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Efficacy and safety of intraoperative cone-beam CT-guided localization of small pulmonary nodules. 术中锥形束ct引导下肺小结节定位的有效性和安全性。
4区 医学 Q2 Medicine Pub Date : 2022-09-09 DOI: 10.1093/icvts/ivac236
Taisuke Kaiho, Hidemi Suzuki, Atsushi Hata, Takamasa Ito, Kazuhisa Tanaka, Yuichi Sakairi, Hideyuki Kato, Yuki Shiko, Yohei Kawasaki, Ichiro Yoshino

Objectives: This study aimed to evaluate the efficacy and safety of intraoperative cone-beam computed tomography-guided video-assisted thoracoscopic surgery wedge resection of impalpable small pulmonary nodules.

Methods: This was a single-centre phase 2 trial conducted between April 2018 and March 2019. Peripheral small pulmonary nodules, defined as either ground-glass opacity-dominant (>50%) nodules measuring ≤3 cm in diameter (ground-glass opacity-dominant type) or nodules measuring ≤2 cm in diameter located deeper than the nodule diameter from the visceral pleura (deep solid type), were eligible for resection using a cone-beam computed tomography-guided thoracoscopic manner. The primary end-point was macroscopic complete resection, and secondary end-points were: nodule extraction rate, operation time, localization time, marking accuracy, microscopic complete resection and safety.

Results: Twenty-two nodules, in 9 men and 11 women with a mean age of 64.3 years, were visualized and resected. The nodules were located in the right upper, middle and lower lobes in 3, 1 and 5 patients, respectively, and in the left upper and lower lobes in 5 and 8 patients, respectively. Seven nodules were ground-glass opacity-dominant types, and 15 were deep solid types. Cone-beam computed tomography could clearly image all nodules. The mean time for localization was 17.4 min. The mean operation time was 110.7 min. Macroscopic complete resection was accomplished in 21 nodules (95.5%). Microscopic complete resection was achieved in all nodules (100%). Postoperative air leakage and bleeding were observed in 1 patient (5%).

Conclusions: Cone-beam computed tomography might be a safe and useful guide for video-assisted thoracoscopic surgery wedge resection of impalpable peripheral pulmonary nodules.

Date and number of irb approval: 15 November 2017, 381.

Clinical trial registration number: UMIN 000030388.

目的:本研究旨在评价术中锥形束计算机断层扫描引导下电视胸腔镜楔形切除不可触及肺小结节的有效性和安全性。方法:这是一项于2018年4月至2019年3月进行的单中心2期试验。外周小肺结节,定义为直径≤3cm的磨玻璃不透明为主(>50%)结节(磨玻璃不透明为主型)或直径≤2cm的结节位于距离内脏胸膜的结节直径更深(深实型),适合使用锥束计算机断层扫描引导胸腔镜切除。主要终点为宏观完全切除,次要终点为结节提取率、手术时间、定位时间、标记准确性、显微完全切除及安全性。结果:22例结节,男9例,女11例,平均年龄64.3岁。3、1、5例结节位于右侧上、中、下叶,5、8例结节位于左侧上、下叶。7个结节为磨玻璃不浊型,15个结节为深实型。锥束ct可清晰显示所有结节。平均定位时间为17.4 min。平均手术时间110.7 min。肉眼完全切除21例(95.5%)。所有结节均经显微镜完全切除(100%)。术后漏气出血1例(5%)。结论:圆锥束计算机断层扫描可作为电视胸腔镜下肺周围结节楔形切除术的安全有效的指导。irb批准日期和数量:2017年11月15日,381。临床试验注册号:UMIN 000030388。
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引用次数: 0
Pushing the boundaries of minimally invasive repair of pectus excavatum: first experience with a 4-bar technique. 突破微创修复漏斗胸的界限:首次使用4杆技术的经验。
4区 医学 Q2 Medicine Pub Date : 2022-09-09 DOI: 10.1093/icvts/ivac231
Mustafa Yüksel, Hasan Ersöz

Several modifications to minimally invasive repair of pectus excavatum have been reported to date. Of these, the use of multiple bars was a major development. At present, there are 2 established techniques: cross-bar and parallel bar placement. We used a combination of both parallel and cross-bar techniques in a 25-year-old male patient with deep, Grand-Canyon type pectus excavatum, placing a total of 4 bars and 4 stabilizers. The patient had no complications during the 7 months of postoperative follow-up. We share this case report as the first experience using this modified technique in the literature.

目前已经报道了几种微创修复漏斗胸的方法。其中,多杆的使用是一个主要的发展。目前,有两种成熟的技术:横杠和双杠。我们对一名患有大峡谷型深漏斗胸的25岁男性患者使用了平行和交叉杆技术,共放置了4根杆和4个稳定器。术后随访7个月,无并发症发生。我们分享这个病例报告,作为文献中第一次使用这种改良技术的经验。
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引用次数: 1
Segmentectomy versus lobectomy for inner-located small-sized early non-small-cell lung cancer. 内位小体积早期非小细胞肺癌的节段切除术与肺叶切除术。
4区 医学 Q2 Medicine Pub Date : 2022-09-09 DOI: 10.1093/icvts/ivac218
Shinya Tane, Yoshitaka Kitamura, Kenji Kimura, Nahoko Shimizu, Gaku Matsumoto, Kazuya Uchino, Wataru Nishio

Objectives: Although segmentectomy is an acceptable alternative to lobectomy for peripheral small-sized non-small-cell lung cancer, the effectiveness of segmentectomy for inner lesions remains unknown. The aim of this study was to examine the feasibility of segmentectomy in comparison with lobectomy for inner lesions.

