General Thoracic and Cardiovascular Surgery最新文献

Objectives: Evidence to establish standardized damage control surgery for severe chest trauma is insufficient. Therefore, we aimed to evaluate the outcomes, complications, effectiveness, and safety of temporary chest closure and open chest management in our hospital.

Methods: We retrospectively reviewed the backgrounds and perioperative outcomes of 10 patients who underwent open chest management with temporary chest closure for severe trauma at our hospital from January 2015 to June 2024 using their medical records.

Results: The median patient age was 54 years, nine patients had blunt multiple trauma, and one patient had an isolated, penetrating chest injury. All patients had hemorrhagic shock upon arrival: the median chest Abbreviated Injury Scale score and Injury Severity Score were 4.5 and 30, respectively. The initial chest surgery was thoracotomy-based hemostasis for injuries of the chest wall, lungs, heart, and great vessels in six cases, and pulmonary resection for lung injury in four cases; all cases involved open chest management with temporary chest closure after intrapleural gauze packing. The median operative time and intraoperative bleeding was 72 min and 1710 mL, respectively. Seven of the 10 patients survived, with a median open chest management period of 2 days, with no postoperative empyema or wound infection.

Conclusion: Open chest management with temporary chest closure for severe chest trauma is useful for the prompt completion of the initial chest surgery and initiation of treatment for concomitant injuries and resuscitation in the intensive care unit.

Objective: Posterior pericardiotomy can be performed after cardiac surgery to drain pericardial fluid and reduce the incidence of postoperative atrial fibrillation. However, the effect of posterior pericardiotomy in minimally invasive direct coronary artery bypass surgery on the development of postoperative atrial fibrillation remains unknown.

Methods: The patients included in our study underwent complete revascularization through left anterior thoracotomy under cardiopulmonary bypass, using X-clamp and cardioplegia, without any limitations on coronary lesion type or localization. Patients who underwent minimally invasive direct coronary artery bypass were retrospectively divided into two groups: the control group, consisting of patients who did not undergo posterior pericardiotomy, and the posterior pericardiotomy group, consisting of patients who underwent posterior pericardiotomy after this date. The two groups were retrospectively compared in terms of postoperative atrial fibrillation development, the day of left thoracic drain removal, and clinical characteristics.

Results: Lower development of atrial fibrillation was observed in the posterior pericardiotomy group (n = 10, 13.3%) compared to the control group (n = 20, 30.3%) (p = 0.024). When comparing the days of drain removal, the left thoracic drain was removed later in the patients in the posterior pericardiotomy group compared to the control group (3.2 ± 1.18, 2.6 ± 0.96, p = 0.007). There was no difference between the groups in terms of patient characteristics compared (p > 0.05).

Conclusion: In this revascularization technique, where the left-sided pericardiotomy is partially closed to prevent cardiac herniation, posterior pericardiotomy may help prevent the development of postoperative atrial fibrillation by facilitating the drainage of pericardial fluid.

Objectives: Impedance pneumography (IP) records respiratory cycle and provides non-invasive means to evaluate changes after thoracic surgery. This comparative study evaluated if changes after thoracic surgery can be modified by two pulmonary rehabilitation modalities.

Methods: 88 patients undergoing thoracic surgery were randomly allocated to either positive expiratory pressure (PEP) or inspiratory muscle training (IMT) physiotherapy group. Physiotherapy was performed and IP recorded preoperatively and at first and second postoperative days (POD1 and POD2) during tidal breathing. Full three timepoint IP data were collected from 81 patients (42 in the PEP group, 39 in the IMT group). Average inspiration and expiration time in seconds (TinspAvg and TexpAvg) and average breathing frequencies (BrthFreqAvg) were calculated from a 10-min measurement period and assessed as primary outcomes. Results were also assessed in blocks of different surgical techniques (thoracotomy or VATS) and the extent of surgery (pulmonary resection or minor thoracic operation).

Results: TinspAvg and TexpAvg decreased after surgery but started to increase in the IMT group between POD1 and POD2 with no significant difference compared to PEP group. Among patients operated with thoracotomy TexpAvg was slightly but insignificantly higher in the IMT group at POD2. The ratio between the time of expiration and the time of inspiration (EI ratio) was significantly higher in the IMT group with thoracotomy (difference between groups over three timepoints, (p = 0.044) and at POD1 (p = 0.015)).

