搜索结果：Annals of thoracic surgery short reports

The demands of cardiothoracic surgery often affect personal relationships, with those of partners vulnerable to numerous challenges. We aimed to characterize the personal relationship experiences of women cardiothoracic surgeons. We designed a survey gathering information on relationship dynamics from partners of women cardiothoracic surgeons. The survey was loaded into an internet-based platform, and links were disseminated to members of the Women in Thoracic Surgery, who subsequently distributed the survey to their partners and spouses. Questions explored avenues through which the women's surgical careers had affected their partners and relationships. The survey was completed by 32 individuals, and relationship roles included 28 (87.5%) spouses and 4 (12.5%) nonmarital partners. Among respondents, 64.3% (17 of 27) reported that the cardiothoracic surgeon's dedication to her job inspired the partner to be more understanding, whereas 55.6% (15 of 27) noted challenges in maintaining healthy work-life balance. Irregular and demanding work hours resulted in missed important events (44.4%; 12 of 27), reduced quality time together (55.6%; 15 of 27), and increased relationship tension (48.1%; 13 of 27). Notably, 66.7% (18 of 27) reported that their partners' surgical careers did not affect their decision to have children. When comparing experiences across relationship durations, there were no meaningful differences in the distribution of the responses. Our findings highlight challenges encountered by partners of women cardiothoracic surgeons across all stages of their careers and relationships. Elucidating these dynamics enables us to better support those interested in the field and within our community.

BACKGROUND: A survey amongst the European Society of Thoracic Surgeons (ESTS) members has been performed to investigate the currents trends, rates of adoption as well as potential for future expansion of non-intubated thoracic surgery (NITS) performed under spontaneous ventilation. METHODS: A 14-question-based questionnaire has been e-mailed to ESTS members. To facilitate the completion of the questionnaire, questions entailed either quantitative or multiple-choice answers. Investigated issues included previous experience with NITS and number of procedures performed, preferred types of anesthesia protocols (i.e., thoracic epidural anesthesia, intercostal or paravertebral blocks, laryngeal mask, use of additional sedation), type of procedures, ideal candidates for NITS, main advantages and technical disadvantages. Non-univocal answer to multiple-choice questions was permitted. RESULTS: Out of 105 responders, 62 reported an experience with NITS. The preferred types of anesthesia were intercostal blocks with (59%) or without (50%) sedation, followed by laryngeal mask with sedation (43%) and thoracic epidural anesthesia with sedation (20%). The most frequently performed procedures included thoracoscopic management of recurrent pleural effusion (98%), pleural decortication for empyema thoracis and lung biopsy for interstitial lung disease (26% each); pericardial window and mediastinal biopsy (20% each). More complex procedures such as lobectomy, lung volume reduction surgery and thymectomy have been performed by a minority of responders (2% each). Poor-risk patients due to co-morbidities (70%) and patients with poor pulmonary function (43%) were considered the ideal candidates. Main advantages included faster, recovery (67%), reduced morbidity (59%) and shorter hospital stay with decreased costs (43% each). Reported technical disadvantages included coughing (59%) and poor maneuverability due to diaphragmatic and lung movements (56%). Overall, 69% of responders indicated that NITS procedures will be likely to increase in the near future. CONCLUSIONS: Results of this survey, suggest that NITS is already quite widely adopted by ESTS members to perform simple thoracoscopic procedures. A future expanded adoption of this strategy is also hypothesized.

