OBJECTIVES: The aim of this study was to evaluate the impact of different autograft support techniques during the Ross procedure on long-term outcomes in adolescents and young adults. METHODS: Patients (≥12 years) who un...OBJECTIVES: The aim of this study was to evaluate the impact of different autograft support techniques during the Ross procedure on long-term outcomes in adolescents and young adults. METHODS: Patients (≥12 years) who underwent a Ross procedure between 01/1996 and 10/2024 were included. According to autograft support technique, they were divided into 3 groups: No support, Annular support, and Full support (autograft placed inside a straight Dacron graft). Survival was estimated using the Kaplan-Meier method. Cumulative incidence of autograft regurgitation ≥moderate and autograft (+/- valve-sparing) root replacement were analysed using the Gray subdistribution method. RESULTS: Out of 131 patients included (median age 17.2 years [IQR: 14.5-24.0]), 76 (58%) had No support, 43 (33%) Full support, and 12 (9%) Annular support. Patients in group No support were significantly younger (P < .01) and had smaller native aortic annulus (24 mm vs 26 mm, P < .05). Postoperative complications (P = .40) and early mortality (P = 1.0) were similar across groups. Median follow-up was 5.7 years (IQR: 2.1-11.8), and 10-year survival was 99%. While cumulative incidence of reoperation was similar between the 3 groups at 10 years (5.6% vs 0% vs 10.1%, P = .80), patients with Full support experienced a significantly higher rate of autograft regurgitation ≥moderate (32.3% vs 13.3% vs 11.1%, P = .03). CONCLUSIONS: Long-term survival after the Ross procedure was excellent in adolescents and young adults. Full support is associated to autograft valve dysfunction at 10 years, while annular support gave more stable autograft outcomes. Further studies are needed to determine whether this reflects a technical learning curve or a reproducible pattern.
OBJECTIVES: This study aimed at identifying predictors of loco-regional recurrence in patients who underwent non-anatomical (wedge) resection(s) of lung metastases at 15 European centres. METHODS: Multicentre retrospecti...OBJECTIVES: This study aimed at identifying predictors of loco-regional recurrence in patients who underwent non-anatomical (wedge) resection(s) of lung metastases at 15 European centres. METHODS: Multicentre retrospective analysis of patients ≥18 years who underwent curative-intent wedge resection(s) of lung metastases (January 2010-December 2018). Exclusion criteria were: previous metastasectomy, non-curative intent, incomplete (R1/R2) resection, and lack of data concerning recurrence. Loco-regional recurrence was defined as any recurrence occurring in the lungs, hilar-mediastinal lymph nodes, and/or pleurae. Subset analyses were conducted on patients with a solitary metastasis. RESULTS: A total of 588 patients were included (56.1% adenocarcinoma). Five-year overall survival was 63.9% (95% CI = 60.43; 67.18). Five-year loco-regional recurrence rate was 47.7% (95% CI = 42.8; 52.4). Mean resection margin width was 6.8 mm (IQR = 2.0-10.0). 422 patients (71.8%) underwent a single wedge resection. In the total sample, univariable Cox regression showed that primary tumour site (P = .0003), primary tumour histology (P = .0027), resection margin width (P = .0060), log(margin-to-tumour size ratio) (P = .0022), and number of metastases (P < .0001) were significantly associated with loco-regional recurrence. In patients with a solitary metastasis, univariable analyses showed that primary tumour site (P = .0150), primary tumour histology (P = .0248), and log(margin-to-tumour size ratio) (P = .0355) were significantly associated with loco-regional recurrence. In multivariable analyses (solitary metastasis group), primary squamous-cell carcinoma histology was significantly associated with loco-regional recurrence (P = .0023). Resection margin width and log(margin-to-tumour size ratio) did not significantly affect loco-regional recurrence. CONCLUSIONS: Loco-regional recurrence after pulmonary metastasectomy seems to be correlated with primary tumour histology and the number of metastases. Further studies are needed to clarify the role of size-adjusted margin parameters in preventing recurrence.
