Interactive cardiovascular and thoracic surgery最新文献

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Is video-assisted thoracoscopic surgery comparable with thoracotomy in perioperative and long-term survival outcomes for patients with non-small cell lung cancer following neoadjuvant therapy intended for anatomical lung resection?'. Altogether 655 papers were found using the reported search, of which 12 studies represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type and relevant outcomes and results of these papers are tabulated. Almost all of the enrolled cohort studies reported that video-assisted thoracoscopic surgery (VATS) was comparable with thoracotomy in negative surgical margin rate, postoperative mortality, complication rate, overall survival and disease-free survival. Moreover, 7 studies found patients in the VATS group had a significantly shorter hospital stay. Furthermore, in these well-matched cohort studies (6 studies), it still held true that VATS was comparable with thoracotomy in long-term prognosis with enhanced recovery. However, the issue regarding surgical radicality and intraoperative conversion to thoracotomy still should be noted carefully among these patients receiving VATS surgery because all the current available evidence was retrospective based on relatively small sample sizes. Nevertheless, thoracic surgeons should not consider VATS inferior to thoracotomy for patients after neoadjuvant treatment. VATS surgery could be an alternative for selected patients with locally advanced but relatively small, peripheral, fewer positive N2 lymph nodes and non-squamous NSCLC intended for anatomic lung resection.

Objectives: This study assessed the impact of early postoperative organ dysfunction (EPOD) on in-hospital mortality of patients with type A aortic dissection (TAAD) after surgery.

Methods: Patients with TAAD who underwent surgical repair requiring deep hypothermic circulatory arrest from January 2020 to December 2021 were included. The Sequential Organ Failure Assessment (SOFA) score was calculated for 3 days postoperatively to stratify the severity of organ dysfunction. Patients with the SOFA of 0-4, 5-8 or >8 were defined as mild, moderate or severe EPOD. The primary outcome was in-hospital mortality, and a composite secondary outcome was defined as in-hospital death or any major complications. Kaplan-Meier curves were used to compare survival probability. The area under the receiver operating characteristic curve and calibration plots were used to evaluate the predictive power and overall performance of SOFA.

Results: Of the 368 patients, 5 patients (3%) with moderate EPOD and 33 patients (23%) with severe EPOD died. No patient died with mild EPOD. The areas under the receiver operating characteristic curve of SOFA for predicting mortality and the composite outcome were 0.85 (0.81-0.88) and 0.81 (0.77-0.85) on postoperative day 1. Each point of postoperative day 1 SOFA score corresponded to an odds ratio of 1.65 (1.42-1.92) for mortality. Of the 6 components of the SOFA system, only coagulation (2.34 [1.32-4.13]), cardiovascular (1.47 [1.04-2.08]), central nervous system (1.96 [1.36-2.82]) and renal (1.67 [1.04-2.70]) functions were associated with the higher risk of mortality.

Conclusions: EPOD stratified by the SOFA score was associated with a higher risk of death and predicted the clinical outcomes of patients with TAAD with good accuracy.

We describe a case of aortic repair using bovine pericardium for a pseudoaneurysm of a dissecting abdominal aorta. A 71-year-old man had undergone several aortic replacement surgeries for type B aortic dissection. He developed paraparesis after thoraco-abdominal aortic surgery and recovered. After 3 years, the scheduled computed tomography scan showed a pseudoaneurysm of the dissecting abdominal aorta. Because he was at high risk of spinal cord ischaemia, aortic repair using bovine pericardium was performed, and all lumbar arteries were preserved. During the 12-month follow-up, he was asymptomatic, and computed tomography scans showed no dilation of the aorta.

Objectives: The aim of this study was to perform a meta-analysis of studies reporting outcomes in patients with liver dysfunction addressed by the model of end-stage liver disease and Child-Turcotte-Pugh scores undergoing cardiac surgery.

Methods: A systematic literature search was conducted to identify contemporary studies reporting short- and long-term outcomes in patients with liver dysfunction compared to patients with no or mild liver dysfunction undergoing cardiac surgery (stratified in high and low score group based on the study cut-offs). Primary outcome was perioperative mortality. Secondary outcomes were perioperative neurological events, prolonged ventilation, sepsis, bleeding and/or need for transfusion, acute kidney injury and long-term mortality.

Results: A total of 33 studies with 48 891 patients were included. Compared with the low score group, being in the high score group was associated with significantly higher risk of perioperative mortality [odds ratio (OR) 3.72, 95% confidence interval (CI) 2.75-5.03, P < 0.001]. High score group was also associated with a significantly higher rate of perioperative neurological events (OR 1.49, 95% CI 1.30-1.71, P < 0.001), prolonged ventilation (OR 2.45, 95% CI 1.94-3.09, P < 0.001), sepsis (OR 3.88, 95% CI 2.07-7.26, P < 0.001), bleeding and/or need for transfusion (OR 1.95, 95% CI 1.43-2.64, P < 0.001), acute kidney injury (OR 3.84, 95% CI 2.12-6.98, P < 0.001) and long-term mortality (incidence risk ratio 1.29, 95% CI 1.14-1.46, P < 0.001).

Conclusions: The analysis suggests that liver dysfunction in patients undergoing cardiac surgery is independently associated with higher risk of short and long-term mortality and also with an increased occurrence of various perioperative adverse events.

