European Journal of Cardio-Thoracic Surgery最新文献

Objectives: This study aimed to compare the oncological features of centrally and peripherally located small-sized (≤2 cm), radiologically solid-dominant, cN0 non-small-cell lung cancer (NSCLC).

Methods: We retrospectively reviewed 1240 patients who underwent lobectomy or segmentectomy for radiologically solid-dominant cN0 NSCLC tumours ≤2 cm in size. Tumours were categorized as centrally (inner two-thirds of the pulmonary parenchyma) or peripherally (outer one-third) located. Clinicopathological characteristics and prognoses were compared between the 2 groups.

Results: Among the 1240 patients, 299 had centrally located and 941 had peripherally located tumours. Centrally located tumours showed a significantly higher proportion of pure solid tumours and pathological lymph node upstaging than peripherally located tumours (P = 0.018 and P = 0.038, respectively). Multivariable logistic regression analysis identified central location as an independent predictor for pN1 (odds ratio, 1.91; 95% confidence interval, 1.09-3.36; P = 0.024), but not for pN2, upstaging. The cumulative incidence of loco-regional and distant recurrences did not significantly differ between the 2 groups (P = 0.455 and P = 0.383, respectively). Overall survival and recurrence-free survival rates were also similar among patients with central and peripheral tumours (P = 0.267 and P = 0.269, respectively).

Conclusions: Patient prognosis following complete anatomical resection was comparable between centrally and peripherally located radiologically solid-dominant cN0 NSCLC tumours ≤2 cm in size. However, centrally located tumours were associated with a higher risk of pN1 upstaging, highlighting the importance of thorough hilar lymph node dissection in these patients.

Objectives: Bilateral endoscopic thoracic sympathectomy is an effective treatment for primary hyperhidrosis, yet the causes of its main side effect, compensatory sweating, remain unclear. This study aimed to identify risk factors for compensatory sweating in a long-term follow-up cohort.

Methods: Patients who underwent bilateral endoscopic thoracic sympathectomy for primary hyperhidrosis between 2010 and 2023 (n = 98) were interviewed, and preoperative data were collected. Compensatory sweating was classified as mild, moderate, or severe according to the Society of Thoracic Surgeons guidelines. Quality of life (QOL) was assessed using the Hyperhidrosis Disease Severity Scale from the International Hyperhidrosis Society. Logistic and ordinal Bayesian regression models were applied to analyse associations between predictors, compensatory sweating outcomes, and QOL.

Results: The procedure achieved an overall effectiveness of 94.38%, with 34.69% of patients reporting compensatory sweating, predominantly mild (26.53%). Nearly all patients (97.95%) experienced a ≥ 50% reduction in sweating, and 94.89% achieved ≥80% reduction. Higher haemoglobin levels and marijuana protected against compensatory sweating incidence and severity. Conversely, smoking and hyperhidrosis involving both hands and axillae increased compensatory sweating risk. Better QOL outcomes were correlated with higher haemoglobin levels and female sex, while worse outcomes were associated with older age, higher body mass index, and axillary involvement.

Conclusions: Long-term follow-up highlights key predictors for compensatory sweating, emphasizing the importance of tailored preoperative counseling. Identifying at-risk patients, such as smokers and those with low haemoglobin levels, is essential for improving outcomes and managing expectations in the treatment of primary hyperhidrosis.

Objectives: The prevalence of mediastinal masses in large-scale populations in China has been rarely reported. During COVID19 pandemic, many incidentalomas were reported due to the large amount of chest computed tomography scan performed in emergency setting.

Methods: Retrospective analysis of emergency chest computed tomography scans (February 2020-February 2021) for COVID-19 screening, including mediastinal abnormalities (excluding lymph nodes, dysplasia, pneumomediastinum and other non-mass alterations), with computed tomography features, diagnostic workup and 1 year follow-up data were reviewed.

