Thorac Cardiovasc Surg
· 2025 Oct · PMID 40306662
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Pediatric lung transplantation is considered to be an effective treatment for end-stage lung disease in children, and this study mainly conducts a bibliometric analysis in the field of pediatric lung transplantation.We u...Pediatric lung transplantation is considered to be an effective treatment for end-stage lung disease in children, and this study mainly conducts a bibliometric analysis in the field of pediatric lung transplantation.We used the web of science databases to perform a bibliometric analysis of the progress of research in the field of pediatric lung transplantation from 1996 to 2024. In addition, we used VOSviewer software and the "bibliometrix" package in R to visualize and analyze the authors, countries, journals, institutions, and keywords of the literature.We identified 359 literature studies related to pediatric lung transplantation, which were cited 6,387 times by 1,400 journals. The journal with the highest number of average citations was the "New England Journal of Medicine," while the journals with the highest number of publications were the "Journal of Heart and Lung Transplantation and Pediatric Transplantation." The United States was the country with the highest number of publications (64.3%), followed by the United Kingdom (11.1%) and Canada (8.08%).Research in the field of pediatric lung transplantation is currently on the rise, while research is still dominated by developed countries, with most developing countries in their infancy. Against the background of COVID-19 and global health challenges, the unique need for pediatric lung transplantation is becoming a trend.
To construct and internally validate a nomogram predicting postoperative delirium (POD) in patients with pulmonary malignancies undergoing lobectomy.Clinical electronic medical record data were retrospectively collected...To construct and internally validate a nomogram predicting postoperative delirium (POD) in patients with pulmonary malignancies undergoing lobectomy.Clinical electronic medical record data were retrospectively collected from 1,066 patients who underwent lobectomy, divided into a training cohort (746) and a validation cohort (320) using a 7:3 temporal split. A nomogram for POD was developed using Lasso regression and multivariable logistic regression analysis according to the TRIPOD statement. Performance was assessed through receiver operating characteristic curves (ROC) and calibration plots.POD occurred in 203 patients (19.04%). The nomogram incorporated predictors such as age, body mass index (BMI), education level, history of diabetes, history of cerebrovascular disease, surgical approach, duration of surgery, and time to recovery from anesthesia. The area under the ROC curve (AUC) was 0.871 (95% confidence interval [CI]: 0.841-0.901) for the training cohort and 0.914 (95% CI: 0.877-0.951) for the validation cohort. Calibration curves demonstrated good agreement between predicted and actual probabilities in both cohorts.This novel nomogram can help clinicians and patients' families predict the likelihood of developing delirium following lobectomy, enabling the implementation of targeted prevention strategies.
Ex-vivo lung perfusion (EVLP) is a novel organ preservation technique introduced to assess extended lung donors and determine their suitability for human use.This retrospective cohort study analyzed lung transplant recip...Ex-vivo lung perfusion (EVLP) is a novel organ preservation technique introduced to assess extended lung donors and determine their suitability for human use.This retrospective cohort study analyzed lung transplant recipients in the U.S. from 2011 to 2021, using data from the Scientific Registry of Transplant Recipients (SRTR). Kaplan-Meier curves were used for time-to-event survival analysis, and the Cox proportional hazards model was used to determine hazard ratios for overall survival.Of 23,261 patients, 608 had EVLP-donor lungs. The 5-year survival was similar across groups. Centers with EVLP access had median wait times of 48 days (SD 260.80) versus 68 days (SD 273.73) at other centers. Cox proportional hazards model showed no significant disparity in 5-year survival with EVLP (HR 1.14, 0.08), gender (HR 1.04, 0.07), and high volume (HR 0.8, 0.07). Perioperative extracorporeal membrane oxygenation (ECMO) (HR 1.29, < 0.01) and black recipient race (HR 1.15, < 0.01) influenced survival; there were no statistical differences in any other race. Black EVLP-assessed recipients showed a nonsignificant trend toward a survival benefit ( = 0.26) with a 14.2% higher 5-year survival (95% CI 2.7-28.7).EVLP has not adversely affected 5-year survival rates in lung transplantation recipients and is associated with shorter wait times. A survival advantage in black recipients with EVLP-assessed lungs needs further research.
