Journal of Cardiothoracic Surgery最新文献

Background: The lacking proper regulation of International Normalized Ratio (INR) as the main problem in patients with mechanical valve replacement surgery poses the risk of thrombosis and embolism on the one hand and the risk of bleeding on the other. For this reason, the correct monitoring of INR via the Time in Therapeutic Range (TTR) is needed. The present study aimed to explore the blood coagulation monitoring of patients with mechanical heart valve in Imam Ali Hospital of Kermanshah in 2021.

Method: In the present cross-sectional study, the research population consisted of 139 patients, who underwent mechanical heart valve replacement. Information on patients' demographic variables, health records, comorbidities, and medications was collected using a checklist. During the monthly follow-up, INR and thrombotic and bleeding events were recorded through calls made to patients. Then the TTR was estimated based on Rosendahl's model and compared with the standard rate to test the relationship with hemorrhagic and thrombotic events in SPSS21.

Results: The mean and standard deviation of patients' age was 58.25 ± 10.16 years. Among 139 patients with mechanical heart valves, 55 (39.6%) were male and 84 (60.4%) were female. Ninety-one patients (65.5%) had primary-school education, 22 (15.8%) middle school education, 17 (12.2%) high school education and 9 (6.5%) had a university degree. Chi-square test results showed a positive and significant difference between the blood coagulation monitoring of patients with mechanical heart valves and sex, education, blood pressure, captopril drug and the number of visits and follow-up (p ≥ 0.05).

Conclusion: The present study showed that TTR was lower than normal in the target population. Therefore, it is necessary to closely monitor patients' blood coagulation for the appropriate therapeutic dose according to patients' sex, education, blood pressure, captopril drug and the number of visits and follow-up.

Background: Post-pneumonectomy bronchopleural fistula (BPF) is a life-threatening event whose treatment is not standardized.

Case presentation: We report the management of a 28-year-old patient with a 3-year history of BPF complicating right pneumonectomy for congenital emphysema. Despite closure by an Amplatzer device, the patient had chronic pyothorax and severely deteriorated general health and quality of life. An attempt at Amplatzer device removal through an open window thoracostomy failed. A median sternotomy was performed, the carina was resected, and the left main bronchus was anastomosed to the trachea. The thoracostomy was closed using fasciocutaneous pedicled flaps. At 9 months, the patient was doing well.

Conclusion: The utilisation of an Amplatzer device to close a broncho-pleural fistula can have adverse effects and potentially result in fatal sepsis in those cases where it is unsuccessful. The endoscopic treatment of BPF should be reserved for expert centers, considering the location, size, and stability of the fistula when choosing the treatment strategy. The surgical management of failed Amplatzer closure may be extremely complex, requiring a highly experienced team.

Objectives: Transcatheter edge-to-edge repair (TEER) is an alternative for patients with severe degenerative mitral regurgitation (MR). The objective of this study was to compare the outcomes of surgery and TEER in older patients with degenerative MR patients using real life data.

Methods: Consecutives older patients (≥ 65 years-old), with severe symptomatic, degenerative MR requiring surgery or TEER between 2013 and 2023 were included. Exclusion criteria were secondary MR, and active endocarditis. Primary outcome was a composite of all-cause death, hospitalization for heart failure or mitral valve intervention within one year.

Results: A total of 295 patients were included (203 underwent surgery and 92 underwent TEER). At 1 year, 26 (9%) patients had died, required reintervention or rehospitalization for heart failure: 8 patients in the surgery group (4%) and 18(20%) in the TEER group(p < 0.01). Factors independently associated with the combined outcome were residual MR > 2 (aHR 4.31 (95% CI: 1.51-12.25)), history of cardiac surgery (aHR 6.24 (95%CI: 2.16-18.05)), BMI (aHR 0.88 (95% CI: 0.77-0.98)), TR > 2 at baseline (aHR: 2.47 (95% CI: 1.03-5.91)). After adjustement on confounding factors, intervention type was not associated with the primary composite outcome (aHR: 3.41 (95% CI: 0.63-18.27)), p = 0.15).