Methods: We retrospectively analysed 570 patients with small (≤2 cm) cN0 non-small-cell lung cancer who underwent segmentectomy or lobectomy between January 2007 and March 2021. We focused on patients with lesions located in the inner two-thirds, which were determined using three-dimensional computed tomography (n = 227). After propensity score matching analysis based on sex, age, pulmonary function, serum carcinoembryonic antigen level, radiographic tumour findings and tumour location, we compared the surgical and oncological outcomes in patients who underwent segmentectomy (n = 66) and lobectomy (n = 66).

Results: Postoperative mortality or morbidity did not differ significantly between the 2 groups. The 5-year recurrence-free and overall survival rates in the segmentectomy and lobectomy groups were 93.6% vs 84.1% and 95.8% vs 87.9%, respectively. The differences between 2 groups were not significant (P = 0.62 and P = 0.23, respectively). The 2 groups also showed no differences in loco-regional recurrence. Multivariable Cox regression analysis revealed that segmentectomy had a comparable impact on recurrence-free survival (hazard ratio, 0.61; 95% confidence interval, 0.17-2.03; P = 0.43).

Conclusions: Segmentectomy for inner-located small-sized non-small-cell lung tumours could be an acceptable treatment in comparison with lobectomy.

目的:虽然对于周围小尺寸非小细胞肺癌,节段切除术是一种可接受的替代肺叶切除术,但对于内部病变,节段切除术的有效性尚不清楚。本研究的目的是探讨与肺叶切除术相比,节段切除术治疗内病变的可行性。方法:我们回顾性分析了570例2007年1月至2021年3月期间接受节段切除术或肺叶切除术的小(≤2 cm) cN0非小细胞肺癌患者。我们重点研究了病变位于内三分之二的患者,这是通过三维计算机断层扫描确定的(n = 227)。在基于性别、年龄、肺功能、血清癌胚胎抗原水平、影像学肿瘤表现和肿瘤位置的倾向评分匹配分析后,我们比较了66例节段切除术(n = 66)和肺叶切除术(n = 66)患者的手术和肿瘤结果。结果:两组患者术后死亡率和发病率无显著差异。节段切除术组和肺叶切除术组的5年无复发率和总生存率分别为93.6%对84.1%和95.8%对87.9%。两组间差异无统计学意义(P = 0.62、P = 0.23)。两组局部-区域复发率也无差异。多变量Cox回归分析显示,节段切除术对无复发生存有相当的影响(风险比,0.61;95%置信区间为0.17-2.03;p = 0.43)。结论:与肺叶切除术相比,肺节段切除术治疗内定位的小型非小细胞肺肿瘤是一种可接受的治疗方法。
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引用次数: 5
Systematic review and meta-analysis comparing low-flow duration of extracorporeal and conventional cardiopulmonary resuscitation. 比较体外和常规心肺复苏低流量持续时间的系统综述和荟萃分析。
4区 医学 Q2 Medicine Pub Date : 2022-09-09 DOI: 10.1093/icvts/ivac219
Loes Mandigers, Eric Boersma, Corstiaan A den Uil, Diederik Gommers, Jan Bělohlávek, Mirko Belliato, Roberto Lorusso, Dinis Dos Reis Miranda

Objectives: After cardiac arrest, a key factor determining survival outcomes is low-flow duration. Our aims were to determine the relation of survival and low-flow duration of extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) and if these 2 therapies have different short-term survival curves in relation to low-flow duration.

Methods: We searched Embase, Medline, Web of Science and Google Scholar from inception up to April 2021. A linear mixed-effect model was used to describe the course of survival over time, based on study-specific and time-specific aggregated survival data.

Results: We included 42 observational studies reporting on 1689 ECPR and 375 751 CCPR procedures. Of the included studies, 25 included adults, 13 included children and 4 included both. In adults, survival curves decline rapidly over time (ECPR 37.2%, 29.8%, 23.8% and 19.1% versus CCPR-shockable 36.8%, 7.2%, 1.4% and 0.3% for 15, 30, 45 and 60 min low-flow, respectively). ECPR was associated with a statistically significant slower decline in survival than CCPR with initial shockable rhythms (CCPR-shockable). In children, survival curves decline rapidly over time (ECPR 43.6%, 41.7%, 39.8% and 38.0% versus CCPR-shockable 48.6%, 20.5%, 8.6% and 3.6% for 15, 30, 45 and 60 min low-flow, respectively). ECPR was associated with a statistically significant slower decline in survival than CCPR-shockable.

Conclusions: The short-term survival of ECPR and CCPR-shockable patients both decline rapidly over time, in adults as well as in children. This decline of short-term survival in relation to low-flow duration in ECPR was slower than in conventional cardiopulmonary resuscitation.

Trial registration: Prospero: CRD42020212480, 2 October 2020.