OBJECTIVES: Micropapillary pattern (MPP) in ≤2 cm invasive lung adenocarcinoma (ILADC) is strongly associated with poor prognosis, making its preoperative identification critical for determining optimal surgical strategy...OBJECTIVES: Micropapillary pattern (MPP) in ≤2 cm invasive lung adenocarcinoma (ILADC) is strongly associated with poor prognosis, making its preoperative identification critical for determining optimal surgical strategy. This study aimed to develop a predictive model integrating clinical features, radiomics features, and deep learning features to non-invasively identify MPP in ≤2 cm ILADC. METHODS: This retrospective study analysed 311 patients with pathologically confirmed ILADC (102 with MPP ≥ 5%, 209 without MPP) treated at Zhongda Hospital, Southeast University, from January 2018 to August 2023. Clinical features, radiomics features extracted using PyRadiomics, and deep learning features obtained from a 3D convolutional neural network (NASLung) were selected through t-tests and random forest (RF) feature-importance analysis. Three base models (Clinic, Radiomics, Deep Learning) were trained using RF or support vector machine (SVM) classifiers, and their predicted probabilities were fused to construct 3 combined models: (1) Clinic + Rad-based model (CR), (2) Clinic + Deep Learning-based model (CD), (3) Rad + Deep Learning-based model (RDL), and (4) Clinic + Rad + Deep Learning-based model (CRDL). Model performance was evaluated by receiver operating characteristic (ROC) analysis, calibration, and decision curve analysis (DCA). RESULTS: A total of 6 clinical features, 30 radiomics features, and 8 deep learning features were ultimately selected. In the testing set, the CRDL model demonstrated the best performance, achieving an AUC of 0.8817, a sensitivity of 77.4%, and a specificity of 81.0%, outperforming all other models. The calibration curve showed good agreement between predicted and observed outcomes, and the DCA further confirmed the clinical net benefit of the CRDL model. CONCLUSIONS: CRDL model effectively predicts MPP in ≤2 cm ILADC preoperatively, offering a non-invasive tool to guide surgical decision-making and optimize patient management.
Pompili C, Kobayashi AK, Lo Torto S
… +11 more, Novoa NM, Bertani A, Ostrowski M, Takamiya S, Suzuki H, Horinouchi H, Tsuboi M, Watanabe SI, Kikawa Y, Yoshino I, Ichimura H
OBJECTIVES: This study aimed to evaluate the progress in the collection and interpretation of patient-reported outcomes (PRO) and health-related quality of life (HRQoL) in thoracic surgery. METHODS: We invited all member...OBJECTIVES: This study aimed to evaluate the progress in the collection and interpretation of patient-reported outcomes (PRO) and health-related quality of life (HRQoL) in thoracic surgery. METHODS: We invited all members of the European Society of Thoracic Surgeons (ESTS) and the Japanese Association for Chest Surgery (JACS) via e-mail, providing survey information in both English and Japanese. It consisted of 19 questions addressing the use of HRQoL assessment in clinical practice. RESULTS: In total, we received 234 responses: 84 from ESTS, 128 from JACS, and 22 from other societies. The present survey showed that 58.5% of surgeons have never collected HRQoL data in their practice. The EORTC-QLQ-LC29 was the most frequently used questionnaire, reported by 24.7% of participants. A total of 137 (59.6%) responses identified HRQoL as the most important PROM. As for timing of data collection, 37.1% responded most important timing of data collection was prior to adjuvant chemotherapy and 24.1% of participants rated HRQoL evaluation 6 months after surgery. CONCLUSIONS: This study successfully collected responses from thoracic surgeons in both Europe and Japan. Although still underused, these findings highlight that surgeons increasingly recognize the value of PROMs, particularly in the context of multimodal treatment.