This study aimed to assess the association between the Model for End-Stage Liver Disease excluding international normalized ratio (MELD-XI) score and heart failure (HF) after isolated mitral valve surgery for degenerative mitral valve regurgitation (dMR). Patients undergoing mitral valve surgery for dMR were divided into groups of high MELD-XI score (>11, n = 28) and low MELD-XI score (&#x2264;11, n = 144). The primary end point was early HF events, defined as operative mortality, use of mechanical circulatory support, and prolonged use of inotropic agents after the surgery. The secondary end point was a composite outcome consisting of all-cause mortality and HF admission. The median follow-up period was 338 (70-789) days. Thirty-day mortality rate was 0.7% in the low MELD-XI score group and 3.6% in the high MELD-XI score group (P = .737). The prolonged use of inotropic agents was significantly higher in the high MELD-XI score group than in the low MELD-XI score group (25.0% vs 6.9%; P = .015). Freedom from composite outcomes was significantly lower in the high MELD-XI score group than in the low MELD-XI score group (log-rank, P < .001). MELD-XI score (odds ratio, 1.10 [95% CI, 1.01-1.19]; P = .023) was identified as a significant risk factor of the early HF events. Multivariate Cox regression analysis found the MELD-XI score (hazard ratio, 1.07 [95% CI, 1.01-1.14]; P = .027) to be a significant risk factor for the composite outcome after surgery. In patients undergoing isolated mitral valve surgery for dMR, elevated preoperative MELD-XI score was associated with an increased risk of early HF events and the composite outcome.

Thoracic outlet syndrome (TOS) involves the compression of vascular or neural structures between the first rib and the scalene muscles that leads to diverse symptoms. Traditional surgical treatments include transaxillary or supraclavicular first rib resection, but robotic first rib resection is increasingly popular because of enhanced visualization of the thoracic inlet. We report a unique complication of spontaneous bilateral second rib fractures after robotic bilateral first rib resection in a 34-year-old man with neurogenic and venous TOS. As robotic TOS surgery becomes more common, recognizing the risk of spontaneous second rib fractures is crucial, particularly in patients with potentially reduced bone integrity.

Growth is the Holy Grail of tissue implants in pediatrics, yet the outcomes from a small but increasing number of studies have not been assessed using metrics of growth. A systematic review was conducted to identify preclinical and pediatric clinical trials of implanted vascular grafts and heart valves, indicating growth of the implant based on a proposed definition of functional regenerative growth: increases in critical physical dimension(s) by increases in tissue mass with maintenance of required function. Five distinct approaches, distinguished by scaffold type and use of preseeded cells, were identified among studies reported for tissue-engineered vascular grafts (TEVGs) and heart valves (TEHVs), with 2 of these approaches being used for both indications. A total of 11 publications were selected for data tabulation. For TEVGs, increases in length are reported across all studies (14%-130%), whereas diameter change (-38% to +89%) varied with anatomical location. For TEHVs, increases of diameter consistent with somatic growth have been reported for 4 different biologic valves (12%-78%) across preclinical studies. Commensurate leaflet growth has not been clearly established. Growth capacity of TEVGs has been established in preclinical studies for multiple approaches, including some proceeding to clinical trials. For TEHVs, increases in the diameter are reported for several approaches in preclinical studies, but limited evidence exists to date for leaflet growth. TEVGs and TEHVs have both demonstrated potential for growth and, thus, improved clinical outcomes compared with current implants that have no growth capacity.

Significant residual aortic insufficiency (AI), paravalvular leak, and an embolized valve after transcatheter aortic valve replacement (TAVR) may require an additional TAVR valve as an unplanned intervention. However, the outcome of an unplanned additional valve deployment is scarcely documented. We evaluated postoperative outcomes in patients with unplanned additional TAVR valve deployment. Between January 2021 and September 2023, 1131 patients underwent TAVR at Albany Medical Center Hospital (Albany, NY). A balloon-expanding valve was placed in 98.3% of patients, whereas a self-expanding valve was used in 1.7%. An additional unplanned transfemoral transcatheter aortic valve deployment was required in 0.01% (9 of 1131) of the patients (0.07% [7 of 1112] in the balloon-expanding valve group and 10.5% [2 of 19] in the self-expanding valve group. The indication for an additional valve was severe AI, valve embolization, or improper position of the first valve (66.7%, 22.2%, and 11.1%, respectively). AI was resolved in all patients except for 1, who died after second valve deployment for severe AI. Permanent pacemaker placement after a second TAVR was required in 2 patients (22%). The 30-day mortality was 16.7% (1 of 6) in the severe AI group, 0% (0 of 2) in the valve embolization group, and 0% (0 of 1) in the improper position group. The mean follow-up term was 5.3 (6.4) months. No aortic valve reintervention was performed in the follow-up term. The cumulative survival rates in patients with unplanned additional valve deployment were 88.9% at 1 month and 71.1% at 12 months. The outcome of unplanned second valve deployment in TAVR was satisfactory. However, unplanned additional valve deployment may increase the risk of permanent pacemaker placement.

