General Thoracic and Cardiovascular Surgery最新文献

Objectives: Thoracic empyema is a serious infection. Video-assisted thoracoscopic surgery is a recommended treatment, and pleural fluid and tissue cultures are collected intraoperatively. The combination of a pleural peels tissue culture and a pleural fluid culture improves the positive culture rate. We aimed to investigate the role of respiratory secretion cultures to determine the optimal management for improving surgical outcome.

Methods: The study analyzed 225 adult patients with phase II/III thoracic empyema who underwent thoracoscopic decortication. Respiratory secretion cultures were obtained and compared with pleural cultures. Key outcomes were culture positivity and pathogen consistency, with secondary outcomes including intensive care unit stay, hospital stay, and mortality.

Results: There were 225 empyema patients with either a positive pleural fluid culture or a positive pleural peel tissue culture. Of these, 76 patients had positive respiratory secretion culture findings during hospitalization. The most common pathogen species were Pseudomonas aeruginosa (44%) and Klebsiella pneumoniae (16%) in the respiratory secretion cultures and Streptococcus spp. (38%) and Klebsiella pneumoniae (12%) in the pleural cultures. There were 30 patients having a common pathogen in the respiratory secretion culture and in the pleural fluid/tissue culture. Poor outcome measures were found in these patients, including the longer use of antibiotics preoperatively [2.50 (1.00-6.00) days versus 5.00 (2.75-11.00) days, p = 0.006] and a higher mortality rate during hospitalization (40.0% versus 17.4%, p = 0.002).

Conclusions: Respiratory secretion cultures are vital for predicting surgical outcomes in bacterial empyema, and prompt specimen collection can improve patient survival.

Objective: The postoperative respiratory function has been compared between lobectomy and segmentectomy based on the resting spirometric change in many previous studies. However, spirometric change has only been assessed in static conditions, and it is unclear whether it accurately reflects the cardiopulmonary function.

Methods: We used spirometry and a 6-min walk test to evaluate patients who underwent lobectomy and segmentectomy and examined the changes in heart rate (HR), respiratory rate (RR), and saturation of percutaneous oxygen (SpO₂) before and after walking between the two groups.

Results: The present study included 24 patients who underwent segmentectomy and 21 who underwent lobectomy. There was no significant difference in the reduction of the median forced expiratory volume in 1 s (FEV1.0) after surgery. In the 6-min walk test, the increase in HR and RR after surgery has no significant differences between lobectomy and segmentectomy (HR: p = 0.372 and RR: p = 0.131). However, the two groups showed a significant difference in the reduction of SpO₂ (p < 0.001). In addition, correlation analysis found that the more the number of resected segments, the more the reduction of SpO₂ with a statistical significance (p = 0.002).

Conclusions: Patients who received segmentectomy showed to suppress the reduction of SpO₂ with a statistical difference after the 6-min walk test in comparison to those who received lobectomy. These results suggest that segmentectomy has less impact on the cardiopulmonary function and the 6-min walk test is useful for evaluating the postoperative cardiopulmonary function.

Objective: Although the challenging prognosis of functional single ventricles with common atrioventricular valves due to complex morphology and uncontrollable regurgitation by valvuloplasty has been highlighted, reports on when and how these extremely complicated atrioventricular valves should be repaired are few. This study investigated the timing and risk factors for valve intervention in these patients.

Methods: Between April 2006 and March 2023, 40 patients with heterotaxy syndrome associated with functional single ventricles underwent surgery. Valve intervention was performed in 14 of the 40 patients with moderate or severe atrioventricular valve regurgitation.

Results: The timing of the first valve intervention varied, with four, five, three, and two patients undergoing valve intervention before the cavopulmonary shunt, simultaneously with the cavopulmonary shunt, before total cavopulmonary connection, and simultaneously with total cavopulmonary connection, respectively. Mechanical valve replacements were performed in three patients. Among the 14 patients undergoing valve intervention, four died. Three of the four patients underwent valvuloplasty before the cavopulmonary shunt, including two who could undergo the cavopulmonary shunt but died after the procedure. Eight of the fourteen patients completed total cavopulmonary connection. The cumulative survival rate was not significantly different between the 14 patients who underwent and 26 who did not undergo intervention (hazard ratio, 2.52; 95% confidence interval, 0.56-11.24; P = 0.23).

Conclusion: Our surgical strategies provide a chance for the next staged repair of common atrioventricular valves in patients with both heterotaxy and valvular regurgitation. Including patch augmentation, advanced valve intervention is possible at or after the cavopulmonary shunt.