Nakamura S, Kinoshita F, Seki Y
… +6 more, Tsunoda Y, Hayashi Y, Nakagawa T, Ogawa K, Chen-Yoshikawa TF, Yamada K
Eur J Cardiothorac Surg
· 2026 Jan · PMID 41495228
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OBJECTIVES: Treatment for patients with macrolide-resistant Mycobacterium avium complex (MR-MAC) pulmonary disease is a major clinical challenge, as pharmacologic options are limited and outcomes with antibiotics alone a...OBJECTIVES: Treatment for patients with macrolide-resistant Mycobacterium avium complex (MR-MAC) pulmonary disease is a major clinical challenge, as pharmacologic options are limited and outcomes with antibiotics alone are unsatisfactory. Although surgical intervention has been considered in selected cases, clinical evidence specific to MR-MAC is limited. This study aimed to compare the clinical outcomes of surgical intervention for MR-MAC pulmonary disease to those of non-resistant cases. METHODS: This multicentre study included 248 patients who underwent pulmonary resection for MAC pulmonary disease. Among them, 34 patients (13.7%) had MR-MAC, which was defined as isolates with a clarithromycin minimum inhibitory concentration of ≥32 mg/L. Clinical outcomes were compared between the MR-MAC and non-MR-MAC groups. A multivariable analysis was conducted to identify risk factors for infectious relapse. RESULTS: In the MR-MAC and non-MR-MAC groups, the 5-year overall survival, 5-year relapse-free survival and postoperative complication rates were 100% and 98.5%, 85.4% and 67.9%, and 8.8% and 11.9%, respectively (P = .72, .47, and .78, respectively). Multivariable analysis revealed older age and lack of amikacin use as independent risk factors for infectious relapse, but not macrolide resistance. CONCLUSIONS: Surgical resection is a viable and safe therapeutic option for selected patients with MR-MAC pulmonary disease, with long-term infection control comparable to that of non-MR-MAC cases. These findings support early surgical intervention in carefully selected patients with localized destructive lesions.
OBJECTIVES: Severe mitral annular calcification (MAC) carries an increased risk of perioperative complications in patients undergoing mitral valve surgery and may be considered a prohibitive surgical risk. Cavitron ultra...OBJECTIVES: Severe mitral annular calcification (MAC) carries an increased risk of perioperative complications in patients undergoing mitral valve surgery and may be considered a prohibitive surgical risk. Cavitron ultrasonic surgical aspiration (CUSA) has been reported as a method for controlled debridement of severe MAC during mitral valve surgery; however, experience in the literature is limited. METHODS: We assessed 30-day and intermediate-term outcomes in 67 consecutive patients (mean age: 72 [SD 9] years; female sex: 65.7% [44/67]) with severe MAC who underwent mitral valve repair or replacement for mitral stenosis and/or regurgitation using CUSA from March 2021 through December 2024. Operations included isolated mitral valve replacement (41.8% [28/67]), isolated mitral valve repair (4.5% [3/67]), mitral and aortic valve replacement (37.3% [25/67]), mitral valve replacement with coronary bypass (6.0% [4/67]), and mitral and aortic valve replacement with coronary bypass (10.4% [7/67]). Intermediate survival was estimated using the Kaplan-Meier method. RESULTS: Mortality rate was 6.0% (4/67), stroke was 3.0% (2/67), and new postoperative atrial fibrillation was 29.0% (20/67). There were no atrioventricular groove ruptures. At a median echocardiographic follow-up time of 361 days (interquartile range [IQR] 112, 671), moderate paravalvular leak occurred in 3.0% (1/67). Mid-term all-cause mortality was 9.0% at a mean follow-up time of 42.5 (95% CI, 39.0, 46.0) months. CONCLUSIONS: The use of CUSA to debride severe mitral annular calcification in patients undergoing mitral valve surgery is associated with acceptable short-term morbidity and mortality and durable intermediate-term results. This technique allows surgical intervention in patients who may otherwise be deemed prohibitive surgical risk.
Jones DG, Anstee C, Yasufuku K
… +8 more, Malthaner R, Safieddine N, Finley C, Kidane B, French D, Johnston B, Ferri L, Seely AJE
Eur J Cardiothorac Surg
· 2026 Jan · PMID 41494984
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OBJECTIVES: Lobectomy remains a cornerstone of curative intent treatment for lung cancer; however, postoperative adverse events (AEs) remain common, harmful, and costly. To support value-based quality improvement (QI) pr...OBJECTIVES: Lobectomy remains a cornerstone of curative intent treatment for lung cancer; however, postoperative adverse events (AEs) remain common, harmful, and costly. To support value-based quality improvement (QI) programmes, we sought to estimate the in-hospital costs of AEs following lobectomy and identify which complications are the primary cost drivers. METHODS: Lobectomy data from 10 Canadian hospitals were included (2017-2022). Annual lobectomy volume, demographics, length of stay (LOS), incidence, and severity of AEs were obtained from a prospectively collected national database. Using literature-derived index hospitalization costs of AEs, supported by Canadian Institution of Health Information database, estimates of annual AE costs were obtained (2025 CDN$). RESULTS: Mean annual lobectomy volume 1150 (SD = 165): 44% male, aged 67 years (SD = 10.9), median LOS of 4 days (interquartile range [IQR] = 4), with minimally invasive surgery performed in 86%. Prolonged air leak (PAL) contributed 51% of total AEs occurrences, followed by atrial arrhythmia (13%), pneumonia (7.9%), reoperation (5.2%), atelectasis (3.9%), delirium (3.4%), transfusion (2.8%), respiratory failure (2.8%), empyema (2.2%), acute kidney injury (1.7%), and pulmonary embolism (1.2%), adding over $7.31 million (M) to hospital-level costs. PAL, mean annual incidence of 17%, was the strongest driver of costs. Extrapolated nationally, lobectomy-related AEs are estimated to contribute over $48 million in excess annual costs. CONCLUSIONS: Postoperative AEs following lobectomy impose substantial financial burdens, with PAL alone accounting for more than half of total costs. These findings underscore the need for value-based QI initiatives targeting high-impact AEs, requiring coordinated action among surgeons, hospital leadership, and policymakers.