The literature offers limited guidance on revision strategies for gastric conduit dysfunction after esophagectomy, traditionally approached through open or combined thoracoscopic-laparoscopic methods. We present our institution's early experience with robot-assisted transhiatal revisional surgery for severe conduit dysfunction. A retrospective, single-institution review was conducted of patients who underwent robot-assisted transhiatal revision of the gastric conduit after esophagectomy between January 1999 and April 2024. We identified 15 patients (mean age, 64.1 years). All had redundant conduit anatomy, with or without angulation or a supradiaphragmatic shelf; dysphagia was the primary symptom. Paraconduit hernia was present in 6 patients (40%). The median time from the index esophagectomy to revision was 62 months. Median hospital stay was 3 days. Two patients (13.3%) experienced perioperative complications: 1 port-site hernia and 1 pneumonia and pulmonary embolism requiring reintubation and anticoagulation. One patient required redo revision for reherniation due to vigorous coughing. One patient died of sudden death at home after an unremarkable 4-day postoperative course. At a median follow-up of 5.3 months, the 14 surviving patients reported at least partial symptom resolution and were no longer dependent on supplemental feeding. Robot-assisted transhiatal revision of gastric conduit dysfunction after esophagectomy is feasible and safe, offering shorter hospital stays and acceptable perioperative morbidity. Although complete symptom resolution remains difficult to achieve, most patients experienced meaningful improvement in swallowing and nutritional independence. Further studies are warranted to improve outcomes in this complex patient population.

We report the case of a 54-year-old woman with thalassemia intermedia and large bilateral intrathoracic extramedullary hematopoiesis since childhood. The patient presented with severe dyspnea and a suspected left-sided hemothorax on a computed tomography scan accompanied by almost complete atelectasis of the left lower lobe 3 weeks after blunt trauma. Microcoil embolization of the affected intercostal arteries was performed before a challenging but successful surgical resection.

Pain after robot-assisted thoracoscopic lung surgery is a contributing factor to postoperative complications and patient satisfaction. Cryoablation of the intercostal nerves temporarily disrupts nerve function and decreases pain. We evaluated the effect of cryoablation of the intercostal nerves on postoperative pain and opioid use. We performed a retrospective single-institution analysis of patients who underwent robot-assisted thoracoscopic lung surgery, with or without cryoablation between 2019 and 2022. We analyzed demographics, postoperative pain scores using a Likert scale, opioid use, postoperative complications, length of stay, and readmission. Robot-assisted thoracoscopic lung surgery was performed in 230 patients, and 39 (17%) patients underwent cryoablation. Pain scores for the cryoablation group were lower at 12 hours (0 vs 2, P = .04) and higher at 5 weeks (4 vs 1, P = .01). The cryoablation group was more likely to receive an opioid prescription (46.2% vs 29.3%, P = .04) and a higher reported use of narcotics at 5 weeks (61.5% vs 37.7%, P < .01). There were no statistical differences in postoperative morphine milliequivalents per day, minor and major complication rates, total length of hospital stay, and readmission rates. Cryoablation of multilevel intercostal nerves has higher pain levels at 5 weeks without significant differences in the outcomes. This may be due to an increase in neuroma formation at multiple levels from the cryoablation.

