Zhigang Chen, Lei Jiang, Hua Zheng, Wentian Zhang, Xin Lv, Amr Abdellateef
Abstract OBJECTIVES Preoperative selection bias led to the inability to generalize the proposed benefit of subxiphoid uniportal video-assisted thoracoscopic surgery (SVATS) as having less postoperative pain than uniportal intercostal VATS. So, we conducted this prospective, single-blinded, randomized controlled trial to investigate the hypothesis that SVATS may have less early postoperative pain than UVATS in patients who undergo major lung resection for early-stage lung cancer. METHODSA total of 262 patients were randomly allocated between 2 groups (each with 131 patients), the first being the UVATS group and the second being the SVATS group. The values indicated on the numerical rating scale (NRS) of pain were collected at 24 h and 48 h during rest and during coughing. In addition, different perioperative variables were analysed and compared between the 2 groups. RESULTS Multiple linear regression analysis showed that the type of surgical approach was a significant predictor of the postoperative NRS values. The postoperative NRS pain values were significantly lower in the SVATS group after 24 h during rest and coughing and after 48 h during coughing. Postoperatively, patients in the SVATS group got out of bed significantly earlier [16.37 (2.54) vs 18.05 (3.29) h, p < 0.001]. The SVATS group showed a significantly higher rate of intraoperative arrhythmia [20 (15.3%) vs 3 (2.3%) patients, p = 0.03]. CONCLUSIONS SVATS major pulmonary resection in early-stage lung cancer is associated with less early postoperative pain than the UVATS approach. Operating on patients with cardiac problems using the SVATS approach is still a limiting factor for randomization due to the potential compression on the heart with resulting arrhythmia. Clinical trial registration The trial was registered under clinical trials.gov Identifier: NCT03331588. https://clinicaltrials.gov/ct2/show/NCT03331588.
{"title":"Early postoperative pain after subxiphoid uniportal thoracoscopic major lung resection: a prospective, single- blinded, randomized controlled trial","authors":"Zhigang Chen, Lei Jiang, Hua Zheng, Wentian Zhang, Xin Lv, Amr Abdellateef","doi":"10.1093/icvts/ivac133","DOIUrl":"https://doi.org/10.1093/icvts/ivac133","url":null,"abstract":"Abstract OBJECTIVES Preoperative selection bias led to the inability to generalize the proposed benefit of subxiphoid uniportal video-assisted thoracoscopic surgery (SVATS) as having less postoperative pain than uniportal intercostal VATS. So, we conducted this prospective, single-blinded, randomized controlled trial to investigate the hypothesis that SVATS may have less early postoperative pain than UVATS in patients who undergo major lung resection for early-stage lung cancer. METHODSA total of 262 patients were randomly allocated between 2 groups (each with 131 patients), the first being the UVATS group and the second being the SVATS group. The values indicated on the numerical rating scale (NRS) of pain were collected at 24 h and 48 h during rest and during coughing. In addition, different perioperative variables were analysed and compared between the 2 groups. RESULTS Multiple linear regression analysis showed that the type of surgical approach was a significant predictor of the postoperative NRS values. The postoperative NRS pain values were significantly lower in the SVATS group after 24 h during rest and coughing and after 48 h during coughing. Postoperatively, patients in the SVATS group got out of bed significantly earlier [16.37 (2.54) vs 18.05 (3.29) h, p < 0.001]. The SVATS group showed a significantly higher rate of intraoperative arrhythmia [20 (15.3%) vs 3 (2.3%) patients, p = 0.03]. CONCLUSIONS SVATS major pulmonary resection in early-stage lung cancer is associated with less early postoperative pain than the UVATS approach. Operating on patients with cardiac problems using the SVATS approach is still a limiting factor for randomization due to the potential compression on the heart with resulting arrhythmia. Clinical trial registration The trial was registered under clinical trials.gov Identifier: NCT03331588. https://clinicaltrials.gov/ct2/show/NCT03331588.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86672708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shengnan Li, Ming Liu, Xiang Liu, Dong Yang, N. Dong, Fei Li
