General Thoracic and Cardiovascular Surgery最新文献

Objective: We investigated whether the coagulation function was improved and bleeding tendency was controlled by fibrinogen concentrate.

Methods: In 32 patients with hypofibrinogenemia < 150 mg/dL during either thoracic or thoracoabdominal aortic surgery, blood coagulation ability was observed using ROTEM Sigma® and the 3 min bleeding amount was measured during surgery.

Results: The mean blood fibrinogen levels decreased to 109 ± 26 mg/dl at the end of cardiopulmonary bypass, but significantly increased to 231 ± 38 mg/dl after the administration of fibrinogen concentrate (p < 0.0001). The 3 min bleeding amount was 144 ± 88 ml after heparin neutralization, but it significantly decreased to 85 ± 74 ml with fibrinogen concentrate (p = 0.0001). FIBTEM A10 was extremely low at 4.8 ± 2.7 mm after heparin neutralization, but the value increased to 14.1 ± 4.1 mm with fibrinogen concentrate (p < 0.0001). EXTEM A10 (the extrinsic coagulation ability) and INTEM A10 (the intrinsic coagulation ability) were both low at 31.3 ± 11.0 mm and 30.9 ± 10.7 mm, after heparin neutralization, but they both significantly increased to 42.2 ± 8.9 mm and 39.1 ± 8.7 mm (p < 0.0001) with fibrinogen concentrate. There were no operative deaths, but there were three cases in which thromboembolism could not be ruled out. Two patients had myocardial infarction due to occlusion of the reconstructed right coronary artery and the other had newly developed cerebral infarction, but the causes could not be clarified.

Conclusion: The administration of fibrinogen concentrate rapidly increased blood fibrinogen levels and significantly reduced the 3 min bleeding amount. In addition, significant improvements in extrinsic and intrinsic coagulation abilities were observed with the administration of fibrinogen concentrate.

Purpose: The intrapulmonary location of a tumor is important for evaluating recurrence risk. This study assessed the prognostic impact of the tumor-pleura distance (TPd) in patients with clinical stage IA solid-predominant or pure-solid non-small cell lung cancer (NSCLC), as well as associations with pleural invasion, recurrence, and tumor subtype defined by the consolidation-to-tumor ratio (CTR).

Methods: A total of 358 patients who underwent anatomical lung resection for clinical stage IA NSCLC between 2014 and 2023 were retrospectively analyzed. TPd and CTR were measured on preoperative computed tomography. Receiver-operating characteristic analysis for pleural invasion identified an optimal TPd cutoff of 2.0 mm.

Results: A 2-mm cutoff classified tumors as pleura-adjacent (< 2 mm) or non-pleura-adjacent (≥ 2 mm), with pleural invasion observed in 23.5% of pleura-adjacent and 4.5% of non-pleura-adjacent tumors (P < 0.001). The 5-year recurrence-free survival (RFS) rate was significantly lower in the pleura-adjacent group (68.9% vs. 80.2%, P = 0.021). Multivariate analysis identified pleura-adjacent as an independent predictor of RFS (HR, 1.755; 95% confidence interval (CI) 1.097-2.805; P = 0.019). In the pure-solid subgroup, pleura-adjacent tumors were an independent predictor of RFS (HR, 2.168; 95% CI 1.283-3.663; P = 0.004); no association was found in the solid-predominant subgroup. In the pure-solid subgroup, competing-risk analysis identified pleura-adjacent as an independent risk factor for locoregional recurrence (HR, 2.558; 95% CI 1.250-5.234; P = 0.010).

Conclusion: TPd < 2 mm is a radiological marker strongly associated with pleural invasion. Its adverse prognostic impact was the most evident in pure-solid tumors, in which pleura-adjacent lesions were linked to poorer RFS and higher locoregional recurrence.

Objectives: Cryopreserved aortic allografts in pediatric patients have limited durability due to graft calcification, resulting in high rate of reoperations. Physiological hyperphosphatemia in the young, coupled with inflammatory responses against post-transplant allografts, accelerates allograft calcification in a rat model. We aimed to examine the anti-calcification effect of a phosphate binder, lanthanum carbonate, on aortic allografts in a growing porcine model with blood flow and pressure that resembled clinical settings.

Methods: Four-week-old male specific pathogen-free crossbred piglets were used as donors and recipients. The descending aortas harvested from 5 donors were divided, cryopreserved, and transplanted into the descending aorta of 10 recipient piglets. The lanthanum group received lanthanum carbonate (45 mg/kg/day for 1 week preoperatively and 4 weeks postoperatively; n = 5) and was compared to the control group (without lanthanum carbonate; n = 5). The conduits were explanted at 8 weeks and examined using von Kossa staining and for calcium content quantification by atomic absorption spectroscopy. The sera and femurs were also retrieved to analyze adverse events of lanthanum carbonate.

Results: In the lanthanum group, allograft medial calcification developed less frequently, and the calcium content of the allografts was significantly lower than that in controls (p = 0.009). Body weight, hematocrit levels, and femur mineral density did not differ significantly between the groups at 8 weeks.

Conclusions: Our results suggest that short-term lanthanum carbonate administration may alleviate cryopreserved allograft calcification in young recipients, without adverse effects.

Background: Pulmonary sequestration (PS) is a rare congenital lung malformation often requiring surgical resection due to recurrent infections or hemoptysis. Traditionally treated via open thoracotomy, recent advancements have made minimal-invasive approaches like robotic-assisted thoracoscopic surgery (RATS) increasingly viable. This study compares outcomes between RATS and open resection for PS in a high-volume center.

Methods: In this retrospective cohort study, 23 adult patients who underwent surgical resection of PS between 2010 and 2023 were analyzed. Fifteen patients were treated via open thoracotomy (THKT), while eight underwent RATS using the DaVinci-X system. We compared preoperative findings, intraoperative variables, and postoperative outcomes.

Results: The patients in the RATS group were younger (median age: 36 vs 47 years) and had a shorter median hospital stay (5 vs 10 days, p < 0.001) compared to the THKT group. The RATS group also experienced earlier chest drainage removal (3 vs. 4 days, p = 0.016). However, the median duration of surgery was longer for RATS (118 vs. 75 min, p = 0.018). A trend towards less postoperative complications was observed in the RATS group (33% vs. 0%).

Conclusions: RATS provides a safe and effective alternative to open surgery for PS resection, with benefits including reduced hospital stay and earlier chest tube removal. Despite longer operative times, the minimally invasive approach may offer enhanced recovery and fewer complications. Continued accumulation of experience with RATS is likely to improve operative efficiency, making it a valuable option in the surgical management of pulmonary malformations.