General Thoracic and Cardiovascular Surgery最新文献

Objectives: Few physiological assessments are available for patients who undergo mitral valve repair for severe mitral regurgitation (symptomatic or asymptomatic). The aim of the study was to evaluate change in exercise tolerance as a means of physiological assessment following mitral valve repair.

Methods: We studied 41 consecutive patients who received elective isolated mitral valve repair for severe mitral regurgitation in a minimally invasive manner via a completely endoscopic platform and who underwent cardiopulmonary exercise testing in our institution between February 2018 and August 2019. There were 21 asymptomatic (group A) and 20 symptomatic (group S) patients. Physiological assessment was performed by cycle ergometer cardiopulmonary exercise testing pre-operatively and at approximately 6 months post-operatively.

Results: Mean age was 59 ± 11.6 years and 24 patients were male (58.5%). Overall, there was no significant change in peak oxygen consumption or anaerobic threshold after surgical repair. There were no intergroup differences in terms of peak oxygen consumption, anaerobic threshold, ventilation/carbon dioxide production, or gas exchange ratio. There were no intergroup differences in any transthoracic echocardiographic variable except for post-operative left atrial dimension (group A: 35.2 ± 5.9 vs. group S: 39.8 ± 6.2, p = 0.01).

Conclusions: There was no statistically discernible change in functional capacity at 6-12 months after endoscopic mitral valve repair. The physiological assessment found no improvements in cardiopulmonary exercise testing values post-operatively despite improvement of the symptoms.

Objective: Non-small cell lung cancer with malignant pleural effusion is generally considered inoperable. The aim of this study was to investigate the prognosis and outcomes of patients with subclinical malignant pleural effusion who underwent surgical resection for lung cancer.

Methods: Between 2013 and 2022, 2261 patients underwent lung resections for non-small cell lung cancer. We retrospectively reviewed the records of 29 patients with cT1-2N0 lung cancer and subclinical malignant pleural effusion < 10 mL.

Results: The surgical procedures included wedge resection (n = 8) and anatomical resection (segmentectomy or lobectomy, n = 21). Fifteen patients underwent surgery + postoperative chemotherapy. During the follow-up period, 21 patients relapsed and 18 patients died. The median overall survival was 49 months, with a 3-year overall survival rate of 65.0%. The median progression-free survival was 14 months, with a 3-year progression-free survival rate of 20.1%. The 3-year overall survival rate was significantly higher for anatomical resection than for wedge resection (85.4% vs. 12.5%; P < 0.001). The 3-year progression-free survival rate was also significantly higher in the surgery + postoperative chemotherapy group than in the surgery-alone group (33.3% vs. 0%; P < 0.002).

Conclusion: Although the findings do not support surgery over conservative therapy, anatomical resection may be a reasonable option for patients with subclinical malignant pleural effusion.

Objectives: Distal stent graft-induced new entry is a major complication after frozen elephant trunk procedure for type A acute aortic dissection. We investigated the impact of anastomosis location on this complication.

Methods: We reviewed 58 patients who underwent total arch replacement using frozen elephant trunk technique (2015-2023). Patients were divided by anastomosis location: Stent group (n = 24; anastomosis at stent part) and Fabric group (n = 34; anastomosis at graft part). We assessed early complications and mid-term distal aortic events during the follow-up.

Results: Patient characteristics were similar between groups. Early distal stent graft-induced new entry occurred in none of the Stent group versus 6 patients (18%) in the Fabric group (p = 0.04). Both groups showed similar false lumen thrombosis at arch and descending aorta. Freedom from distal aortic events at 1, 3, and 5 years was 100%, 81%, 81% (Stent group) versus 79%, 67%, 33% (Fabric group) (p = 0.049).

Conclusions: Anastomosis at the stent part during frozen elephant trunk procedure reduced distal stent graft-induced new entry and improved mid-term outcomes. In distal anastomosis, the fabric should be as short as possible.

Objective: We evaluated trends and outcomes of aortic valve-preserving surgery (AVPS) in Japan, particularly with regard to aortic regurgitation (AR), in comparison with data from 2014.

Methods: We conducted a nationwide survey across 244 hospitals in Japan, focusing on aortic valve and aortic root surgeries performed in 2019. The breakdown of procedures, including isolated aortic valvuloplasty (AVP) and valve-sparing root replacement (VSRR), in AR patients was examined, and compared with the results from 2014.

Results: In 2019, the isolated AVP rate for AR was 5.5%, down from 7.5% in 2014. The VSRR rate among aortic root surgeries remained (33.1%). Within VSRR procedures, aortic valve reimplantation (reimplantation) accounted for 62.7% of cases, aortic root remodeling (remodeling) for 32.0%, and other root replacement techniques for 5.3%. AVPS was performed in 102 hospitals, with 10 institutions accounting for 42.2% of all cases. One-year reoperation rates for AVP, reimplantation, remodeling, and other root replacement were 8.0%, 1.8%, 6.0%, and 14.3%, respectively. Short-term (up to 4 years) aortic valve-related reoperation rates for AVP, reimplantation, and remodeling were 9.7%, 6.1%, and 9.5%, respectively. Use of a pericardial patch emerged as an independent risk factor for reoperation following AVPS (P = 0.022; odds ratio 3.382; 95% confidence interval 1.195-9.570).