Abstract OBJECTIVES Acute kidney injury (AKI) is common following cardiac surgery. The aim was to investigate the characteristics of AKI that occurred within 48 h and during 48 h to 7 days after cardiac surgery. METHODS Patient data were extracted from Medical Information Mart for Intensive Care III database. AKI was defined according to the Kidney Disease Improving Global Outcomes guideline and divided into early (within 48 h) and late (during 48 h to 7 days) AKI. Multivariable logistic regression models were established to investigate risk factors for AKI. Cox proportional hazards model was used to analyse 90-day survival. RESULTS AKI occurred in 51.2% (2741/5356) patients within the first 7 days following cardiac surgery, with the peak occurrence at 36–48 h. The incidence of early and late AKI was 41.9% and 9.2%, respectively. Patients with late AKI were older and had more comorbidities compared to early AKI patients. Risk factors associated with early AKI included age, body mass index, congestive heart failure and diabetes. While late AKI was related to atrial fibrillation, estimated glomerular filtration rate, sepsis, norepinephrine, mechanical ventilation and packed red blood cell transfusion. In Cox proportional model, both late and early AKIs were independently associated with 90-day mortality, and patients with early AKI had better survival than those with late AKI. CONCLUSIONS AKI that occurred earlier was distinguishable from AKI that occurred later after cardiac surgery. Time frame should be taken into consideration.
{"title":"Associated factors and short-term mortality of early versus late acute kidney injury following on-pump cardiac surgery","authors":"Shengnan Li, Ming Liu, Xiang Liu, Dong Yang, N. Dong, Fei Li","doi":"10.1093/icvts/ivac118","DOIUrl":"https://doi.org/10.1093/icvts/ivac118","url":null,"abstract":"Abstract OBJECTIVES Acute kidney injury (AKI) is common following cardiac surgery. The aim was to investigate the characteristics of AKI that occurred within 48 h and during 48 h to 7 days after cardiac surgery. METHODS Patient data were extracted from Medical Information Mart for Intensive Care III database. AKI was defined according to the Kidney Disease Improving Global Outcomes guideline and divided into early (within 48 h) and late (during 48 h to 7 days) AKI. Multivariable logistic regression models were established to investigate risk factors for AKI. Cox proportional hazards model was used to analyse 90-day survival. RESULTS AKI occurred in 51.2% (2741/5356) patients within the first 7 days following cardiac surgery, with the peak occurrence at 36–48 h. The incidence of early and late AKI was 41.9% and 9.2%, respectively. Patients with late AKI were older and had more comorbidities compared to early AKI patients. Risk factors associated with early AKI included age, body mass index, congestive heart failure and diabetes. While late AKI was related to atrial fibrillation, estimated glomerular filtration rate, sepsis, norepinephrine, mechanical ventilation and packed red blood cell transfusion. In Cox proportional model, both late and early AKIs were independently associated with 90-day mortality, and patients with early AKI had better survival than those with late AKI. CONCLUSIONS AKI that occurred earlier was distinguishable from AKI that occurred later after cardiac surgery. Time frame should be taken into consideration.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76487412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marta L Medina Estrada, M. Silaschi, E. Charitos, H. Treede
Abstract A 46-year-old male patient presented with cardiac decompensation due to a giant left ventricular aneurysm combined with a severely reduced left ventricular function after a silent myocardial infarction. Left ventricular unloading was performed with a microaxial pump as a bridge to surgery. Myocardial function in the basal segments was preserved and surgical ventricular reconstruction was performed successfully.