Hadzijusufovic E, Lozanovski VJ, Bellaio L
… +5 more, Tagkalos E, Uzun E, Griemert EV, Lang H, Grimminger PP
Thorac Cardiovasc Surg
· 2025 Dec · PMID 40233825
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Minimally invasive robot-assisted esophagectomies have proven superior to traditional open surgery. While transhiatal and transthoracic approaches are common, subcostal access remains less frequent in minimally invasive...Minimally invasive robot-assisted esophagectomies have proven superior to traditional open surgery. While transhiatal and transthoracic approaches are common, subcostal access remains less frequent in minimally invasive esophageal surgery. Recent advancements in robotic systems, such as the da Vinci Single-Port (SP), now facilitate precise subcostal access. This innovation holds potential to reduce postoperative pain, enhance patient mobility, and broaden surgical options for patients with multiple health conditions. The Single-Port Subcostal Robot-Assisted Minimal Invasive Esophagectomy (SP SC RAMIE) utilizes an SP and laparoscopic approach, enabling effective mediastinal dissection and esophageal mobilization with radical lymphadenectomy. This novel technique shows promise, especially for frail patients with multiple comorbidities who stand to benefit greatly from expedited recovery pathways. Nonetheless, further exploration is necessary to fully assess its clinical effectiveness and reproducibility.
Atrial fibrillation is associated with an increased risk of embolic strokes and is present in about one-fourth of all patients undergoing cardiac surgery. Closure of the left atrial appendage (LAA) can effectively reduce...Atrial fibrillation is associated with an increased risk of embolic strokes and is present in about one-fourth of all patients undergoing cardiac surgery. Closure of the left atrial appendage (LAA) can effectively reduce the risk of neurological events and is now a class IB recommendation in the most recent ESC/EACTS AF guidelines. The working group "Heart Rhythm Disorders" of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) evaluates the current state of clinical research and recommends concomitant LAA closure in patients with preoperative atrial fibrillation as a routine part of heart surgeries.
Lung volume reduction surgery (LVRS) is an important treatment option for patients with advanced emphysema and is typically performed in a non-anatomical fashion. This study reports the outcome of anatomical LVRS by mean...Lung volume reduction surgery (LVRS) is an important treatment option for patients with advanced emphysema and is typically performed in a non-anatomical fashion. This study reports the outcome of anatomical LVRS by means of uniportal video-assisted thoracoscopic surgery (VATS).We retrospectively evaluated patients who underwent anatomical LVRS between June 2017 and September 2023 at our institution. Patient characteristics, including demographic data, lung function, as well as morbidity and mortality, were extracted from hospital records.A total of 44 patients (17 males, 38.6%) underwent anatomical LVRS at our institution during the observation period. The preoperative forced expiratory volume per second (FEV1) and FEV1% were 35.4 ± 20.0% and 45.7 ± 18.2%, respectively. Lobectomy was performed in 37 patients (84.1%), while segmentectomy was performed in 10 patients (22.7%, duplicated). Postoperative FEV1 and FEV1% significantly improved compared to preoperative values at the initial follow-up (11.8 ± 6.9 months after the operation): 38.3 ± 19.5%, < 0.002 and 49.4 ± 18.4%, < 0.01, respectively. Unfortunately, two patients (4.5%) died within 30 days postoperation. A further follow-up lung function test was performed in 25 patients (56.8%) at 33.1 ± 13.8 months after the operation, showing that FEV1 and FEV1% remained similar to the preoperative values (33.9 ± 20.7%, = 0.10 and 45.3 ± 18.1%, = 0.06, respectively).Anatomical lung resection via uniportal VATS is an effective procedure for LVRS in patients with severe emphysema and is associated with acceptable morbidity and mortality.
