Annals of thoracic surgery short reports最新文献_第7页

Surgical Approaches to Left Ventricular Assist Device Deactivation: Lessons From Remission From Stage D Heart Failure 左心室辅助装置失活的手术方法：从D期心力衰竭缓解的经验教训

Annals of thoracic surgery short reports

Pub Date : 2026-09-01 Epub Date: 2026-02-18 DOI: 10.1016/j.atssr.2026.02.001

Ian Nickel MD, Emma Birks MD, PhD, Hui Li MD, MSTAT, Mark S. Slaughter MD, Eduardo Rame MD, Brian Lowes MD, PhD, Snehal Patel MD, Daniel Goldstein MD, Simon Maybaum MD, John Um MD, Christopher Cunningham PhD, Jaimin Trivedi MD, Pavan Atluri MD, Randall Starling MD, MPH, Josef Stehlik MD, MPH, Stavros Drakos MD, PhD, Craig H. Selzman MD

Background

Remission From Stage D Heart Failure (RESTAGE-HF) was a multicenter study demonstrating that a selected patient population with left ventricular assist devices (LVADs) could achieve functional recovery and subsequent durable pump explantation. The purpose of our study was to describe the impact of surgical approach to deactivation in this study cohort.

Methods

The study prospectively enrolled 40 patients with HeartMate II LVAD. Overall, 19 (52.8%) of 36 evaluable patients reached the predefined criteria and underwent LVAD deactivation. Three approaches were used: complete explantation (n = 8), partial explantation (n = 10), and percutaneous decommissioning (n = 1). The primary outcome was survival free from transplantation or LVAD reimplantation.

Results

Patients with partial explantation had a longer duration of heart failure and a larger posterior wall thickness before ventricular assist device implantation. There were no differences in other preimplantation parameters. Median follow-up was 7.9 years. Median time to deactivation was similar between approaches. Post-LVAD survival free from LVAD reimplantation or transplantation was 90% at 1 year and remained stable after 4 years at 74% for the entire cohort. No significant intergroup differences in 7-year survival were observed (87.5% vs 40%; P = .06).

Conclusions

This analysis represents the longest follow-up of post-LVAD patients stratified by surgical approach and suggests that select patients can achieve sustained myocardial recovery after LVAD deactivation.

D期心力衰竭缓解（RESTAGE-HF）是一项多中心研究，表明选择的患者群体使用左心室辅助装置（lvad）可以实现功能恢复和随后的持久泵移植。本研究的目的是描述该研究队列中手术入路对失活的影响。方法前瞻性纳入40例心脏伴侣II型左心室辅助装置患者。总体而言，36例可评估患者中有19例（52.8%）达到预定标准并行左室辅助功能失活。采用三种方法：完全外植体（n = 8），部分外植体（n = 10）和经皮退役（n = 1）。主要结果是无移植或LVAD再植入术的生存。结果部分外植体患者在植入心室辅助装置前心力衰竭持续时间较长，后壁厚度较大。其他种植前参数无差异。中位随访时间为7.9年。两种方法的中位失活时间相似。LVAD术后1年无LVAD再植或移植的生存率为90%，4年后保持稳定，为74%。7年生存率组间差异无统计学意义（87.5% vs 40%; P = 0.06）。结论本分析是LVAD术后患者手术分层随访时间最长的一次，表明部分患者在LVAD失活后可以实现持续的心肌恢复。

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引用次数: 0

The Contemporary Utility of the Eloesser Flap for Management of Complex Pleural Space Infections Eloesser皮瓣在复杂胸膜腔感染治疗中的当代应用

Annals of thoracic surgery short reports

Pub Date : 2026-09-01 Epub Date: 2026-04-06 DOI: 10.1016/j.atssr.2026.03.015

Ioana B. Florea MD, MPHS, Johanna Lou MD, Keshav Kooragayala MD, Erin Crable BFA, Christopher Derivaux MD, John Aversa MD, Kenji Minakata MD, David D. Shersher MD

A 27-year-old man with hyperimmunoglobulin E syndrome and remote left upper lobectomy for refractory hemoptysis presented with recurrent hemoptysis and a defunctionalized left lung. He underwent a reoperative thoracotomy and completion pneumonectomy complicated by a bronchopleural fistula. A 45-year-old man with a prior left upper lobectomy for adenocarcinoma presented with progressive cavitary Mycobacterium avium refractory to third-line antibiotics. These cases of chronic pleural space pathology in the immunosuppressed, reoperative setting were successfully addressed through a staged operative intervention with Eloesser thoracoplasty, demonstrating its ongoing utility in the armamentarium of the modern thoracic surgeon.

