centers, deep hypothermia can exacerbate coagulopathy and lead to increa...BACKGROUND: DeBakey type I aortic dissection requires circulatory arrest during arch reconstruction, putting the brain at risk. In resource-limited centers, deep hypothermia can exacerbate coagulopathy and lead to increased bleeding. This study compares outcomes between mild and moderate hypothermia under unilateral cerebral perfusion (UCP). METHODS: Retrospective analysis of 60 patients who underwent modified Bentall procedures with hemiarch replacement under UCP between 2014 and 2024. Patients were divided into two groups: mild hypothermia (mH, 32°C; = 40) and moderate hypothermia (MH, 24°C; = 20). Exclusion criteria included bilateral cerebral perfusion, additional procedures (e.g., total arch replacement, bypass surgery), preexisting neurological or renal conditions, and incomplete datasets. Neurological events, blood loss, transfusion requirements, acute kidney injury (AKI), and mortality were assessed. RESULTS: Neurological outcomes (permanent neurological dysfunction and transient neurological dysfunction) were comparable in both groups (20% each). The mH group had significantly lower blood loss (787 vs. 1,183 mL), reduced red blood cell transfusion (200 vs. 828 mL), and less fresh frozen plasma use (259.5 vs. 882 mL). The mH group also had lower rates of AKI (15 vs. 30%), rethoracotomy (10 vs. 22.5%), and infections (10 vs. 20%). Mortality was 20% (mH) versus 35% (MH). CONCLUSION: Mild hypothermia under UCP provides cerebral protection comparable to moderate hypothermia while reducing coagulopathy, transfusion needs, and complications-particularly relevant for centers in resource-limited countries.
Two primary techniques, namely, the conventional transfissural and the fissureless approaches, have been defined for videothoracoscopic lobectomy. We hypothesized that a videothoracoscopic fissureless, non-arterial disse...Two primary techniques, namely, the conventional transfissural and the fissureless approaches, have been defined for videothoracoscopic lobectomy. We hypothesized that a videothoracoscopic fissureless, non-arterial dissection (NAD) technique-using new generation staplers-for lower lobe resections may reduce operative time and lower the intra- and postoperative complication rates.We had 69 consecutive patients assigned to a fissureless NAD or a conventional lobectomy for lower lobes. In the fissureless NAD technique, the pulmonary artery, together with the adjacent lung parenchyma along the fissure line, was divided as the last anatomical structure using staplers with tri-height cartridges. We analyzed the feasibility and safety of the fissureless NAD technique.A total of 29 (42%) patients underwent NAD lobectomy. The mean operative time was significantly shorter in the NAD group ( = 0.003). No patient had intraoperative complication, and three (10.3%) patients ( = 0.212) had postoperative complication in the NAD group. The mean time of chest tube removal ( = 0.031) and the length of hospital stay ( = 0.008) were significantly shorter in the NAD group.The fissureless NAD videothoracoscopic lobectomy is a safe and feasible technique for lower lobectomies. This technique significantly reduces the operative time with potential benefit of earlier patient discharge.
Contraceptive implants are widely used for long-acting reversible contraception (LARC) due to their high efficacy and convenience. However, complications including migration and, rarely, embolisation to the pulmonary art...Contraceptive implants are widely used for long-acting reversible contraception (LARC) due to their high efficacy and convenience. However, complications including migration and, rarely, embolisation to the pulmonary arterial system have been reported. This case series presents three cases of contraceptive implant embolisation to the pulmonary arterial system, managed at a tertiary thoracic surgery unit between 2021 and 2024. Different surgical management was performed in all three cases influenced by factors including: length of time since possible embolisation, implant location, and suspected degree of endothelialisation. The cases highlight challenges in surgical management of embolized contraceptive implants, focusing on arteriotomy and anatomical resection approaches. The importance of prompt diagnosis, multidisciplinary decision-making, and necessity for further research to establish guidelines for the management of embolized contraceptive implants is exemplified. Suppliers should be aware of this rare complication and consider methods to prevent its occurrence.
