Thorac Cardiovasc Surg [JOURNAL]
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200 papers
Total Artificial Heart Implantation as a Bridge to Transplantation in Slovakia.
Hulman M, Artemiou P, Durdik S … +4 more , Lesny P, Olejarova I, Goncalvesova E, Gasparovic I
Thorac Cardiovasc Surg · 2026 Jan · PMID 39342944 · Publisher ↗
Although left ventricular assist device implantation represents the majority of durable mechanical circulatory support implants for patients with advanced heart failure, as many as 20 to 30% will subsequently have right...
Although left ventricular assist device implantation represents the majority of durable mechanical circulatory support implants for patients with advanced heart failure, as many as 20 to 30% will subsequently have right heart failure requiring extended inotropic support or short-term mechanical circulatory support, and the total artificial heart is an established tool in the bridge to transplant armamentarium. The aim of this short report is to present our center's experience with the use of SynCardia total artificial heart. Between November 2017 and April 2021, 10 SynCardia total artificial heart devices were implanted. Of the 10 patients who underwent total artificial heart implantation, 6 (60%) were successfully bridged to transplant with a median time of 6.5 (interquartile range [IQR] 6-8) months, and 4 patients died on device support during the index hospitalization. The 30-day, 1-year, and 3-year survival rates after heart transplantation were the same at 66.7% (4/6). Despite the uncertain future of total artificial hearts, it remains a viable option for patients who require biventricular bridge to transplant or for a select subset of patients with advance heart failure who may not otherwise survive.
Echocardiographic Evaluation of Cardiac Remodeling after FET.
Meissl D, Kreibich M, Czerny M … +6 more , Kletzer J, Eschenhagen M, Kondov S, Rylski B, Gottardi R, Berger T
Thorac Cardiovasc Surg · 2025 Sep · PMID 39299245 · Publisher ↗
This study aimed to investigate if frozen elephant trunk (FET) implantation leads to negative cardiac remodeling in dissection and non-dissection patients and to determine whether there are differences when FET is implan...
This study aimed to investigate if frozen elephant trunk (FET) implantation leads to negative cardiac remodeling in dissection and non-dissection patients and to determine whether there are differences when FET is implanted as an aortic redo procedure or initially.Between March 2013 and April 2022, 148 patients received FET without any concomitant procedures and therefore formed our cohort. One hundred and four were treated for dissecting and 44 for non-dissecting pathologies. Eighty-four received FET initially and 64 as an aortic redo procedure. Data were collected retrospectively using our center's dedicated aortic database as well as transthoracic echocardiographic reports of our cardiologists.In the first weeks after FET implantation, dissection and non-dissection patients show a significant increase of mild valvular insufficiencies-a significant decrease of ejection fraction is only seen in dissection patients but these changes do not stay significant during later follow-up. Patients who receive FET as an aortic redo procedure tend to have significantly larger left ventricular (LV) end-diastolic diameters and higher LV masses, however, in longitudinal analysis, there were no long-term negative effects in patients who received FET initially or as aortic redo.In the first 2 years after implantation, FET has no echocardiographically measurable effect regarding negative cardiac remodeling in dissection and non-dissection patients, independent of the fact it is implanted initially or as an aortic redo procedure.
Survival Correlates with Regurgitation Degree Before and After Invasive Atrioventricular Valve Treatment.
Doenst T, Caldonazo T, Mukharyamov M … +2 more , Tasoudis P, Kirov H
Thorac Cardiovasc Surg · 2025 Oct · PMID 39270743 · Publisher ↗
The degree of both mitral (MR) and tricuspid valve regurgitation (TR) correlates with mortality. A vicious cycle has been proposed consisting of increasing regurgitation and decreasing ventricular function. Restoration o...
The degree of both mitral (MR) and tricuspid valve regurgitation (TR) correlates with mortality. A vicious cycle has been proposed consisting of increasing regurgitation and decreasing ventricular function. Restoration of valve competence should break this vicious cycle and improve life expectancy. However, a "pop-off" mechanism keeps being entertained, presumably allowing poorly pumping ventricles to relieve volume into the low-pressure atrium through an incomplete repair, avoiding pump failure. We reasoned that if such a mechanism exists, it should offset the relationship between mortality and valve regurgitation after an invasive procedure. In this context, we meta-analytically compared valve regurgitation degree and survival before or after atrio-ventricular valve treatment. The results show significant relationships between valve regurgitation and mortality under all conditions (i.e., before and after surgery or intervention) and irrespective of the underlying pathology (i.e., functional or structural). In summary, the ubiquitously present relationship between valve regurgitation and mortality suggests that generating a tight and durable repair of the affected valve is key to long-term exploitation of a symptom-reducing and life-prologing mechanism, independent of the underlying valve pathology. This recognition may explain current controversies in the treatment effects of MR and TR.
