Pulmonary endarterectomy through inverted-T upper hemisternotomyCentral MessagePerspective
Objective: We aimed to explore the feasibility of an inverted-T upper hemisternotomy approach for pulmonary endarterectomy (PEA) and report the results after 17 cases. Methods: PEA was conducted through a 7-cm skin incision using an inverted-T upper hemisternotomy across the third intercostal spaces...
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Elsevier
2024-12-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250724004309 |
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| author | Marie De Vos, MD Bart Meyns, MD, PhD Rozenn Anne Quarck, MSc, PhD Catharina Belge, MD, PhD Laurent Godinas, MD, PhD Steffen Rex, MD, PhD Dirk Vlasselaers, MD, PhD Marion Delcroix, MD, PhD Tom Verbelen, MD, PhD |
| author_facet | Marie De Vos, MD Bart Meyns, MD, PhD Rozenn Anne Quarck, MSc, PhD Catharina Belge, MD, PhD Laurent Godinas, MD, PhD Steffen Rex, MD, PhD Dirk Vlasselaers, MD, PhD Marion Delcroix, MD, PhD Tom Verbelen, MD, PhD |
| author_sort | Marie De Vos, MD |
| collection | DOAJ |
| description | Objective: We aimed to explore the feasibility of an inverted-T upper hemisternotomy approach for pulmonary endarterectomy (PEA) and report the results after 17 cases. Methods: PEA was conducted through a 7-cm skin incision using an inverted-T upper hemisternotomy across the third intercostal spaces. Cardiopulmonary bypass (CPB) was established through central arterial and percutaneous femoral dual-staged venous cannulation. Perioperative and hemodynamic data were compared with 17 previous conventional PEAs performed by the same surgeon. Results: From July 2022 to September 2023, 22 PEAs were performed, 17 through inverted-T upper hemisternotomy. Contraindications were an inferior caval vein filter, concomitant coronary revascularization or mitral valve surgery, pulmonary artery intimal sarcoma, and an emergency. Compared with 17 preceding conventional PEAs, there was no significant difference in demographics or in CPB time (274 [256-301] vs 264 [250-274] minutes, P = .1629), deep hypothermic circulatory arrest time (56 [45-65] vs 54 [50-58] minutes, P = .9587), preoperative pulmonary vascular resistance (4.12 [3.10-4.79] vs 4.49 [3.25-6.24] Wood units, P = .5890), 6-month postoperative pulmonary vascular resistance (1.90 [1.40-2.56] vs 1.83 [1.44-2.20] Wood units, P = .6374), or hospital stay (10 [8-12] vs 11 [9-14] days, P = .3327). Intravenous opioid use (0.29 [0.21-0.83] vs 2.99 [1.31-4.33] mg, P < 1.10−4) was significantly lower. Conclusions: PEA using an inverted-T upper hemisternotomy approach is feasible and safe and obtains similar hemodynamic results compared with a full sternotomy approach without prolonging CPB and deep hypothermic circulatory arrest times. It offers bilateral treatment via a single incision and has few contraindications. |
| format | Article |
| id | doaj-art-bf8e52239e3345049af8236b7d13fae4 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-bf8e52239e3345049af8236b7d13fae42025-08-20T04:01:56ZengElsevierJTCVS Techniques2666-25072024-12-0128657210.1016/j.xjtc.2024.09.021Pulmonary endarterectomy through inverted-T upper hemisternotomyCentral MessagePerspectiveMarie De Vos, MD0Bart Meyns, MD, PhD1Rozenn Anne Quarck, MSc, PhD2Catharina Belge, MD, PhD3Laurent Godinas, MD, PhD4Steffen Rex, MD, PhD5Dirk Vlasselaers, MD, PhD6Marion Delcroix, MD, PhD7Tom Verbelen, MD, PhD8Department of Cardiac Surgery, University Hospitals Leuven, Leuven, BelgiumDepartment of Cardiac Surgery, University Hospitals Leuven, Leuven, BelgiumClinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, BelgiumClinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, BelgiumClinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, BelgiumDepartment of Anesthesiology, University Hospitals Leuven, Leuven, BelgiumDepartment of Intensive Care, University Hospitals Leuven, Leuven, BelgiumClinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, BelgiumDepartment of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium; Address for reprints: Tom Verbelen, MD, PhD, Department of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium.Objective: We aimed to explore the feasibility of an inverted-T upper hemisternotomy approach for pulmonary endarterectomy (PEA) and report the results after 17 cases. Methods: PEA was conducted through a 7-cm skin incision using an inverted-T upper hemisternotomy across the third intercostal spaces. Cardiopulmonary bypass (CPB) was established through central arterial and percutaneous femoral dual-staged venous cannulation. Perioperative and hemodynamic data were compared with 17 previous conventional PEAs performed by the same surgeon. Results: From July 2022 to September 2023, 22 PEAs were performed, 17 through inverted-T upper hemisternotomy. Contraindications were an inferior caval vein filter, concomitant coronary revascularization or mitral valve surgery, pulmonary artery intimal sarcoma, and an emergency. Compared with 17 preceding conventional PEAs, there was no significant difference in demographics or in CPB time (274 [256-301] vs 264 [250-274] minutes, P = .1629), deep hypothermic circulatory arrest time (56 [45-65] vs 54 [50-58] minutes, P = .9587), preoperative pulmonary vascular resistance (4.12 [3.10-4.79] vs 4.49 [3.25-6.24] Wood units, P = .5890), 6-month postoperative pulmonary vascular resistance (1.90 [1.40-2.56] vs 1.83 [1.44-2.20] Wood units, P = .6374), or hospital stay (10 [8-12] vs 11 [9-14] days, P = .3327). Intravenous opioid use (0.29 [0.21-0.83] vs 2.99 [1.31-4.33] mg, P < 1.10−4) was significantly lower. Conclusions: PEA using an inverted-T upper hemisternotomy approach is feasible and safe and obtains similar hemodynamic results compared with a full sternotomy approach without prolonging CPB and deep hypothermic circulatory arrest times. It offers bilateral treatment via a single incision and has few contraindications.http://www.sciencedirect.com/science/article/pii/S2666250724004309CTEPHpulmonary endarterectomyminimal access surgeryhemisternotomy |
| spellingShingle | Marie De Vos, MD Bart Meyns, MD, PhD Rozenn Anne Quarck, MSc, PhD Catharina Belge, MD, PhD Laurent Godinas, MD, PhD Steffen Rex, MD, PhD Dirk Vlasselaers, MD, PhD Marion Delcroix, MD, PhD Tom Verbelen, MD, PhD Pulmonary endarterectomy through inverted-T upper hemisternotomyCentral MessagePerspective JTCVS Techniques CTEPH pulmonary endarterectomy minimal access surgery hemisternotomy |
| title | Pulmonary endarterectomy through inverted-T upper hemisternotomyCentral MessagePerspective |
| title_full | Pulmonary endarterectomy through inverted-T upper hemisternotomyCentral MessagePerspective |
| title_fullStr | Pulmonary endarterectomy through inverted-T upper hemisternotomyCentral MessagePerspective |
| title_full_unstemmed | Pulmonary endarterectomy through inverted-T upper hemisternotomyCentral MessagePerspective |
| title_short | Pulmonary endarterectomy through inverted-T upper hemisternotomyCentral MessagePerspective |
| title_sort | pulmonary endarterectomy through inverted t upper hemisternotomycentral messageperspective |
| topic | CTEPH pulmonary endarterectomy minimal access surgery hemisternotomy |
| url | http://www.sciencedirect.com/science/article/pii/S2666250724004309 |
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