Journal of Cardiothoracic Surgery最新文献

Background and aim: Removing the chest tube in cardiac patients after surgery is one of the worst experiences of hospitalization in the intensive care units. Various pharmacological and non-pharmacological methods are available to control pain in these patients. This study aimed to investigate the combined effect of reflexology massage and respiratory relaxation on pain following chest tube removal in cardiac surgery patients of Shahid Beheshti Hospital in Shiraz, Iran, in 2023.

Methods: This was a double-blind randomized clinical trial performed on 140 patients who underwent heart surgery and had a chest tube in Shiraz, Iran. The samples were randomly divided into four groups: 1- control group, 2- respiratory relaxation group, 3- foot reflex massage group, and 4- a combination of respiratory relaxation and reflexology massage. To collect data, two demographic questionnaires, and a visual analog scale were used.

Results: The participants of the four groups were not meaningfully different in terms of age, BMI, duration of surgical operation, gender, job, education, place of residency, number of chest tubes, history of operation (P = 0.99, 0.31, 0.06, 0.81, 0.97, 0.96, 0.17, 0.10, 0.89 respectively). The mean scores of pain intensity during chest tube removal, and 15 min after chest tube removal were not statistically different among the four groups of study (P = 0.15, 0.54 respectively); However, just after chest tube removal, the mean scores of pain intensity differed meaningfully among four groups (P = 0.008).

Conclusion: The results showed that reflexology massage and respiratory relaxation both reduce pain immediately after chest tube removal in heart surgery patients. Also, the combination of these two techniques was more effective in reducing patients' average pain.

Background: Near-infrared spectroscopy (NIRS) enables a non-invasive measurement of tissue oxygen saturation (StO₂) in regions illuminated by near-infrared lights. Vascular occlusion test (VOT) serves as a model to artificially induce forearm ischemia-reperfusion. The combination of StO₂ monitoring and VOT allows for dynamic evaluation of the balance between oxygen delivery and consumption in tissue, as well as the functional reserve of microcirculation. However, the implications of these measurements for patient outcomes remain inadequately understood. This study aimed to investigate the association between StO₂-VOT measurements and the occurrence of postoperative acute kidney injury (AKI), in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).

Methods: Between March 2020 and March 2021, 100 adult patients who scheduled to undergo cardiac surgery with mild hypothermic CPB were enrolled to this prospective observational study. StO₂ was continuously monitored at the right forearm and ipsilateral VOT procedure was performed before initiation of CPB, at the time before weaning from CPB, and at the end of surgery. Preoperative and intraoperative factors, along with StO₂-VOT parameters, were evaluated for their independent association with the occurrence of AKI following cardiac surgery. StO₂-VOT parameters were also compared between patients with hyperlactatemia (peak blood lactate ≥ 4 mmol/L) and those without hyperlactatemia.

Results: In our patient population (n = 87), 13.79% (12/87) patients developed AKI after surgery. Multivariable analysis revealed that CPB time and post-CPB desaturation speed (D-speed) were independently associated with AKI. Post-CPB D-speed had an area under receiver operating characteristic (ROC) curve of 0.79 (95% CI, 0.66-0.93) with a cutoff value of 0.08%·min^- 1 in predicting AKI. Patients with hyperlactatemia had longer pre-CPB T₁ and higher D-speed during CPB. However, ROC analysis indicated that T₁ and D-speed exhibited limited predictive capacity for hyperlactatemia. Patients with AKI exhibited an increased risk of prolonged ICU stays, postoperative stroke, reoperation, and in-hospital mortality.

Conclusions: NIRS monitoring combined with VOT shows promise in predicting postoperative AKI in patients undergoing cardiac surgery with mild hypothermic CPB.

Trial registration: ChiCTR1900021436 with registered date 21/02/2019.

Background: Lung adenocarcinoma is the most common form of lung cancer and one of the most life-threatening malignant tumors. Ferroptosis is an iron-dependent regulatory cell death pathway that is crucial for tumor growth. SNX30 is a key regulatory factor in cardiac development; however, its regulatory mechanism and role in inducing ferroptosis in lung adenocarcinoma remain unclear.