Pulmonary Metastasectomy after Immune Checkpoint Inhibitors in Renal Cell Carcinoma.
Sakanoue I, Hamaji M, Nakajima D … +1 more , Date H
Thorac Cardiovasc Surg · 2025 Jan · PMID 39251208 · Publisher ↗
The management of oligometastatic renal cell carcinoma with pulmonary metastases is controversial and occasionally requires multimodality management, including salvage pulmonary metastasectomy after immune checkpoint inh...
The management of oligometastatic renal cell carcinoma with pulmonary metastases is controversial and occasionally requires multimodality management, including salvage pulmonary metastasectomy after immune checkpoint inhibitors (ICIs). However, limited data are available on these patients. We describe a case series of three consecutive patients who underwent salvage pulmonary metastasectomy after ICIs for oligometastatic renal cell carcinoma and discussed the important characteristics of these patients. After salvage pulmonary metastasectomy, none of the patients had recurrent pulmonary metastases, although one of them developed a brain metastasis postoperatively. Our case series suggests that salvage pulmonary metastasectomy after ICIs may control pulmonary metastases in carefully selected patients with oligometastatic renal cell carcinoma, although the management of extrapulmonary metastases may be required after salvage pulmonary metastasectomy.
Boilerplates.
Heinemann MK
Thorac Cardiovasc Surg · 2024 Sep · PMID 39242082 · Publisher ↗
Abstract loading — click title to view on PubMed.
Pulmonary Endarterectomy: Risk Factors for Early and Late Mortality.
Yildizeli SO, Arıkan H, Güngör S … +8 more , Tufan A, Kocakaya D, Ataş H, Mutlu B, Tas S, Ak K, Bekiroğlu GN, Yildizeli B
Thorac Cardiovasc Surg · 2025 Apr · PMID 39231495 · Full text
BACKGROUND: Pulmonary endarterectomy (PEA) is a potentially curative treatment option for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to identify predictors of short- and long-term outcomes af...
BACKGROUND: Pulmonary endarterectomy (PEA) is a potentially curative treatment option for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to identify predictors of short- and long-term outcomes after PEA for CTEPH patients, including age. METHODS: Patients who underwent surgery between March 2014 and January 2024 were included in the study. Perioperative and follow-up data were retrospectively studied, including age, in-hospital mortality, 1- and 5-year survival, and the length of intensive care unit (ICU) and hospital stays after PEA. RESULTS: In total, 834 consecutive patients (mean age 51 ± 15.3 years) underwent PEA and were included in the analysis. The in-hospital mortality rate was 7.8% ( = 65), while overall mortality rates at 1 and 5 years were 10.6% and 11.3%, respectively. The in-hospital mortality rate was 6.7% for patients <70 years compared with 12.4% for patients ≥70 years ( = 0.029). In the multivariate analysis of mortality, age ( = 0.007), and length of ICU stay ( = 0.028) emerged as independent predictors of in-hospital mortality, while the Charlson Comorbidity Index ( < 0.001) and 6-minute walk distance ( = 0.005) were also significant predictors of 1-year survival. CONCLUSION: Despite higher short-term mortality rates, PEA was feasible and well-tolerated among elderly patients. Despite surgical advancements, careful patient selection remains crucial, particularly in the presence of comorbidities. Significant clinical and hemodynamic improvements were observed, along with favorable long-term survival outcomes.
Staging of Early-Stage Lung Cancer without Routine PET in Candidates for Segmentectomy.
Lopez-Pastorini A, Tatli Z, von Bargen A … +5 more , Faltenberg D, Beling H, Koryllos A, Galetin T, Stoelben E
Thorac Cardiovasc Surg · 2025 Jun · PMID 39209315 · Publisher ↗
INTRODUCTION: We aimed to investigate the accuracy of clinical staging without the routine use of positron emission tomography/computed tomography (PET/CT) in patients with cIA1 and cIA2 non-small-cell lung cancer (NSCLC...