Conclusion: Patients with severe primary MR treated with TEER experienced a higher rate of adverse events within one year compared to surgically managed patients. However, these differences were mainly associated to clinical characteristics and were no longer significant after adjustment on residual MR > 2.

Objective: miRNA, circRNA, and lncRNA play crucial roles in the pathogenesis and progression of myocardial ischemia-reperfusion injury (MI/RI). This study aims to provide valuable insights into miRNA, circRNA, lncRNA, and MI/RI from a bibliometric standpoint, with the goal of fostering further advancements in this area.

Methods: The relevant literature in the field of miRNA, circRNA, lncRNA, and MI/RI was retrieved from the Science Citation Index Expanded (SCI-E) database within Web of Science. The "Analyze Results" and "Citation Report" functions in WOS were utilized to compile the annual publication and citation counts in this field. Microsoft Office Excel 2019 was used to organize and visualize the data. Furthermore, bibliometric and visualization analyses of countries/regions, institutions, authors, keywords, and references were conducted using the bibliometric visualization software CiteSpace.

Results: A total of 858 publications were included for further analysis in this field. The literature was published across 297 journals, with Molecular Medicine Reports contributing the highest number of publications. Researchers from 45 countries participated in studies within this field, with those from China contributing the most publications. The research hotspots in this field primarily focus on three areas: the role of miRNA, circRNA, and lncRNA in the pathogenesis of MI/RI, their potential as therapeutic targets, and their role as biomarkers. Among these, circular RNA, therapy target, inflammatory response, and cardiomyocyte ferroptosis are likely to emerge as emerging trends in this field.

Conclusion: The overall development of research in this field is on the rise. The compilation of research hotspots and emerging trends in this area may provide researchers with more references and assistance in selecting research directions, ultimately benefiting MI/RI patients.

Background: This article aims to use high-throughput sequencing to identify miRNAs associated with ferroptosis in myocardial ischemia-reperfusion injury, select a target miRNA, and investigate its role in H9C2 cells hypoxia-reoxygenation injury.

Methods: SD rats and H9C2 cells were used as subjects. ELISA kits quantified MDA, SOD, GSH, LDH, and ferritin levels. TTC staining evaluated infarction size. HE staining observed histopathological changes. DCFH-DA fluorescent probe detected ROS. CCK-8 kit measured cell viability. HiSeq 2000 sequencing performed differential expression analysis of miRNAs. qRT-PCR and Western blots assessed the expression levels of GPX-4, ACSL-4, HO-1, TFR-1 and TFR-2. SPSS 21.0 software conducted statistical analysis.

Results: Myocardial ischemia-reperfusion injury resulted in decreased levels of SOD and GSH, increased levels of LDH and MDA, up-regulation of ferritin, ACSL-4, HO-1, and TFR-2, down-regulation of GPX-4, increased tissue damage, and accumulation of ROS. However, DFO treatment reversed these changes. Subsequently, the target gene miRNA-541-5p was obtained by miRNA sequencing screening, and further validation revealed that miRNA-541-5p expression was increased in the myocardial tissues of rats in the I/R injury model group compared with those of rats in the NC group, P < 0.05. Subsequently, by constructing H9C2 cell lines with miRNA-541-5p overexpression and miRNA-541-5p expression inhibition, miRNA-541-5p expression was inversely correlated with the survival of H9C2 cells after hypoxia-reoxygenation injury. miRNA-541-5p up-regulation led to a decrease in SOD and GSH, an increase in ferritin and MDA, and an accumulation of ROS. wb and qRT-PCT demonstrated that high miRNA-541-5p expression up-regulated the expression of protein/mRNA expression of ACSL-4, HO-1, ferritin, and TFR-1, but down-regulated protein/mRNA expression of GPX-4. In addition, ADAM 7, FNIP 2, HOXD 10, HCCS and STK 3 were preliminarily identified as potential candidate target genes for miRNA-541-5p by bioinformatics analysis. Among them, ADAM7 emerges as the most suitable potential target gene based on the selection criteria.

Conclusion: In summary, miRNA-541-5p may be a biomarker of myocardial I/R damage diseases and can regulate oxidative stress and iron death by inhibiting the expression of miRNA-541-5p, thereby reducing mechanisms of I/R injury.

