General Thoracic and Cardiovascular Surgery最新文献

Objective: The Nuss procedure is widely applied for the treatment of pectus excavatum (PE); however, postoperative infection remains a significant concern. Herein, we evaluated the postoperative outcomes and risk factors for postoperative infections following the Nuss procedure.

Methods: This study comprised a retrospective review of 112 cases of PE treated via the Nuss procedure between January 2019 and March 2024. Postoperative infection control measures, including thorough disinfection of the surgical field and perioperative intravenous administration of cefazolin, were ensured in all cases. Patient characteristics, surgical outcomes, and postoperative complications were analyzed, and risk factors for postoperative infection were assessed via multivariate analysis.

Results: Postoperative complications were observed in 17 cases (15.2%), including 6 (5.4%) with infection. Atopic dermatitis (AD) was significantly more common in the infection group (4/6, 66.7%) than in the non-infection group (8/106, 7.6%, p < 0.01). Multivariate analysis further identified the use of topical steroid medications for AD as the only independent risk factor for postoperative infection (Odds Ratio: 51.0, 95% CI: 7.12-366.0). Notably, two infections occurred beyond the typical 90-day surveillance period.

Conclusions: AD is a significant risk factor for postoperative infection following the Nuss procedure, particularly when managed with topical steroid medications. These results suggest that patients with AD undergoing this procedure require meticulous preoperative management, rigorous infection control measures, and extended follow-up owing to the continued risk of infection throughout the bar placement period.

Objective: This study aims to compare early postoperative outcomes of robotic-assisted mitral valve replacement (r-MVR) and conventional sternotomy-based mitral valve replacement (c-MVR) in patients with rheumatic mitral valve disease (RMVD).

Methods: A retrospective analysis included 225 adult patients who underwent isolated MVR for RMVD between November 2018 and December 2023. Among them, 105 underwent r-MVR and 120 underwent c-MVR. Evaluated parameters included operative time, cardiopulmonary bypass (CPB) and cross-clamp times, extubation time, ICU and hospital stay, chest drainage, mechanical ventilation duration, postoperative pain scores, complications, and 30-day mortality.

Results: Patients in the r-MVR group showed significantly better short-term outcomes. Postoperative drainage was lower (323 ± 154 mL vs. 532 ± 320 mL), red blood cell transfusion was reduced (0.8 ± 0.9 vs. 2.3 ± 2.4 units), and intubation time was shorter (10.2 ± 6.2 vs. 17.7 ± 21.3 h) compared to the c-MVR group (p < 0.001). Additionally, hospital stay (6.8 ± 3.7 vs. 9.4 ± 4.7 days) and pain scores (2.4 ± 0.85 vs. 3.5 ± 0.96) were significantly improved in the robotic group. However, CPB and cross-clamp times were longer in r-MVR (168 ± 47 vs. 104 ± 31 min and 106 ± 34 vs. 69 ± 21 min, respectively; p < 0.001). Complication and 30-day mortality rates were similar between groups.

Conclusion: Robotic-assisted mitral valve replacement is a safe and effective alternative to conventional surgery in RMVD. Despite longer operative times, it offers better early recovery and may be preferred in experienced centers for selected patients.