{"title":"Surgical reconstruction of a giant left ventricular aneurysm with prior unloading using a microaxial pump","authors":"Marta L Medina Estrada, M. Silaschi, E. Charitos, H. Treede","doi":"10.1093/icvts/ivac137","DOIUrl":"https://doi.org/10.1093/icvts/ivac137","url":null,"abstract":"Abstract A 46-year-old male patient presented with cardiac decompensation due to a giant left ventricular aneurysm combined with a severely reduced left ventricular function after a silent myocardial infarction. Left ventricular unloading was performed with a microaxial pump as a bridge to surgery. Myocardial function in the basal segments was preserved and surgical ventricular reconstruction was performed successfully.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75903241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract A subaortic left ventricular diverticulum (SLVD) represents an extremely rare congenital anomaly. It can be asymptomatic but sometimes develops fatal complications. Treatment has been debated due to limited experience. We present the successful treatment of a giant SLVD with aortic regurgitation and stenosis and ascending aorta dilatation. Our goal is to improve understanding of this rare entity.
{"title":"Giant subaortic left ventricular diverticulum with aortic regurgitation and stenosis","authors":"R. Hu, Zhiwei Wang, Jin‐ling Chen, Zhiyong Wu","doi":"10.1093/icvts/ivac121","DOIUrl":"https://doi.org/10.1093/icvts/ivac121","url":null,"abstract":"Abstract A subaortic left ventricular diverticulum (SLVD) represents an extremely rare congenital anomaly. It can be asymptomatic but sometimes develops fatal complications. Treatment has been debated due to limited experience. We present the successful treatment of a giant SLVD with aortic regurgitation and stenosis and ascending aorta dilatation. Our goal is to improve understanding of this rare entity.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"87 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73210879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Ectopic adrenocorticotrophic hormone (ACTH) syndrome has historically been a therapeutic challenge because of the difficulty localizing occult ACTH-secreting tumours. Here, we report a case of a 67-year-old woman with ectopic ACTH syndrome and had an ACTH-secreting tumour hidden within a congenitally hypoplastic left lung. A satisfactory therapeutic outcome was obtained after left pneumonectomy was performed on patient in this case.
{"title":"An ACTH-secreting tumour hidden in a congenitally hypoplastic left lung","authors":"Xueyu Chen, Yajie Zhang, Jules Lin, Hecheng Li","doi":"10.1093/icvts/ivac130","DOIUrl":"https://doi.org/10.1093/icvts/ivac130","url":null,"abstract":"Abstract Ectopic adrenocorticotrophic hormone (ACTH) syndrome has historically been a therapeutic challenge because of the difficulty localizing occult ACTH-secreting tumours. Here, we report a case of a 67-year-old woman with ectopic ACTH syndrome and had an ACTH-secreting tumour hidden within a congenitally hypoplastic left lung. A satisfactory therapeutic outcome was obtained after left pneumonectomy was performed on patient in this case.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81063235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Kimura, Masanori Nakamura, Reiya Takagi, M. Mieno, A. Yamaguchi, M. Czerny, F. Beyersdorf, F. Kari, B. Rylski
Abstract OBJECTIVES We aimed to determine whether non-A non-B aortic dissection (AD) differs in morphologic and haemodynamic properties from type B AD. METHODS We simulated and compared haemodynamics of patients with acute type B or acute non-A non-B AD by means of computational fluid dynamics. Wall pressure and wall shear stress (WSS) in both the true lumen (TL) and false lumen (FL) at early, mid- and late systole were evaluated. Morphology, WSS and the FL/TL wall pressure ratio were compared between groups. RESULTS Nineteen patients (type B, n = 7; non-A non-B, n = 12) were included. The median age (51 [46, 67] vs 53 [50, 63] years; P = 0.71) and a complicated course (14% vs 33%; P = 0.6) did not differ between the type B group and the non-A non-B group. However, the median entry tear width was increased in the non-A non-B group (9.7 [7.3, 12.7] vs 16.3 [11.9, 24.9] mm; P = 0.010). Streamlines showed, in patients with non-A non-B AD, blood from the TL flowed into the FL via the entry tear. Prevalence of a FL/TL wall pressure ratio >1.0 (type B versus non-A non-B) at early, mid- and late systole was 57% vs 83% (P = 0.31), 43% vs 83% (P = 0.13) and 57% vs 75% (P = 0.62), respectively. WSS did not differ between the groups. CONCLUSIONS The increased FL/TL wall pressure ratio observed during systole in non-A non-B AD may beget a complicated presentation.