Conduit durability after repair of truncus arteriosus is dependent on right ventricle-to-pulmonary artery (RV-PA) conduit size and type. The role of branch pulmonary artery (PA) stenosis on RV-PA conduit longevity has not been well studied. A single-center retrospective review was performed of patients who underwent repair of truncus arteriosus from 2001 to 2023. Patients were divided into 2 groups based on those who did (group 1) and did not (group 2) need early branch PA reintervention (before conduit reintervention/reoperation). The outcomes of interest were overall survival, conduit longevity, and burden of right ventricular outflow tract (RVOT) reinterventions. Early branch PA reintervention was required in 25 of 118 patients (21.1%). There was no difference in clinical characteristics between those who required early branch PA reintervention (group 1) and those who did not (group 2) (P > .05). Overall survival (P = .323) and time to RVOT reintervention/reoperation (P = .232) did not differ between groups. However, the number of RVOT reinterventions/reoperations per patient-year was higher in group 1 (0.315 vs 0.158, P < .001). By multivariable analysis, early branch PA reintervention did not have a significant effect on survival or conduit longevity (P > .05). Early branch PA reintervention after truncus repair does not adversely affect overall survival or conduit longevity but does confer a higher lifetime burden of RVOT reinterventions/reoperations.

Poland syndrome is a rare congenital condition of the chest wall characterized by unilateral absence of the pectoral muscles. This is often associated with pectus deformities, rib and cartilage malformation, and breast hypoplasia, as well as with upper limb defects. Traditional methods for repair have involved cartilage resection, chest wall reconstruction, and myocutaneous flaps, and are associated with significant morbidity for patients. The variability of presentation and complexity of associated deformities poses challenges for surgical reconstruction, with limited evidence to guide operative decision-making. This is a study is a single-center experience of the use of customized 3-dimensional silicone elastomer implants in patients with Poland syndrome. Implants were designed using computer-aided design based on preoperative computed tomographic scans and manufactured at a single center. Data were collected retrospectively on 3 patients operated on between 2023 and 2024. Three patients with Poland syndrome were treated with customized computer-aided designed silicone implants between 2023 and 2024. All had excellent cosmetic results. Repositioning of the implant was required in 1 patient. There was minimal morbidity associated with the procedure. This case series highlights the surgical management of Poland syndrome using custom-made 3-dimensional implants is feasible, safe, and yields excellent cosmetic results with high patient satisfaction. Custom-made implants answer the need for an individualized and tailored approach to surgical reconstruction in Poland syndrome.

Robotic assisted minimally invasive direct coronary artery bypass grafting (RA-MIDCAB) represents an effective alternative to conventional coronary artery bypass grafting for revascularization of the left anterior descending artery (LAD) with the left internal thoracic artery (LITA). The first LITA-LAD bypass using a robot was performed in 1998. Since then, progress has been made, bringing the benefits of reduced surgical trauma and faster patient recovery. We report on our single-center initial experience of RA-MIDCAB surgery. This retrospective study included the first 27 patients who underwent RA-MIDCAB between July 2024 and September 2025. Baseline characteristics, perioperative and postoperative outcomes were collected from institutional databases and patient records. All RA-MIDCAB procedures were successfully performed by 2 expert surgeons. Intraoperative graft patency was measured. No mortality was registered, neither on 30-day nor long-term. Conversion to sternotomy never occurred. The mean surgery time was 245.7 minutes. Early outcomes included postoperative new onset atrial fibrillation (n = 2; 7.4%) and respiratory failure (n = 1; 3.7%). Mean length of intensive care unit stay and hospital stay were, respectively, 2.4 and 3.9 days. No patients underwent repeat revascularization or suffered major adverse cardiovascular events. RA-MIDCAB surgery can be performed safely with excellent results. Despite an initial investment, starting a RA-MIDCAB program improves quality of care.