Objective: This study aimed to elucidate the functions and specific mechanisms of action of SNX30 in lung adenocarcinomas.

Methods: SNX30 levels in lung adenocarcinoma cell lines (A549 and HCC827) were determined using reverse transcription quantitative real-time PCR (RT-qPCR) or western blotting. Cell proliferation and apoptosis were assessed by CCK8 and flow cytometry, respectively. The intracellular levels of total iron and Fe²⁺ were detected using Iron Assay Kits. Reactive oxygen species (ROS) levels were evaluated using a DCFH-DA probe and flow cytometry. Cysteine (Cys), glutathione (GSH), and glutathione peroxidase 4 (GPX4) levels were measured using detection assay kits. Other related markers, including Ptgs2, Chac1, SETDB1 cleaved-Caspase3, and Caspase3 were analyzed by RT-qPCR or western blotting.

Results: SNX30 is downregulated in lung adenocarcinoma cell lines. SNX30-plasmid depressed lung adenocarcinoma cell proliferation, accelerated apoptosis, enhanced cleaved-Caspase3 expression and cleaved-Caspase3/Caspase3 ratio. Ferrostatin-1 significantly reversed the effects of the SNX30-plasmid on cell ferroptosis in lung adenocarcinoma, as confirmed by the reduced ROS levels, inhibited intracellular total iron and Fe²⁺ levels, decreased Ptgs2 and Chac1 expression, and increased Cys, GSH, and GPX4 release. We observed that the level of SETDB1 was lower in the SNX30-plasmid group than in the control-plasmid group, whereas the opposite results in ferrostatin-1 treated cells. SNX30 negatively regulates SETDB1 expression in lung adenocarcinoma cells. The upregulation of SETDB1 reversed the effects of the SNX30-plasmid on ferroptosis in lung adenocarcinoma cells.

Conclusion: SNX30 inhibits lung adenocarcinoma cell proliferation and induces ferroptosis by regulating SETDB1 expression.

Objective: To explore the safety and efficacy of low-intensity anticoagulation in patients after On-X mechanical aortic valve replacement.

Methods: A total of 104 patients undergoing aortic valve replacement in Cardiac Surgery Department of Sichuan Provincial People's Hospital from December 2018 to December 2021 were randomly divided into low-intensity anticoagulant (INR:1.5-2.0) and high-intensity anticoagulant (INR:2.0-2.5) to compare the incidence of adverse events related to postoperative anticoagulation between the two groups.

Results: Fifty-three patients were included in the low-intensity anticoagulation group (INR 1.5-2.0), and 51 patients were included in the high-intensity group (2.0-2.5). There was no significant difference in baseline data and surgical index between the two groups (P > 0.05); there were statistically significant differences in PT, INR and bleeding events (P < 0.05), but no significant difference in embolic events (P > 0.05).

Conclusion: For patients requiring On-X mechanical aortic valve replacement who have no risk factors for thromboembolism, it is appropriate to control the INR in the target range 1.5-2.0, which can reduce the incidence of bleeding adverse events and significantly improve the quality of life, without increasing the risk of thromboembolic adverse events.

Background: Several methods for blindly positioning bronchial blockers (BBs) for one-lung ventilation (OLV) have been proposed. However, these methods do not reliably ensure accurate positioning and proper direction. Here, we developed a clinically applicable two-stage maneuver by modifying a previously reported one-stage maneuver for successful insertion of a BB at the appropriate depth and direction in patients requiring lung isolation where a flexible bronchoscope (FOB) is not applicable.