Kreuzer M, Sames-Dolzer E, Tulzer A
… +5 more, Mair R, Gierlinger G, Seeber F, Bakos M, Mair R
Eur J Cardiothorac Surg
· 2026 Jan · PMID 41494983
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OBJECTIVES: Despite the increasing use of the en bloc rotation of the outflow tracts to treat patients with transposition of the great arteries with left ventricular outflow tract obstruction, long-term outcome data are...OBJECTIVES: Despite the increasing use of the en bloc rotation of the outflow tracts to treat patients with transposition of the great arteries with left ventricular outflow tract obstruction, long-term outcome data are scarce. Cases with simultaneous Mustard operation are a challenging technical expansion. This retrospective study aims to evaluate long-term outcomes in a single-centre cohort. METHODS: All patients undergoing the en bloc rotation at the Children's Heart Center Linz between 2003 and 2024 were retrospectively analysed. RESULTS: The en bloc rotation was performed in 38 patients. Median age at operation was 4.1 (0.7; 23.9) months, weight 5.4 (3.7; 9.6) kg. A congenitally corrected transposition was present in 3 patients, in which a simultaneous Mustard procedure was performed. Median cardiopulmonary bypass time was 291 (270; 353) minutes, aortic cross-clamp time 160 (142; 185) minutes. The pulmonary valve could be preserved in 24 children (63%). Two patients died during the hospital stay (5%). During a follow-up period of median 9.3 (4.4; 14.3) years, 3 further children deceased, 5 surgical reinterventions were necessary. There was no death or surgical reintervention in the congenitally corrected transposition group. CONCLUSIONS: The long-term outcome of the en bloc rotation is very promising, as could be expected due to the anatomic repair with growth potential in all tubular structures. The increased experience also with the Mustard operation allowed the combination of both complex procedures with excellent short-term outcome. CLINICAL REGISTRATION NUMBER: EK Nr 1011/2025, Ethics committee of the Medical Faculty at the Johannes Kepler University Linz.
OBJECTIVES: Thymectomy reportedly increases the risk of cancer, autoimmune disease, and death. Studies are few and data limited. We sought to determine the incidence of postoperative malignancy and autoimmune disease in...OBJECTIVES: Thymectomy reportedly increases the risk of cancer, autoimmune disease, and death. Studies are few and data limited. We sought to determine the incidence of postoperative malignancy and autoimmune disease in patients who underwent thymectomy. METHODS: We conducted a retrospective review of adult patients undergoing thymectomy between 2008 and 2020. Postoperative cancers and autoimmune disease were diagnosed after thymectomy. Incidence rates were calculated using patient-years and compared to the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) programme incidence of cancer for the US general population. Autoimmune disease rates were compared to previously published results. RESULTS: There were 226 patients with a median age of 55 years (interquartile range [IQR] = 39-67), mostly female (129, 57%) and non-smokers (132, 58%). At baseline, 117 (52%) had autoimmune disease, including 102 (45%) with myasthenia gravis. Eighty-four (37%) thymomas were identified. Median follow-up was 6.0 years (134 with >5-year follow-up and 44 with >10-year follow-up). We observed 13 (6%) new malignancies for an incidence of 0.87 cases/100 person-years (0.87%) and comparable to the NCI rate of 0.81 cases/100 person-years (0.81%). Incident cancers developed within the first 5 years after surgery at 0.92 cases/100 person-years (0.92%) or 4.6% cumulatively over 5 years, compared to NCI data at 4%. There were 19 (8%) new autoimmune diagnoses with an incidence rate of 1.3 cases/100 person-years (1.3%) and is higher than large population studies (0.7 cases/100 person-years for all ages). CONCLUSIONS: Development of new cancers following thymectomy in the United States is similar to the general population. But we identified a higher incidence of autoimmune disease, matching prior studies.