INTRODUCTION: We aimed to investigate the accuracy of clinical staging without the routine use of positron emission tomography/computed tomography (PET/CT) in patients with cIA1 and cIA2 non-small-cell lung cancer (NSCLC) scheduled for segmentectomy. METHODS: A total of 305 consecutive segmentectomies were retrospectively analyzed. Overall survival was calculated using the Kaplan-Meier method. Logistic regression was performed to investigate factors independently associated with pathologic upstaging. RESULTS: The Union for International Cancer Control (UICC) upstaging was found in 86 patients (28%). Upstaged patients had longer operative times (146 ± 46 vs. 131 ± 44 minutes, = 0.009), a higher number of lymph node resection (17 ± 10 vs. 13 ± 8, = 0.001), and a higher rate of L1 involvement (34 vs. 16%, < 0.001) than nonupstaged patients. N1 was found in 10 patients (3%) and N2 in 13 patients (4%). Nodal positive patients had longer operation times (154 ± 50 vs. 133 ± 44 minutes, = 0.031) and higher rates of R1 (9 vs. 1%, = 0.006) and L1 (39 vs. 20%, < 0.026) than patients without nodal involvement. The 3- and 5-year overall survival rates for nonupstaged and upstaged patients were 85 and 67% and 67 and 54%, respectively ( = 0.040). In logistic regression, L1 involvement (odds ratio [OR]: 2.394, = 0.005) and the number of dissected lymph nodes (OR: 1.037, = 0.016) were independently associated with upstaging. Patients who received PET as part of clinical staging did not have a significantly lower nodal upstaging. CONCLUSION: Selective use of PET/CT based on the results of CT may be a viable option for patients with proven or suspected NSCLC up to 2 cm in size.
Single-Port da Vinci Robot-Assisted Cervical Esophagectomy: How to Do It.
Hadzijusufovic E, Lozanovski VJ, Griemert EV … +3 more , Bellaio L, Lang H, Grimminger PP
Thorac Cardiovasc Surg · 2024 Dec · PMID 39209314 · Full text
Minimally invasive esophagectomies, including robot-assisted procedures, have demonstrated superiority over traditional open surgery. Despite the prevalence of transhiatal and transthoracic approaches, cervical access is...
Minimally invasive esophagectomies, including robot-assisted procedures, have demonstrated superiority over traditional open surgery. Despite the prevalence of transhiatal and transthoracic approaches, cervical access is less common in minimally invasive esophageal surgery. Advancements in robotic systems, such as the da Vinci Single Port (SP), enable controlled transcervical extrapleural mediastinoscopic access, potentially reducing pulmonary complications and extending surgical options to patients with comorbidities. The da Vinci SP robot-assisted cervical esophagectomy (SP-RACE) employs an SP and laparoscopic approach, demonstrating feasibility with comparable lymphadenectomy and recurrent nerve palsy rates to transthoracic methods. This technique, performed for the first time in Europe at the University Hospital Mainz, involves a transcervical SP phase that allows for effective mediastinal dissection and esophageal mobilization. Despite technical challenges due to limited space, robotic systems enhance controlled access and eliminate arm collision. The da Vinci SP platform's advantages include improved triangulation, fewer interferences, and better control of instruments in confined spaces. This novel approach shows promise for patients with high esophageal tumors and those unsuitable for transthoracic surgery, warranting further investigation into its clinical utility and reproducibility.
Evaluation of Point-of-Care-Directed Coagulation Management in Pediatric Cardiac Surgery.
Zajonz T, Edinger F, Hofmann J … +4 more , Yoerueker U, Akintürk H, Markmann M, Müller M
Thorac Cardiovasc Surg · 2025 Aug · PMID 39137896 · Publisher ↗
Coagulatory alterations are common after pediatric cardiac surgery and can be addressed with point-of-care (POC) coagulation analysis. The aim of the present study is to evaluate a preventive POC-controlled coagulation a...
Coagulatory alterations are common after pediatric cardiac surgery and can be addressed with point-of-care (POC) coagulation analysis. The aim of the present study is to evaluate a preventive POC-controlled coagulation algorithm in pediatric cardiac surgery.This single-center, retrospective data analysis included patients younger than 18 years who underwent cardiac surgery with cardiopulmonary bypass (CPB) and received a coagulation therapy according to a predefined POC-controlled coagulation algorithm. Patients were divided into two groups (<10 and >10 kg body weight) because of different CPB priming strategies.In total, 173 surgeries with the use of the POC-guided hemostatic therapy were analyzed. In 71% of cases, target parameters were achieved and only in one case primary sternal closure was not possible. Children with a body weight ≤10 kg underwent surgical re-evaluation in 13.2% (15/113), and respectively 6.7% (4/60) in patients >10 kg. Hemorrhage in children ≤10 kg was associated with cyanotic heart defects, deeper intraoperative hypothermia, longer duration of CPB, more complex procedures (RACHS-1 score), and with more intraoperative platelets, and respectively red blood cell concentrate transfusions (all values 0.05). In children ≤10 kg, fibrinogen levels were significantly lower over the 12-hour postoperative period (without revision: 3.1 [2.9-3.3] vs. with revision 2.8 [2.3-3.4]). Hemorrhage in children >10 kg was associated with a longer duration of CPB ( 0.042), lower preoperative platelets ( 0.026), and over the 12-hour postoperative period lower platelets ( 0.002) and fibrinogen ( 0.05).The use of a preventive, algorithm-based coagulation therapy with factor concentrates after CPB followed by POC created intraoperative clinical stable coagulation status with a subsequent executable thorax closure, although the presented algorithm in its current form is not superior in the reduction of the re-exploration rate compared to equivalent collectives. Reduced fibrinogen concentrations 12 hours after surgery may be associated with an increased incidence of surgical revisions.