Coronary artery disease patients suffering from ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) require rapid decision on invasive therapy relying on state-of-the-art concepts. This article provides evid...Coronary artery disease patients suffering from ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) require rapid decision on invasive therapy relying on state-of-the-art concepts. This article provides evidence-based recommendations on the choice between, or the combination of, the mechanistically different options, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)-with a special focus on multivessel disease patients. Furthermore, strategies of modern CABG in STEMI and NSTEMI patients are presented.
Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are invasive treatment options for coronary artery disease (CAD), aiming to improve quality of life and reduce cardiovascular morbidity...Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are invasive treatment options for coronary artery disease (CAD), aiming to improve quality of life and reduce cardiovascular morbidity and mortality. Guidelines-based revascularization decisions should consider anatomical complexity, comorbidities, and patient preferences, with procedural risk assessed through validated scoring systems. However, the current legal quality assurance (QA) programs in Germany remain procedure specific and therefore lack a patient-centered, diagnosis-oriented approach. This study proposes a paradigm shift toward diagnosis-based QA to optimize individualized treatment selection, improve outcome attribution, and ensure transparent quality assessment. By integrating guideline recommendations with enhanced data linkage, this framework aims to standardize and improve CAD care quality while addressing limitations of existing QA schemes.This mixed-methods study aims to develop a cross-disciplinary QA framework for CAD patients undergoing elective PCI or CABG. Qualitative methods will be employed to formulate preliminary evidence-based quality indicators (QI), while secondary data analyses will provide empirical support for QI prioritization, modeling, and future evaluation. Findings from both approaches will undergo a structured consensus process to establish validated QI as basis of a redesigned QA scheme.The resulting framework seeks to standardize and improve QA procedures across CAD care pathways, integrating clinical expertise with real-world data to enhance patient outcome.The study proposes a patient-centered, diagnosis-based quality assurance framework for coronary artery disease care, aiming to improve treatment decisions and outcomes. By integrating guideline, expert input, and real-world data, it seeks to enhance transparency and standardization in quality assessment across CAD treatment pathways.
BACKGROUND: In patients at elevated risk for redo mitral valve surgery, transcatheter mitral valve replacement (TMVR) can be taken into consideration as a less invasive alternative. However, long-term outcome data on mit...BACKGROUND: In patients at elevated risk for redo mitral valve surgery, transcatheter mitral valve replacement (TMVR) can be taken into consideration as a less invasive alternative. However, long-term outcome data on mitral valve-in-ring (ViR) and valve-in-valve (ViV) procedures are scarce. We herein report the 3-year outcomes following these interventions. METHODS: Between 2014 and 2023, 51 consecutive patients received ViR/ViV TMVR at our center. Baseline, periprocedural, and 3-year outcome parameters were analyzed according to M-VARC criteria. RESULTS: Among 51 patients (70.9 ± 13.6 years, Society of Thoracic Surgeons (STS) score 3.3 ± 2.3%, left ventricular ejection fraction (LVEF) 50 ± 12%), 19 underwent ViR and 32 underwent ViV TMVR. Follow-up ranged from 1 to 71 months. The 30-day mortality rate was 5.9% (3/51 patients). Over time, access shifted from transapical to transseptal ( for trend <0.01). Rehospitalization, neurological events, and myocardial infarction occurred in 2.0% (1/51 patients), 2.0% (1/51 patients), and 0.0% of the cases, respectively. No structural valve failure was observed. Functional failure was 3.9% of cases due to significant residual mitral valve regurgitation (MR). Most paravalvular leak occluder implantations were performed in ViR patients (6/9, 66.7%; four rigid rings and two semirigid rings). Three-year survival was 87.5% for ViR and 83.4% for ViV, with no difference between groups. CONCLUSION: Mitral ViR and ViV procedures demonstrate acceptable safety and clinical efficacy up to 3 years. Rigid annuloplasty rings are associated with an increased risk of significant residual regurgitation. Over the last decade, a clear transition from the transapical to the transseptal access has been observed, further reducing procedural trauma in this high-risk subset of patients.