Lu L, Shuhuan Y, Zuyuan Z
… +4 more, Xiang S, Ziyin Z, Li Z, Li L
Eur J Cardiothorac Surg
· 2026 Feb · PMID 41632620
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Full text
OBJECTIVES: Comparative effects of Baduanjin training versus bedside cycle ergometer training on pulmonary function in lung cancer patients after thoracoscopic surgery. METHODS: A total of 520 patients who had undergone...OBJECTIVES: Comparative effects of Baduanjin training versus bedside cycle ergometer training on pulmonary function in lung cancer patients after thoracoscopic surgery. METHODS: A total of 520 patients who had undergone video-assisted thoracoscopic surgery (VATS) for lung cancer at Huaihe Hospital of Henan University between January 2022 and January 2025 were selected for this study. These patients were randomly assigned to either a Baduanjin training group (experimental group, n = 260) or a bedside cycle ergometer training group (control group, n = 260). The study compared baseline and post-rehabilitation measurements between the 2 groups, including pulmonary function, pain levels, immune markers, cancer-related fatigue (CRF), and quality of life to evaluate the short-term efficacy of these 2 rehabilitation approaches for post-VATS recovery. RESULTS: No statistically significant differences were found in baseline characteristics between the 2 groups (P > .05). The experimental group showed significantly higher forced expiratory volume in 1 second (FEV1) (2.53 ± 0.29, 2.00 ± 0.24, P < .001) [0.484, 0.576], forced vital capacity (FVC) (3.59 ± 0.39, 2.92 ± 0.33, P < .001) [0.608, 0.732], and FEV1/FVC ratio (69.9 ± 3.5, 67.3 ± 3.3, P < .001) [2.015, 3.185]. Pain intensity scores were significantly lower in the experimental group (1.3 ± 0.4, 2.0 ± 0.5, P < .001) [-0.778, -0.622]. The experimental group also demonstrated significantly higher CD4+/CD8+ ratio (1.70 ± 0.31, 1.53 ± 0.28, P < .001) [0.119, 0.221], lower TNF-α levels (8.2 ± 1.8, 9.3 ± 2.1, P < .001) [-1.436, -0.764], and lower IL-6 levels (8.4 ± 2.1, 10.0 ± 2.7, P < .001) [-2.016, -1.184]. The experimental group exhibited significantly lower CRF scores (3.0 ± 0.7, 3.7 ± 0.7, P < .001) [-0.820, -0.580] and significantly higher quality of life scores (91.23 ± 6.78, 87.89 ± 7.01, P < .001) [2.155, 4.525]. No statistically significant difference was found in the incidence of complications between the 2 groups (P = .631). CONCLUSIONS: Baduanjin yields superior comprehensive benefits compared to bedside cycle ergometer training in post-VATS lung cancer patients, demonstrating enhanced efficacy in pulmonary function recovery, pain relief, inflammation reduction, immune enhancement, fatigue alleviation, and quality of life improvement. As a device-free, cost-effective, and readily applicable intervention, it presents significant clinical value as a scientific and economical alternative for postoperative pulmonary rehabilitation. TRIAL REGISTRATION: This study was registered at the Chinese Clinical Trial Registry (Registration No. ChiCTR2500109262).