一个27岁的男性高免疫球蛋白E综合征和远端左上肺叶切除难治性咯血提出复发性咯血和左肺功能障碍。他接受了再手术开胸和全肺切除术，并发支气管胸膜瘘。一名45岁男性，先前因腺癌切除左上肺叶，出现对三线抗生素难治的进行性空腔鸟分枝杆菌。这些慢性胸膜间隙病理在免疫抑制，再手术设置成功地通过Eloesser胸廓成形术的分阶段手术干预，证明其在现代胸外科医生的武器的持续效用。一个27岁的男性高免疫球蛋白E综合征和远端左上肺叶切除难治性咯血提出复发性咯血和左肺功能障碍。他接受了再手术开胸和全肺切除术，并发支气管胸膜瘘。一名45岁男性，先前因腺癌切除左上肺叶，出现对三线抗生素难治的进行性空腔鸟分枝杆菌。这些慢性胸膜间隙病理在免疫抑制，再手术设置成功地通过Eloesser胸廓成形术的分阶段手术干预，证明其在现代胸外科医生的武器的持续效用。

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引用次数: 0

Negative Pressure Wound Therapy for Residual Cavity Reduction After Open-Window Thoracostomy Following Pneumonectomy 全肺切除术后开窗开胸术后残余腔缩小负压伤口治疗

Annals of thoracic surgery short reports

Pub Date : 2026-09-01 Epub Date: 2026-02-25 DOI: 10.1016/j.atssr.2026.02.010

Machiko Nishii MD, Satoru Okada MD, PhD, Takumi Nakagawa MD, Shunta Ishihara MD, PhD, Ryosuke Tokuda MD, Taiyo Kawamura MD, Masanori Shimomura MD, PhD, Tatsuo Furuya MD, PhD, Ayako Kawarazaki MD, PhD, Masayoshi Inoue MD, PhD

Postpneumonectomy empyema with a bronchopleural fistula (BPF) usually requires open-window thoracostomy, which can leave a large difficult-to-close residual cavity when muscle or omental flaps are unavailable. An 81-year-old man who developed empyema with a BPF after completion left pneumonectomy underwent open-window thoracostomy. The BPF closed with granulation, and the large pleural cavity remained. Negative-pressure wound therapy (−50 to −75 mm Hg) achieved >50% cavity reduction within 10 days, enabling definitive thoracoplasty. Negative-pressure wound therapy appears a safe and effective option for reducing postpneumonectomy cavities and facilitating chest closure when conventional filling procedures are not feasible.

肺切除术后肺气肿合并支气管胸膜瘘（BPF）通常需要开窗开胸术，当没有肌肉或大网膜皮瓣时，可能会留下一个难以关闭的大残留腔。一例81岁男性患者在完成左侧全肺切除术后出现脓胸伴BPF，并行开窗开胸术。BPF因肉芽形成而闭合，保留了大片胸膜腔。负压伤口治疗（- 50至- 75毫米汞柱）在10天内实现了50%的腔缩小，从而实现了最终的胸廓成形术。负压伤口治疗是一种安全有效的选择，可以减少肺切除术后的空腔，并在常规填充手术不可行的情况下促进胸部闭合。肺切除术后肺气肿合并支气管胸膜瘘（BPF）通常需要开窗开胸术，当没有肌肉或大网膜皮瓣时，可能会留下一个难以关闭的大残留腔。一例81岁男性患者在完成左侧全肺切除术后出现脓胸伴BPF，并行开窗开胸术。BPF因肉芽形成而闭合，保留了大片胸膜腔。负压伤口治疗（- 50至- 75毫米汞柱）在10天内实现了50%的腔缩小，从而实现了最终的胸廓成形术。负压伤口治疗是一种安全有效的选择，可以减少肺切除术后的空腔，并在常规填充手术不可行的情况下促进胸部闭合。

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引用次数: 0

Symmetrical Bicuspidization Minimizing Use of Pericardium for Unicuspid Aortic Valve With Aortic Regurgitation 对称双尖瓣置换术对有主动脉反流的单尖瓣主动脉瓣减少心包的使用

Annals of thoracic surgery short reports

Pub Date : 2026-09-01 Epub Date: 2026-05-05 DOI: 10.1016/j.atssr.2026.04.027

Yutaka Okita MD, Ryo Kawabata MD

引用次数: 0

Beating the Odds: Finding Fulfillment and Success as an International Medical Graduate in Cardiothoracic Surgery 战胜困难：作为心胸外科国际医学毕业生找到成就感和成功