A thorough literature search was conducted on patients with Left Ventricular Assist Device (LVAD) and aortic insufficiency undergoing transcatheter aortic valve replacement (TAVR). We identified all original research studies that compared the long-term outcomes of surgical transcatheter aortic valve replacement (SAVR) versus TAVR for patients with LVAD, published between 1990 and 2023. The primary endpoint was the composite of in-hospital mortality, stroke, transient ischemic attack, myocardial infarction (MI), pacemaker implantation, vascular complications and cardiac tamponade. Secondary endpoints were the median overall survival (OS), the incidence of acute kidney injury (AKI), any bleeding needing transfusions or reintervention and cost. A total of fourteen studies and 358 patients were included (TAVR: 242; SAVR: 116). The composite outcome, the incidence of AKI, the bleeding needing transfusion, along with cost were significantly higher in the SAVR group. In addition, there was no significant difference between TAVR and SAVR in terms of median OS. The median OS in the TAVR group was 18 months. Finally, the most common causes of death were progression of heart failure and pneumonia. The present meta-analysis indicates that TAVR is associated with enhanced outcomes compared to SAVR for patients with LVAD presenting aortic insufficiency. Further well-designed original studies with greater sample sizes are necessary to validate our findings.

Objective: Branched prostheses are used to treat aortic arch with dissection. However, changes in the neck vessel geometry and diameter after dissection are not well known. We aimed to evaluate neck vessels geometry and changes in diameter with dissection.

Methods: A total of 209 patients admitted to our hospital for acute type A aortic dissection, and we excluded patients with insufficient computed tomography image to evaluate neck vessels; as such 201 patients were included. We measured the neck vessels geometry with or without dissection, and additionally evaluated the pre- and postdissection neck vessel diameters in 16 patients for whom predissection computed tomography were available.

Results: The average differences between the non-dissected and dissected vessels were 3.0 mm in proximal innominate artery (IA), 2.8 mm in distal IA, 2.5 mm in proximal left carotid artery (LCCA), 3.1 mm in distal LCCA, 2.7 mm in proximal left subclavian artery (LSA), and 1.9 mm in distal LSA. The average pre- and postdissection diameters of the neck vessels were as follows: IA: 15.1 ± 2.6 and 16.7 ± 3.2 mm (P = 0.002); LCCA: 10.7 ± 0.9 and 12.3 ± 1.2 mm (P = 0.054); and LSA: 12.4 ± 2.5 and 12.8 ± 2.1 mm (P = 0.32).

Conclusion: In patients with acute type A aortic dissection, dissected neck vessels diameter is significantly larger than that of the non-dissected neck vessels diameter. However, the postdissection diameter changes in the neck vessels were mostly <2 mm.

Introduction: Off-pump coronary artery bypass graft surgery (OPCAB) has been suggested as superior to on-pump coronary artery bypass graft surgery (ONCAB) in certain high-risk subgroups, but its benefit in patients with chronic obstructive pulmonary disease (COPD) remains controversial. This meta-analysis aimed to evaluate OPCAB versus ONCAB outcomes in COPD patients.

Methods: We followed PRISMA guidelines and searched PubMed, Embase, and the Cochrane Library in August 2024 for studies comparing OPCAB and ONCAB in COPD patients. Statistical analysis was conducted using Review Manager 5.4.1 and Rstudio with a fixed or random effects model.

Results: Six studies with a total of 1,687 patients were included, of which 1,062 (62.95%) underwent OPCAB. The mean patient age was 63.6 years. OPCAB did not significantly affect all-cause mortality compared to ONCAB (OR 1.14; 95% CI 0.65-1.99). There were no significant differences in reintubation (OR 0.81; 95% CI 0.53-1.23), prolonged ventilation (OR 0.54; 95% CI 0.24-1.22), post-operative atrial fibrillation (OR 0.90; 95% CI 0.70-1.15), or ARDS (OR 0.43; 95% CI 0.14-1.33). However, ventilation time was significantly shorter in the OPCAB group (MD - 5.30 h; 95% CI - 7.22 to - 3.38).

Conclusion: OPCAB is associated with reduced ventilation time in COPD patients though it shows no significant difference in all-cause mortality or other post-operative complications compared to ONCAB.

Objectives: Pulmonary function after lobectomy is often higher than what is predicted. This occurrence could be related to postoperative expansion of the residual lung. The study aim was to determine if residual lung expansion affects pulmonary function after lobectomy.

Methods: The participants in this retrospective study were 142 patients who had undergone lobectomy via video-assisted thoracic surgery. Computed tomography and pulmonary function tests were performed preoperatively and 1 year postoperatively. Three-dimensional computed tomography volumetry was performed to assess lung volumes preoperatively and postoperatively, and the predicted postoperative forced expiratory volume in 1 s was calculated. The residual lung expansion ratio was defined as the postoperative-to-preoperative residual lung volume ratio, and the postoperative forced expiratory volume in 1 s ratio was defined as the measured-to-predicted postoperative forced expiratory volume in 1 s ratio. The effect of the residual lung expansion ratio on the postoperative forced expiratory volume in 1 s ratio as well as the factors affecting the postoperative forced expiratory volume in 1 s ratio were evaluated.

Results: The median residual lung expansion ratio was 1.17 (interquartile range: 1.10-1.24), and the median postoperative forced expiratory volume in 1 s ratio was 1.13 (interquartile range: 1.04-1.21). The residual lung expansion ratio significantly affected postoperative forced expiratory volume in 1 s ratio (p < 0.001).

Conclusion: After lobectomy, better residual lung expansion was associated with improved postoperative pulmonary function.