目的:心脏骤停后,决定生存结果的关键因素是低流量持续时间。我们的目的是确定体外心肺复苏(ECPR)和常规心肺复苏(CCPR)的生存与低流量持续时间的关系,以及这两种治疗方法是否具有不同的与低流量持续时间相关的短期生存曲线。方法:检索Embase、Medline、Web of Science和Google Scholar数据库,检索时间从成立之初至2021年4月。基于特定研究和特定时间的总体生存数据,使用线性混合效应模型来描述随时间的生存过程。结果:我们纳入了42项观察性研究,报告了1689例ECPR和375 751例CCPR手术。在纳入的研究中,25项包括成人,13项包括儿童,4项包括两者。在成人中,生存曲线随着时间的推移迅速下降(低流量15、30、45和60分钟时,ECPR为37.2%、29.8%、23.8%和19.1%,ccpr为36.8%、7.2%、1.4%和0.3%)。与具有初始休克节律(CCPR-shockable)的CCPR相比,ECPR与生存率下降的统计学意义显著相关。在儿童中,生存曲线随着时间的推移迅速下降(低流量15、30、45和60分钟时,ECPR为43.6%、41.7%、39.8%和38.0%,ccpr为48.6%、20.5%、8.6%和3.6%)。与ccpr -休克相比,ECPR与生存率下降有统计学意义。结论:无论是成人还是儿童,ECPR和ccpr -休克患者的短期生存率都随着时间的推移而迅速下降。与低流量持续时间相比,ECPR短期生存期的下降速度要慢于常规心肺复苏。试验注册:Prospero: CRD42020212480, 2020年10月2日。
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引用次数: 8
Optimal timing for lung metastasectomy in patients with colorectal cancer. 结直肠癌患者肺转移切除术的最佳时机。
4区 医学 Q2 Medicine Pub Date : 2022-09-09 DOI: 10.1093/icvts/ivac224
Junji Ichinose, Kohei Hashimoto, Yosuke Matsuura, Masayuki Nakao, Takashi Akiyoshi, Yosuke Fukunaga, Sakae Okumura, Mingyon Mun

Objectives: The possibility of occult metastasis remains a concern when deciding on lung metastasectomy. This study aimed to evaluate the utility of our two-step determination, which required confirmation that no new metastases had occurred over 3 months before surgery.

Methods: Patients who were referred for colorectal lung metastases between 2007 and 2015 were reviewed. Immediate wedge resection was performed for cases with a single peripheral metastasis, whereas surgical indications for others were determined by the two-step determination. Early increase was defined as the emergence of new metastases within 4 months after the diagnosis of lung metastases.

Results: Among 369 patients included, 92 were unresectable upon initial diagnosis, and 74 with single peripheral metastasis underwent immediate wedge resection. Surgical indications for the remaining 203 patients were ascertained based on the two-step determination. Surgery was not indicated in 48 patients (24%) due to new metastases or a favourable response to chemotherapy, with a median waiting duration of 4.8 months. Those who did not receive surgery had a worse prognosis than those who did (5-year overall survival: 21% vs 69%, P < 0.001) and were comparable to the initially unresectable group (5-year overall survival: 23%). Thirty-eight patients with early increase had lower surgical resection rates and worse prognoses than those without. Multivariable analysis identified early increase as an independent prognostic factor (hazard ratio: 4.49, P < 0.001).

Conclusions: Patients with colorectal lung metastasis who developed new metastasis during the waiting period exhibited poor prognosis, suggesting the utility of the two-step determination of surgical indications.