OBJECTIVES: This study analysed the correlation between spread through air spaces (STAS) and brain metastasis, as a distant recurrence site in patients with early-stage (less than 2 cm tumour size) lung adenocarcinomas....OBJECTIVES: This study analysed the correlation between spread through air spaces (STAS) and brain metastasis, as a distant recurrence site in patients with early-stage (less than 2 cm tumour size) lung adenocarcinomas. METHODS: Data of 207 patients with ≤2 cm adenocarcinomas were retrospectively analysed. Fifty-two patients (25.1%) had STAS (STAS-P group) and 155 patients (74.9%) had no STAS (STAS-N group). Study period was from January 1, 2010 till December 31, 2021. The end of follow-up was December 31, 2024. The incidence of the brain metastasis was collected from the national health system database. RESULTS: The mean age of the 2 groups was 69 years in the STAS-P and 65.9 years in the STAS-N group. Brain metastasis occurred in 19.2% (10/52) and 7.7% (12/155) (P = .019) in the STAS-P and STAS-N groups, respectively. The disease-free interval till brain metastases was 24 (10-77) and 26 (6-71) months (P = .832) in the STAS-P and STAS-N groups, respectively. In brain metastasis cases, the most frequent adenocarcinoma subtype was acinar (36.3%) and solid (27.3%). In a subgroup analysis of 117 patients, operated between 2015 and 2021, the median progression-free survival (PFS) was 59 (0-113) months in the STAS-P and 71 (1-119) months in the STAS-N group (P = .046). CONCLUSIONS: The presence of STAS in ≤2 cm adenocarcinomas is significantly associated with brain metastasis. In case of STAS, brain metastasis developed earlier, and PFS was significantly shorter. Brain metastases developed most typically after solid and acinar adenocarcinomas.
OBJECTIVES: Minimally invasive direct coronary artery bypass grafting (MIDCAB) is an appealing alternative to conventional coronary artery bypass grafting (CABG) for the treatment of the left anterior descending artery (...OBJECTIVES: Minimally invasive direct coronary artery bypass grafting (MIDCAB) is an appealing alternative to conventional coronary artery bypass grafting (CABG) for the treatment of the left anterior descending artery (LAD). This study aimed to evaluate risk-adjusted mortality rates following MIDCAB. METHODS: All consecutive patients who underwent isolated MIDCAB were included from four international centres. Predicted 30-day all-cause mortality was calculated by the European System for Cardiac Operative Risk Evaluation (EuroSCORE II) to assess the ratio between observed and expected deaths (O-E ratio). Risk-stratified analyses of MIDCAB were performed across various risk profiles. Sensitivity analyses were performed for robotic- and non-robotic MIDCAB procedures. Overall and individual institutional learning curves were evaluated using cumulative sum (CUSUM) analyses. RESULTS: In total, 1231 patients were included (robotic n = 945, non-robotic n = 286). Median age was 67 years (IQR, 60-74), while 17.4% of patients were female. Notably, 327 patients (26.6%) underwent MIDCAB as part of hybrid revascularization. Overall mortality rate was 0.8% (n = 10, 95% CI, 0.4-1.2%), with an O-E ratio of 0.50 (95% CI, 0.20-0.85), while the O-E ratio was 0.37 (95% CI, 0.07-0.73) and 0.79 (95% CI, 0.16-1.58) for the robotic and non-robotic groups respectively (p-for-interaction = 0.058). There was no significant interaction effect for risk categories. CUSUM analyses revealed a safe learning-curve with consistent O-E ratios <1. CONCLUSIONS: Both robotic- and non-robotic-procedure MIDCAB were associated with excellent risk-adjusted mortality rates, and O-E ratios consistently <1. These findings confirm the safety and reproducibility of the MIDCAB procedure, supporting widespread adoption of MIDCAB for the treatment of LAD-disease.