目的:研究非a型非B型主动脉夹层(AD)在形态和血流动力学特性上是否与B型AD有所不同。方法采用计算流体动力学方法模拟和比较急性B型和急性非a型非B型AD患者的血流动力学。测定收缩期早期、中期和晚期真腔(TL)和假腔(FL)的壁压和壁剪切应力(WSS)。比较各组形态学、WSS及FL/TL壁压比。结果19例患者(B型，n = 7;非a非b, n = 12)。中位年龄(51 [46,67]vs 53[50,63]岁;P = 0.71)和复杂病程(14% vs 33%;P = 0.6) B型组与非a型非B型组之间无差异。然而，非a非b组的中位入口撕裂宽度增加(9.7 [7.3,12.7]vs 16.3 [11.9, 24.9] mm;p = 0.010)。流线显示，在非a -非b型AD患者中，TL的血液通过入口撕裂流入FL。收缩期早、中、晚期FL/TL壁压比>1.0 (B型vs非a型vs非B型)的患病率分别为57% vs 83% (P = 0.31)、43% vs 83% (P = 0.13)、57% vs 75% (P = 0.62)。两组间WSS无差异。结论:非a -非b型AD患者收缩期FL/TL壁压比升高可能导致复杂的表现。
{"title":"False lumen/true lumen wall pressure ratio is increased in acute non-A non-B aortic dissection","authors":"N. Kimura, Masanori Nakamura, Reiya Takagi, M. Mieno, A. Yamaguchi, M. Czerny, F. Beyersdorf, F. Kari, B. Rylski","doi":"10.1093/icvts/ivac138","DOIUrl":"https://doi.org/10.1093/icvts/ivac138","url":null,"abstract":"Abstract OBJECTIVES We aimed to determine whether non-A non-B aortic dissection (AD) differs in morphologic and haemodynamic properties from type B AD. METHODS We simulated and compared haemodynamics of patients with acute type B or acute non-A non-B AD by means of computational fluid dynamics. Wall pressure and wall shear stress (WSS) in both the true lumen (TL) and false lumen (FL) at early, mid- and late systole were evaluated. Morphology, WSS and the FL/TL wall pressure ratio were compared between groups. RESULTS Nineteen patients (type B, n = 7; non-A non-B, n = 12) were included. The median age (51 [46, 67] vs 53 [50, 63] years; P = 0.71) and a complicated course (14% vs 33%; P = 0.6) did not differ between the type B group and the non-A non-B group. However, the median entry tear width was increased in the non-A non-B group (9.7 [7.3, 12.7] vs 16.3 [11.9, 24.9] mm; P = 0.010). Streamlines showed, in patients with non-A non-B AD, blood from the TL flowed into the FL via the entry tear. Prevalence of a FL/TL wall pressure ratio >1.0 (type B versus non-A non-B) at early, mid- and late systole was 57% vs 83% (P = 0.31), 43% vs 83% (P = 0.13) and 57% vs 75% (P = 0.62), respectively. WSS did not differ between the groups. CONCLUSIONS The increased FL/TL wall pressure ratio observed during systole in non-A non-B AD may beget a complicated presentation.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89109134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Tanahashi, E. Suzuki, N. Yoshii, Takuya Watanabe, H. Tsuchida, Shogo Yobita, Kensuke Iguchi, Suiha Uchiyama, Minori Nakamura
Abstract OBJECTIVES The present study compared the utility of fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) for predicting the pathological response and prognosis following neoadjuvant therapy for locally advanced non-small-cell lung cancer (NSCLC). METHODS This retrospective analysis included 72 patients in whom adjacent structures showed involvement and/or cN2 NSCLC who received induction chemoradiotherapy (ICRT) and subsequent surgery at our hospital from 2008 to 2019. FDG-PET and CT were performed in all patients before and after ICRT using the same scanner with similar techniques. We calculated the reduction in the maximum standardized uptake value in FDG-PET (ΔSUVmax) and tumour size on CT (ΔCT-size) before and after ICRT and investigated the relationship between the pathological response and prognosis. RESULTS The disease response was classified as a major pathological response in 43 patients, and a minor response in 29 patients. ΔSUVmax 60% and ΔCT-size 30% were identified as the optimal cut-off values for predicting a major pathological response. ΔSUVmax was superior to ΔCT-size in terms of sensitivity, specificity, positive predictive value and negative predictive value. Furthermore, ΔSUVmax was superior to ΔCT-size for predicting the prognosis. CONCLUSIONS Based on the results of the present study, FDG-PET appeared to have greater utility than CT in predicting the pathological response following ICRT and the postoperative prognosis in patients with locally advanced NSCLC.