Methods: This prospective, randomized, crossover study was conducted at a tertiary university hospital and included 94 patients requiring OLV for elective thoracic surgery under general anesthesia. The patients underwent the one-stage maneuver followed by the two-stage maneuver and vice versa, and the success rates of the two methods were compared. After tracheal intubation, the deflated rigid-angle BB was inserted into the endotracheal tube (ET) until a pre-marked point indicating that the BB was just protruding from the ET tip. To identify the carinal depth without FOB, the BB balloon was inflated and advanced toward the intended side whilst monitoring abrupt changes in peak inspiratory pressure and expiratory tidal volume to indicate placement at the carina. In one-stage maneuver, the BB balloon was deflated and advanced 3 cm further from the estimated carinal depth. During the two-stage maneuver, the same procedure was performed to determine the carinal depth, and the deflated BB was withdrawn and reinserted to a predetermined depth with its tip directed 90 degree toward the target bronchus. The accuracy of BB positioning for both maneuvers was evaluated by a 4-point scale, with grades 1 and 2 considered acceptable for providing OLV.

Results: BB placement was more accurate in the two-stage maneuver than in the one-stage maneuver [88.0% (81/92) vs. 73.9% (68/92), relative risk (95% confidence interval [CI]), 0.45 (0.23-0.88), P < 0.001]. This improvement was particularly significant when targeting the left main bronchus [84.8% (39/46) vs. 58.7% (27/46), relative risk (95% CI), 0.36 (0.17-0.79), P < 0.001)].

Conclusions: The novel two-stage maneuver significantly improved the success rate of blindly positioning the BB.

Trial registration: This study was registered in ClinicalTrials.gov (NCT02981537) on December 05, 2016.

Objectives: Despite the advances in medicine, aortic dissection remains a cardiac surgery emergency with high mortality and morbidity rates. This study examined the effects of the Glue + Felt technique, which uses biological glue and felt to repair the proximal anastomotic site, on the outcomes of patients with acute type A aortic dissection.

Methods: A total of 108 patients who underwent surgery for acute type A aortic dissection at our clinic between 2007 and 2020 were included in the study. The patients were divided into two groups: the "Glue + Felt Technique" and the "Bentall-De Bono" groups, based on the surgical technique used for the aortic root. The effects of these two techniques on the development of intraoperative and postoperative complications and survival rates were statistically analyzed.

Results: The Glue + Felt technique was used for 76 patients, while the Bentall-De Bono technique was used for 32 patients. The Kaplan-Meier analysis revealed significant differences in survival rates between the two groups over the entire follow-up period, both with and without propensity score matching (p < 0.001 and p = 0.02, respectively). However, no significant differences were observed in comparisons beyond the first 30 days of follow-up, either with or without propensity score matching (p = 0.573 and p = 0.561, respectively). The main factors contributing to this difference were the duration of cardiopulmonary bypass and aortic cross-clamp time (p < 0.05). During the average follow-up period of 46.2 ± 31.6 months, no re-intervention was required in patients from the Glue-Felt technique group.

Conclusions: The mortality rate in aortic dissection surgery is higher with more extensive surgical intervention as the duration of cardiopulmonary bypass and aortic cross-clamp time increases. Repairing the lumen and reducing operation time in suitable patients using the Glue-Felt technique for the proximal anastomotic site positively impacts postoperative complications and improves in-hospital and 30-day survival rates, without increasing long-term re-intervention rates.

Background: Gauzoma is a foreign body reactive granuloma which is an extremely rare complication of thoracic surgery. We describe a case of a Gauzoma in which the gauzes were removed by mini-thoracotomy as a less invasive procedure, discovered incidentally after 35 years of follow-up.

Case presentation: A 51-year-old man was referred to our department for hyperhidrosis treatment, and imaging studies and biopsy confirmed the diagnosis of Gauzoma. As the Gauzoma gradually grew for a few years, surgical intervention was judged necessary, and the removal of the gauzes was performed in this case. A two-stage operation in two days was required to complete the surgery. The completion of gauze removal was confirmed in the second surgery using a postoperative computed tomography (CT) scan. The patient is currently doing well 17 months after surgery, and the size of granuloma unchanged.

