General Thoracic and Cardiovascular Surgery最新文献

Objective: This study aims to evaluate the efficacy of Large Language Models (LLMs) in generating patient educational content on pediatric cardiothoracic surgical procedures.

Methods: In this comparative observational study we employed five LLMs, ChatGPT 4o, ChatGPT 4, Google Gemini, Perplexity AI and Claude AI, to create educational pamphlets for 24 different pediatric cardiothoracic procedures. Each LLM produced three pamphlets per procedure, resulting in a total of 360 unique pamphlets. These pamphlets were evaluated for accuracy, consistency, and relevance using structured scoring scales. Five reviewers were employed, resulting in 1800 evaluations for accuracy and 600 for consistency. Patient advocates independently reviewed relevance. Readability was assessed using six different metrics.

Results: The study revealed significant differences in accuracy, with Perplexity AI performing best in cardiac procedures (p < 0.00001) and Claude AI excelling in pulmonary procedures (p = 0.001). Consistency across models varied significantly, with ChatGPT 4 having high variability across pamphlets. Readability analysis indicated that Gemini produced the most comprehensible content. The overall relevance of the pamphlets was highest with Perplexity AI (p < 0.00001). Post-hoc analysis revealed that overall, ChatGPT 4 and Perplexity AI tend to have similar levels of readability across the measures.

Conclusion: LLMs demonstrate significant potential in creating educational materials for pediatric cardiothoracic surgery. However, our findings suggest that their effectiveness varies based on the type of procedure and evaluation criteria. Tailoring LLM-generated content to specific contexts, along with physician oversight, is critical. Additionally, readability should be optimized to ensure adequate comprehension by the general public.

Background: Although retrosternal route reconstruction is commonly used in esophagectomy, its anatomical constraints may increase the risk of anastomotic leakage because of the compression of reconstructed organs and deformation of the anastomosis. Therefore, this study retrospectively investigated the effect of anastomosis deformation on leakage.

Methods: In this study, 228 patients who underwent esophagectomy with the McKeown method and triangular anastomosis between 2009 and 2022 were included. The postoperative computed tomography images were analyzed to measure the axial deviation of the esophagogastric anastomosis in the coronal (AD-C) and sagittal (AD-S) images. Moreover, the relationship between axial deviation and anastomotic leakage was examined.

Results: No significant differences were observed between patients with and without anastomotic leakage in terms of patient background, cancer stage, or surgical technique. However, the patients with anastomotic leakage had significantly greater AD-C and AD-S values than those without. Multivariate analysis identified AD-C > 20° as an independent risk factor for anastomotic leakage (odds ratio, 4.93; 95% confidence interval, 2.06-11.92; p < 0.01).

Conclusions: The axial deviation of the esophagogastric anastomosis is a potential risk factor for anastomotic leakage during retrosternal reconstruction. Further studies incorporating three-dimensional imaging and biomechanical analysis are needed to clarify its impact and optimize the anastomotic geometry.

Background: In South Korea, extracorporeal membrane oxygenation (ECMO) is used as a bridge to optimize utilization of heart obtained from donors after brain death. However, the heart utilization rate and the effectiveness of ECMO in donation after brain death (DBD) donors, prior to donation, remain unclear. This study aimed to analyze the early postoperative outcomes of recipients who received hearts from DBD donors supported by ECMO, and to identify the factors associated with successful transplantation outcomes.

Methods: Donors who received ECMO support were divided into two groups, one, whose hearts were successfully transplanted (n = 3), and the other, whose hearts were not utilized for transplantation (n = 13), at our institution between 2013 and 2024. Preoperative donor characteristics of the two donor groups were compared to identify the factors influencing successful heart transplantation. Recipients' preoperative, intraoperative findings, and 1-year postoperative outcomes were analyzed.

Results: Among 190 DBD donors, 16 (8.4%), supported by ECMO, were grouped. The transplanted heart rate in this group was 18.8% (3 out of 16 ECMO-supported potential donors). The 1-year graft survival and recipient survival rates were 100%. The transplanted donor group tended to be younger than the non-transplanted group, with a median age difference of 26 years (p = 0.031).

Conclusion: Prior to donation, ECMO can be effectively used in brain-dead donors, to improve the rate of heart transplants. The postoperative outcomes of recipients, who received hearts procured from ECMO-supported donors, were satisfactory. Among ECMO-supported DBD donors, the median age tended to be lower in the transplanted donor group.

Objectives: Ventricular septal rupture is a rare but fatal complication of acute myocardial infarction. Although mechanical circulatory support is increasingly being used to stabilize the hemodynamics in such cases, its definitive clinical benefit remains unclear. Delayed surgical intervention after achieving hemodynamic stabilization with mechanical circulatory support is considered to offer better outcomes than emergency surgery. This study aimed to evaluate the efficacy of using the Impella device (Abiomed, Danvers, MA, USA) as a bridge to surgical repair in patients with post-infarction ventricular septal rupture.

Methods: We retrospectively analyzed 12 patients who underwent surgical ventricular septal rupture closure under perioperative Impella support between October 2022 and June 2025 at our institution.

Results: The 30-day mortality was 8% (1/12 patients). The mean duration from admission to surgery was 64 ± 35 h (range 2-118 h). Preoperatively, inhaled nitric oxide (NO) was administered to nine patients (75%). The mean serum lactate concentration was 24.9 mg/dL at presentation and improved to 10.2 mg/dL at the time of surgery (p=0.001). One device-related complication was observed. A residual shunt was present in four patients (33%), one of whom required reoperation.

Conclusions: Our findings demonstrated favorable early outcomes with a 30-day mortality of 8%. Impella support facilitated preoperative optimization of the systemic condition and enabled a safe transition to definitive surgical repair. Further investigations are warranted to refine the optimal timing of surgery and to assess long-term outcomes in this challenging population of patients with ventricular septal rupture.

Objectives: Primary spontaneous pneumothorax (PSP) is a condition that primarily affects young patients and has a high recurrence rate. While surgery is the treatment option associated with the lowest recurrence rate for PSP, some patients experience long-term chest drain placement due to prolonged air leak. Our study aimed to elucidate the relationship between coagulation abnormalities and prolonged postoperative air leak in PSP.

Methods: Patients who underwent surgery for PSP were retrospectively reviewed. Patients were divided into the exploratory and the validation cohorts. From the exploratory cohort, patients with prolonged chest drain placement were identified as the air-leak prolonged (AL-P) group, and the Control group matched at a 1:4 ratio was selected using propensity score matching.

Results: In the exploratory cohort, 15 patients were assigned to the AL-P group and 60 to the control group. Among the coagulation markers including prothrombin time, activated partial thromboplastin time (APTT) and platelet count, univariate analysis revealed a significantly prolonged APTT in the AL-P group (median 33 vs. 31 s, odds ratio 1.26, p = 0.006). Multivariate analysis identified prolonged APTT as an independent risk factor for prolonged chest drain placement. Receiver operating characteristic curve of APTT values for predicting the incidence of prolonged chest drain placement showed a cutoff of 31.5 s. In the validation cohort, patients with an APTT ≥ 31.5 s showed significantly longer chest drain placement (p = 0.03).

Conclusions: Our study suggests a potential association between prolonged APTT and prolonged postoperative chest drain placement in patients with PSP.