OBJECTIVES: The impact of minimally invasive surgical aortic valve replacement (SAVR) on long-term quality of life (QoL) is uncertain. This randomized controlled trial compared QoL 5 years after SAVR through upper hemist...OBJECTIVES: The impact of minimally invasive surgical aortic valve replacement (SAVR) on long-term quality of life (QoL) is uncertain. This randomized controlled trial compared QoL 5 years after SAVR through upper hemisternotomy (UHS) or full median sternotomy. METHODS: Patients undergoing SAVR were randomized to UHS or full median sternotomy. The primary outcome was postoperative cardiac-specific QoL during 5 years, assessed by the Kansas City Cardiomyopathy Questionnaire physical limitations domain. Secondary outcomes include survival, other QoL domains, and factors associated with declined QoL between 1 and 5 years. RESULTS: Surgical aortic valve replacement via UHS resulted in better QoL as indicated by more favourable physical limitation and total symptoms scores (estimated mean difference [95% confidence interval] -1.89 [-2.93 to -0.85; P-value ≤.001] and 2.96 [-4.71 to -1.22; P-value = .016], respectively). Quality of life improvement persisted for 5 years, despite a decline after 1 year postoperative. Age and valve size smaller than or equal to 21 were independent predictors of decline in physical functioning, while full median sternotomy independently predicted declined total symptoms score. Five-year survival was 91.9% and similar between approaches (P-value = .417). CONCLUSIONS: Minimally invasive SAVR was associated with a modest but statistically significant improvement in cardiac-specific QoL over 5 years compared to median sternotomy, driven by earlier recovery, with comparable outcomes at 5 years. Full median sternotomy independently predicted decline in QoL demonstrated by decreased total symptom scores. CLINICAL REGISTRATION NUMBER: The Limited access Aortic valve Replacement trial is registered at ClinicalTrials.gov, number NCT04012060. Available via https://clinicaltrials.gov/study/NCT04012060.
OBJECTIVES: To demonstrate the outcome of thoracic endovascular aortic repair (TEVAR) for patients with type B aortic dissection (TBAD) accompanying retrograde intramural haematoma (RTIMH) in zone 0-2. METHODS: Patients...OBJECTIVES: To demonstrate the outcome of thoracic endovascular aortic repair (TEVAR) for patients with type B aortic dissection (TBAD) accompanying retrograde intramural haematoma (RTIMH) in zone 0-2. METHODS: Patients were registered in a retrospective multicentre study and divided into 2 groups: presence of RTIMH involving zone 0-2 (group 1) and RTIMH confined to zones 1 and 2 not involving zone 0 (group 2). The primary end-point was any adverse aortic event (AAE), including the development of full dissection in the ascending aorta, aorta-related mortality, reintervention, and procedure-related complications. RESULTS: A total of 155 patients were enrolled, with 68 (43.9%) in group 1 and 87 (56.1%) in group 2. The AAEs occurred in 14 (9.0%) patients, with 8 in group 1 and 6 in group 2, and no significant differences were found between the 2 groups (P = .294). Patients in group 1 were younger (50.1 ± 6.5 vs 55.6 ± 9.2, P = .04) and more often had a primary entry at the inner curvature of the arch (57.4% vs 25.3%, P < .001). In group 1, freedom from reintervention was significantly lower than in group 2 with 79.1% in group 1 and 93.3% in group 2 (P = .02). CONCLUSIONS: In selected cases, TEVAR is an effective alternative treatment modality to open repair for TBAD with RTIMH extending to zone 0. However, the rate of reintervention is higher in those with RTIMH propagation into the proximal ascending aorta, suggesting closer follow-up. CLINICAL REGISTRATION NUMBER: This retrospective multicenter analysis registered as a Chinese Clinical Trial (ChiCTR2300071443).