Impella 5.5 Support for Delayed Surgical Ventricular Septal Defect Repair-A Paradigm Shift?
Eghbalzadeh K, Großmann C, Krasivskyi I … +7 more , Djordjevic I, Kuhn EW, Origel Romero C, Bakhtiary F, Mader N, Deppe AC, Wahlers TCW
Thorac Cardiovasc Surg · 2025 Apr · PMID 39134038 · Publisher ↗
BACKGROUND: Ventricular septal defects (VSDs) remain a rare but life-threatening complication of myocardial infarction. Although the incidence has decreased due to better treatment options, the mortality rate remains hig...
BACKGROUND: Ventricular septal defects (VSDs) remain a rare but life-threatening complication of myocardial infarction. Although the incidence has decreased due to better treatment options, the mortality rate remains high. The timing of VSD repair remains critical to outcome. The use of mechanical circulatory support is rarely described in the literature, although it may help to delay repair to allow tissue stabilization. While Impella is currently considered contraindicated due to the potential worsening of the right-to-left shunt and possible systemic embolization of necrotic debris, there is no comprehensive evidence for this. Therefore, we aimed to analyze whether the use of Impella 5.5 as a first choice for patients undergoing VSD repair should be considered for discussion. METHODS: This retrospective study analyses four consecutive patients who underwent delayed ventricular septal repair after prior implantation of Impella 5.5 (Abiomed Inc., Danvers, Massachusetts, United States). RESULTS: A total of 75% of patients ( = 3) presented with acute right heart failure prior to implantation with a mean systolic pulmonary artery pressure of 64 ± 3.0 mmHg. Implantation was performed under local anesthesia in three cases. The mean time to surgery was 9.8 ± 3.1 days. All patients remained on the Impella 5.5 device postoperatively. Weaning from Impella 5.5 was successful in 75% ( = 3). The mean length of stay in the intensive care unit was 22.3 ± 7.5 days. CONCLUSION: Preoperative implantation of the Impella 5.5 device is a safe and feasible option for patients undergoing VSD repair. Outcomes may be improved by performing Impella implantation under local anesthesia and continuing Impella support after VSD repair. However, it is important to note that these patients represent a high-risk cohort and the mortality rate remains high.
Evaluation of Risk Factors for Early Insufficiency after Bronchial Sleeve Resections.
Levchenko E, Shabinskaya V, Levchenko N … +3 more , Mikhnin A, Mamontov O, Ergnyan S
Thorac Cardiovasc Surg · 2025 Mar · PMID 39117326 · Publisher ↗
BACKGROUND: Bronchoplastic resections are now widely used as a surgical treatment for resectable central lung cancer. However, bronchial dehiscence is one of the most life-threatening complications, making it important t...
BACKGROUND: Bronchoplastic resections are now widely used as a surgical treatment for resectable central lung cancer. However, bronchial dehiscence is one of the most life-threatening complications, making it important to identify its risk factors to separate patients who require more attention during the postoperative period. METHODS: The data of 285 patients who underwent bronchoplasty from 2006 to 2021 were retrospectively reviewed. We collected demographic characteristics, history of neoadjuvant therapy, preoperative assessment, perioperative outcomes, and postoperative complications to investigate different variables as risk factors for bronchial dehiscence by univariate and multivariate analyses. RESULTS: Bronchial dehiscence was diagnosed in 12 patients (4.2%) with a mean presentation on postoperative day 10 (range: 1-24 days). By multivariate analysis, current smoking (odds ratio [OR]: 4.8, 95% confidence interval [CI]: 1.1-20.1, = 0.032), chronic obstructive pulmonary disease (COPD; OR: 6.5, 95% CI: 1.2-33.8, = 0.027), bronchoplastic right lower lobectomy (OR: 12.9, 95% CI: 2.4-69.7, = 0.003), and upper sleeve bilobectomy with segmentectomy S6 by performing an anastomosis between right main bronchus (RMB) and bronchus of basal pyramid (BP) (OR: 30.4, 95% CI: 3.4-268.1, = 0.002) were confirmed as relevant risk factors for developing bronchial dehiscence. CONCLUSION: Current smoking, COPD, bronchoplastic right lower lobe, and upper l with segmentectomy S6 by performing an anastomosis between RMB and bronchus of BP were identified with the occurrence of bronchial dehiscence after sleeve resection.