Background: Lung cancer is the first cause of cancer-related death. Awake lung resection is a new frontier of the concept of minimally invasive surgery. Our purpose is to demonstrate the feasibility of this technique for lobar and sublobar lung resection in NSCLC patients.

Methods: We retrospective reviewed all the medical charts of patients who underwent awake lung resection in our center between March 2018 and March 2024, focusing on patients with NSCLC, and we compared our results with the ones found in literature.

Results: Among 45 patients treated with awake lung resections, we selected 15 patients with NSCLC and finally analyzed the results of 12 patients who underwent VATS awake lung resection, 3 lobectomies and 9 wedge resections. The median Charlson comorbidity index (CCI) was 3 and we had 5 patients (41.67%) with a CCI ≥ 4 and a median FEV1 of 56%. We report only 2 conversions to general anesthesia (16.67%) and no conversion to open thoracotomy. We used a nebulizator for the atomization of lidocaine on the lung surface to reduce the cough reflex. Our post-operative results are in line with literature, with a low complication rate (2 patients, 16.67%) and a median length of stay of 5 days. We safely performed a proper lymph node dissection in all 3 lobectomies. Median Overall Survival and Disease-Free Survival were 11 months.

Conclusions: Awake lung resections are a feasible way to perform a minimally invasive surgical procedure in NSCLC patients, with low risk of conversion to open surgery.

Background: A broncho-esophageal fistula (BEF) is a medical and surgical disaster. Treatment of BEF is often limited to palliative stent treatment that may migrate or cause erosions and tissue necrosis. Surgical repair of BEF is the only established definite treatment.

Case presentation: BEF presented in a 40-year-old female patient 8 years after curative treatment with pneumonectomy and radio-chemotherapy for advanced lung cancer. She had autoimmune comorbidity, a single lung, vocal cord paralysis and an extremely hostile thorax. Multi-disciplinary collaboration, close patient involvement and evaluation by the hospital medical ethics committee were key elements in the following treatment course. After temporary stent treatment, a carefully staged surgical marathon was performed: Veno-venous ECMO was established to secure oxygenation, and bilateral thoracotomy and laparotomy performed to access structures in the frozen mediastinum. After extensive thoracoplasty and high-risk dissection, esophagectomy was performed and the 20 × 35 mm bronchial defect repaired by bronchoplasty with a latissimus muscle flap. It was complicated by thrombotic occlusion of the upper venous system, repeated postoperative bleedings and critical illness neuropathy. The patient recovered and was discharged 150 days after surgery. Within 1-2 years bronchoscopy showed a smooth undiscernible bronchoplasty with a stable open left main bronchus. At 5 years the patient lives an independent life at home with her family.

Conclusions: Surgical treatment of BEF in an extremely complex patient may turn out successfully. It demands careful ethical considerations, comprehensive surgical strategy, multi-disciplinary teamwork, and shared decision making with the patient. The patient presented in this case report is closely followed up with good life quality after 5 years.

Background: Continuous Positive Airway Pressure (CPAP) treatment brings more benefits than risks to most coronary heart disease (CHD) patients with obstructive sleep apnea (OSA). However, the pathophysiological mechanism by which CPAP treatment improves the prognosis of patients with CHD and OSA remains unclear. The purpose of this study was to clarify whether CPAP can improve arterial stiffness and inflammatory factor levels in CHD patients with OSA, and to further improve prognosis.

Method: 59 patients with coronary heart disease complicated by moderate to severe sleep apnea were divided into a CPAP treatment group (CPAP + coronary heart disease standard treatment) and a control group (only coronary heart disease standard treatment). Peripheral blood test reports were collected and pulse wave velocity (PWV) measurements were performed for each patient at the beginning, 3 months, and 6 months of treatment.

Results: After 6 months of treatment, the CPAP group showed more significant improvement in the levels of inflammatory factors such as white blood cell (WBC), neutrophil (N), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and PWV than the control group.