OBJECTIVES: Enhanced recovery after surgery (ERAS) protocols are patient-centred, interprofessional perioperative care models aimed at reducing hospital stays, complications, healthcare costs, and improving patient satis...OBJECTIVES: Enhanced recovery after surgery (ERAS) protocols are patient-centred, interprofessional perioperative care models aimed at reducing hospital stays, complications, healthcare costs, and improving patient satisfaction. Evidence for ERAS in cardiac surgery is scarce; therefore, we aimed to assess its efficacy and safety in minimally invasive heart valve surgery (MIHS). METHODS: Interdisciplinary Perioperative Care in Minimally Invasive Heart Valve Surgery (INCREASE) is a randomized-controlled trial that compares ERAS with standard care in MIHS. The intervention group (IG) received ERAS-based treatment; the control group (CG) standard care. Co-primary end-points were in-hospital stay for cardiovascular reasons within 1 year postoperatively (superiority hypothesis) and physical performance (6-minute walk test [6MWT]) at discharge (non-inferiority hypothesis). Superiority hypothesis was tested primarily in surgically treated patients (modified intention to treat population), while non-inferiority hypothesis was tested in per protocol population. RESULTS: In total, 201 patients scheduled for MIHS were randomized (IG: 101; CG: 100). Total weighted in-hospital stay within 1 year was non-significantly shorter in the IG (adjusted mean difference -2.7 days, 95% confidence interval (CI) (-6.3, 0.9), 1-sided P = .07). Sensitivity analyses favoured the IG (adjusted ratio 0.71, 95% CI, 0.6, 0.85). For 6MWT, adjusted mean difference was -14%, 95% CI (-43%, 15%) exceeding the non-inferiority margin of -15% (1-sided P = .48). Without baseline adjustment, 6MWT values revealed a mean difference between groups of -1%, 95% CI (-10%, 8%), reaching non-inferiority of the IG. Safety outcomes were comparable with the exception of an unexpected higher rate of post-operative atrial fibrillation in patients randomized to ERAS. CONCLUSIONS: ERAS is feasible and safe in MIHS. The trial did not demonstrate a reduction in length of hospital stay during the first postoperative year in the population studied. Exploratory analyses suggest that further evaluation of ERAS concepts is justified.
Brancaccio G, Cantarutti N, Procino G
… +13 more, Iacobelli R, Marcello C, Bellanti E, Verrengia M, Iodice F, Giorni C, Ragni L, Miraldi F, Trezzi M, Pilati M, Rebonato M, D'Inzeo V, Galletti L
OBJECTIVES: Mitral valve repair (MVR) is the preferred surgical approach for paediatric mitral valve disease, but predictors of long-term durability remain poorly defined. We aimed to describe long-term outcomes after MV...OBJECTIVES: Mitral valve repair (MVR) is the preferred surgical approach for paediatric mitral valve disease, but predictors of long-term durability remain poorly defined. We aimed to describe long-term outcomes after MVR in children and to identify echocardiographic predictors of mitral valve reintervention. METHODS: We retrospectively reviewed all consecutive patients younger than 18 years who underwent MVR between 2000 and 2024 at a single tertiary centre. Patients with atrioventricular septal defects or single-ventricle physiology were excluded. Preoperative and predischarge echocardiography assessed mitral regurgitation grade and mean transmitral gradient. Clinical and echocardiographic follow-up data were reviewed and analysed. Reintervention was analysed using competing-risk methods including postoperative mean transmitral gradient and residual mitral regurgitation at discharge. RESULTS: A total of 112 children were included (age range 5 days to 17 years; body weight 2.3-100 kg). Operative mortality was 0.9% (n = 1), late mortality 3.6% (n = 4), and one patient underwent heart transplantation. The cumulative incidence of mitral valve reintervention was 27.5%, 32.9%, 46.6%, and 46.6% at 5, 10, 15, and 20 years, respectively. In the Fine and Gray model, higher postoperative mean transmitral gradient was associated with an increased cumulative incidence of reintervention (subdistribution hazard ratio [sHR] 1.26 per 1 mm Hg, 95% confidence interval [CI] 1.16-1.38; P < .001), whereas moderate-or-greater residual mitral regurgitation at discharge was not significantly associated (sHR 0.54, 95% CI 0.25-1.17; P = .12). Death and/or heart transplantation events were rare during follow-up. CONCLUSIONS: In this paediatric cohort, MVR was associated with low operative mortality and satisfactory long-term survival, but reintervention represented the main late risk. Higher postoperative mean transmitral gradient was associated with reduced valve durability, whereas moderate-or-greater residual regurgitation was not independently associated. These findings support efforts to minimize postoperative transmitral gradients when feasible while individualizing the balance between residual stenosis and regurgitation according to valve pathology and repair complexity.