Conclusions: IMT seemed to enhance expiration specifically among thoracotomy patients and thus may provide means for enhancing the recovery after thoracic operations.

Clinical trial registration: NCT02931617/U.S. National Library of Medicine, ClinicalTrials.gov.

Objectives: We sought to examine long-term results of the total cavopulmonary connection with an extracardiac lateral tunnel using expanded polytetrafluoroethylene graft and the outside of right atrial wall, with special attention to angiographic evaluation of serial changes of the tunnel geometry.

Methods: Of 113 patients subjected to the Fontan operation between April 2003 and April 2022, 65 patients who opted for the extracardiac lateral tunnel technique were retrospectively analyzed. Of these, 35 patients who had at least two postoperative catheterizations (mean 0.7 ± 0.4 and 6.6 ± 3.5 years post-op) were analyzed for changes in tunnel diameter.

Results: There was one case (1.5%) of 30-day death, and three late deaths. The cumulative survival rate at 14 years after the surgery was 91.2%. There was one case (1.5%) which required conversion to total cavopulmonary connection with an extracardiac conduit. Angiographically, Fontan route diameter increased significantly at both the level of inferior vena cava anastomosis (11.0 ± 2.4 to 14.9 ± 3.4 mm, P < 0.001), the middle level of Fontan route (11.0 ± 2.5 to 12.9 ± 3.2 mm, P < 0.001), and the level of pulmonary artery anastomosis (10.0 ± 2.5 to 13.6 ± 4.9 mm, P < 0.001), whereas the diameter indexed to the normal inferior vena cava remained over 100%.

Conclusions: Long-term results of the Fontan operation with extracardiac lateral tunnel using half cut expanded polytetrafluoroethylene graft and outside of the right atrium were favorable. Proportional increase of conduit size was demonstrated, suggesting a potential of the conduit to grow and that the growth might correlate with somatic growth.

Objectives: Recent advances in therapeutics have substantially improved breast cancer treatment outcomes. However, data on prognostic factors after surgical resection of pulmonary metastases from breast cancer remain limited.

Methods: This single-center retrospective study analyzed data from patients with breast cancer who had undergone pulmonary metastasectomy between 2000 and 2023. We reviewed clinical and pathological parameters, including the disease-free interval (DFI), size and number of pulmonary metastases.

Results: This study included 33 patients. The median postoperative survival of breast cancer patients with lung metastasis was 40 (range 4-217) months. According to univariate analysis, hormone receptor-positive breast cancer, pStage I or II breast cancer, lung metastases < 20 mm, hormone receptor-positive lung metastases, absence of other metastases, and DFI ≥ 24 months were significantly associated with better survival. Multivariate analysis identified DFI < 24 months (hazard ratio [HR] 9.520, 95% confidence interval [CI] 2.158-27.070) and tumor size ≥ 20 mm (HR 4.958, 95% CI 1.290-27.550) independently predicted poorer survival; ≥ 2 metastatic lesions showed a non-significant trend toward worse outcomes (HR 3.272, 95% CI 0.913-11.090).

Conclusions: This study clarified the criteria for pulmonary metastasectomy in patients with breast cancer. Considering subtype changes between the primary tumor and metastases could enable personalized therapies.

Objective(s): Due to the poor prognosis of dialysis patients, accurately predicting life expectancy after aortic stenosis surgery remains challenging, leading to potential misselection of treatment options. This study aimed to develop a prognostic model specific to dialysis patients to facilitate individualized treatment selection.

Methods: A total of 171 dialysis patients with aortic stenosis who underwent initial isolated surgical aortic valve replacement at seven cardiovascular centers in Japan between 2011 and 2021 were enrolled. The cohort was randomly divided into the training and validation cohorts in a 2:1 ratio. Risk factors contributing to mortality were identified from preoperative variables, and a prognostic model was developed using the Cox proportional hazards model.