Conclusion: We performed the removal of the gauzes as the treatment for Gauzoma. Although removing the gauze may have prevented its growth so far, careful follow-up is still needed.

Background: Solid lung lesions are common in clinical practice, and percutaneous thermal ablation has been shown to be an effective treatment for these lesions. While computed tomography (CT)-guided microwave ablation (MWA) therapy is frequently used for adult solid lesions, it is rarely considered for pediatric cases.

Case presentation: A case of an 8-year-old child with adrenal neuroblastoma and a left upper lung mass. The child successfully underwent lung mass ablation and experienced a long-term progression-free period with good recovery and no recurrence.

Conclusions: This case suggests that MWA could be a valuable addition to existing treatment options for solid lesions in children.

Objective: To investigate the therapeutic effect of levosimendan on hemodynamics in patients undergoing major cardiac surgery and presenting with acute postoperative heart failure.

Methods: The subjects of the study were 160 patients with severe cardiac conditions who underwent surgery and had acute heart failure. Eighty cases each were assigned to the research and control groups using a random number table. Document the general patient data for each of the two groups; compare the clinical outcomes of the two groups. The hemodynamic states of the two groups were compared both before and after therapy. 48 h after surgery, echocardiography was performed in both groups to determine cardiac function. 48 h after surgery, N-terminal pro-brain B-type natriuretic peptide (NT-Pro-BNP) levels were compared between the two groups.

Results: The overall effective rate was significantly higher in the research group (92.5%) compared to the control group (76.25%, P < 0.05). Post-treatment, the research group demonstrated a significant reduction in CVP (9.25 ± 2.11 cmH2O vs. 11.36 ± 3.08 cmH2O, P < 0.001), heart rate (100.30 ± 8.69 bpm vs. 105.74 ± 7.69 bpm, P < 0.001), and lactic acid levels (1.68 ± 0.59 mmol/L vs. 2.69 ± 0.55 mmol/L, P < 0.001). The research group also showed improvements in SBP (117.23 ± 8.74 mmHg vs. 113.25 ± 7.55 mmHg, P = 0.002) and urine output (4.21 ± 1.76 mL/kg/h vs. 3.65 ± 1.23 mL/kg/h, P = 0.021). Cardiac function indicators 48 h after surgery indicated a higher LVEF (55.21 ± 8.04% vs. 47.18 ± 6.60%, P < 0.001) and lower LVEDVi and LVESVi in the research group (P < 0.001 for both). NT-Pro-BNP levels were significantly lower in the research group (6010.19 ± 1208.52 pg/mL vs. 9663.21 ± 2391.34 pg/mL, P < 0.001). The incidence of complications was lower in the research group (5% vs. 22.5%, P = 0.001).

Conclusion: Cardiac surgery patients are prone to complications with acute heart failure after surgery. Treatment with levosimendan can significantly improve clinical efficacy and reduce complications. It can also effectively improve patients' cardiac function and promote hemodynamic stability.

Background: The intricate anatomical variations in lung structure often perplex thoracic surgeons, and the accurate identification of these variations is closely associated with favorable surgical outcomes.

Case presentation: A 53-year-old female patient who underwent computed tomography (CT) examination due to chest discomfort, revealing the presence of a partial solid nodule highly suspected of early-stage lung cancer, measuring approximately 2.8 × 2.6 cm in the left lower lobe. Consequently, the patient underwent a single direction thoracoscopic left lower lobectomy and lymph node dissection. Intraoperatively, while attempting to dissect and free the left lower lobe vein from surrounding tissues, technical difficulties were encountered. Upon meticulous review of preoperative CT scans during surgery, an anomalous connection between the lingular vein of the left upper lobe and the left lower lobe vein was identified. Once this anatomical variation was confirmed, surgical intervention proceeded uneventfully without any significant complications.

Conclusion: Precise recognition of pulmonary anatomical structures before and during surgery is paramount in recognizing rare variations such as this one as it aids in preventing potential intraoperative injuries and minimizing postoperative complications.