Gender Differences in 381 Patients Undergoing Isolated Mitral Regurgitation Repair.
Cheng YH, Ma WG, Zeng JW … +3 more , Han YF, Sun K, Huang WQ
Thorac Cardiovasc Surg · 2025 Oct · PMID 39117325 · Publisher ↗
This study aimed to compare the gender differences in isolated mitral regurgitation (MR) repair.Of 381 adults aged 54.8 ± 12.3 years undergoing mitral valve repair (MVP) for isolated MR from January 2019 to December 2022...
This study aimed to compare the gender differences in isolated mitral regurgitation (MR) repair.Of 381 adults aged 54.8 ± 12.3 years undergoing mitral valve repair (MVP) for isolated MR from January 2019 to December 2022, the baseline and operative data, and outcomes were compared between 161 women (42.3%) and 220 men (57.7%).Women tended to be nonsmokers (98.1 vs. 45%, 0.001), and have more cerebrovascular accidents (38.5% vs. 24.1%, = 0.004) and isolated annular dilatation (19.3 vs. 9.1%, = 0.010), lower creatinine (70.0 ± 19.5 vs. 86.3 ± 19.9 μmol/dL, 0.001), and smaller left ventricular end-diastolic diameter (LVEDD; 54.4 ± 6.7 vs. 57.8 ± 6.6 mm, 0.001). One female died of stroke at 2 days (0.3%). Another female (0.3%) underwent mitral valve replacement for failed repair. Stroke occurred in 4 (1.0%). Two underwent reexploration for bleeding (0.5%). Women were more likely to have less 24-hour drainage (290 ± 143 vs. 385 ± 196 mL, 0.001). Over a mean follow-up of 2.1 ± 1.1 years (100% complete), 1 woman died and 1 man underwent a reoperation; 28 had moderate MR, and 9 had severe MR. Neither did early and late mortality and reoperation, nor freedom from late moderate or severe MR (71.6 vs. 71.4% at 5 years; = 0.992) differ significantly between the two genders. Predictors for late moderate or severe MR were anterior leaflet prolapse (hazard ratio [HR] 4.45; 95% confidence interval [CI] 1.18-16.72; = 0.027) and isolated annular dilation (HR 5.47, 95% CI 1.29-23.25; = 0.021).In this series of patients undergoing isolated MR repair, despite significant differences in smoking, cerebrovascular accidents, creatinine, LVEDD, and isolated annular dilatation at baseline, and 24-hour drainage postoperatively, women and men did not show significant differences in early and late survival, reoperation, and freedom from late moderate or severe MR.
The Solid Volume Ratio is Better Than the Consolidation Tumor Ratio in Predicting the Malignant Pathological Features of cT1 Lung Adenocarcinoma.
Liu Y, Jiang N, Zou Z … +4 more , Liu H, Zang C, Gu J, Xin N
Thorac Cardiovasc Surg · 2025 Jun · PMID 39106958 · Full text
BACKGROUND: More effective methods are urgently needed for predicting the pathological grade and lymph node metastasis of cT1-stage lung adenocarcinoma. METHODS: We analyzed the relationships between CT quantitative para...
BACKGROUND: More effective methods are urgently needed for predicting the pathological grade and lymph node metastasis of cT1-stage lung adenocarcinoma. METHODS: We analyzed the relationships between CT quantitative parameters (including three-dimensional parameters) and pathological grade and lymph node metastasis in cT1-stage lung adenocarcinoma patients of our center between January 2015 and December 2023. RESULTS: A total of 343 patients were included, of which there were 233 males and 110 females, aged 61.8 ± 9.4 (30-82) years. The area under the receiver operating characteristic (ROC) curve for predicting the pathological grade of lung adenocarcinoma using the consolidation-tumor ratio (CTR) and the solid volume ratio (SVR) were 0.761 and 0.777, respectively. The areas under the ROC curves (AUCs) for predicting lymph node metastasis were 0.804 and 0.873, respectively. Multivariate logistic regression analysis suggested that the SVR was an independent predictor of highly malignant lung adenocarcinoma pathology, while the SVR and pathological grade were independent predictors of lymph node metastasis. The sensitivity of predicting the pathological grading of lung adenocarcinoma based on SVR >5% was 97.2%, with a negative predictive value of 96%. The sensitivity of predicting lymph node metastasis based on SVR >47.1% was 97.3%, and the negative predictive value was 99.5%. CONCLUSION: The SVR has greater diagnostic value than the CTR in the preoperative prediction of pathologic grade and lymph node metastasis in stage cT1-stage lung adenocarcinoma patients, and the SVR may replace the diameter and CTR as better criteria for guiding surgical implementation.