目的:在决定是否进行肺转移切除术时,隐匿性转移的可能性仍然是一个值得关注的问题。本研究旨在评估我们的两步测定方法的实用性,该方法需要在手术前3个月内确认没有新的转移灶发生。方法:回顾性分析2007年至2015年间转诊的结直肠肺转移患者。对于单个外周转移的病例,立即进行楔形切除,而其他病例的手术指征则由两步确定。早期增加定义为肺转移诊断后4个月内出现新的转移灶。结果:在369例患者中,92例初诊无法切除,74例单纯外周转移患者立即行楔形切除。其余203例患者采用两步确定手术指征。48例(24%)患者由于新的转移或对化疗的有利反应而不需要手术,中位等待时间为4.8个月。未接受手术的患者预后较接受手术的患者差(5年总生存率:21% vs 69%)。结论:在等待期出现新转移的结直肠癌肺转移患者预后较差,提示两步确定手术指征的实用性。
{"title":"Optimal timing for lung metastasectomy in patients with colorectal cancer.","authors":"Junji Ichinose,&nbsp;Kohei Hashimoto,&nbsp;Yosuke Matsuura,&nbsp;Masayuki Nakao,&nbsp;Takashi Akiyoshi,&nbsp;Yosuke Fukunaga,&nbsp;Sakae Okumura,&nbsp;Mingyon Mun","doi":"10.1093/icvts/ivac224","DOIUrl":"https://doi.org/10.1093/icvts/ivac224","url":null,"abstract":"<p><strong>Objectives: </strong>The possibility of occult metastasis remains a concern when deciding on lung metastasectomy. This study aimed to evaluate the utility of our two-step determination, which required confirmation that no new metastases had occurred over 3 months before surgery.</p><p><strong>Methods: </strong>Patients who were referred for colorectal lung metastases between 2007 and 2015 were reviewed. Immediate wedge resection was performed for cases with a single peripheral metastasis, whereas surgical indications for others were determined by the two-step determination. Early increase was defined as the emergence of new metastases within 4 months after the diagnosis of lung metastases.</p><p><strong>Results: </strong>Among 369 patients included, 92 were unresectable upon initial diagnosis, and 74 with single peripheral metastasis underwent immediate wedge resection. Surgical indications for the remaining 203 patients were ascertained based on the two-step determination. Surgery was not indicated in 48 patients (24%) due to new metastases or a favourable response to chemotherapy, with a median waiting duration of 4.8 months. Those who did not receive surgery had a worse prognosis than those who did (5-year overall survival: 21% vs 69%, P < 0.001) and were comparable to the initially unresectable group (5-year overall survival: 23%). Thirty-eight patients with early increase had lower surgical resection rates and worse prognoses than those without. Multivariable analysis identified early increase as an independent prognostic factor (hazard ratio: 4.49, P < 0.001).</p><p><strong>Conclusions: </strong>Patients with colorectal lung metastasis who developed new metastasis during the waiting period exhibited poor prognosis, suggesting the utility of the two-step determination of surgical indications.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9462424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40647566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Midterm results of endoscopically assisted first rib resection in the zero position for thoracic outlet syndrome. 内窥镜辅助零位第一肋骨切除术治疗胸廓出口综合征的中期结果。
4区 医学 Q2 Medicine Pub Date : 2022-09-09 DOI: 10.1093/icvts/ivac239
Hiroshi Satake, Ryusuke Honma, Toshiya Nito, Yasushi Naganuma, Junichiro Shibuya, Masahiro Maruyama, Tomohiro Uno, Michiaki Takagi

Objectives: We have hypothesized that an endoscopically assisted transaxillary approach in the zero position would be able to improve visualization and allow safe surgery for thoracic outlet syndrome.

Methods: We performed surgery only for patients with certain objective findings, including blood flow disruption, low blood flow and accelerated blood flow in the subclavian artery demonstrated using Doppler sonography, narrowing of the scalene interval width between the anterior and middle interscalene muscles (interscalene base) or costoclavicular space demonstrated using Duplex ultrasonography or computed tomography angiography. The present study included 45 consecutive patients (50 limbs) who underwent endoscopic transaxillary first rib resection with scalenotomy and brachial plexus neurolysis. We assessed the intraoperative parameters, including the interscalene base, blood loss, operation time, patient satisfaction, preoperative and postoperative Quick Disability of the Arm, Shoulder and Hand and complications.

Results: The mean intraoperatively measured interscalene base width was 6.4 mm. All patients showed improvement after surgery. The outcome was excellent in 40% of cases, good in 48%, fair in 12% and poor in none. Pneumothorax was present in 6%. There were no other complications and no recurrences. Among patients who had been followed up for at least 2 years, the Quick Disability of the Arm, Shoulder and Hand score was significantly improved (42 before surgery vs 12 at final follow-up), especially in athletes relative to non-athletes (0.2 vs 16). The present approach achieved complete relief in 43% of cases overall (91% in athletes and 16% in non-athletes).

Conclusions: Endoscopically assisted transaxillary first rib resection and brachial plexus neurolysis in the zero position are useful and safe for thoracic outlet syndrome, especially in athletes.