Objectives: This study aimed to evaluate the outcomes of the patients who underwent restrictive annuloplasty (RA) plus papillary muscle relocation anteriorly (PMR-A) with the risk factors in mitral valve repair for functional mitral regurgitation (FMR).

Methods: Eighty-six patients underwent mitral valve repair with RA for FMR. Thirty-five of them received additional bilateral papillary muscle relocation for severe leaflet tethering. The papillary muscles were relocated posteriorly (PMR-P) early in the study. Then, in the later period, the technique was modified to PMR-A, in which the papillary muscles were relocated anteriorly for 24 cases. The survival of the patients undergoing RA + PMR-A was examined retrospectively, adjusting for differences in patient background.

Results: Twenty-three deaths were observed during the follow-up period out of the 86 cases. Independent preoperative risk factors for survival were left ventricular ejection fraction, patient age and B-type natriuretic peptide (BNP) level. Among the patients with BNP <1000 pg/ml, 5-year survival after RA plus PMR-A was 84.7%, while RA alone was 78.6% and RA + PMR-P 57.1%. Cox proportional hazards regression adjusted for the preoperative risk factors showed a significantly higher hazard ratio of RA + PMR-P to RA + PMR-A (12.77, P = 0.011), while the hazard ratio of RA alone to RA + PMR-A was not significantly different. Furthermore, reverse remodelling of the left ventricle was observed for 3 years only in RA + PMR-A.

Conclusions: Long-term survival for patients who underwent RA plus bilateral PMR-A was promising. Patients with significantly higher BNP had lower survival after valve repair for FMR.

Objectives: Mechanical strain plays a major role in the development of aortic calcification. We hypothesized that (i) valvular calcifications are most pronounced at the localizations subjected to the highest mechanical strain and (ii) calcification patterns are different in patients with bicuspid and tricuspid aortic valves.

Methods: Multislice computed tomography scans of 101 patients with severe aortic stenosis were analysed using a 3-dimensional post-processing software to quantify calcification of tricuspid aortic valves (n = 51) and bicuspid aortic valves (n = 50) after matching.

Results: Bicuspid aortic valves exhibited higher calcification volumes and increased calcification of the non-coronary cusp with significantly higher calcification of the free leaflet edge. The non-coronary cusp showed the highest calcium load compared to the other leaflets. Patients with annular calcification above the median had an impaired survival compared to patients with low annular calcification, whereas patients with calcification of the free leaflet edge above the median did not (P = 0.53).

Conclusions: Calcification patterns are different in patients with aortic stenosis with bicuspid and tricuspid aortic valves. Patients with high annular calcification might have an impaired prognosis.

Objectives: Since postoperative complications, defined as Clavien-Dindo grade ≥II, correlate with long-term survival after lung resection surgery in patients with primary lung cancer, identification of intraoperative risk factors for postoperative complications is crucial for better perioperative management. In the present study, we investigated the possible association between intraoperative variables for use in anaesthetic management and Clavien-Dindo grade ≥II.

Methods: In this multi-institutional observational study, consecutive adult patients undergoing video-assisted thoracic surgery for primary lung cancer under general anaesthesia from March 2019 to April 2021 were enrolled. All patients were divided into 2 groups with Clavien-Dindo grade

Results: After univariable analysis between patients with Clavien-Dindo grade

Conclusions: Higher mean NR, as intraoperative variables for use in anaesthetic management, is associated with the higher incidence of postoperative complications after primary lung cancer surgery.

Objectives: We aimed to compare the outcomes of segmentectomy with those of lobectomy in clinical-stage IA radiological solid-predominant non-small-cell lung cancer (NSCLC) >2 cm in maximum tumour size.

Methods: A retrospective review was performed for radiological solid-predominant NSCLC >2-3 cm in maximum tumour size with a ground-glass opacity component on thin-section computed tomography. Multivariable or propensity score-matched analyses were performed to control for confounders for survival. Overall survival (OS) was analysed using a Kaplan-Meier estimation.

Results: Of the 215 eligible cases, segmentectomy and lobectomy were performed in 46 and 169 patients. Multivariable analysis revealed that standardized uptake value (hazard ratio: 1.148, 95% confidence interval: 1.032-1.276, P = 0.011) was an independently significant prognosticators of OS, while the operative mode was not associated (hazard ratio: 0.635, 95% confidence interval: 0.132-3.049, P = 0.570). The 5 y-OS was excellent and did not differ significantly between segmentectomy and lobectomy (95.5% vs 90.2%; P = 0.697), which was also shown in the propensity score analysis (96.8% vs 94.0%; P = 0.406), with a median follow-up time of 5.2 years. Locoregional recurrence was found in 2 (4.3%) segmentectomy and 13 (7.7%) lobectomy (P = 0.443). In the subgroup analysis stratified by solid component size, the 5 y-OS was similar between segmentectomy and lobectomy in the c-T1b and c-T1c groups, respectively [c-T1b (n = 163): 94.1% vs 91.8%; P = 0.887 and c-T1c (n = 52): 100% vs 84.9%; P = 0.197].

Conclusions: Segmentectomy showed similar oncological results compared to lobectomy in solid-predominant NSCLC with a ground-glass opacity component >2-3 cm in maximum tumour size. More prospective randomized trials are needed to adequately expand the indication of anatomic segmentectomy for early-stage NSCLC.