OBJECTIVES: Thymus removal can alter immune function and potentially influence cancer development. However, the relationship between the extent of thymus removal and postoperative cancer development remains underexplored...OBJECTIVES: Thymus removal can alter immune function and potentially influence cancer development. However, the relationship between the extent of thymus removal and postoperative cancer development remains underexplored. This study aimed to identify risk factors for cancer development post-thymectomy, with particular focus on the extent of thymic resection. METHODS: We reviewed 254 patients who underwent thymectomy between 2005 and 2021. Patients with myasthenia gravis, combined resection of adjacent organs, thymic cancer, or tumour recurrence were excluded. Clinical characteristics and postoperative cancer incidence were compared between the total and partial thymectomy groups. RESULTS: This study included 112 patients: 91 (81%) and 21 (19%) in the total and partial thymectomy groups, respectively. Patients in the total thymectomy group were significantly older than those in the partial thymectomy group (median age, 60 vs 44 years; P = .021). No significant differences were observed in sex, smoking history, preoperative cancer history, or observation period between the groups. Postoperative cancer development was significantly more common in the total thymectomy group (21 [23.1%] vs 1 [4.8%], P = .032). The median interval between surgery and cancer development was 2367 days. In the multivariable analysis, total thymectomy was identified as an independent risk factor for cancer development (hazard ratio 6.26, P = .032) after adjusting for potential confounders (age, sex, surgical method, and smoking history). CONCLUSIONS: Total thymectomy was identified as the only independent factor associated with increased postoperative cancer risk. These findings suggest the need to consider the extent of thymectomy and long-term cancer surveillance post-surgery. IRB INFORMATION: Institutional Review Board of Kitasato University (approval number: B24-079). The need to obtain written informed consent from each patient was waived because the study was retrospective.
Şişli E, Kar F, İnan K
… +6 more, Taştekin T, Şahin A, Çetinkaya D, Burukoğlu Dönmez D, Uslu S, Dernek S
Eur J Cardiothorac Surg
· 2026 Jan · PMID 41494979
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OBJECTIVES: This study hypothesizes that induced hypothermia (IH) can safely extend aortic cross-clamp (ACC) time, significantly reducing metabolic burden and end-organ injury, thereby enabling more comprehensive aortic...OBJECTIVES: This study hypothesizes that induced hypothermia (IH) can safely extend aortic cross-clamp (ACC) time, significantly reducing metabolic burden and end-organ injury, thereby enabling more comprehensive aortic arch reconstructions and offering distinct advantages. METHODS: In this experimental animal research, 62 New Zealand white rabbits were randomized into normothermia (39°C) and mild hypothermia (35°C) groups. Animals in each group underwent proximal aortic arch (PAA) clamping for 20, 30, or 40 minutes. Serial blood samples measured biochemistry, oxidative stress biomarkers, arterial and mixed venous blood gases, and lactate levels. Kidney and liver tissues were harvested for histopathological evaluation of ischaemic changes. RESULTS: Normothermic rabbits experienced significant increases in oxidative stress, metabolic acidosis, and end-organ injury (renal, hepatic, and exclusively, spinal cord injury) with prolonged clamping. Conversely, IH markedly attenuated these adverse effects, preserving acid-base balance and reducing histological injury. Notably, the metabolic burden and end-organ injury observed after 30 minutes of hypothermic ischaemia were comparable with those after 20 minutes of normothermic ischaemia, suggesting a substantial extension of safe clamping time. CONCLUSIONS: Induced hypothermia during ACC provides significant protection against ischaemia-reperfusion injury by minimizing oxidative damage, preserving antioxidant capacity, and maintaining metabolic balance, thereby enhancing haemodynamic function post-surgery. This approach allows for safely extended ACC times, with a safety margin appearing to correspond to 30 minutes under hypothermia, facilitating complex aortic arch reconstructions and enabling safer surgical training. Clinical trials are warranted to confirm these findings in humans.