目的:我们假设内镜辅助下经腋窝零位入路可以提高胸廓出口综合征的可视性,并允许安全手术。方法:我们只对有一定客观表现的患者进行手术,包括多普勒超声显示的锁骨下动脉血流中断、低血流量和血流量加速,双工超声或计算机断层血管造影显示的前、中斜角肌间肌(斜角肌基底)或肋锁骨间隙狭窄。本研究包括45例连续患者(50条肢体),他们接受了经腋窝第一肋骨切除术,肩胛切除术和臂丛神经松解术。我们评估术中参数,包括斜角肌间基底、出血量、手术时间、患者满意度、术前和术后手臂、肩部和手部的快速失能及并发症。结果:术中测量的斜角间基底平均宽度为6.4 mm。所有患者术后均有改善。40%的病例结果为极好,48%为良好,12%为一般,没有一例为差。6%的患者有气胸。无其他并发症,无复发。在随访至少2年的患者中,手臂、肩膀和手的快速残疾评分显著改善(术前42分,最终随访12分),尤其是运动员相对于非运动员(0.2比16)。目前的方法在43%的病例中获得完全缓解(运动员91%,非运动员16%)。结论:内镜下经腋窝第一肋骨切除术和零位臂丛神经松解术是治疗胸廓出口综合征的有效和安全的方法,尤其是运动员。
{"title":"Midterm results of endoscopically assisted first rib resection in the zero position for thoracic outlet syndrome.","authors":"Hiroshi Satake,&nbsp;Ryusuke Honma,&nbsp;Toshiya Nito,&nbsp;Yasushi Naganuma,&nbsp;Junichiro Shibuya,&nbsp;Masahiro Maruyama,&nbsp;Tomohiro Uno,&nbsp;Michiaki Takagi","doi":"10.1093/icvts/ivac239","DOIUrl":"https://doi.org/10.1093/icvts/ivac239","url":null,"abstract":"<p><strong>Objectives: </strong>We have hypothesized that an endoscopically assisted transaxillary approach in the zero position would be able to improve visualization and allow safe surgery for thoracic outlet syndrome.</p><p><strong>Methods: </strong>We performed surgery only for patients with certain objective findings, including blood flow disruption, low blood flow and accelerated blood flow in the subclavian artery demonstrated using Doppler sonography, narrowing of the scalene interval width between the anterior and middle interscalene muscles (interscalene base) or costoclavicular space demonstrated using Duplex ultrasonography or computed tomography angiography. The present study included 45 consecutive patients (50 limbs) who underwent endoscopic transaxillary first rib resection with scalenotomy and brachial plexus neurolysis. We assessed the intraoperative parameters, including the interscalene base, blood loss, operation time, patient satisfaction, preoperative and postoperative Quick Disability of the Arm, Shoulder and Hand and complications.</p><p><strong>Results: </strong>The mean intraoperatively measured interscalene base width was 6.4 mm. All patients showed improvement after surgery. The outcome was excellent in 40% of cases, good in 48%, fair in 12% and poor in none. Pneumothorax was present in 6%. There were no other complications and no recurrences. Among patients who had been followed up for at least 2 years, the Quick Disability of the Arm, Shoulder and Hand score was significantly improved (42 before surgery vs 12 at final follow-up), especially in athletes relative to non-athletes (0.2 vs 16). The present approach achieved complete relief in 43% of cases overall (91% in athletes and 16% in non-athletes).</p><p><strong>Conclusions: </strong>Endoscopically assisted transaxillary first rib resection and brachial plexus neurolysis in the zero position are useful and safe for thoracic outlet syndrome, especially in athletes.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/e1/ivac239.PMC9536291.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33462949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The association of depression and postoperative delirium: we may need more information. 抑郁症与术后谵妄的关系:我们可能需要更多的信息。
4区 医学 Q2 Medicine Pub Date : 2022-09-09 DOI: 10.1093/icvts/ivac228
Carlos A Mestres, Eduard Quintana
Cerebral complications after cardiac surgery with cardiopulmonary bypass have a substantial impact on outcomes and resource utilization. Roach et al. [1] defined 2 types of outcomes in a seminal contribution. Type I, death due to stroke/hypoxic encephalopathy, non-fatal stroke, transient ischaemic attack or stupor or coma at discharge; Type II, new deterioration in intellectual function, confusion, agitation, disorientation, memory deficit or seizure without evidence of focal injury [1]. Delirium is an acute organ dysfunction with mental status changes including alterations in level of consciousness, known to burden postoperative outcomes [2] and investigated in patients undergoing non-cardiac [3] and cardiac surgery [4]. Preoperative cognitive status and depression have been associated with postoperative delirium (POD). Assessment scores can be influenced by age, education or ethnicity [4]. Some strategies are currently being investigated aiming at predicting and treating POD after in different settings [5, 6]. In this issue of the Journal, Falk et al. [7] aimed at investigating preoperative depression as predictor of POD after cardiac surgery, analysing 1133 patients operated between 2013 and 2016. Fourteen per cent reported depressive symptoms preoperatively; the observed incidence of POD was 26%, being highest among elderly patients. One-third of patients with depression developed POD in comparison one-quarter of the non-depressed. Odds of POD were 2.19 times higher in individuals with depressive symptoms compared to controls. The onset of delirium was most common on the first 2 days after surgery. The authors concluded that in their unique population-based study, preoperative depression is associated with POD in a large proportion of patients. The corollary is that improved preoperative screening for depression and enhanced clinical surveillance in the early postoperative period for all patients is required. Although this study established the actual observed rates of POD in relation to preoperative symptoms of depression in a given population like that of the authors, there are some unclear aspects. This study was conducted between 2013 and 2016, an acute study as authors only investigated POD rates with no follow-up. It is somewhat surprising that data have been reported after a substantially long period of time, considering as said, that this looked as an acute study. Population changes of interest may have occurred during this period. One may argue that the authors’ regional population remains stable over time and that changes might be unlikely. Although population stability may be the key factor, the readership would have been keen to integrate a brief elaboration. The authors distributed the local version of the Patient Health Questionnaire (PHQ-9) 2 weeks before a scheduled operation. As confirmed by the authors in their revisions, 30% of their patients are operated as ‘urgent’ patients; however, in the final sample, urgent surgery ra
{"title":"The association of depression and postoperative delirium: we may need more information.","authors":"Carlos A Mestres,&nbsp;Eduard Quintana","doi":"10.1093/icvts/ivac228","DOIUrl":"https://doi.org/10.1093/icvts/ivac228","url":null,"abstract":"Cerebral complications after cardiac surgery with cardiopulmonary bypass have a substantial impact on outcomes and resource utilization. Roach et al. [1] defined 2 types of outcomes in a seminal contribution. Type I, death due to stroke/hypoxic encephalopathy, non-fatal stroke, transient ischaemic attack or stupor or coma at discharge; Type II, new deterioration in intellectual function, confusion, agitation, disorientation, memory deficit or seizure without evidence of focal injury [1]. Delirium is an acute organ dysfunction with mental status changes including alterations in level of consciousness, known to burden postoperative outcomes [2] and investigated in patients undergoing non-cardiac [3] and cardiac surgery [4]. Preoperative cognitive status and depression have been associated with postoperative delirium (POD). Assessment scores can be influenced by age, education or ethnicity [4]. Some strategies are currently being investigated aiming at predicting and treating POD after in different settings [5, 6]. In this issue of the Journal, Falk et al. [7] aimed at investigating preoperative depression as predictor of POD after cardiac surgery, analysing 1133 patients operated between 2013 and 2016. Fourteen per cent reported depressive symptoms preoperatively; the observed incidence of POD was 26%, being highest among elderly patients. One-third of patients with depression developed POD in comparison one-quarter of the non-depressed. Odds of POD were 2.19 times higher in individuals with depressive symptoms compared to controls. The onset of delirium was most common on the first 2 days after surgery. The authors concluded that in their unique population-based study, preoperative depression is associated with POD in a large proportion of patients. The corollary is that improved preoperative screening for depression and enhanced clinical surveillance in the early postoperative period for all patients is required. Although this study established the actual observed rates of POD in relation to preoperative symptoms of depression in a given population like that of the authors, there are some unclear aspects. This study was conducted between 2013 and 2016, an acute study as authors only investigated POD rates with no follow-up. It is somewhat surprising that data have been reported after a substantially long period of time, considering as said, that this looked as an acute study. Population changes of interest may have occurred during this period. One may argue that the authors’ regional population remains stable over time and that changes might be unlikely. Although population stability may be the key factor, the readership would have been keen to integrate a brief elaboration. The authors distributed the local version of the Patient Health Questionnaire (PHQ-9) 2 weeks before a scheduled operation. As confirmed by the authors in their revisions, 30% of their patients are operated as ‘urgent’ patients; however, in the final sample, urgent surgery ra","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9512090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40336747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Descending thoracic aortic repair outcomes for chronic aortic dissection: a single-centre experience. 慢性主动脉夹层的胸降主动脉修复结果:单中心经验。
4区 医学 Q2 Medicine Pub Date : 2022-09-09 DOI: 10.1093/icvts/ivac233
Yoshitaka Yamane, Susumu Oshima, Kazumasa Ishiko, Makoto Okiyama, Tomohiro Hirokami, Yuki Hirai, Shigeru Sakurai, Kensuke Ozaki, Kenichi Yoshimura, Shinya Takahashi, Shin Yamamoto