Guideline concordance with surgical ablation in patients undergoing isolated coronary artery bypass grafting (CABG) is poor. Additional atriotomy and safety concerns are barriers to ablation. We sought to evaluate the initial safety and associated rhythm outcomes of a novel non-atriotomy surgical ablation (NASA) left atrial box lesion in patients undergoing isolated CABG. A multicenter retrospective review included all concomitant NASA in patients with preexisting atrial fibrillation undergoing isolated CABG. The primary outcome was NASA-related intraoperative complications. Associated rhythm outcomes were per the Heart Rhythm Society definition of freedom from atrial fibrillation, atrial flutter, and atrial tachycardia (FFAF) <30 seconds at 12 months off class I or III antiarrhythmic medications by >24-hour continuous monitoring. Data are reported as median (interquartile range). Ninety-seven patients were analyzed. The median age was 73 (68-76) years; CHA2DS2-Vasc score, 4.0 (3-5); left ventricular ejection fraction, 55% (45%-60%); and left atrial diameter, 4.0 (3.6-4.7) cm. Most patients (86% [83/97]) had paroxysmal atrial fibrillation. The primary safety outcome of intraoperative complications attributed to NASA was not observed (0% [0/97]). Thirty-five patients (35/97 [36%]) had at least 12 months (median, 12 months; interquartile range, 12-24 months) of continuous ambulatory monitoring, and FFAF was 94% (33/35); 91% (29/32) showed FFAF off antiarrhythmic medications. In patients with mostly paroxysmal atrial fibrillation undergoing isolated CABG surgery, concomitant NASA was safe and associated with favorable restoration of normal sinus rhythm at 1 year.

A 68-year-old asymptomatic patient presented with a pulmonary sequestration with a 4 cm partially thrombosed and calcified aneurysmal feeding vessel. The fragile-appearing aneurysm abutted the inferior pulmonary vein and aorta. Bronchopulmonary sequestration with an aneurysmal feeding vessel is extremely rare and presents a unique challenge due to risk of intraoperative hemorrhage. A staged hybrid approach of thoracic endovascular aortic repair to exclude the aneurysmal artery, followed by lower lobectomy, minimized risk and provided definitive treatment.

Chronic intractable ventricular tachycardia can cause significant morbidity and mortality. In the setting of failed intracardiac ablation, interruption of the sympathetic nerve can provide relief. We present our series of thoracoscopic sympathectomy for chronic recurrent and intractable ventricular tachycardia. We retrospectively reviewed records of sympathectomies performed at a large academic medical center between January 2018 and February 2024. We collected information regarding patients' procedures, cardiovascular history, hospital course, postoperative cardiovascular outcomes, and mortality. A total of 20 patients underwent sympathectomy for refractory cardiac arrhythmias. Two patients died in the hospital for reasons unrelated to surgery. Three patients were lost to follow-up. Of the 15 remaining patients, 2 patients died after hospitalization due to recurrent arrythmias, 1 patient died due to unknown reasons, and 12 patients were living and had follow-up. Three of these patients were without further arrythmias. Four patients had notable reduction in their symptoms. Two patients had continued episodes of ventricular tachycardia, and 3 patients proceeded to listing for heart transplantation. After surgery, 7 patients were recorded as having further ablations, with a maximum of 2 postoperative ablations. The mean number of postoperative ablations was 0.4. In a cohort of critically ill patients with refractory cardiac arrhythmias, sympathectomy is well tolerated. In this case series, a large proportion of patients undergoing sympathectomy experienced significant symptom reduction or complete remission of their cardiac pathologies, indicating that this procedure should be considered in select patients with refractory arrhythmias.

An 80-year-old woman with a history of non-Hodgkin lymphoma and branch retinal artery occlusion presented with acute visual changes and received a diagnosis of multifocal embolic cerebral infarcts. Cardiac imaging revealed a mobile left atrial mass on the mitral valve. Surgical excision was undertaken because of the high risk of recurrent embolization and strokes. Histopathologic examination demonstrated chronic lymphocytic leukemia/small lymphocytic lymphoma within a fibrinous and calcified matrix. This case illustrates a rare intracardiac manifestation of lymphoma serving as a cardioembolic source and highlights the importance of considering hematologic malignant disease in the differential diagnosis of intracardiac masses.