Bieling F, Cesnjevar RA, Cuomo M
… +3 more, Weigelt A, Dittrich S, Purbojo A
Thorac Cardiovasc Surg
· 2025 Jan · PMID 40154546
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Left superior vena cava (LSVC)-related obstruction of mitral inflow is a rare condition in patients with complex cardiac anomalies like hypoplastic left heart complex. We report on the impact of establishing LSVC to righ...Left superior vena cava (LSVC)-related obstruction of mitral inflow is a rare condition in patients with complex cardiac anomalies like hypoplastic left heart complex. We report on the impact of establishing LSVC to right superior vena cava (RSVC) continuity on the growth of borderline hypoplastic left ventricular structures as an addendum to our previously published work.Twenty-two patients underwent LSVC to RSVC anastomosis, whereas six had LSVC ligation ( = 4) or clip closure ( = 2), all alongside congenital heart defect correction. The indication was LSVC-related obstruction of left ventricular inflow due to a dilated coronary sinus. Clinical data were systematically reviewed, with regular follow-up. Left ventricular end diastolic diameters (LVEDD), aortic valve diameters, and left ventricular outflow tract (LVOT) diameters were recorded using echocardiography.Follow-up showed 90% survival at 3.3 ± 0.4 years. Mean LVEDD Z-scores improved from -2.19 ± 0.35 to -1.24 ± 0.26 after repair ( < 0.01) and to -1.33 ± 0.56 at 6-month follow-up. In patients without mitral repair, LVEDD Z-scores improved from -2.11 ± 0.62 preoperatively to -1.85 ± 0.88 postoperatively ( < 0.05). LVOT Z-scores increased from -2.49 ± 0.48 to -0.87 ± 0.75 ( < 0.05) and aortic valve Z-scores improved from -1.08 ± 0.57 to 0.5 ± 0.39 over 24 months ( < 0.05).Anatomical LSVC correction may improve left ventricular filling and growth of the left ventricle, aortic valve, and LVOT in patients with borderline left ventricles and could be considered without as a potential recruitment strategy.
Farag M, Isern Hacker M, Grieshaber P
… +5 more, Fonseca Escalante E, Karck M, Arnold R, Gorenflo M, Loukanov T
Thorac Cardiovasc Surg
· 2025 Jan · PMID 40154545
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This single-center study investigated long-term outcomes after surgical correction of atrioventricular septal defect (AVSD).A total of 248 patients underwent biventricular repair for AVSD between 1995 and 2022. A total o...This single-center study investigated long-term outcomes after surgical correction of atrioventricular septal defect (AVSD).A total of 248 patients underwent biventricular repair for AVSD between 1995 and 2022. A total of 208 (83.9%) patients had complete (cAVSD), 29 (11.7%) partial (pAVSD), and 11 (4.4%) transitional AVSD (tAVSD). Associated cardiovascular anomalies were present in 88 (35.5%) cases and 61 (24.6%) patients were born prematurely. Median age at repair was 7.1 for cAVSD, 23.7 for pAVSD, and 13 months for tAVSD.Overall survival or reoperation incidence did not differ significantly between AVSD types and improved significantly over surgical eras. Survival of the entire cohort was 88.3% at 10, 83.8% at 15, and 79.6% at 25 years. Prematurity (hazard ratio [HR]: 2.43, = 0.029), low weight (<4 kg) (HR: 3.05, = 0.028), and partial cleft closure (HR: 2.43, = 0.037) were independent risk factors for mortality. Forty-eight patients (19.4%) underwent a total of 64 reoperations over the study period. The main indication for reoperation was left atrioventricular valve regurgitation (LAVVR) with 55/64 procedures. However, 36% of procedures were performed to address several lesions, with left ventricular outflow tract obstruction being the second most common indication. Freedom from reoperation was 78.2, 75.8, and 72.5% at 10, 15, and 25 years, respectively. The incidence of reoperation increased significantly in association with early postoperative LAVVR ≥ I-II° (HR: 2.6, 95% confidence interval [CI]: 1.4-4.7, = 0.002) and presence of residual cardiac defects (HR: 2.0, 95% CI: 1.1-3.6, = 0.018).While LAVVR is the main indication for reoperation, a significant proportion of procedures address additional pathologies. Premature patients and those with associated cardiovascular anomalies should receive special attention during postoperative follow-up.