Conclusions: The rate of AVP performed for AR in Japan decreased significantly from 2014 to 2019, while the rate of VSRR for root procedures remained stable. Use of a pericardial patch was identified as an independent risk factor for aortic valve-related reoperation following initial repair.

Objective: Spread through air spaces (STAS) in lung adenocarcinoma impacted prognosis and treatment decisions, but lacked reliable preoperative prediction. We aimed to construct an easy-to-use model for clinical stage IA adenocarcinoma patients.

Methods: This study analyzed 1212 patients with clinical stage IA lung adenocarcinoma undergoing lung resections from November 2020 to January 2022. Two logistic regression models were developed. Model 1 used demographic and computed tomography features, and Model 2 incorporated maximum standardized uptake values additionally. Internal validation used tenfold cross-validation. Model discrimination and calibration were described by the area under the curve (AUC) and Spiegelhalter z test, respectively.

Results: Prevalence of STAS was 10.6%. Model 1 consisted of maximum tumor diameter, smoking history, location, spiculation and lobulation, showing moderate discrimination (AUC = 0.700). Model 2 consisted of smoking history, the maximum standardized uptake value, spiculation and lobulation, receiving an AUC of 0.807 and good calibration. Model 2 has a sensitivity and a specificity of 0.857 and 0.652. A nomogram for Model 2 was also developed.

Conclusion: Our study developed and validated two predictive models for STAS for clinical stage IA lung adenocarcinoma. Model 2, integrating maximum standardized uptake value, outperformed Model 1 and offered a more comprehensive approach to predicting STAS. Surgeon could consider the results of Model 2 and intraoperative frozen sections sequentially to optimize surgical strategies. External validation remained warranted.

Background: Reinterventions after congenital heart disease surgery include not only reoperations but also medical catheter interventions, and the details of these treatment realities are often unclear. This study aimed to elucidate the medical and surgical reinterventions and associated medical costs after the tetralogy of Fallot (TOF) repair using Japanese health insurance claims data.

Methods and results: We analyzed reinterventions and medical costs from insurance claims data of patients who underwent TOF repair between 2005 and 2021. Of 174 patients who underwent TOF repair, 23 (13.2%) received a total of 34 reinterventions. These included 23 percutaneous catheter interventions and 11 reoperations. The 5-year reintervention-free rate was 87.5% overall, 94.9% for surgeries with right ventricular outflow tract reconstruction (N = 130), and 65.6% for surgeries with peripheral pulmonary artery plasty (N = 44). The median (interquartile range) medical cost for patients without reintervention was ¥5.33 million (4.62-7.14 million) and the cost for the patients with reintervention was ¥ 10.59 million (7.73-13.97 million).

Conclusion: Using Japanese insurance claims data, we analyzed the reoperation and catheter intervention after the TOF repair. The reintervention-free rate after TOF repair differed significantly by surgical procedure with a tendency for poorer postoperative prognosis, particularly in cases involving the peripheral pulmonary artery plasty. These analysis results may contribute to predicting outcomes after TOF repair for healthcare professionals.

Objective: Systolic anterior motion (SAM) is an important factor for hypertrophic obstructive cardiomyopathy (HOCM) patients with a hypertrophic interventricular septum. We developed the 'floating stitch technique' to relieve SAM and have used it since 2017. The mid-term results of the floating stitch technique are reported.

Methods: Ten consecutive HOCM patients (5 male, mean age 65.6 years) who underwent septal myectomy and the floating stitch technique from 2017 to 2022 were included. All patients underwent preoperative, pre-discharge, and annual follow-up echocardiographic evaluations. The median postoperative observation period was 3.5 (range 1.2-6.6) years.

Results: There were no cases of cutting or elongation of the floating stitch during the follow-up period. The median mitral valve area (MVA) was 2.9 [interquartile range (IQR) 2.6-3.1] cm² before surgery, 2.6 (IQR 2.2-2.7) cm² before discharge, and 2.6 (IQR 2.2-2.8) cm² at the latest follow-up. There were no cases of mitral stenosis clinically. All cases showed a significant decrease in the left ventricular outflow tract pressure gradient after surgery, but one case required re-operation due to recurrent obstruction at the mid-cardiac position. SAM did not recur in any cases, and all patients were in NYHA class 1 at the latest follow-up.

Conclusions: The floating stitch technique showed an excellent SAM-suppression effect and durability. MVA decreased about 10% following the floating stitch technique, but sufficient area was secured without functional mitral stenosis. The combination of septal myectomy and floating stitch technique is a simple and reproducible procedure for HOCM, especially with severe SAM.