OBJECTIVES: To compare long-term clinical outcomes of patients undergoing surgical (SAVR) or transcatheter aortic valve replacement (TAVR) in the Italian clinical practice and enrolled in the multicentre OBSERVANT (Obser...OBJECTIVES: To compare long-term clinical outcomes of patients undergoing surgical (SAVR) or transcatheter aortic valve replacement (TAVR) in the Italian clinical practice and enrolled in the multicentre OBSERVANT (Observational Study of Effectiveness of SAVR-TAVI Procedures for Severe Aortic Stenosis Treatment) Study. METHODS: Propensity score matching was used to compare patients undergoing SAVR or transfemoral (TF) TAVR with similar baseline characteristics. The primary end points were all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) at 10 years. Prespecified secondary end points included cerebrovascular accidents, repeat aortic intervention, repeat hospitalization due to cardiac reasons and heart failure. All outcomes were adjudicated through a linkage with administrative databases. RESULTS: From the entire cohort (n = 5707 SAVR and n = 1911 TAVR treated between December 2010 and June 2012), 650 matched pairs of patients were considered. At 10 years, TF-TAVR was associated with a higher risk of all-cause mortality (Hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.22-1.59; P < .001) and MACCE (HR 1.33, 95% CI 1.18-1.51; P < .001) compared to SAVR. Secondary end-points did not differ for rehospitalization for heart failure (P = .443) or cardiac reasons (P = .552), and for cerebrovascular events (P = .573), but TAVR had a significantly lower risk of repeat aortic intervention (Sub-distributional HR [SHR], 0.33; 95% CI, 0.12-0.91; P = .024] at 10 years. CONCLUSIONS: At 10 years, early generation TAVR had a significantly higher risk of all-cause mortality and MACCE, but a lower risk of repeat aortic intervention in clinical practice.
OBJECTIVES: This study aims to assess whether aortic arch anatomy, classified as Arch Type I, II, and III configuration, was associated with the Stanford aortic syndrome type at presentation. METHODS: This is a retrospec...OBJECTIVES: This study aims to assess whether aortic arch anatomy, classified as Arch Type I, II, and III configuration, was associated with the Stanford aortic syndrome type at presentation. METHODS: This is a retrospective, single-centre study including patients admitted between 2006 and 2023. Stanford type A/B acute and chronic aortic syndromes, including intramural haematoma and penetrating aortic ulcer, were evaluated. Aortic anatomy and aortic syndrome patterns were assessed via contrast-enhanced CT angiography performed at disease onset. Patients underwent follow-up through outpatient visits. RESULTS: Throughout the study period, 846 patients presented with acute or chronic Type A or B aortic syndrome. Of these, 605 patients with baseline contrast-enhanced CT angiography were analysed. Patients were grouped by arch configuration: Arch Type I (n = 199, 32.9%), Arch Type II (n = 190, 31.4%), and Arch Type III (n = 216, 35.7%). Mean ascending aorta length and maximum diameter were significantly greater in Arch Type I, compared to Arch Type II and III (10.2 cm vs 10 cm vs 9.7 cm, MD Arch Type I vs Arch Type III 0.68, 95% CI 0.31-1.06, P < .001; 46 mm vs 43 mm vs 40.5 mm, MD Arch Type I vs Arch Type III 4.21, 95% CI 1.81-6.61, P < .001). Arch Type I was significantly associated with Type A aortic syndrome (OR 2.14, 95% CI 1.51-3.03, P < .001) and Arch Type III with Type B aortic syndrome (OR 2.28, 95% CI 1.62-3.20, P < .001). During hospital stay, 344 (56.8%) patients underwent open surgery, 147 (24.3%) endovascular treatment, 110 (18.2%) medical treatment, and 4 (0.7%) died before treatment. Thirty-day mortality in Arch Type I, Type II and Type III was 12.1%, 9.5% and 6.9% (P = .2). Kaplan-Meier analysis, restricted to treated patients with available follow-up (n = 432), showed higher 5-year survival rate in Arch Type I compared to Arch Type II and Arch Type III (HR 1.83, 95% CI 1.12-2.97, 90.1% vs 88.2% vs 87.8%, P = .05). CONCLUSIONS: Aortic arch morphology may be associated with aortic syndrome type. Arch Type I was associated with larger and longer ascending aorta and Type A aortic disease, whereas Arch Type III emerged as a potential indicator for Type B disease.
