Journal of Cardiothoracic Surgery最新文献

Background: Anterior mediastinal hematomas following blunt chest trauma are usually not life threatening. However, in rare cases, they can cause extrapericardial tamponade, requiring urgent surgical intervention. Despite its increasing adoption in elective thoracic procedures, the use of subxiphoid uniportal video-assisted thoracoscopic surgery (SUVATS) in trauma remains scarcely reported. This case highlights a rare instance of extrapericardial tamponade caused by an anterior mediastinal hematoma, successfully managed using SUVATS in a trauma setting.

Case presentation: We report the case of a 65-year-old man who had a 4-meter fall and sustained a retrosternal hematoma and sternal fracture, as confirmed on chest computed tomography without evidence of intracardiac or major vascular injuries. Following initial hemodynamic stability, evolving hemodynamic compromise led to transthoracic echocardiography, which demonstrated right ventricular compression consistent with extrapericardial tamponade, necessitating surgical evacuation. SUVATS was performed for hematoma evacuation and hemostasis. During subsequent sternal fixation via a separate limited midline incision, thoracoscopic visualization enabled assessment of the posterior sternal surface. The patient was extubated on the day of surgery and was discharged without complications.

Conclusions: This case demonstrates the extended utility of SUVATS beyond hematoma evacuation, including its adjunctive role in sternal fixation. This minimally invasive approach provided excellent mediastinal exposure, reduced postoperative pain, and minimized respiratory complications. SUVATS may be a feasible option in selected trauma cases, including those with tamponade physiology. In trauma patients without major vascular injury, it may offer a less invasive yet effective alternative to median sternotomy, potentially improving early recovery and outcomes.

Background: Pulmonary segmentectomy is a valid alternative to lobectomy in early-stage non-small cell lung cancer (NSCLC). However, limited data are available on post-operative compensatory volume changes following segmentectomy. The aim was to clarify the temporal patterns of lobar volume changes in the residual and contralateral lung at 6 and 12 months post-segmentectomy using 3D reconstruction.

Methods: We retrospectively reviewed patients who underwent video-assisted thoracoscopic surgery (VATS) segmentectomy for early-stage NSCLC from 2017 to 2022. Pre-operative lung lobe volumes were calculated from three dimensional (3D) reconstruction (Materialize^®) and compared with volumes at 6 and 12 months post-operatively.

Results: A total of 30 patients (median age: 66, sex ratio M/F: 14/16) were included. On the right side (n = 15), median lobar volume loss reached 62.4% (p = 0.03) after upper S1 segmentectomy, 38.9% (p > 0.05) after S2 and 35.5% (p > 0.05) after S6 at 12 months. Compensatory expansion was predominant in the lower lobe for upper segmentectomies, respectively + 24.2% (p > 0.05) for S1 and + 22.2 (p > 0.05) for S2, whereas compensation in middle lobe was present for S1 segmentectomy (+ 17%, p = 0.03) and for S6 (+ 14.9%, p > 0.05). On the left side, median volume loss was 73.0% (p = 0.03) after upper trisegmentectomy, 34.8% (p > 0.05) after lingulectomy, and 37.4% (p = 0.03) after S6 resection. Compensatory expansion mainly involved the lower lobe for upper resections (+ 31.4%, p = 0.03), while the upper lobe increased by + 11.4% (p = 0.03) following lower-lobe segmentectomy. No volume difference was observed in the contralateral lobes over 12 months across resection types. Overall total lung volume was largely unchanged at 12 months across resection types, except for left S6 segmentectomy (a 6.6% decrease, p = 0.03).

Conclusion: Volume compensation mechanisms occur after VATS segmentectomy, with more pronounced volume reduction following upper-lobe resections compared to lower-lobe resections. The absence of contralateral volumetric compensation may allow subsequent compensatory responses to occur and potentially contribute to a better preservation of lung function in patients undergoing additional pulmonary resections. Characterizing these patterns is important for surgical planning and optimizing postoperative management in patients undergoing segmentectomy for early-stage NSCLC.

Background: Coronary artery bypass grafting (CABG) has been shown to reduce mortality and improve quality of life in patients with extensive coronary artery disease. However, evidence regarding its benefits in the context of acute coronary syndrome (ACS) remains limited, especially considering patient selection, graft patency and in-hospital mortality reduction. This study examines the experience of patients undergoing off-pump CABG during ACS in a high-complexity cardiology center in Argentina.

Methods: This study analyzed a single-center longitudinal prospective cohort of ACS patients undergoing off-pump CABG (OPCAB) between January 2002 and December 2022. The demographic, clinical, and surgical data were examined, focusing on major adverse cardiovascular events (MACE) and in-hospital morbidity including periprocedural AMI, reoperation for bleeding, among others. Independent risk factors for in-hospital mortality and morbidity were identified through multivariate analysis using stepwise logistic regression.

Results: Among 1,738 patients, predominantly male (85.5%), 28.3% had diabetes, and 24.2% were smokers. The average age was 64 years, with a mean ejection fraction of 55%. 6.5% of procedures were performed as emergency surgeries within 24 h of hospital admission and 3.4% required conversion to cardiopulmonary bypass. Hospital mortality was 3.5%, and multivariate analysis showed that age (OR 1.082; 95% CI: 1.036-1.129, p = 0.001) and baseline ejection fraction (OR 0.952; 95% CI: 0.924-0.981, p = 0.001) were associated with this event.

Conclusions: In our experience, OPCAB proved to be a feasible option in specialized centers with expertise, characterized by low mortality, minimal need for conversion to CPB, and high success rates in complete revascularization using arterial grafts.Age and baseline ejection fraction significantly influence hospital outcomes, although these results should be correlated with long-term randomized studies.