Results: Of the 40 112 patients [mean age 54.5 (17.2) years; male-to-female ratio 1.02:1] screened for COVID-19, 293 (0.73%) had mediastinal masses of which 223 (0.56%) located in the anterior mediastinum. As participants aged, the prevalence tended to increase (P < 0.001). The prevalence was not different between the sexes (P = 0.635). An oval shape, anterior mediastinal location, and thymus involvement were the most common computed tomography characteristics. Surgery confirmed 11.3% (33 of 293) of nodal lesions, with a benign to malignant ratio of 51.4: 48.5. A computed tomography scan follow-up was conducted in 32.3% (84/260) of the patients, and in 82.1% (69/84) of cases the lesion was stable. Additionally, mediastinal masses were detected in 7.7% (20/260) of elderly patients who passed away soon after their primary disease worsened.

Conclusions: In Chinese COVID-19 screening chest computed tomography, the prevalence of all mediastinal masses and anterior mediastinal masses was 0.73% and 0.56%, respectively. Findings support risk-stratified management: growing/suspicious lesions warrant intervention versus surveillance for stable masses. Standardized protocols and multidisciplinary consensus are critical.

Objectives: Imaging-based methods of measuring aortic biomechanics may provide superior and a more personalized in vivo risk assessment of patients with thoracic aortic aneurysms compared to traditional aortic size criteria such as maximal aortic diameter. We aim to summarize the data on in vivo imaging techniques for evaluation of aortic biomechanics.

Methods: A thorough search of literature was conducted in MEDLINE, EMBASE and Google Scholar for evidence of various imaging-based biomechanics techniques. All imaging modalities were included. Data involving preclinical/animal models or exclusively focussed on abdominal aortic aneurysms were excluded.

Results: The various imaging-based biomechanical parameters can be divided into categories of increasing complexity: strain-based, stiffness-based and computational modelling-derived. Strain-based and stiffness-based parameters are more simply calculated and can be derived using multiple imaging modalities. Initial studies are promising towards linking these parameters with clinically relevant end-points, including aortic dissection, though work is required for standardization. Computationally derived parameters provide detail of stress exerted on the aortic wall with great spatial resolution. However, they are highly dependent on the assumptions applied to the models, such as material properties of the aortic wall.

Conclusions: Imaging-based aortic biomechanics represent a major technical advancement for personalized in vivo risk stratification of patients with ascending thoracic aortic aneurysm. The next steps in clinical translation require large-scale validation of these markers towards predicting aortic dissections and comparison against the gold standard ex vivo aortic biomechanics as well as development of a user-friendly, low-cost algorithm that can be widely adopted.

Objectives: This study aimed to investigate the benefits and potential risks of implantable cardioverter-defibrillators in paediatric and congenital heart disease (CHD) patients in the current era.

Methods: All patients with CHD, paediatric cardiomyopathy or primary electrical disease, who underwent implantation of a defibrillator from 2001 to 2023, were examined. The occurrence of appropriate therapy, unplanned surgeries due to device complications, inappropriate shocks and associated risk factors were analysed.

Results: A total of 214 patients were included, with 61% having CHD, 17% having paediatric cardiomyopathy and 22% having primary electrical disease. The most common diagnoses were transposition of the great arteries and tetralogy of Fallot (each 12%). The median age at implantation was 23 years (interquartile ranges 15-38), and the median follow-up was 5.7 years (95% confidence interval 4.9-7.3). A total of 196 patients met the criteria for outcome analysis, where appropriate therapy was observed in 41% (n = 80), occurring more often in patients with indications for secondary prevention than primary prevention (56% vs 26% at 5 years, P = 0.003). The cumulative incidence of inappropriate shocks was 13% (n = 26), with patients with CHD being more frequently affected. Unplanned surgeries were required in 36% (n = 71), predominantly due to lead-related issues in those with abdominal generator placement.

Conclusions: The high rate of appropriate therapies underscores the critical importance of risk assessment in ICD selection, particularly to mitigate lead failures and unnecessary shocks. However, defibrillator therapy has a relevant rate of unplanned surgeries, with abdominal generators and epicardial/extracardiac leads being risk factors.