For the 11th consecutive time, we systematically reviewed the cardio-surgical literature for the past year (2024), using the PRISMA approach for a results-oriented summary. In 2024, the discussion on the value of randomi...For the 11th consecutive time, we systematically reviewed the cardio-surgical literature for the past year (2024), using the PRISMA approach for a results-oriented summary. In 2024, the discussion on the value of randomized and registry evidence increased, triggered by consistent findings in the field of coronary artery disease (CAD) and discrepant results in structural heart disease. The literature in 2024 again confirmed the excellent long-term outcomes of CABG compared with PCI in different scenarios, generating further validation for the CABG advantage reported in randomized studies. This has been reflected in the new guidelines for chronic CAD in 2024. Two studies indicate novel perspectives for CABG, showing that cardiac shockwave therapy in CABG improves myocardial function in ischemic hearts and that CABG guided by computed tomography is safe and feasible. For aortic stenosis, an early advantage for transcatheter (TAVI) compared with surgical (SAVR) treatment has found more support; however, long-term TAVI results keep being challenged, this year by new FDA and registry data in favor of SAVR. For failed aortic valves, redo-SAVR showed superior results compared with valve-in-valve TAVI. In the mitral field, studies showed short-term noninferiority for transcatheter treatment compared with surgery for secondary mitral regurgitation (MR), and significant long-term survival benefit in registries with surgery for primary MR. Finally, surgery was associated with better survival compared with medical therapy for acute type A aortic intramural hematoma. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation but provides up-to-date information for patient-specific decision-making.
Metal hypersensitivity after Nuss procedure is a known complication, but there is no accepted treatment guideline available. Patients undergoing Nuss procedure between 2013 and 2023 were examined retrospectively. Patient...Metal hypersensitivity after Nuss procedure is a known complication, but there is no accepted treatment guideline available. Patients undergoing Nuss procedure between 2013 and 2023 were examined retrospectively. Patients with known allergy, positive blood, and/or culture tests, and redo cases were excluded. Nine of 307 (2.9%) patients developed postoperative allergy. No significant difference was found between single or double bar patients. All were treated with medical protocol. No premature bar removal was necessitated. Medical treatment was successful in postoperative metal allergy after Nuss procedure. Ruling out other causes like surgical technical problems or infections is necessary for correct diagnosis and accurate treatment.
Boening A, Brühl M, Büsch C
… +11 more, Luther N, Xoplaki E, Arif R, Noack T, Pöling J, Czerny M, Brickwedel J, Peterss S, Holubec T, Jawny P, GERAADA Study Group
BACKGROUND: The German Registry of Aortic Dissections Type A (GERAADA) is a large European registry documenting patients with type A aortic dissection who have undergone surgical repair. This analysis investigated a pote...BACKGROUND: The German Registry of Aortic Dissections Type A (GERAADA) is a large European registry documenting patients with type A aortic dissection who have undergone surgical repair. This analysis investigated a potential association between the incidence of type A dissections (AADA) and lunar cycles, day of the week, or weather conditions. METHODS: Data from 2,388 patients were analyzed for two endpoints: incidence of AADA surgery per day (analyzed using a Poisson regression to account for overdispersed data) and early mortality after surgery (analyzed using a logistic mixed regression to account for center heterogeneity). In both models, the influence of weather conditions (season, temperature, temperature difference, radiation, and synoptic conditions), moon phase, and weekday of operation was examined. RESULTS: The occurrence of AADA surgery was similar between weekdays (Monday to Friday), but less frequent on weekends. The 30-day mortality odds ratio was higher for surgeries performed on weekends than on weekdays. Operations were more frequent in winter than in other seasons. The occurrence of surgery or early mortality after surgery was not associated with synoptic weather conditions. Mean daily temperature and global radiation were not found to be different between survivors and patients with early deaths. No significant association was found between the moon phase and the occurrence or the outcome of surgery. CONCLUSION: The occurrence of AADA surgery was higher during winter, with colder mean temperatures, and lower on weekends than on weekdays. Mortality after surgery on weekends was higher than after surgery on weekdays.
