General Thoracic and Cardiovascular Surgery最新文献

Objective: Studies have reported poor surgical outcomes in patients with lung cancer and interstitial lung disease. Therefore, we retrospectively analyzed the perioperative and long-term outcomes of this patient population.

Methods: Between 2004 and 2021, we enrolled 103 patients with interstitial lung disease and clinical stage I lung cancer (8th edition of the TNM classification) without a history of lung cancer treatment within 5 years before surgery and undergoing complete resection from our institution.

Results: The median patient age was 74 years (range: 60-89 years), and 90 patients were male. The most common surgical procedures were lobectomy (n = 85), followed by partial resection (n = 13), segmentectomy (n = 4), and pneumonectomy (n = 1). The median observation period was 1102 days. Concerning perioperative outcomes, 90-day postoperative mortality was 7 (6.8%) and complications (≥ Grade 3 according to the Clavien-Dindo classification) were observed in 30 patients (29.1%). Regarding long-term outcomes, lung cancer recurrence was observed in 38 patients. Fifty-six patients died during the observation period, but only 20 (35.7%) died of lung cancer recurrence. Pathological upstaging was observed in 51 patients (49.5%). The 5-year overall survival and recurrence-free survival rates were 48.6% and 41.8%, respectively.

Conclusions: A relatively high 90-day mortality rate was observed. Deaths from causes other than lung cancer recurrence were observed more frequently than those from lung cancer recurrence. Hence, when selecting treatment strategies for early lung cancer combined with interstitial lung disease, the risks of acute exacerbation and progression of interstitial lung disease should be considered.

Objective: Frailty is a major risk factor for adverse outcomes following cardiac surgery, yet its routine clinical integration is hindered by the lack of a standardized, convenient assessment method. This study aimed to develop and validate a simplified frailty model using three objective measures: gait speed, serum albumin, and grip strength.

Methods: In this prospective observational study of 261 patients (≥ 65 years) undergoing elective cardiac surgery, frailty was assessed using both the Japanese Cardiovascular Health Study criteria and our simplified model. The model defined frailty as having ≥ 2 of the following: slowness (gait speed < 1.0 m/s), hypoalbuminemia (albumin ≤ 3.5 g/dL), and weakness (grip strength < 28 kg for men, < 18 kg for women).

Results: The simplified model demonstrated high diagnostic accuracy for frailty defined by the Japanese Cardiovascular Health Study criteria (area under the curve = 0.868; sensitivity, 55.8%; specificity, 91.4%). Frailty defined by our model was a strong predictor of worse 3-year survival (hazard ratio, 10.43; 95% confidence interval, 2.82-38.58; p < 0.001) and event-free survival (hazard ratio, 2.52; 95% confidence interval, 1.47-4.34; p < 0.001), with prognostic power comparable to the Japanese Cardiovascular Health Study criteria.

Conclusions: A simplified frailty model incorporating gait speed, serum albumin, and grip strength provides robust diagnostic and prognostic utility. Its objectivity and ease of use may facilitate consistent preoperative risk stratification in patients undergoing cardiac surgery.

Purpose: Up-to-date national data on minimally invasive cardiac surgery (MICS) are essential for quality control but remain limited. This report summarizes 2022 outcomes of right- or left-minithoracotomy, thoracoscopic/port-assisted, and robotic-assisted MICS in Japan, based on the Japan Cardiovascular Surgery Database (JCVSD).

Methods: Data were collected from patients undergoing mitral valve repair/replacement (MV repair, n = 2525; MVR, n = 279), aortic valve replacement (AVR, n = 1114), coronary artery bypass grafting (CABG, n = 450), atrial septal defect closure (ASD, n = 212), and cardiac tumor resection (n = 113) using MICS approaches. Perioperative data included 30-day and in-hospital mortality, conversion rates, and major morbidities.