{"title":"Role of fluorodeoxyglucose-positron emission tomography in predicting the pathological response and prognosis after neoadjuvant chemoradiotherapy for locally advanced non-small-cell lung cancer","authors":"M. Tanahashi, E. Suzuki, N. Yoshii, Takuya Watanabe, H. Tsuchida, Shogo Yobita, Kensuke Iguchi, Suiha Uchiyama, Minori Nakamura","doi":"10.1093/icvts/ivac113","DOIUrl":"https://doi.org/10.1093/icvts/ivac113","url":null,"abstract":"Abstract OBJECTIVES The present study compared the utility of fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) for predicting the pathological response and prognosis following neoadjuvant therapy for locally advanced non-small-cell lung cancer (NSCLC). METHODS This retrospective analysis included 72 patients in whom adjacent structures showed involvement and/or cN2 NSCLC who received induction chemoradiotherapy (ICRT) and subsequent surgery at our hospital from 2008 to 2019. FDG-PET and CT were performed in all patients before and after ICRT using the same scanner with similar techniques. We calculated the reduction in the maximum standardized uptake value in FDG-PET (ΔSUVmax) and tumour size on CT (ΔCT-size) before and after ICRT and investigated the relationship between the pathological response and prognosis. RESULTS The disease response was classified as a major pathological response in 43 patients, and a minor response in 29 patients. ΔSUVmax 60% and ΔCT-size 30% were identified as the optimal cut-off values for predicting a major pathological response. ΔSUVmax was superior to ΔCT-size in terms of sensitivity, specificity, positive predictive value and negative predictive value. Furthermore, ΔSUVmax was superior to ΔCT-size for predicting the prognosis. CONCLUSIONS Based on the results of the present study, FDG-PET appeared to have greater utility than CT in predicting the pathological response following ICRT and the postoperative prognosis in patients with locally advanced NSCLC.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72481521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Bottet, C. Rivera, M. Dahan, P. Falcoz, S. Jaillard, J. Baste, A. Seguin-Givelet, Richard Bertrand de la Tour, Francois Bellenot, A. Rind, D. Gossot, P. Thomas, X. D'Journo
Abstract OBJECTIVES The reporting of patient safety incidents (PSIs) occurring in minimally invasive thoracic surgery (MITS) is crucial. However, previous reports focused mainly on catastrophic events whereas minor events are often underreported. METHODS All voluntary reports of MITS-related PSIs were retrospectively extracted from the French REX database for ‘in-depth analysis’. From 2008 to 2019, we retrospectively analysed and graded events according to the WHO classification of PSIs: near miss events, no harm incidents and harmful incidents. Causes and corrective measures were analysed according to the human-technology-organization triad. RESULTS Of the 5145 cardiothoracic surgery PSIs declared, 407 were related to MITS. Among them, MITS was performed for primary lung cancer in 317 (78%) and consisted in a lobectomy in 249 (61%) patients. PSIs were: near miss events in 42 (10%) patients, no harm incidents in 81 (20%) patients and harmful incidents in 284 (70%) patients (mild: n = 163, 40%; moderate: n = 78, 19%; severe: n = 36, 9%; and deaths: n = 7, 2%). Human factors represented the most important cause of PSIs with 267/407 (65.6%) cases, including mainly vascular injuries (n = 90; 22%) and non-vascular injuries (n = 43; 11%). Pulmonary arteries were the most affected site with 57/91 cases (62%). In all, there were 7 deaths (2%), 53 patients required second surgery (13%) and 30 required additional lung resection (7%). CONCLUSIONS The majority of reported MITS -related PSIs were non-catastrophic. Human factors were the main cause of PSIs. Systematic reporting and analysis of these PSIs will allow surgeon and his team to avoid a large proportion of them.