Objectives: Thoracic endovascular aortic repair is a widely accepted treatment for chronic aortic dissection because of good early results compared to open surgical repair. We provide early and long-term results of descending thoracic aortic repair for chronic aortic dissection.

Methods: Patients who underwent descending thoracic aortic repair for chronic aortic dissection between January 2012 and December 2020 at Kawasaki Aortic Centre were included in this analysis.

Results: Four hundred ninety-two patients (median age, 64 years; interquartile range, 52-75 years) were included. The median duration of follow-up was 3.2 years (interquartile range, 1.5-5.2 years). The early mortality rate was 2.0% (n = 10); strokes occurred in 17 patients (3.5%); and spinal cord injuries occurred in 30 patients (6.1%). Early major adverse events including early death, stroke, spinal cord injury, tracheostomy and haemodialysis at the time of discharge occurred in 62 patients. Multivariable analysis indicated that age > 70 years and non-elective surgery were predictors of early major adverse events. Among patients without both risk factors (i.e. low-risk patients), 1 early death (0.4%), 3 strokes (1.5%) and 1 spinal cord injury (0.4%) were observed, 2 tracheostomies were performed (0.8%) and no patients required haemodialysis at the time of hospital discharge. The 5-year survival rate was 87.2%. The cumulative incidence of chronic aortic dissection-related aortic reintervention at 5 years was 7.9%.

Conclusions: Descending thoracic aortic repair for chronic aortic dissection resulted in good early and long-term results, and it can serve as the gold standard for low-risk patients.