OBJECTIVES: Sex-related disparities are well established in cardiovascular disease, but their impact on outcomes after valve-sparing root replacement (VSRR) is not well defined. In a multicentre international cohort, we...OBJECTIVES: Sex-related disparities are well established in cardiovascular disease, but their impact on outcomes after valve-sparing root replacement (VSRR) is not well defined. In a multicentre international cohort, we evaluated sex-based differences in clinical characteristics, radiographic features and outcomes after elective VSRR. METHODS: We retrospectively analysed all patients who underwent VSRR between 2004 and 2024 at 3 high-volume centres in the United States and Europe. Baseline, operative, and imaging data were compared between sexes. The primary end-point was a composite of all-cause mortality, 30-day cerebrovascular accident, and Zone 0-3 aortic reintervention or aortic valve reintervention. Kaplan-Meier and competing risk analyses were performed, with 4:1 propensity score matching (calliper 0.2) to adjust for baseline imbalances. RESULTS: A total of 1019 patients (191 women, 19%) undergoing VSRR were included in the study. Women were younger (46.7 vs 50.4 years, P = .002), more likely to present with heritable thoracic aortic disease (HTAD) (51% vs 17%, P < .001), and had smaller aortic diameters but larger indexed dimensions compared with men (all P ≤ .001). Aortic valve leaflet repair was performed less frequently in women (17% vs 34%, P < .001). After matching, no significant sex differences were observed in early outcomes. At 10 years, freedom from the composite end-point was similar between women and men (82.8% vs 83.9%, P = .740), as were survival (95.0% vs 96.4%, P = .920) and cumulative incidences of reintervention or dissection. Age thresholds for adverse events were lower in women (>50 years) than in men (>59 years). CONCLUSIONS: Only one-fifth of VSRR patients were women, who presented younger with more HTAD and smaller absolute aortic diameters. Despite these differences, long-term outcomes were equivalent, suggesting that sex alone does not determine surgical results. Earlier surgical referral guided by indexed aortic measurements may improve recognition and outcomes in women.
OBJECTIVES: Anatomic repair is the contemporary preferred management strategy for congenitally corrected transposition of the great arteries (ccTGA). Most outcome data derive from small single-centre series. The goal of...OBJECTIVES: Anatomic repair is the contemporary preferred management strategy for congenitally corrected transposition of the great arteries (ccTGA). Most outcome data derive from small single-centre series. The goal of this study was to review long-term outcomes of surgical treatment in a multicentre cohort of ccTGA patients in the Netherlands over a 28-year period. METHODS: All patients with ccTGA undergoing anatomic repair (double switch repair, arterial switch operation with hemi-Mustard/bidirectional Glenn, or Rastelli/Nikaidoh with Mustard or hemi-Mustard/bidirectional Glenn) between 1997 and 2025 were analysed retrospectively. RESULTS: Sixty-two patients underwent anatomic repair at a median age of 2.5 (IQR: 1.4-4.0) years. Overall hospital mortality was 6.5%, decreasing to 1.9% after 2006. At a median follow-up of 11.9 years, the 20-year survival exceeded 80%. Reoperation was required in 31%, most often for conduit replacement after the Rastelli/Nikaidoh procedure, baffle obstruction or neoaortic valve/root disease after a double switch procedure, and least often after the arterial switch with hemi-Mustard/bidirectional Glenn (11.7%). Percutaneous interventions were performed in 16%. Complete atrioventricular block requiring a pacemaker implant occurred in one-third, whereas late atrial arrhythmias were infrequent (<10%). At the latest follow-up, systemic left ventricular function was preserved in most patients, with only 2 patients showing moderate dysfunction. CONCLUSIONS: After an initial learning curve, anatomic ccTGA repair exhibited low operative mortality, good long-term survival and preserved systemic left ventricular function in the majority of patients. Reintervention rates are considerable.