{"title":"Reporting of patient safety incidents in minimally invasive thoracic surgery: a national registered thoracic surgeons experience for improvement of patient safety","authors":"B. Bottet, C. Rivera, M. Dahan, P. Falcoz, S. Jaillard, J. Baste, A. Seguin-Givelet, Richard Bertrand de la Tour, Francois Bellenot, A. Rind, D. Gossot, P. Thomas, X. D'Journo","doi":"10.1093/icvts/ivac129","DOIUrl":"https://doi.org/10.1093/icvts/ivac129","url":null,"abstract":"Abstract OBJECTIVES The reporting of patient safety incidents (PSIs) occurring in minimally invasive thoracic surgery (MITS) is crucial. However, previous reports focused mainly on catastrophic events whereas minor events are often underreported. METHODS All voluntary reports of MITS-related PSIs were retrospectively extracted from the French REX database for ‘in-depth analysis’. From 2008 to 2019, we retrospectively analysed and graded events according to the WHO classification of PSIs: near miss events, no harm incidents and harmful incidents. Causes and corrective measures were analysed according to the human-technology-organization triad. RESULTS Of the 5145 cardiothoracic surgery PSIs declared, 407 were related to MITS. Among them, MITS was performed for primary lung cancer in 317 (78%) and consisted in a lobectomy in 249 (61%) patients. PSIs were: near miss events in 42 (10%) patients, no harm incidents in 81 (20%) patients and harmful incidents in 284 (70%) patients (mild: n = 163, 40%; moderate: n = 78, 19%; severe: n = 36, 9%; and deaths: n = 7, 2%). Human factors represented the most important cause of PSIs with 267/407 (65.6%) cases, including mainly vascular injuries (n = 90; 22%) and non-vascular injuries (n = 43; 11%). Pulmonary arteries were the most affected site with 57/91 cases (62%). In all, there were 7 deaths (2%), 53 patients required second surgery (13%) and 30 required additional lung resection (7%). CONCLUSIONS The majority of reported MITS -related PSIs were non-catastrophic. Human factors were the main cause of PSIs. Systematic reporting and analysis of these PSIs will allow surgeon and his team to avoid a large proportion of them.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"139 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79872086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Kremer, A. El-Dor, W. Sommer, U. Tochtermann, G. Warnecke, M. Karck, A. Ruhparwar, A. Meyer
Abstract OBJECTIVES Our goal was to analyse adverse events in adolescent and adult patients with the Berlin Heart EXCOR and to assess the outcome of a subsequent heart transplant (HTX). METHODS From 2006 to 2020, a total of 58 patients (12–64 years old) received a biventricular assist device (BIVAD) at our institution and were included in this study. RESULTS The causes of biventricular heart failure were nonischaemic cardiomyopathy (62.1%), ischaemic cardiomyopathy (22.4%) and myocarditis (15.5%). The median INTERMACS score was I (I—III). The median age was 49 years (interquartile range, 34–55 years), and 82.8% were male. Causes of death were multiorgan failure (25.0%), septic shock (17.9%), cerebral haemorrhage (14.3%), bleeding (14.3%) and embolic events (14.3%). Major bleeding was more frequent in the patients who died while on BIVADs (60.7 vs 6.7%, P < 0.001). Wound infections were more prevalent in HTX recipients (n = 21, 70.0%). After BIVAD thrombosis, 104 chamber exchanges were performed in 28 patients (48.3%). HTXs were performed in 52.6% of the patients after a BIVAD support time of 316 ± 240 days. The mean time to follow-up of 30 HTX recipients was 1722 ± 1368 days. One-, 6- and 12-month survival after an HTX were 96.7%, 90.0% and 76.7%, respectively. Long-term survival after 5 and 10 years was 69.7%. CONCLUSIONS Pump thrombosis, infections and bleeding after receiving a BIVAD did not preclude a successful HTX. Although only 50% of patients with BIVADs were successfully given a transplant, long-term survival after an HTX in patients with BIVAD was noninferior compared to that of other recipients.