Results: For MV repair, the 30-day and in-hospital mortality rates were 0.3% and 0.2% in isolated cases (n = 1461) and 0.4% and 0.6% overall, respectively. Mortality rates for MVR were 2.5% and 4.2% in isolated cases (n = 120) and 2.9% and 4.3% overall, respectively. Mortality rates for AVR were 0.6% and 1.0% in isolated cases (n = 981) and 0.9% and 1.3% overall, respectively. Mortality rates for CABG were 1.6% and 1.8%, respectively. Mortality rates were 0% for both ASD closure and tumor resection. Across the groups, conversion to full sternotomy ranged from 0% to 1.8%.

Conclusion: The 2022 nationwide MICS data demonstrate consistently low mortality and morbidity across all procedure types. As MICS adoption grows, these updated JCVSD findings will serve as vital benchmarks for ongoing quality improvement in Japan.

Objectives: The indications for transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS) are gradually expanding in Japan, with insurance coverage for low-risk patients approved in 2021. Although some reports have compared procedural costs, data addressing low-risk populations remain limited. This study aimed to assess in-hospital costs and outcomes of isolated TAVR versus surgical aortic valve replacement (SAVR) in low-risk patients with AS in real-world practice in Japan.

Methods: We retrospectively analyzed 128 low-risk (Society of Thoracic Surgeons [STS] score < 4%) patients with AS who underwent isolated TAVR (n = 80) or SAVR (n = 48) between August 2021 and December 2024 at The University of Osaka Hospital.

Results: Both groups achieved excellent outcomes, with no in-hospital or 30-day mortality. Patients who underwent TAVR had shorter intensive care unit (ICU) stays (1 [1-1] vs. 3 [2-4] days) and shorter postoperative stays (7 [5-11] vs. 14 [11-18] days). However, total in-hospital and combined operative plus postoperative costs were significantly higher for TAVR (5.62 vs. 5.11 million Japanese Yen (JPY), p < 0.0001), (5.29 million vs. 4.80 million JPY, p = 0.0002).

Conclusions: In this cohort of low-risk patients with AS in Japan, TAVR was associated with significantly higher in-hospital costs than SAVR, despite shorter postoperative stay.

Objective: Prolonged preoperative fasting has been reported to increase patient discomfort, induce insulin resistance, and lead to complications and delayed recovery. We introduced preoperative oral carbohydrate (CHO) loading, and this study aimed to evaluate the influence on the outcomes of esophageal cancer surgery.

Methods: We evaluated 270 patients who underwent minimally invasive esophagectomy for esophageal cancer. Before implementation, patients fasted after the evening meal on the day before surgery and received glucose-electrolyte infusion. After implementation, patients received oral CHO loading up to three hours before surgery instead of infusion. We evaluated its impact on the incidence of perioperative complications, time to first defecation, length of hospital stay, and postoperative glycemic changes using interrupted time series analysis.

Results: There were 136 and 134 patients before and after implementation, respectively. No patient experienced aspiration during anesthesia induction. No significant changes were observed in the incidence of postoperative complications (coefficient 6.51, 95% confidence interval - 20.6 to 33.6) or length of stay (coefficient 1.34, 95% confidence interval - 4.75 to 7.42) after the implementation. Meanwhile, a significant reduction in time to first defecation was observed after implementation (coefficient - 0.73, 95% confidence interval - 1.42 to - 0.05). No significant differences in postoperative blood glucose levels were noted.

Conclusions: Preoperative oral CHO loading for esophageal cancer surgery can be safely implemented without increasing postoperative complications, blood glucose levels, or length of hospital stay, and is associated with reduction in time to first defecation.

Objective: Thrombus in the subclavian and internal jugular veins can occur after resection of the left innominate vein in patients with mediastinal tumors, for whom anticoagulants are generally administered. However, no evidence exists that anticoagulants should be discontinued in such patients.

Methods: Between 2009 and 2024, 913 patients underwent surgical interventions for mediastinal tumors. Among them, 19 patients who underwent left innominate vein resection were included, excluding 14 who had superior vena cava reconstruction. The clinical features and computed tomography (CT) findings of the preoperative, acute (within 30 days), and chronic (after 30 days) phases were evaluated.