Annals of thoracic surgery short reports

Pub Date : 2026-09-01 Epub Date: 2026-05-14 DOI: 10.1016/j.atssr.2026.05.001

Andrew R. Brownlee MD

引用次数: 0

Successful Repair of a Blunt Injury to the Donor's Pulmonary Artery and Subsequent Use of the Lungs 供体肺动脉钝性损伤的成功修复及肺的后续使用

Annals of thoracic surgery short reports

Pub Date : 2026-09-01 Epub Date: 2026-02-28 DOI: 10.1016/j.atssr.2026.02.014

Eugene Golts MD, MBA, Samvel Gaboyan MS, Alejandro Bribriesco MD, Travis Pollema DO, Ian Glenn MD, Rebecca Golts, Aideen Afshar, Aiden Walters, Kamyar Afshar DO

A significant proportion of lungs accepted for lung transplantation are not transplanted due to chest trauma. We present a successful repair of a blunt injury to the pulmonary artery of the donor during lung transplantation. Lungs with this type of injury can be transplanted safely after repair, potentially expanding the donor pool without compromising the postoperative course.

很大一部分接受肺移植的肺由于胸部创伤而没有移植。我们提出了一个成功的修复钝性损伤的供体肺动脉在肺移植。有这种类型损伤的肺在修复后可以安全地移植，潜在地扩大供体池而不影响术后病程。很大一部分接受肺移植的肺由于胸部创伤而没有移植。我们提出了一个成功的修复钝性损伤的供体肺动脉在肺移植。有这种类型损伤的肺在修复后可以安全地移植，潜在地扩大供体池而不影响术后病程。

引用次数: 0

A Predictive Tool Using The Society of Thoracic Surgeons Risk Calculator for Safe Operating Room Extubation After Coronary Bypass Surgery 使用胸外科学会风险计算器预测冠状动脉搭桥术后安全拔管的工具

Annals of thoracic surgery short reports

Pub Date : 2026-09-01 Epub Date: 2026-03-18 DOI: 10.1016/j.atssr.2026.02.036

John G. Byrne MD, Farhaan Chaugle BS, Thomas W. Kessinger MD, Curtis S. Dickey DO, Ali Asghar MD, Prince Thommen MD, Shahistha Hyder MD, Hannaan Chaugle MD

Background

Operating room extubation (ORE) after coronary artery bypass grafting (CABG) has proven benefit. However, predicting which patients should undergo ORE is difficult. We hypothesized that The Society of Thoracic Surgeons (STS) risk scores could be used as a predictive tool for ORE.

Methods

Between January 1, 2023 and November 30, 2025, the STS risk scores of 687 consecutive patients who underwent on-pump CABG were calculated. Risk scores for death (in-hospital or 30-day mortality), stroke (cerebrovascular accident), acute kidney injury (AKI), reoperation, prolonged ventilation, deep sternal wound infection, prolonged length of stay, and blood transfusions were used to generate the predictive model for ORE. Multivariate logistic regression analysis was used to determine which STS scores were independent predictors of ORE. A composite score, along with a receiver operating characteristic curve with area under the curve, were also generated.

Results

Among the 687 patients, 289 (42%) underwent ORE, and 1 of 289 (0.3%) required reintubation. Multivariate analysis determined that the risk of prolonged ventilation <3% (odds ratio [OR], 1.62; P = .03; 95% CI, 1.06-2.46), the risk of in-hospital or 30-day mortality <0.5% (OR, 2.58; P < .01; 95% CI, 1.39-4.80), and the risk of AKI <2% (OR, 1.67; P = .05; 95% CI, 0.99--2.84) were all independently associated with successful ORE. The receiver operating characteristic and area under the curve documented that the model’s performance was accurate 65% of the time. A composite score <7% favored ORE, whereas a composite score >25% favored FTE.

Conclusions

ORE is safe in selected patients undergoing CABG, particularly if ORE is practiced with high frequency and in patients with an STS calculator risk of prolonged ventilation <3%, in-hospital or 30-day mortality <0.5%, and AKI <2%.