Comparison of Pulmonary Outcome in Minimally Invasive (TCRAT) and Full Sternotomy CABG.
Sellin C, Sand U, Demianenko V … +4 more , Schmitt C, Schäfer B, Schier R, Doerge H
Thorac Cardiovasc Surg · 2025 Apr · PMID 39095028 · Publisher ↗
BACKGROUND: Pulmonary complications are among the main causes of increased mortality, and morbidity, as well as prolonged intensive care unit (ICU) and hospital stay after cardiac surgery. Recently, a sternum-sparing con...
BACKGROUND: Pulmonary complications are among the main causes of increased mortality, and morbidity, as well as prolonged intensive care unit (ICU) and hospital stay after cardiac surgery. Recently, a sternum-sparing concept of minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) was introduced. A higher risk of pulmonary injury could be anticipated due to the thoracic incision and the longer duration of surgery. Pulmonary complications in TCRAT were compared to standard coronary artery bypass grafting (CABG) via full median sternotomy (FS). METHODS: Records of 151 consecutive TCRAT (from September 2021 to November 2022) and 229 consecutive FS patients (from January 2017 to December 2018) patients, who underwent elective or urgent CABG, were analyzed. Preoperative baseline characteristics (age, sex, body mass index, diabetes, hypertension, chronic obstructive pulmonary disease, smoking status, left ventricular ejection fraction, pulmonary hypertonus, and EuroScore II) were comparable between groups. RESULTS: Differences between examined groups examined were found for the pulmonary parameters: Horowitz index 6 hours after operation (TCRAT 270 ± 72 vs. FS 293 ± 73, < 0.05), pneumothorax (TCRAT 0% vs. FS 2.6%, < 0.05), bronchoscopies (TCRAT 5.9% vs. FS 1.7%, < 0.05), and pleural effusion (TCRAT 8.6% vs. FS 3.5%, < 0.05). Moreover, there were differences between groups with regard to mean ICU stay (TCRAT 2.4 ± 3.0 days vs. FS 1.8 ± 1.8 days, < 0.05), stroke (TCRAT 0% vs. FS 1.3%, < 0.05), and hospital stay (TCRAT 10.9 ± 8.5 days vs. FS 13.2 ± 9.3 days, < 0.05). There were no differences regarding atelectasis, reintubations, tracheostomies, ventilation time, and mortality. CONCLUSION: Pulmonary complications in terms of pleural effusions were more common with TCRAT, however, without substantial impact on clinical outcome.
Fontan Completion in Adult Patients with Functionally Univentricular Hearts.
Alpat S, Aydin A, Aykan H … +1 more , Yilmaz M
Thorac Cardiovasc Surg · 2025 Mar · PMID 39095027 · Publisher ↗
BACKGROUND: Although there are considerable amounts of data on the outcomes of pediatric patients who have undergone Fontan repair, little is known about having Fontan completed in adulthood. The study presented the midt...
BACKGROUND: Although there are considerable amounts of data on the outcomes of pediatric patients who have undergone Fontan repair, little is known about having Fontan completed in adulthood. The study presented the midterm results of our unit's experience with the Fontan completion procedure in adult patients with functionally univentricular hearts. METHODS: Between 2014 and 2023, 16 adult patients underwent total cavopulmonary connection (TCPC) completion. Relevant information was retrospectively collected. RESULTS: Sixteen patients with a median age of 19 years (18-21 years) were included. Median arterial oxygen saturation was 76% (70-80.75%), and 62.5% of the patients were New York Heart Association (NYHA) Class III. The median mean pulmonary artery pressure was 14 mm Hg (9.5-14.5 mm Hg). Nine patients (56%) had heterotaxy syndrome, and the median time between the last operation and TCPC was 15.5 years (6.75-17.5 years). The median durations for bypass and cross-clamp were 160 minutes (130-201 minutes) and 120 minutes (84.5-137.5 minutes), consecutively. The postoperative course was straightforward in all. The median arterial oxygen saturation before discharge was 89.5% (85-90%), and 68.75% of the patients were NYHA Class II. Follow-up was complete for all patients with a median of 24 months. There was no early or late mortality or significant morbidity during the study period. CONCLUSION: We concluded that the intra-extracardiac Fontan technique was feasible for meticulously selected adults undergoing TCPC completion, as evidenced by an acceptable mortality rate and a satisfactory midterm outcome, including improvements in their NYHA functional class. However, the long-term consequences must be monitored.