目的:胸部血管内主动脉修复术是一种被广泛接受的治疗慢性主动脉夹层的方法,因为与开放式手术修复相比,它具有良好的早期效果。我们提供了早期和长期的结果,胸降主动脉修复慢性主动脉夹层。方法:2012年1月至2020年12月在川崎主动脉中心接受降主动脉修复术治疗慢性主动脉夹层的患者纳入本分析。结果:492例患者(中位年龄64岁;包括四分位数范围(52-75岁)。中位随访时间为3.2年(四分位数范围为1.5-5.2年)。早期死亡率为2.0% (n = 10);卒中17例(3.5%);脊髓损伤30例(6.1%)。62例患者出院时发生早期重大不良事件,包括早期死亡、中风、脊髓损伤、气管切开术和血液透析。多变量分析表明,年龄> 70岁和非择期手术是早期主要不良事件的预测因素。在没有这两种危险因素的患者(即低危患者)中,有1例早期死亡(0.4%),3例中风(1.5%),1例脊髓损伤(0.4%),2例气管造口术(0.8%),出院时无患者需要血液透析。5年生存率为87.2%。5年内慢性主动脉夹层相关主动脉再介入的累积发生率为7.9%。结论:胸降主动脉修复术治疗慢性主动脉夹层的早期和远期效果良好,可作为低危患者的金标准。
{"title":"Descending thoracic aortic repair outcomes for chronic aortic dissection: a single-centre experience.","authors":"Yoshitaka Yamane,&nbsp;Susumu Oshima,&nbsp;Kazumasa Ishiko,&nbsp;Makoto Okiyama,&nbsp;Tomohiro Hirokami,&nbsp;Yuki Hirai,&nbsp;Shigeru Sakurai,&nbsp;Kensuke Ozaki,&nbsp;Kenichi Yoshimura,&nbsp;Shinya Takahashi,&nbsp;Shin Yamamoto","doi":"10.1093/icvts/ivac233","DOIUrl":"https://doi.org/10.1093/icvts/ivac233","url":null,"abstract":"<p><strong>Objectives: </strong>Thoracic endovascular aortic repair is a widely accepted treatment for chronic aortic dissection because of good early results compared to open surgical repair. We provide early and long-term results of descending thoracic aortic repair for chronic aortic dissection.</p><p><strong>Methods: </strong>Patients who underwent descending thoracic aortic repair for chronic aortic dissection between January 2012 and December 2020 at Kawasaki Aortic Centre were included in this analysis.</p><p><strong>Results: </strong>Four hundred ninety-two patients (median age, 64 years; interquartile range, 52-75 years) were included. The median duration of follow-up was 3.2 years (interquartile range, 1.5-5.2 years). The early mortality rate was 2.0% (n = 10); strokes occurred in 17 patients (3.5%); and spinal cord injuries occurred in 30 patients (6.1%). Early major adverse events including early death, stroke, spinal cord injury, tracheostomy and haemodialysis at the time of discharge occurred in 62 patients. Multivariable analysis indicated that age > 70 years and non-elective surgery were predictors of early major adverse events. Among patients without both risk factors (i.e. low-risk patients), 1 early death (0.4%), 3 strokes (1.5%) and 1 spinal cord injury (0.4%) were observed, 2 tracheostomies were performed (0.8%) and no patients required haemodialysis at the time of hospital discharge. The 5-year survival rate was 87.2%. The cumulative incidence of chronic aortic dissection-related aortic reintervention at 5 years was 7.9%.</p><p><strong>Conclusions: </strong>Descending thoracic aortic repair for chronic aortic dissection resulted in good early and long-term results, and it can serve as the gold standard for low-risk patients.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/10/ivac233.PMC9519091.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40356091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Risk factors for early adverse outcomes after bovine jugular vein conduit implantation: influence of oversized conduit on the outcomes. 牛颈静脉导管植入术早期不良后果的危险因素:超大导管对预后的影响。
4区 医学 Q2 Medicine Pub Date : 2022-09-09 DOI: 10.1093/icvts/ivac197
Dong-Hee Kim, Young Kern Kwon, Eun Seok Choi, Bo Sang Kwon, Chun Soo Park, Tae-Jin Yun

Objectives: We investigated potential risk factors for early failure of bovine jugular vein conduit (Contegra®) implantation for right ventricular outflow tract (RVOT) reconstruction.

Methods: A single-centre retrospective review of 115 consecutive patients (54 males) who underwent RVOT reconstruction with Contegra between 2016 and 2019 was performed. Overall survival, explantation-free survival and freedom from significant RVOT lesions (valve regurgitation ≥ moderate or flow velocity ≥3.5 m/s) were investigated.

Results: Median age, body weight and Contegra diameter were 10.3 months [interquartile range (IQR) 5.7-26.9 months], 7.8 kg (IQR 6.3-12.4 kg) and 14 mm (IQR 12-16 mm), respectively. During the median follow-up duration of 25.1 months, there were 7 deaths, 34 significant RVOT lesions, 10 endocarditis episodes and 15 explantations. Overall survival and explantation-free survival at 3 years were 94.8% and 78.4%, respectively. Significant RVOT lesions (n = 34) comprised 20 stenoses, 8 regurgitations and 6 combined lesions. Freedom from significant RVOT lesions at 3 years was 62.6%. Cox regression identified higher indexed Contegra size (Contegra diameter/body weight, mm/kg) as the only risk factor for decreased time to explantation or death (hazard ratio 2.32, P < 0.001) and time to significant RVOT lesions development (hazard ratio 2.75, P < 0.001). The cut-off value of indexed Contegra size for significant RVOT lesions at 12 months was 1.905 mm/kg (sensitivity, 0.75; specificity, 0.78; area under the curve, 0.82).

Conclusions: Outcomes of RVOT reconstruction using Contegra were acceptable. However, oversized Contegra should be avoided when possible.

Irb approval date: 26 October 2020.

Irb registration number: S2020-2505-0001.