OBJECTIVES: Despite the detrimental consequences associated with residual, progressive aortic regurgitation (AR) during LVAD support, correction of AR at LVAD implantation has rarely been shown to improve survival. METHO...OBJECTIVES: Despite the detrimental consequences associated with residual, progressive aortic regurgitation (AR) during LVAD support, correction of AR at LVAD implantation has rarely been shown to improve survival. METHODS: A retrospective study was conducted using the Japanese registry database, which included 300 continuous-flow LVAD recipients with pre-existing AR (mild or greater). Patients were divided into two groups: those who underwent concomitant surgery for AR during LVAD implantation (n = 77) and those who did not (n = 223). The groups were compared for significant AR development, all-cause mortality, and readmission for adverse events. A propensity score-matched cohort was also created to allow comparison of these outcomes to those of patients with similar baseline. RESULTS: The cumulative incidence of significant AR was lower after corrected AR than after uncorrected AR in both the pre-matched and matched analyses (p < 0.05). While mortality and readmission rates were similar between groups in the pre-matched cohort, mortality after uncorrected AR was higher in the matched cohort (p = 0.052). When the pre-matched cohort was divided by age, a trend towards improved survival (p = 0.099) was observed with correction compared to no correction in older patients (≥57 years), whereas the difference was negligible (p = 0.956) in younger patients (<57 years). These results were consistent in patients with mild AR at implantation, including the increased risk of significant AR for uncorrected AR (p = 0.058), as well as improved survival with AR correction in the older population (p = 0.054), but no survival difference in the younger population (p = 0.492). CONCLUSIONS: In older patients, correction of pre-existing AR, including mild AR, may improve long-term survival after LVAD implantation.
OBJECTIVES: With the popularization and wide acceptance of low-dose computed tomography lung cancer screening, an increasing number of lung cancers are found in the form of small pulmonary nodules (SPNs). Accurate, rapid...OBJECTIVES: With the popularization and wide acceptance of low-dose computed tomography lung cancer screening, an increasing number of lung cancers are found in the form of small pulmonary nodules (SPNs). Accurate, rapid, and safe localization of SPNs is crucial for their surgical resection. This study aims to evaluate the efficacy and safety of an augmented reality (AR) navigation-guided pulmonary nodule (PN) localization system. METHODS: This is a prospective, multicentre, single-arm objective performance criteria clinical trial. The puncture navigation software and PN localization system were employed in the operating room for preoperative localization of SPNs, and subsequent resection was performed by video-assisted thoracic surgery (VATS). The primary end point was the localization success, and the secondary end points included localization time, distance from nodule to localizer, device performance evaluation, and localization-related complication as a safety end point. RESULTS: A total of 106 patients underwent PN localization and VATS resection. Localization success was achieved in 101 patients at a rate of 95.28% (95% CI (confidence interval), 91.25%-99.32%), reaching the objective performance criteria of 91%. The median localization time was 3.1 min (range: 1.0-22.0 min). The median distance from nodule to localizer was 5 mm (range: 1-9 mm). In 104 (98.11%) patients, software recognition, post-processing software fluency, and post-processing software prompt accuracy were excellent. No localization-related complication was observed. CONCLUSIONS: The newly developed AR navigation-guided PN localization system is effective and safe in facilitating the localization of SPNs. CLINICAL REGISTRATION NUMBER: This study was registered with the Chinese Clinical Trial Registry (ChiCTR2200055612).
OBJECTIVES: To evaluate if the use of robotic technique (RATS) was able to achieve a better lymph node staging when compared with video-assisted (VATS) and open techniques for lung resections for treatment of non-small c...OBJECTIVES: To evaluate if the use of robotic technique (RATS) was able to achieve a better lymph node staging when compared with video-assisted (VATS) and open techniques for lung resections for treatment of non-small cell lung cancer. METHODS: We used data from the Brazilian Lung Cancer Registry to retrospectively analyse 1376 patients submitted to lung resections for non-small cell lung cancer with curative intention. A propensity score matching analysis was performed to create groups with comparable baseline characteristics in a pairwise fashion (open vs RATS and VATS vs RATS). The primary endpoint was nodal upstaging. RESULTS: After propensity score matching, 165 patients in the open group were compared with 165 in the RATS group. The rate of overall upstaging was higher in the open but not statistically significant when compared with RATS (open 22.4% vs RATS 15.2%; P = .09). Total lymph node count was similar for both groups (open 10; interquartile range [IQR] 5-17 vs RATS 11; IQR 8-17), P = .054). In the other comparison, 279 patients in the VATS group were compared with 279 patients in the RATS group. The rate of overall upstaging was the same in both groups (VATS 11.1% vs RATS 11.1%; P = 1). RATS had a higher number of lymph nodes harvested (VATS 9; IQR 6-13 vs RATS 10; IQR 7-15, P < .001). CONCLUSIONS: RATS had a similar upstaging rate when compared with both VATS and open techniques.