背景：冠状动脉旁路移植术（CABG）后的手术室拔管（ORE）已被证明是有益的。然而，预测哪些患者应该接受ORE是困难的。我们假设胸外科学会（Society of Thoracic Surgeons， STS）的风险评分可以作为ore的预测工具。方法在2023年1月1日至2025年11月30日期间，计算687例连续接受无泵搭桥手术的患者的STS风险评分。死亡（住院或30天死亡）、中风（脑血管意外）、急性肾损伤（AKI）、再手术、延长通气时间、深胸骨伤口感染、延长住院时间和输血的风险评分用于生成ORE的预测模型。采用多因素logistic回归分析确定哪些STS评分是ORE的独立预测因子。同时生成了曲线下面积为的受者工作特性曲线。结果687例患者中，289例（42%）接受了ORE， 289例中有1例（0.3%）需要再插管。多因素分析表明，延长通气时间3%的风险（优势比[OR]， 1.62; P = 0.03; 95% CI, 1.06-2.46）、住院或30天死亡率0.5%（优势比[OR]， 2.58; P = 0.01; 95% CI, 1.39-4.80）和AKI风险2%（优势比[OR]， 1.67; P = 0.05; 95% CI, 0.99- 2.84）都与成功的ORE独立相关。受试者的工作特征和曲线下面积证明该模型的性能在65%的时间内是准确的。综合得分>； 7%倾向于ORE，而综合得分>；25%倾向于FTE。结论：在接受CABG的特定患者中，疼痛是安全的，特别是如果ORE进行频率较高，并且STS计算的患者延长通气风险为3%，住院或30天死亡率为0.5%，AKI为2%。

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引用次数: 0

Selective Sinus Replacement for a Patient With an Unruptured Sinus of Valsalva Aneurysm 选择性鼻窦置换术治疗未破裂Valsalva动脉瘤患者一例

Annals of thoracic surgery short reports

Pub Date : 2026-09-01 Epub Date: 2026-01-12 DOI: 10.1016/j.atssr.2025.12.020

Takuya Matsushiro MD, Ryotaro Kitadai MD, Naoki Edo MD, Ren Saito MD, Shinichi Imai MD, PhD, Yujiro Miura MD

This report describes the case of an 82-year-old man incidentally diagnosed with an unruptured saccular aneurysm of the left coronary sinus, a condition that occurs infrequently. Computed tomography and echocardiography revealed a 10-mm aneurysm. The aneurysm and the surrounding left sinus wall were resected and reconstructed using a polyester graft with a selective sinus replacement technique. This case supports the feasibility and safety of elective surgical treatment for an unruptured sinus of Valsalva aneurysm in high-risk anatomical locations, particularly using a selective sinus replacement approach to preserve valve function and coronary flow while minimizing the risk of recurrence.

本报告描述了一个82岁的男子偶然诊断为未破裂的囊状动脉瘤的左冠状窦，这种情况很少发生。计算机断层扫描和超声心动图显示一个10毫米的动脉瘤。动脉瘤和左窦壁周围切除和重建使用聚酯移植物选择性窦置换技术。本病例支持选择性手术治疗高危解剖位置未破裂Valsalva动脉瘤的可行性和安全性，特别是使用选择性窦置换入路来保留瓣膜功能和冠状动脉血流，同时将复发风险降至最低。本报告描述了一个82岁的男子偶然诊断为未破裂的囊状动脉瘤的左冠状窦，这种情况很少发生。计算机断层扫描和超声心动图显示一个10毫米的动脉瘤。动脉瘤和左窦壁周围切除和重建使用聚酯移植物选择性窦置换技术。本病例支持选择性手术治疗高危解剖位置未破裂Valsalva动脉瘤的可行性和安全性，特别是使用选择性窦置换入路来保留瓣膜功能和冠状动脉血流，同时将复发风险降至最低。

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引用次数: 0

Subcoronary Implantation of Decellularized Aortic Allografts—An Ex Vivo and In Vivo Feasibility Study 脱细胞主动脉异体冠状动脉下植入术——体外和体内可行性研究

Annals of thoracic surgery short reports

Pub Date : 2026-09-01 Epub Date: 2026-01-22 DOI: 10.1016/j.atssr.2026.01.006

Murat Avsar MD, PhD, Tomislav Cvitkovic MD, Alexander Weymann MD, PhD, Klaus Hoeffler, Dmitry Bobylev MD, PhD, Dietmar Boethig MD, PhD, Arjang Ruhparwar MD, PhD, Samir Sarikouch MD, PhD, Alexander Horke MD, PhD

Background

Decellularized aortic homografts were introduced in 2008 as a further option for pediatric aortic valve replacement. Subcoronary decellularized aortic homograft implantation may eliminate the need for aortic root replacement and coronary artery reimplantation in patients with sufficient left ventricular outflow tract dimensions.

Methods

Ovine aortic xenografts were harvested from the slaughterhouse and decellularized using an approved detergent-based decellularization protocol. Two cardiac surgeons performed subcoronary implantation in explanted ovine hearts, and results were compared regarding procedure time and procedural success. After these ex vivo experiments, 4 adult black-headed sheep were operated on in acute experiments.