Although insurance status has been linked to surgical outcomes in thoracic aortic operations, its specific association with the outcomes of Type A Aortic Dissection (TAAD) repair remains underexplored. This study aimed t...Although insurance status has been linked to surgical outcomes in thoracic aortic operations, its specific association with the outcomes of Type A Aortic Dissection (TAAD) repair remains underexplored. This study aimed to conduct a comprehensive, population-based analysis to assess the association between insurance status and in-hospital outcomes after TAAD repair using a national registry.Patients who underwent TAAD repair were identified in National Inpatient Sample from the last quarter of 2015 to 2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients using public and private insurance while adjusting for demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status.There were 2,380 (55.58%) and 1,468 (34.28%) patients under public and private insurance, respectively. Patients under public and private insurance had comparable time from admission to operation ( = 0.08) and adjusted in-hospital mortality rates (aOR = 1.172, 95 CI = 0.925-1.484, = 0.19). However, patients under public insurance had higher mechanical ventilation (aOR = 1.185, 95 CI = 1.024-1.373, = 0.02), acute kidney injury (aOR = 1.213, 95 CI = 1.052-1.399, = 0.01), and infection (aOR = 1.428, 95 CI = 1.087-1.876, = 0.01). Moreover, patients under public insurance had higher transfer-out rate ( < 0.01), longer length of stay ( < 0.01), and higher total hospital charge ( < 0.01).Although patients with public insurance had comparable adjusted mortality outcomes to those of privately insured patients, they experienced higher rates of postoperative complications and resource utilization. Future studies should investigate the underlying systemic reasons for these disparities and explore strategies for improving surgical outcomes and ensuring equitable healthcare delivery for these vulnerable populations.
Prolonged air leak (PAL) is a major cause of morbidities and increased treatment costs following lung resection. The Goddard score (GS) quantifies pulmonary emphysema on computed tomography, a risk factor for PAL, from 0...Prolonged air leak (PAL) is a major cause of morbidities and increased treatment costs following lung resection. The Goddard score (GS) quantifies pulmonary emphysema on computed tomography, a risk factor for PAL, from 0 to 24.We evaluated the GS as a predictor of PAL in pulmonary segmentectomies by retrospectively analyzing 131 patients with anatomical segmentectomy. We identified predictors of PAL and performed logistic regression.Eighty-three percent of patients had a history of smoking. The mean air leak duration was 4.2 days; 16% had PAL (>7 days). Median GS was 1. The optimal cutoff was GS ≥ 6 (area under the curve AUC = 0.625). GS did not correlate with air leak duration. In combination, body mass index, cumulative pack-years, immunosuppression, adhesiolysis, operation time, and GS ≥ 6 best predicted PAL with AUC = 0.914. Omitting GS still leads to an AUC = 0.864.The GS does not add enough information to be of practical value in anatomic segmentectomies, but it is of academic significance to quantify and compare lung emphysema in the context of clinical studies.
To investigate the efficacy of balloon dilatation combined with stent implantation in the treatment of iliac vein compression syndrome (IVCS).This research was a retrospective study that enrolled 127 IVCS patients for cl...To investigate the efficacy of balloon dilatation combined with stent implantation in the treatment of iliac vein compression syndrome (IVCS).This research was a retrospective study that enrolled 127 IVCS patients for clinical data. The patients were divided into percutaneous transluminal angioplasty (PTA) group ( = 63) and stent implantation group ( = 64). The PTA group was treated with iliac vein balloon dilatation, and the stent implantation group was treated with combined stent implantation based on the PTA group. In both the groups, the quality of life was assessed using Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ); complications occurring during the perioperative period and at postoperative follow-up were recorded; the vascular patency rate was calculated, and patient's condition was evaluated using the Villalta scale.The stent implantation group exhibited lower postoperative CIVIQ scores than the PTA group, and the stent implantation group (4.60%) had lower complication rate than the PTA group (19.05%). At 2 years of follow-up, the stent implantation group (92.19%) had higher vascular patency rate than the PTA group (79.37%). Villalta scores were lower in the stent implantation group than in the PTA group at 6, 12, and 24 months postoperatively.Iliac vein balloon dilatation combined with stent implantation for the treatment of IVCS can improve vessel patency rates, alleviate patients' clinical symptoms, and enhance their quality of life.
In this article, we summarize the most important issues and recommendations on the anatomy and physiology of tetralogy-like lesions, diagnosis prior to medical, interventional, or surgical intervention, timing and types...In this article, we summarize the most important issues and recommendations on the anatomy and physiology of tetralogy-like lesions, diagnosis prior to medical, interventional, or surgical intervention, timing and types of interventions, management of high-risk patients, and the need for future interventions in a subset of patients. The long versions of the original guidelines are reprinted in the supplement, providing a more comprehensive overview and enabling a more detailed approach to tetralogy and its variants.