The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2024
The Performance of a New Nanosecond Pulsed Field Ablation Surgical Clamp in Ablation of Cardiac Tissue: A Chronic Porcine Model.
The purpose of this chronic porcine model is to demonstrate the safety and efficacy of a new nanosecond pulsed-field ablation (nsPFA) parallel clamp in ablating different cardiac tissue. ⋯ In this chronic porcine model, a single 1.25-second application independent of tissue thickness with the CellFX Parallel Clamp System demonstrated promising safety and efficacy profile. All lesions produced by this technology resulted in persistent exit block around pulmonary veins and the posterior atrial wall consistent with a reliable, contiguous and transmural ablation without injury to adjacent organs.
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J. Thorac. Cardiovasc. Surg. · Dec 2024
Surgeon-Led Point-Of-Care UltraSound-guided THORacic (POCUS-THOR) Biopsy: A New Paradigm in Efficient Diagnosis and Resource-Sparing Care.
Tissue diagnosis through a variety of interventional approaches guides thoracic cancer management, but often introduces delay to definitive treatment and can be resource intensive. We introduced a thoracic surgeon-led, point-of-care ultrasound-guided biopsy program to provide rapid diagnosis for patients with thoracic cancers. We assessed the diagnostic yield and adverse events with this approach. ⋯ Thoracic surgeon-led ultrasound-guided biopsies are safe in an outpatient clinic setting and have high diagnostic accuracy. This results in reduced time to diagnosis by an estimated 28 to 35 days and frees up endoscopic and radiology resources for other patients. This low-cost procedure can be adopted as part of comprehensive thoracic malignancy assessment and can accelerate patient access to cancer treatment.
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J. Thorac. Cardiovasc. Surg. · Dec 2024
Optimal circulatory arrest temperature for total aortic arch replacement: outcomes of neurological complications.
The optimal hypothermic circulatory arrest temperature during total arch replacement and the impact of hypothermic circulatory arrest temperature on postoperative neurological complications are still uncertain. The aim of this study is to explore the impact of hypothermic circulatory arrest temperature on short-term postoperative outcomes, especially neurological complications, for patients who undergo total arch replacement. ⋯ For patients undergoing total arch replacement with unilateral antegrade cerebral perfusion, cooling to a temperature of 26 °C to 27 °C was associated with the lowest incidence of stroke.
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J. Thorac. Cardiovasc. Surg. · Dec 2024
Zenker's Per-Oral Endoscopic Myotomy (Z-POEM): The Ideal First Line Therapy for Treatment of Zenker's Diverticulum.
Zenker diverticulum is a mucosal herniation at the pharyngoesophageal junction. Although open surgical myotomy is the conventional treatment, robust evidence on third-space flexible endoscopic myotomy is lacking. We assessed safety, effectiveness, and patient-reported outcomes of per-oral endoscopic myotomy (Z-POEM) in the largest reported single-center experience with this technique. ⋯ We demonstrate significant and sustained relief of patient-reported outcomes/symptoms after Z-POEM, including for small diverticuli, with low complication rates. Its safety and versatility has made it the new standard of care locally; Z-POEM can be adopted by third-space endoscopy-trained thoracic surgeons.