Results

The 2 surgeons were able to perform the ex vivo subcoronary implantation of the decellularized ovine aortic allografts (DOAA) without technical problems within 1 hour. Mechanical strength of the processed ovine DOAA appeared comparable to that of native aortic tissue. Both surgeons stated that there were no differences with respect to appearance, haptics, trimability, and sewability. The initial 2 sheep operated on showed significant valvular incompetence. After modification of the surgical protocol to a single-line suture technique, the next 2 sheep showed fully competent aortic valves with laminar flow across the subcoronary implanted DOAA.

Conclusions

We have developed a technique for subcoronary implantation of decellularized aortic homografts including acute large animal experiments. Long-term animal experiments will provide further insight into durability and recellularization.

背景：去细胞主动脉异体移植于2008年被引入，作为儿童主动脉瓣置换术的进一步选择。冠状动脉下去细胞主动脉同种移植物植入术可以消除左心室流出道足够尺寸的患者主动脉根置换和冠状动脉再植的需要。方法从屠宰场采集异种主动脉移植物，使用经批准的基于洗涤剂的脱细胞方案进行脱细胞。两名心脏外科医生在移植的羊心脏中进行冠状动脉下植入术，并对手术时间和手术成功率进行了比较。在离体实验结束后，对4只成年黑头羊进行急性手术实验。结果2名外科医生均能在1小时内完成脱细胞羊主动脉异体离体冠状动脉下植入术（DOAA），无技术问题。加工后的羊DOAA的机械强度与天然主动脉组织相当。两位外科医生都表示，在外观、触觉、可修剪性和可缝合性方面没有差异。最初接受手术的2只羊表现出明显的瓣膜功能不全。在将手术方案修改为单线缝合技术后，接下来的2只羊显示主动脉瓣功能完全正常，冠状动脉下植入的DOAA有层流。结论我们已经建立了冠状动脉下脱细胞主动脉同种异体移植技术，包括急性大型动物实验。长期的动物实验将提供对耐久性和再细胞化的进一步了解。

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引用次数: 0

Patient-Prosthesis Mismatch After Mitral Valve Replacement Using Bileaflet Preservation Technique for Mitral Regurgitation 二尖瓣置换术后采用双小瓣保存技术治疗二尖瓣返流的患者与假体失配

Annals of thoracic surgery short reports

Pub Date : 2026-09-01 Epub Date: 2026-02-21 DOI: 10.1016/j.atssr.2026.02.006

Abel Cherian BS, Chidiebere Peter Echieh FRCS, Rintaro Kinjo MD, Ayah Ibrahim BS, Alexander Ryan BS, Tawanda Zvavamwe BS, Yash Rohilla, Mohammed Hamidi MD, Dina Al Rameni MD, Toshinobu Kazui MD, PhD

Patient-prosthesis mismatch (PPM) in the mitral valve position is underreported but may occur when both anterior and posterior leaflets are preserved during mitral valve replacement (MVR), a technique that can reduce the area to place an appropriate-size valve. Therefore, balancing the risks and benefits of leaflet preservation is critical, given that certain degrees of left ventricular dysfunction or valvular disease causes may favor bileaflet or partial-leaflet preservation while minimizing the risk for PPM. We report a case of PPM 1 year after MVR with bileaflet preservation in a patient with normal left ventricular size and function who required redo MVR with a larger valve for symptom resolution.

在二尖瓣置换术（MVR）中，当前后瓣均保留时，二尖瓣位置的患者-假体不匹配（PPM）可能会发生，这是一种可以缩小放置合适大小瓣膜的面积的技术。因此，考虑到某些程度的左心室功能障碍或瓣膜疾病可能有利于双小叶或部分小叶保存，同时将PPM的风险降至最低，平衡小叶保存的风险和益处是至关重要的。我们报告了一例左心室大小和功能正常的患者，在MVR后保留双小体1年的PPM，需要用更大的瓣膜重新进行MVR以缓解症状。在二尖瓣置换术（MVR）中，当前后瓣均保留时，二尖瓣位置的患者-假体不匹配（PPM）可能会发生，这是一种可以缩小放置合适大小瓣膜的面积的技术。因此，考虑到某些程度的左心室功能障碍或瓣膜疾病可能有利于双小叶或部分小叶保存，同时将PPM的风险降至最低，平衡小叶保存的风险和益处是至关重要的。我们报告了一例左心室大小和功能正常的患者，在MVR后保留双小体1年的PPM，需要用更大的瓣膜重新进行MVR以缓解症状。

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引用次数: 0