Results: Eleven male patients, with a mean age of 57 years, underwent surgery via hemi-clamshell (11), median sternotomy (5), and robotic approaches (3). Twelve patients had left-arm edema, while nine underwent enhanced CT in the acute phase. Six patients developed thrombosis of the left innominate vein stump and were managed using anticoagulants. The characteristic findings in the acute phase included skin thickness, fluid collection, and subcutaneous and axillary high-fat content (7/9). These findings resolved in the chronic phase, regardless of thrombus presence (0/19). All patients exhibited peripheral vascular dilation (1.3-3.3 folds). Among those with thrombus, two had residual thrombus after 1 year, but no exacerbation was observed after discontinuing antithrombotic therapy.

Conclusions: CT findings post-left innominate vein resection demonstrated disappearance in the acute phase and confirmed peripheral vascular dilation, suggesting minimal thrombus worsening factors. These findings should be confirmed when considering the discontinuation of anticoagulant therapy.

Objective: Primary graft dysfunction, largely caused by ischemia-reperfusion injury (IRI), remains a major determinant of outcomes after lung transplantation. While protective perfusion, achieved by reducing perfusion pressure and flow, has been shown to mitigate lung IRI, the effect of oxygenated blood perfusion remains unclear. We developed an in vivo model using extracorporeal membrane oxygenation (ECMO) to control perfusion pressure and oxygen tension in perfusion blood of ischemic lungs and evaluated its potential protective effects against lung IRI.

Methods: A porcine IRI model was established by clamping the left pulmonary hilum for 2.5 h. After reperfusion, animals were assigned to three groups: the control group, which received only lung rest ventilation; the veno-arterial ECMO (VA-ECMO) group; and the combined veno-arterial and veno-pulmonary artery ECMO (cVPA-ECMO) group, in which oxygenated blood was additionally delivered into the left pulmonary artery (PA). Each group underwent a 4-h intervention period followed by a 4-h observation phase.

Results: Both ECMO groups showed improvements in pulmonary function, hemodynamics, tissue injury, edema, cell death, and inflammatory markers compared with controls, suggesting attenuation of IRI. However, no significant differences were found between the VA-ECMO and cVPA-ECMO groups in any evaluated parameter, and no clear additive benefit from oxygenated blood delivery to the PA was observed.

Conclusions: In lung IRI, oxygenated blood perfusion showed no additive benefit beyond the protective effect of flow control. These findings suggest that ventilation-based oxygenation and hemodynamic management play a greater role in attenuating IRI.

Objectives: Few physiological assessments are available for patients who undergo mitral valve repair for severe mitral regurgitation (symptomatic or asymptomatic). The aim of the study was to evaluate change in exercise tolerance as a means of physiological assessment following mitral valve repair.

Methods: We studied 41 consecutive patients who received elective isolated mitral valve repair for severe mitral regurgitation in a minimally invasive manner via a completely endoscopic platform and who underwent cardiopulmonary exercise testing in our institution between February 2018 and August 2019. There were 21 asymptomatic (group A) and 20 symptomatic (group S) patients. Physiological assessment was performed by cycle ergometer cardiopulmonary exercise testing pre-operatively and at approximately 6 months post-operatively.

Results: Mean age was 59 ± 11.6 years and 24 patients were male (58.5%). Overall, there was no significant change in peak oxygen consumption or anaerobic threshold after surgical repair. There were no intergroup differences in terms of peak oxygen consumption, anaerobic threshold, ventilation/carbon dioxide production, or gas exchange ratio. There were no intergroup differences in any transthoracic echocardiographic variable except for post-operative left atrial dimension (group A: 35.2 ± 5.9 vs. group S: 39.8 ± 6.2, p = 0.01).

Conclusions: There was no statistically discernible change in functional capacity at 6-12 months after endoscopic mitral valve repair. The physiological assessment found no improvements in cardiopulmonary exercise testing values post-operatively despite improvement of the symptoms.