Results: Among the 171 patients, 88 deaths occurred during the total observation period of 488.9 person-years. The cumulative overall survival rates at 1, 3, and 5 years, estimated using the Kaplan-Meier method, were 74.7%, 59.4%, and 38.7%, respectively. An optimal risk model was developed, incorporating six factors: age, serum albumin, peripheral artery disease, sex, insulin-dependent diabetes mellitus, and atrial fibrillation. The model demonstrated strong predictive accuracy, with a 5-year C-statistic of 0.723 (95% confidence interval: 0.658-0.788) and 0.656 (95% confidence interval: 0.543-0.770) in the training and validation cohorts, respectively. Calibration plots confirmed that actual survival up to 5 years was well predicted (intraclass correlation coefficient = 0.918, 95% confidence interval: 0.703-0.981).

Conclusions: The proposed model is a reliable prognostic tool for dialysis patients who underwent surgical aortic valve replacement.

Objective: Reduction of bleeding and prolonged air leak (>5 days) following major lung resection remains a challenge. Hemostasis and aerostasis devices can facilitate earlier pleural de-drainage and fast-track. Our objectives were to evaluate the efficacy of TenaTac^® (an elastic, adhering patch approved as a medical device) in reducing bleeding and prolonged air leak after major lung resection.

Methods: This monocentric retrospective case-control study, using prospectively collected data, includes 60 patients who underwent, between 2022 and 2024, minimally invasive robot-assisted lobectomy or segmentectomy: 30 with TenaTac^® vs. 30 with other devices. Data were extracted from Epithor, the French national database, with ethics committee validation.

Results: Patients characteristics, Index of Prolonged Air Leak, and surgical procedures were similar in both groups (NS). TenaTac^® hemostatic benefit was comparable to other devices (p = 0.56). Prolonged air leak rate was significantly lower with TenaTac^® (3%) than for control devices (37%) (p = 0.0004). Post-operative air leakage duration was significantly shorter in TenaTac^® group than in control group (2.23 ± 2.57 vs. 4.23 ± 3.87 days, p = 0.01). Mean drainage duration and length of stay were both reduced with TenaTac^® by 36 hours. No significant difference was observed between the two groups in terms of morbidity (90-day post-operative complications classified as Clavien-Dindo grade>II, p = 0.33), readmission rates (nil), or 90-day mortality (no deaths).

Conclusions: Numerous hemostatic or aerostatic devices have been previously evaluated without achieving consensus in the prevention of prolonged air leak. As an absorbable, adherent gelatine patch, TenaTac^® significantly reduces the incidence of prolonged air leak after major lung resection.

Objective: Studies suggest that non-small cell lung cancer of the superior segment (S6) affects different lymphatic pathways and results in worse prognosis than basal segment tumors. We aimed to compare survival after lobectomy between non-small cell lung cancer in the S6 and basal segments, focusing specifically on pure-solid tumors, which have higher lymph node metastasis rates and worse prognosis.

Methods: We retrospectively reviewed patients with pure-solid, clinical N0 M0, ≤ 5-cm, lower-lobe non-small cell lung cancer who underwent lobectomy with hilar and mediastinal lymphadenectomy between April 2009 and December 2021. Overall survival, recurrence-free survival and clinicopathological characteristics were evaluated.

Results: We categorized 157 patients into S6 (n = 58) and basal segment (n = 99) groups. The 5-year overall survival (66.4% vs. 68.6%, respectively; p = 0.519; hazard ratio, 1.19; 95% confidence interval, 0.70-2.03), and recurrence-free survival (54.8% vs. 65.5%, respectively; p = 0.452; hazard ratio, 1.22; 95% confidence interval, 0.72-2.06) rates were comparable between the S6 and basal segment groups. Multivariable Cox regression analyses indicated that tumor location was not associated with overall or recurrence-free survival. The S6 group showed a higher tendency for visceral pleural invasion compared with the basal segment group. Superior mediastinal lymph node metastasis was pathologically confirmed exclusively in the S6 group (two cases).

Conclusions: No significant difference in survival was observed between S6 and basal segment pure-solid non-small cell lung cancer after lobectomy with hilar and mediastinal lymph node dissection.