OBJECTIVES: Non-small cell lung cancer (NSCLC) with pleural dissemination is categorized as stage IV (M1a) and traditionally deemed a contraindication for surgical intervention. This study aimed to explore the potential...OBJECTIVES: Non-small cell lung cancer (NSCLC) with pleural dissemination is categorized as stage IV (M1a) and traditionally deemed a contraindication for surgical intervention. This study aimed to explore the potential role of surgery in NSCLC patients with isolated pleural dissemination. METHODS: Patients who either underwent primary tumour resection (PTR) or received only pleural nodules biopsy were included for analysis from the Western China Lung Cancer (WCLC) database (2005-2021) and Surveillance, Epidemiology, and End Results (SEER) database (2010-2015). Survival curves were generated using the Kaplan-Meier method, with significance assessed by the log-rank test. RESULTS: A total of 289 patients (261 PTR and 28 biopsy only) from the WCLC cohort and 2232 patients (278 PTR and 1954 biopsy only) from the SEER cohort were identified for analysis. In both cohorts, patients who underwent PTR showed significantly better outcomes compared to those who received only pleural nodules biopsy, with the 5-year survival rates of 28.3% versus 5.0% in the WCLC cohort (P < .0001) and 30.5% versus 7.4% in the SEER cohort (P < .0001). Subgroup analysis indicated that PTR significantly improved survival in patients without malignant pleural effusion, regardless of tumour size and T stage. Furthermore, anatomic lobectomy with systematic lymph node dissection was associated with better overall survival than partial resection or lobectomy plus lymph node sampling (P = .008). CONCLUSIONS: NSCLC patients with isolated pleural dissemination may represent an M1a subgroup in whom PTR is associated with longer survival, particularly in the absence of malignant pleural effusion.
OBJECTIVES: The central cannulation technique was introduced at our institution in 2018 and has evolved into a primary cannulation strategy for acute type A aortic dissection (ATAAD) surgery. This study aimed to compare...OBJECTIVES: The central cannulation technique was introduced at our institution in 2018 and has evolved into a primary cannulation strategy for acute type A aortic dissection (ATAAD) surgery. This study aimed to compare the clinical outcomes of central aortic cannulation with those of conventional axillary arterial cannulation. METHODS: Between January 2005 and September 2024, 586 patients who underwent aortic repair for ATAAD were retrospectively reviewed. The clinical outcomes of the patients who underwent central cannulation were compared with those of the patients who underwent axillary cannulation. Propensity score matching was used to compare 189 patients in each group. RESULTS: Central cannulation was associated with a significantly shorter total operative time (280.14 min vs 321.20 min, P < .001) and achieved significantly lower early mortality than the axillary cannulation group (3.7% vs 9.5%, P = .037), respectively. The rates of major postoperative complications, including cerebrovascular events and hospital course indicators, were comparable between groups. The mean follow-up duration was 42.77 months, and Kaplan-Meier analysis revealed no statistically significant difference in long-term overall survival between the groups. The most frequently selected central cannulation site was the lesser curvature of the aortic arch, accounting for 43.4% of cases. CONCLUSIONS: Central cannulation significantly reduced operative duration compared with axillary cannulation. Early mortality was lower in the central cannulation group. The rates of significant neurological dysfunction and procedure-related complications were comparable with those associated with axillary cannulation. Central cannulation can be safely and effectively used as a primary cannulation strategy for ATAAD.