This study evaluated contemporary trends in the racial and gender compositions of integrated (I6) and traditional fellowship programs, examining associations between demographic shifts and match rates. Data from the National Residency Matching Program and Accreditation Council for Graduate Medical Education (2011-2022) were analyzed to assess trends in match rates and demographics of I6 and traditional fellowship programs. Time series analyses (Mann-Kendall test, Bayesian trend analysis, autoregressive integrated moving average models) evaluated shifts in racial and gender composition; Dirichlet regression assessed associations between match rate variations and demographic trends. I6 programs showed significant increases in Asian/Pacific Islander (7.5% to 20.7%), Hispanic (0% to 7.8%), and Black trainees (0% to 5.9%) from 2011 to 2022, with White trainees declining from 77.5% to 44.9%. Traditional fellowships had stable racial composition. Women trainees increased significantly in both pathways, with inflection points in 2015 and 2020, and are projected to reach 50% by 2035 (I6) and 2046 (traditional). Match rates fell for traditional fellowships (98% to 63%) with notable declines in 2014 (92% to 73%) and 2021 (72% to 59%) but rose for I6 (25% to 42%). The percentage of women applicants remains lower in traditional fellowships compared with I6. During the last decade, I6 programs have become more racially diverse, whereas traditional fellowships have maintained stable racial compositions. Women are increasingly represented in both. Despite positive trends, ongoing awareness and targeted efforts to enhance access to both integrated and traditional training pathways remain critical for increasing the diversity of the cardiothoracic surgery trainee pool.

Acute Stanford type A aortic dissection necessitates emergency surgery. Despite proximal repair, dilation of the downstream aorta is often observed. Distal anastomotic new entry (DANE) may drive adverse remodeling and reintervention. We evaluated the incidence, recognition, and impact of DANE after hemiarch and zone 2 arch replacement. We retrospectively analyzed 42 patients with residual dissection after type A dissection surgery between January 2022 and 2024. Twenty-three underwent hemiarch and 22 zone 2 arch replacement. All had preoperative computed tomography and up to 1-year follow-up (or until reintervention) of the descending thoracic aorta. DANE was defined as contrast opacification of the false lumen contiguous with the prosthetic lumen. Outcomes included distal aortic growth (&#x2265;5 or &#x2265;10 mm/y), maximum diameter &#x2265;50 mm, and reintervention within 6 and 12 months. DANE was identified in 19 of 42 patients (45%), with similar incidence after hemiarch (45%) and zone 2 (46%) replacement. None were reported in radiology assessments; the multidisciplinary aortic team documented 3 (16%). At 1 year, patients with DANE had larger distal aortic maximum diameters (49.2 vs 40.6 mm; P < .01) and were at a higher risk of &#x2265;5 mm of growth or reintervention within 6 months (odds ratio, 48.0 [7.47-966.0]). Ninety-five percent with DANE experienced &#x2265;5 mm of growth or reintervention within 6 months vs 26% without DANE (P < .01). DANE occurred frequently after acute dissection repair and was underreported. Its presence was associated with early distal aortic growth and reinterventions. Systematic imaging review and preventive measures against DANE may improve long-term outcomes.

Management of infective endocarditis in patients who inject drugs is often a significant challenge. The decision to proceed with surgical management frequently occurs in patients experiencing a complex web of psychosocial, socioeconomic, medical, and legal issues that can be difficult for clinicians to address. The recent addition of percutaneous mechanical aspiration as a potential adjunctive tool adds further still to the complexity of picking a rational therapeutic strategy. We report a case of recurrent infective endocarditis in a patient who injects drugs that illustrates the many difficult dilemmas commonly presented in this population.