本研究的目的是分析青少年和成人Berlin心脏EXCOR患者的不良事件，并评估随后心脏移植(HTX)的结果。方法:从2006年到2020年，共有58例患者(12-64岁)在我院接受了双心室辅助装置(BIVAD)，并被纳入本研究。结果双室心力衰竭的病因为非缺血性心肌病(62.1%)、缺血性心肌病(22.4%)和心肌炎(15.5%)。INTERMACS评分中位数为I (I - iii)。中位年龄为49岁(四分位数范围为34-55岁)，82.8%为男性。死亡原因为多器官衰竭(25.0%)、感染性休克(17.9%)、脑出血(14.3%)、出血(14.3%)和栓塞事件(14.3%)。在BIVADs期间死亡的患者中大出血发生率更高(60.7% vs 6.7%， P < 0.001)。伤口感染在HTX受者中更为普遍(n = 21, 70.0%)。在BIVAD血栓形成后，28例患者(48.3%)进行了104次腔室交换。52.6%的患者在BIVAD支持时间(316±240天)后进行了htx。30例HTX受者平均随访时间为1722±1368天。HTX术后1个月、6个月和12个月生存率分别为96.7%、90.0%和76.7%。5年和10年的长期生存率为69.7%。结论:BIVAD后的泵血栓、感染和出血并不妨碍HTX的成功。虽然只有50%的BIVAD患者成功接受了移植，但与其他受体相比，BIVAD患者HTX术后的长期生存率并不差。
{"title":"Long-term paracorporeal pulsatile mechanical circulatory support in adolescent and adult patients","authors":"J. Kremer, A. El-Dor, W. Sommer, U. Tochtermann, G. Warnecke, M. Karck, A. Ruhparwar, A. Meyer","doi":"10.1093/icvts/ivac107","DOIUrl":"https://doi.org/10.1093/icvts/ivac107","url":null,"abstract":"Abstract OBJECTIVES Our goal was to analyse adverse events in adolescent and adult patients with the Berlin Heart EXCOR and to assess the outcome of a subsequent heart transplant (HTX). METHODS From 2006 to 2020, a total of 58 patients (12–64 years old) received a biventricular assist device (BIVAD) at our institution and were included in this study. RESULTS The causes of biventricular heart failure were nonischaemic cardiomyopathy (62.1%), ischaemic cardiomyopathy (22.4%) and myocarditis (15.5%). The median INTERMACS score was I (I—III). The median age was 49 years (interquartile range, 34–55 years), and 82.8% were male. Causes of death were multiorgan failure (25.0%), septic shock (17.9%), cerebral haemorrhage (14.3%), bleeding (14.3%) and embolic events (14.3%). Major bleeding was more frequent in the patients who died while on BIVADs (60.7 vs 6.7%, P < 0.001). Wound infections were more prevalent in HTX recipients (n = 21, 70.0%). After BIVAD thrombosis, 104 chamber exchanges were performed in 28 patients (48.3%). HTXs were performed in 52.6% of the patients after a BIVAD support time of 316 ± 240 days. The mean time to follow-up of 30 HTX recipients was 1722 ± 1368 days. One-, 6- and 12-month survival after an HTX were 96.7%, 90.0% and 76.7%, respectively. Long-term survival after 5 and 10 years was 69.7%. CONCLUSIONS Pump thrombosis, infections and bleeding after receiving a BIVAD did not preclude a successful HTX. Although only 50% of patients with BIVADs were successfully given a transplant, long-term survival after an HTX in patients with BIVAD was noninferior compared to that of other recipients.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79334482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ryosuke Hayashi, Y. Takami, H. Fujigaki, Kentaro Amano, Yusuke Sakurai, Kiyotoshi Akita, Koji Yamana, A. Maekawa, Kuniaki Saito, Y. Takagi
Abstract OBJECTIVES Patients with cardiovascular disease are vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. Although SARS-CoV2 vaccination may be effective, its impact on surgical patients is not well studied. We investigated the effects of cardiovascular surgery, especially under cardiopulmonary bypass (CPB), on the antibody titres after SARS-CoV2 vaccination. METHODS A prospective observational study was designed for patients undergoing surgery between July and November 2021. The