Osorio-Jaramillo E, El-Nashar J, Kainuma S
… +8 more, Unger E, Schreiner W, El Din M, Pruidze P, Didava G, Weninger WJ, Zimpfer D, Ehrlich MP
Eur J Cardiothorac Surg
· 2026 Jan · PMID 41570092
·
Full text
OBJECTIVES: To evaluate a novel aortic anastomotic device designed for end-to-end anastomosis between a vascular prosthesis and the native aorta, aiming to facilitate aortic replacement and shorten circulatory arrest tim...OBJECTIVES: To evaluate a novel aortic anastomotic device designed for end-to-end anastomosis between a vascular prosthesis and the native aorta, aiming to facilitate aortic replacement and shorten circulatory arrest times. METHODS: Ascending aortic replacements with Dacron grafts and external Teflon felt strips were performed in 10 fresh human cadavers. Five procedures were performed using a continuous 4-0 polypropylene running suture, and 5 with the aortic anastomotic device. The device deploys single straight needle pins through the aortic wall and felt, securing them externally with a cap. Explanted graft-aorta specimens were connected to a pressure pump filled with glycerol/H2O solution (170/90 mm Hg, 5 minutes). The primary end-point was anastomotic time; secondary end-points were fluid loss and tissue trauma assessed macroscopically and microscopically. RESULTS: Median time for end-to-end anastomosis was significantly shorter with the aortic anastomotic device (05:39 [interquartile range, IQR 04:22-06:30] minutes:seconds) compared to conventional suture (09:17 [IQR 06:53-10:34]; P = .016). The number of pins per anastomosis was lower than the number of stitches (17 [15-18] vs 22 [21-24]; P = .008). Fluid loss was comparable between groups (100 [52.5-174.5] mL vs 45 [21.8-104.0] mL; P = .310). Microscopy revealed intimal tears in all sutured specimens but in none of the device group, P = .008. CONCLUSIONS: In this preliminary human cadaver study, the novel aortic anastomotic device proved to be technically feasible, significantly faster than conventional suturing, and produced less tissue trauma while maintaining comparable sealing. The device may shorten circulatory arrest times and improve anastomotic quality in aortic surgery. Further in vivo studies are warranted. CLINICAL TRIAL REGISTRATION: This was a prospective experimental cadaver study, not eligible for registration in a public registry for clinical trials.
OBJECTIVES: Mechanical aortic valve prostheses have long durability but require lifelong anticoagulation, which increases the risk of bleeding. However, the types of bleeding complications following mechanical aortic val...OBJECTIVES: Mechanical aortic valve prostheses have long durability but require lifelong anticoagulation, which increases the risk of bleeding. However, the types of bleeding complications following mechanical aortic valve replacement (AVR) are not well known. Therefore, we conducted this study to investigate various types of bleeding following mechanical AVR. METHODS: In this nationwide, observational cohort study, all patients who underwent mechanical AVR in Sweden between 1997 and 2022 were included. Patients were identified using the SWEDEHEART registry. The primary outcome was the types of first major bleeding event that required hospitalization following mechanical AVR. These outcomes were obtained from the Swedish National Patient Register based on International Classification of Diseases (ICD) codes. RESULTS: In total, 13 508 patients underwent mechanical AVR. Of these, 2029 patients (15%) had a major bleeding event. The mean age was 58 years (95% CI, 57.9-58.3), and 29% were females. Bleeding complications included gastrointestinal bleeding (40%), intracranial bleeding (24%), hematuria (15%), epistaxis (13%), bleeding-induced anaemia (5.4%), airway bleeding (1.6%), and hemopericardium/haemothorax (1.3%). At 20 years, the cumulative incidences of gastrointestinal and intracranial bleeding were 9.0% (95% CI, 8.4-9.6) and 5.3% (95% CI, 4.8-5.8). CONCLUSIONS: Gastrointestinal and intracranial bleeding account for the majority of bleeding complications following mechanical AVR, followed by hematuria and epistaxis. Future studies on strategies to reduce bleeding complications in this population are needed.