Conclusion: After active treatment with CPAP, arterial stiffness and inflammatory cytokine levels in patients with coronary heart disease and OSA improved. This association should be given more attention in clinical practice, and sleep apnea should be actively treated.

Background: Thoracic aortic endovascular repair (TEVAR) is the most commonly employed method for treating type B aortic dissection (TBAD). One of the primary challenges in TEVAR is the reconstruction of the left subclavian artery (LSA). Various revascularization strategies have been utilized, including branch stent techniques, fenestration techniques, chimney techniques, and hybrid techniques. Among these, the single-branched stent graft (SBSG) has emerged as one of the most promising methods. This study employs a meta-analysis to evaluate the efficacy and safety of SBSG in treating TBAD, thereby providing robust evidence to guide clinical practice.

Methods: Published literatures on the treatment of TBAD with SBSG were collected from CNKI, Wanfang Data, VIP, PubMed, Embase, Web of Science and Cochrane Library. The search period ranged from the inception of each database to December 1, 2024. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was conducted using RevMan 5.3 software.

Results: A total of eight studies involving 660 participants were included in this meta-analysis. The results demonstrated that, compared to other surgical methods, SBSG significantly reduced the perioperative neurological complication rate (OR = 0.23, 95%CI(0.07, 0.76), P = 0.02), type I endoleak rate (OR = 0.30, 95%CI(0.15, 0.61), P = 0.001), and left upper limb ischemia rate (OR = 0.06, 95%CI(0.01, 0.49), P = 0.008). Additionally, SBSG was associated with a shorter operation time (SMD = 0.59, 95%CI(0.04, 1.14), P = 0.04). However, no significant differences were observed between SBSG and other surgical methods in terms of technique success rate (OR = 1.51, 95%CI(0.55, 4.14), P = 0.42), hospital length of stay (OR = 1.51, 95%CI(0.55, 4.14), P = 0.42), aortic false lumen thrombosis rate (OR = 1.30, 95%CI(0.55, 3.07), P = 0.56), pulmonary infection rate (OR = 0.50, 95%CI(0.16, 1.58), P = 0.24), and 30-day postoperative mortality (OR = 0.41, 95%CI(0.12, 1.35), P = 0.41).

Conclusion: SBSG demonstrates safety and efficacy in the treatment of TBAD by significantly reducing the perioperative neurological complexity rate, type I leakage rate, and left upper limb ischemia rate, while also decreasing operative time.

Objective: In this study, we aimed to screen the risk factors for delayed extubation after surgery for Ebstein's anomaly (EA), determine the diagnostic cut-off values, and develop a prediction equation to accurately encourage rapid recovery after surgery.

Methods: The perioperative data of 76 pediatric patients undergoing EA surgery in the Surgical Department of the Pediatric Heart Center of Anzhen Hospital from September 2013 to September 2021 were retrospectively analyzed.

Results: Among these cases, 37 (48.6%) were male, with an average age of 4.67 (2, 11.19) years and an average weight of 18 (12.4, 37) kg. The median postoperative duration of mechanical ventilation was 18 (10, 24) h, and the duration of mechanical ventilation ≥ 24 h (75th percentile) was defined as delayed extubation. Body weight (11.25 kg) and preoperative oxygen saturation (SpO₂) (95.5%) were protective factors, while the simplified Great Ormond Street Echocardiogram (GOSE) value (0.995) and the intraoperative cardiopulmonary bypass (CPB) time (135 min) were the risk factors. The prediction model was developed based on these indexes: logit (P) = 8.9 + (0.02 × CPB time) + (2.2 × simplified GOSE) - (0.14 × preoperative SpO₂) - (0.06 × body weight), and the area under the receiver operator characteristic (ROC) curve was 83.4% (P < 0.01). Patients with delayed extubation had a longer intensive care unit stay and a higher incidence of adverse events (P < 0.01).

Conclusion: Low body weight, low preoperative SpO₂, high GOSE value, and long intraoperative CPB time for pediatric patients with EA are likely to lead to prolonged postoperative duration of mechanical ventilation. For low-risk children, early extubation after surgery can be more actively encouraged; however, more care should be taken to avoid the risk of re-intubation.