German Heart Surgery Report 2023: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery.
Beckmann A, Meyer R, Eberhardt J … +2 more , Gummert J, Falk V
Thorac Cardiovasc Surg · 2024 Aug · PMID 39079552 · Publisher ↗
Based on a voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (DGTHG) in 1980, a well-defined but limited dataset of all cardiac and vascular surgery procedures performed in 77 Germ...
Based on a voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (DGTHG) in 1980, a well-defined but limited dataset of all cardiac and vascular surgery procedures performed in 77 German heart surgery departments is reported annually. For the year 2023, a total of 168,841 procedures were submitted to the registry. Of these operations, 100,606 are defined as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 28,996 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 2.8:1) was 97.6%; 97.7% for the 39,859 isolated heart valve procedures (23,727 transcatheter interventions included); and 99.2% for 19,699 pacemaker/implantable cardioverter defibrillator procedures. Concerning short and long-term mechanical circulatory support, a total of 2,982 extracorporeal life support/extracorporeal membrane oxygenation implantations and 772 ventricular assist device implantations (left/right ventricular assist device, BVAD, total artificial heart) were reported. In 2023, 324 isolated heart transplantations, 248 isolated lung transplantations, and 2 combined heart-lung transplantations were performed. This annually updated registry of the DGTHG represents nonrisk adjusted voluntary public reporting and encompasses acute data for nearly all heart surgical procedures in Germany. It constitutes trends in heart medicine and represents a basis for quality management (e.g., benchmark) for all participating institutions.
Old Habits Die Hard.
Heinemann MK
Thorac Cardiovasc Surg · 2024 Aug · PMID 39079551 · Publisher ↗
Abstract loading — click title to view on PubMed.
Artificial Neochordae for Tricuspid Valve Repair in Adults: A Review.
Lechiancole A, Sponga S, Bortolotti U … +3 more , De Pellegrin A, Livi U, Vendramin I
Thorac Cardiovasc Surg · 2025 Mar · PMID 38991531 · Publisher ↗
Expanded polytetrafluoroethylene (ePTFE) neochordae are predominantly used for mitral valve repair (MVr), while the frequency of their employment in tricuspid valve surgery is not well assessed. We have performed a revie...
Expanded polytetrafluoroethylene (ePTFE) neochordae are predominantly used for mitral valve repair (MVr), while the frequency of their employment in tricuspid valve surgery is not well assessed. We have performed a review of the available literature to verify incidence, indications, techniques, and outcomes of the use of artificial neochordae in a variety of tricuspid valve pathologies. We found a total of 57 articles reporting the use of ePTFE sutures in patients in whom tricuspid valve repair (TVr) was performed. From such articles, adequate information on the basic disease, surgical techniques, and outcomes could be obtained in 45 patients in whom the indication to the use of neochordae was posttraumatic tricuspid regurgitation ( = 24), infective endocarditis ( = 8), congenital valvular disease ( = 6), valve injury during cardiac neoplasm excision ( = 3) or following repeated endomyocardial biopsies after heart transplantation ( = 3), and tricuspid valve prolapse ( = 1). Implant techniques generally replicated those currently employed for MVr using artificial neochordae. There were no reported hospital deaths with stability of repair in most cases at follow-up controls. TVr using ePTFE neochordae has been reported so far in a limited number of patients. Nevertheless, it appears a feasible and reproducible technique to be added routinely to the surgical armamentarium during TVr.
The Impact of High-Fidelity Simulator System on Bronchoscopy Operation Skills of Trainees Who Receive Refresher Training: A Teaching Study.
Jin G, Tao X, Xu H
Thorac Cardiovasc Surg · 2024 Oct · PMID 38942057 · Publisher ↗
OBJECTIVE: This study aimed to explore the impact of high-fidelity simulator (HFS) training on the bronchoscopy operation skills, confidence, stress, and learning satisfaction of trainees who further their training at en...