目的:探讨牛颈静脉导管(Contegra®)植入术重建右心室流出道(RVOT)早期失败的潜在危险因素。方法:对2016年至2019年间连续使用Contegra进行RVOT重建的115例患者(男性54例)进行单中心回顾性分析。研究了总生存率、无原因生存率和无显著RVOT病变(瓣膜返流≥中等或流速≥3.5 m/s)。结果:中位年龄为10.3个月[四分位间距(IQR) 5.7 ~ 26.9个月],体重为7.8 kg (IQR 6.3 ~ 12.4 kg), Contegra直径为14 mm (IQR 12 ~ 16 mm)。在25.1个月的中位随访期间,有7例死亡,34例显著RVOT病变,10例心内膜炎发作,15例解释。3年总生存率和无解释生存率分别为94.8%和78.4%。显著RVOT病变(n = 34)包括狭窄病变20例,反流病变8例,合并病变6例。3年无显著RVOT病变的比例为62.6%。Cox回归发现,高指数Contegra大小(Contegra直径/体重,mm/kg)是缩短移植时间或死亡的唯一危险因素(风险比2.32,P)。结论:使用Contegra重建RVOT的结果是可以接受的。但是,应该尽可能避免过大的Contegra。Irb批准日期:2020年10月26日。Irb注册号:S2020-2505-0001。
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引用次数: 2
Association between SLICC/ACR damage index and outcomes for lupus patients after cardiac valve surgery. 狼疮患者心脏瓣膜手术后SLICC/ACR损伤指数与预后的关系
4区 医学 Q2 Medicine Pub Date : 2022-09-09 DOI: 10.1093/icvts/ivac221
Szu-Yen Hu, Chiao-Feng Cheng, Kelvin Jeason Yang, Chih-Hsien Wang, Nai-Hsin Chi, Ron-Bin Hsu, Yih-Sharng Chen, Hsi-Yu Yu

Systemic lupus erythematosus (SLE) is associated with multi-organ damage including cardiac valve, which may need valvular operation. However, methods for outcome prediction and prosthetic valve selection are unclear in SLE patients undergoing cardiac valve surgery. Twenty-five SLE patients receiving valvular operation in a single institute between 2002 and 2020 were enrolled. Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (SLICC/ACR damage index, SDI) was applied to evaluate the damage severity. Clinical outcomes were compared between patients with different SDI. The hospital survival rate was 88%, and long-term survival rate was 59.5% and 40.2% at 5 and 10 years. The median SDI was 4 (interquartile range 3-6) in our study, patients were then grouped into higher SDI (defined as SDI ≥ 5, n = 11) and lower SDI group (defined as SDI < 5, n = 14). The in-hospital survival rate (72.2% vs 100%, P = 0.074) and 5-year survival rate (18.2% vs 92.9%, P < 0.001) were lower in higher SDI group, compared to lower SDI group. SDI score was associated with long-term outcome for SLE patients receiving cardiac valve surgery. SDI ≥ 5 was associated with very poor long-term outcomes. This finding implicates that xenograft might be a reasonable choice for SLE patients with SDI ≥ 5.

系统性红斑狼疮(SLE)与包括心脏瓣膜在内的多器官损害有关,可能需要瓣膜手术。然而,对于接受心脏瓣膜手术的SLE患者,预后预测和人工瓣膜选择的方法尚不清楚。在2002年至2020年期间,在同一研究所接受瓣膜手术的25例SLE患者被纳入研究。采用系统性狼疮国际合作诊所/美国风湿病学会损伤指数(SLICC/ACR损伤指数,SDI)评价损伤严重程度。比较不同SDI患者的临床结果。住院生存率为88%,5年和10年长期生存率分别为59.5%和40.2%。在我们的研究中,中位SDI为4(四分位数范围为3-6),然后将患者分为高SDI组(定义为SDI≥5,n = 11)和低SDI组(定义为SDI)
{"title":"Association between SLICC/ACR damage index and outcomes for lupus patients after cardiac valve surgery.","authors":"Szu-Yen Hu,&nbsp;Chiao-Feng Cheng,&nbsp;Kelvin Jeason Yang,&nbsp;Chih-Hsien Wang,&nbsp;Nai-Hsin Chi,&nbsp;Ron-Bin Hsu,&nbsp;Yih-Sharng Chen,&nbsp;Hsi-Yu Yu","doi":"10.1093/icvts/ivac221","DOIUrl":"https://doi.org/10.1093/icvts/ivac221","url":null,"abstract":"<p><p>Systemic lupus erythematosus (SLE) is associated with multi-organ damage including cardiac valve, which may need valvular operation. However, methods for outcome prediction and prosthetic valve selection are unclear in SLE patients undergoing cardiac valve surgery. Twenty-five SLE patients receiving valvular operation in a single institute between 2002 and 2020 were enrolled. Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (SLICC/ACR damage index, SDI) was applied to evaluate the damage severity. Clinical outcomes were compared between patients with different SDI. The hospital survival rate was 88%, and long-term survival rate was 59.5% and 40.2% at 5 and 10 years. The median SDI was 4 (interquartile range 3-6) in our study, patients were then grouped into higher SDI (defined as SDI ≥ 5, n = 11) and lower SDI group (defined as SDI < 5, n = 14). The in-hospital survival rate (72.2% vs 100%, P = 0.074) and 5-year survival rate (18.2% vs 92.9%, P < 0.001) were lower in higher SDI group, compared to lower SDI group. SDI score was associated with long-term outcome for SLE patients receiving cardiac valve surgery. SDI ≥ 5 was associated with very poor long-term outcomes. This finding implicates that xenograft might be a reasonable choice for SLE patients with SDI ≥ 5.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/30/d4/ivac221.PMC9492178.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40649596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Interactive cardiovascular and thoracic surgery
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