OBJECTIVES: To compare perioperative outcomes of complex basilar sublobar resection (CBSLR) versus lower lobectomy, both performed via a standardized subxiphoid thoracoscopic approach, and to assess the impact of advance...OBJECTIVES: To compare perioperative outcomes of complex basilar sublobar resection (CBSLR) versus lower lobectomy, both performed via a standardized subxiphoid thoracoscopic approach, and to assess the impact of advanced image guidance on pathological quality metrics. METHODS: In a single-centre retrospective analysis (January 2016 to January 2024) of prospectively collected data, 98 consecutive patients underwent multiportal subxiphoid thoracoscopic anatomic resection for lower lobe lesions. Outcomes were compared between CBSLR and lower lobectomy. In non-small-cell lung cancer (NSCLC) patients undergoing CBSLR, pathological margins were analysed according to the use of advanced image guidance, associating 3D dynamic simulation (3D-DS) and fluorescence imaging. RESULTS: Among 98 patients (NSCLC: n = 80; metastasis: n = 14; benign: n = 4), lower lobectomy was performed in 59 (60%) and CBSLR in 39 (40%), of whom 23 received advanced image guidance. Perioperative outcomes were comparable between CBSLR and lower lobectomy, including conversion to thoracotomy (3% vs 9%), overall complications (13% vs 15%), prolonged air leak (5% vs 2%), median length of stay (1 [IQR 1-2] vs 1 [IQR 1-3] days), readmission (5% vs 9%), and 30-day mortality (0% vs 1.7%) (all P > .05). In NSCLC patients, advanced image guidance significantly increased pathological margins (median 23 [19-35] mm vs 10 [10-20] mm, P = .013). CONCLUSIONS: Subxiphoid thoracoscopic CBSLR achieves perioperative outcomes equivalent to lower lobectomy while preserving lung parenchyma. The 3D-DS-assisted "butterfly" approach enhances oncologic margin clearance in challenging basilar resections and represents a promising strategy for lung-sparing anatomic surgery in complex lower lobe lesions.
BACKGROUND: Valve-sparing aortic root replacement has increasingly been performed in Marfan patients. However, there is ongoing debate on whether the non-aneurysmal sized aortic arch should be prophylactically replaced d...BACKGROUND: Valve-sparing aortic root replacement has increasingly been performed in Marfan patients. However, there is ongoing debate on whether the non-aneurysmal sized aortic arch should be prophylactically replaced during the index operation. The aim of our retrospective single-centre study was to investigate the long-term status of the aortic arch in these patients. METHODS: Between 1993 and 2021, a total of 723 patients underwent valve-sparing aortic root replacement with a straight tube graft (David I reimplantation) at our institution; 119 patients had confirmed Marfan disease. Of these 119 Marfan patients, 67 patients had isolated aortic root aneurysm with no aortic arch pathology. These 67 patients underwent isolated David I procedure in an elective setting (only aortic root and ascending aortic replacement) without any concomitant procedures and were included in the present study. RESULTS: This study includes 67 patients with Marfan syndrome who underwent isolated elective valve-sparing aortic root replacement. The median age of patients was 30 years (20-41), and 47 were male (70%). The cardiopulmonary time was 157.5 (145.8-178.3) min, and aortic clamp time was 117.0 ± 19.8 min. The in-hospital mortality and stroke rates were both 0%. Follow-up was 100% complete. Survival at 1, 5, 10, 15, and 20 years were 100%, 100%, 93%, 89%, and 85%, respectively. Freedom from aortic arch reoperation due to aneurysm at 1, 5, 10, 15, and 20 years was 100%, 100%, 100%, 100%, and 95%, respectively. In follow-up, no patient required aortic arch replacement due to aortic arch aneurysm. A total of 3 patients underwent aortic arch replacement for type B aortic dissection. Of these 3 patients, 1 had chronic type B dissection with aortic aneurysm, and 2 had acute type B dissection. CONCLUSIONS: The long-term results after valve-sparing aortic root replacement with a straight tube graft (David I procedure) in Marfan patients are excellent. Our study shows that the risk for future aortic arch intervention after elective valve sparing aortic root replacement in Marfan patients is extremely low. Hence, our study supports the idea that concomitant prophylactic aortic arch replacement during elective valve sparing aortic root replacement in Marfan patients with non-aneurysmal aortic arch is not necessary.