OBJECTIVE: This study aimed to explore the impact of high-fidelity simulator (HFS) training on the bronchoscopy operation skills, confidence, stress, and learning satisfaction of trainees who further their training at endoscopy center in our hospital. The study also investigated the practical application effects of HFS training and provided a reference for the development of clinical teaching and training programs in hospitals. METHODS: The 18 trainees who furthered their training at the endoscopy center were evaluated for their bronchoscopy operation skills, confidence, and stress levels before and after HFS training. A survey on learning satisfaction was conducted after the completion of HFS training. The scores of all evaluations were collected for comparison of differences before and after HFS training. RESULTS: HFS training improved the clinical operation skill levels and confidence of trainees who further their training at the endoscopy center, reduced their stress, and achieved 100% satisfaction from this training. Education level and department had no significant impact on trainees' operational skills and confidence improvement, and stress reduction ( > 0.05). The results of this study supported the influence of the history of endoscopy operations on the improvement of trainees' improved operational skills after HFS training, but it had no relation to the improvement of confidence and stress reduction. Trainees with a history of endoscopy operations had higher operation skill scores before and after HFS training ( = 5, 94.80 ± 2.95 and 97.60 ± 1.82, respectively) than those without a history of endoscopy operations ( = 13, 80.62 ± 2.53 and 86.38 ± 2.82, respectively), and the difference was significant ( < 0.05). CONCLUSION: HFS training is an effective clinical teaching method that can significantly improve trainees' bronchoscopy operation skills and confidence, reduce stress, and achieve high levels of satisfaction.
German Registry for Cardiac Operations and Interventions in Congenital Heart Disease: Annual Report 2022.
Hofbeck M, Arenz C, Bauer UMM … +5 more , Horke A, Kerst G, Meyer R, Tengler A, Beckmann A
Thorac Cardiovasc Surg · 2024 Jan · PMID 38914128 · Publisher ↗
BACKGROUND: The German Registry for Cardiac Operations and Interventions in Patients with Congenital Heart Disease is a voluntary registry initiated by the German Society for Thoracic and Cardiovascular Surgery and the G...
BACKGROUND: The German Registry for Cardiac Operations and Interventions in Patients with Congenital Heart Disease is a voluntary registry initiated by the German Society for Thoracic and Cardiovascular Surgery and the German Society for Pediatric Cardiology and Congenital Heart Defects. Since 2012, the registry collects data for the assessment of treatment and outcomes of surgical and interventional procedures in patients with congenital heart disease (CHD) of all age groups. METHODS: This real-world, prospective all-comers registry collects clinical and procedural characteristics, adverse events (AEs), mortality, and medium-term outcomes (up to 90 days) of patients undergoing surgical and interventional. A unique pseudonymous personal identifier (PID) allows longitudinal data acquisition in case of further invasive treatment in any participating German heart center. Prior to evaluation, all data sets are monitored for data completeness and integrity. Evaluation includes risk stratification of interventional and surgical procedures and classification of AEs. Each year's data are summarized in annual reports containing detailed information on the entire cohort, all subgroups, and 15 index procedures. In addition, each participating center receives an institutional benchmark report for comparison with the national results. This paper presents a comprehensive summary of the annual report 2021. RESULTS: In 2021, a total of 5,439 patients were included by 22 participating centers. In total, 3,721 surgical, 3,413 interventional, and 34 hybrid procedures were performed during 6,122 hospital stays. 2,220 cases (36.3%) could be allocated to the 15 index procedures. The mean unadjusted in-hospital mortality ranged from 0.4% among interventional and 2% among surgical cases up to 6.2 % in cases with multiple procedures. In-hospital mortality among index procedures accounted for 2.3% in total cavopulmonary connection, 20.3% in Norwood procedures, and 0.4% following interventional closure of patent ductus arteriosus. For the remaining seven surgical and five interventional index procedures, no in-hospital deaths were recorded. The 10-year longitudinal evaluation of 1,795 patients after tetralogy of Fallot repair revealed repeat interventional or surgical procedures in 21% of the patients. Over the same period, 31.1% of 2,037 patients, following initial treatment of native coarctation, required at least one additional hospital admission, 39.4% after initial interventional, and 21.3% after initial surgical therapy. CONCLUSION: The annual report 2021 of the German Registry for Cardiac Operations and Interventions in CHD shows continuously good results in accordance with previous data of the registry. Compared to international registries on CHD, it can be ascertained that in Germany invasive treatment of CHD is offered on a high medical level with excellent quality. The proven fact that patients with various malformations like tetralogy of Fallot and coarctation of the aorta require repeat procedures during follow-up confirms the urgent requirement for longitudinal assessment of all patients presenting with complex lesions.
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