immunoglobulin G against the receptor-binding domain was measured and antibody preserved rate (APR) was calculated from perioperative titres comparison. RESULTS Enrolled 63 study patients were divided into 39 undergoing surgery with CPB (Group CPB) and 24 without CPB (Group None). Preoperative vaccines were BNT162b2 (Pfizer/BioNTech) (n = 58, 92%) and mRNA-1273 (Moderna) (n = 5, 8%). While immunoglobulin G against the receptor-binding domain titres did not significantly decrease after surgery in Group None, they decreased significantly in Group CPB from 21.80 [11.15, 37.85] to 11.95 [6.80, 18.18] U/ml (P < 0.001) a day after surgery, 11.40 [7.85, 22.65] U/ml (P < 0.001) 14 days after surgery and 7.60 [4.80, 17.60] U/ml (P < 0.001) a month after surgery. The APRs a day after the surgery were significantly lower in Group CPB (0.46 [0.41, 0.60]) than in Group None (0.80 [0.68, 0.87]) (P < 0.001). CONCLUSIONS The SARS-CoV2 antibody titres significantly decreased with lower APRs immediately after surgery under CPB. Based on our informative results, careful considerations of vaccination schedule might be required for surgery under CPB.
{"title":"Effects of cardiopulmonary bypass on immunoglobulin G antibody titres after SARS-CoV2 vaccination","authors":"Ryosuke Hayashi, Y. Takami, H. Fujigaki, Kentaro Amano, Yusuke Sakurai, Kiyotoshi Akita, Koji Yamana, A. Maekawa, Kuniaki Saito, Y. Takagi","doi":"10.1093/icvts/ivac123","DOIUrl":"https://doi.org/10.1093/icvts/ivac123","url":null,"abstract":"Abstract OBJECTIVES Patients with cardiovascular disease are vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. Although SARS-CoV2 vaccination may be effective, its impact on surgical patients is not well studied. We investigated the effects of cardiovascular surgery, especially under cardiopulmonary bypass (CPB), on the antibody titres after SARS-CoV2 vaccination. METHODS A prospective observational study was designed for patients undergoing surgery between July and November 2021. The immunoglobulin G against the receptor-binding domain was measured and antibody preserved rate (APR) was calculated from perioperative titres comparison. RESULTS Enrolled 63 study patients were divided into 39 undergoing surgery with CPB (Group CPB) and 24 without CPB (Group None). Preoperative vaccines were BNT162b2 (Pfizer/BioNTech) (n = 58, 92%) and mRNA-1273 (Moderna) (n = 5, 8%). While immunoglobulin G against the receptor-binding domain titres did not significantly decrease after surgery in Group None, they decreased significantly in Group CPB from 21.80 [11.15, 37.85] to 11.95 [6.80, 18.18] U/ml (P < 0.001) a day after surgery, 11.40 [7.85, 22.65] U/ml (P < 0.001) 14 days after surgery and 7.60 [4.80, 17.60] U/ml (P < 0.001) a month after surgery. The APRs a day after the surgery were significantly lower in Group CPB (0.46 [0.41, 0.60]) than in Group None (0.80 [0.68, 0.87]) (P < 0.001). CONCLUSIONS The SARS-CoV2 antibody titres significantly decreased with lower APRs immediately after surgery under CPB. Based on our informative results, careful considerations of vaccination schedule might be required for surgery under CPB.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86827929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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