Journal of Cardiothoracic Surgery最新文献

Background: Radiomics has shown promise in the diagnosis and prognosis of lung cancer. Here, we investigated the performance of computed tomography-based radiomic features, extracted from gross tumor volume (GTV), peritumoral volume (PTV), and GTV + PTV (GPTV), for predicting the pathological invasiveness of pure ground-glass nodules present in lung adenocarcinoma.

Methods: This was a retrospective, cross-sectional, bicentric study with data collected from January 1, 2018, to June 1, 2022. We divided the dataset into a training cohort (n = 88) from one center and an external validation cohort (n = 59) from another center. Radiomic signatures (rad-scores) were obtained after features were selected through correlation and least absolute shrinkage and selection operator analysis. Three machine learning models, a support vector machine model, a random forest model, and a generalized linear model, were then applied to build radiomic models.

Results: Invasive adenocarcinoma had a higher rad-score (P<0.001) in the GTV and GPTV. The area under the curves (AUC) of GTV, PTV, and GPTV were 0.839, 0.809, and 0.855 in the training cohort and 0.755, 0.777, and 0.801 in the external validation cohort, respectively. The GPTV model had higher AUCs for predicting pathological invasiveness. The random forest model had the best validity and fit for the proposed machine learning approach, suggesting that it may be the most appropriate model.

Conclusions: GPTV had the highest diagnostic efficiency for predicting pathological invasiveness in patients with pure ground-grass nodules, and the random forest model outperformed other predictive models.

Introduction: High levels of MG53 may attenuate the damage from myocardial infarction (MI). Furthermore, N6-methyl-adenosine (m6A) methylation is a mode of RNA modification that influences mRNA functions. Whether m6A modification on MG53 exerts a protective role on myocardial injury remains largely unknown.

Materials and methods: We established hypoxia/reoxygenation (H/R) H9c2 cell and myocardial ischemia reperfusion (I/R) rat models. MG53 expression was detected using RT-qPCR, and its m6A levels were measured using Me-RIP. The relationship between MG53 and YTHDF2 was evaluated using RNA immunoprecipitation, FISH and immunofluorescence assay, and luciferase reporter assay. MI area of rats was determined using TTC staining. Cell apoptosis was assessed by flow cytometry and TUNEL assay.

Results: The m6A levels of MG53 were increased in H/R-induced H9c2 cells and the myocardium of I/R rats. Moreover, knockdown of YTHDF2 recognized the m6A modification of MG53 and enhanced MG53 stability. Overexpression of MG53 inhibited apoptosis of H/R-treated H9c2 cells, which was reversed by YTHDF2, while downregulation of MG53 m6A methylation caused by METTL3 knockdown further abrogated the effect induced by YTHDF2. Additionally, MG53 attenuated MI and apoptosis in I/R rats, which were rescued by YTHDF2.

Conclusion: YTHDF2 hinders the protective effect of MG53 on MI by recognizing the m6A modification of MG53.

Background: Pneumonectomy, the surgical removal of an entire lung, was first performed in 1933 by Evarts A. Graham for lung carcinoma. Today, pneumonectomy is primarily indicated for non-small cell lung cancer (NSCLC) worldwide. However, it carries a higher risk of morbidity and mortality compared to less extensive lung resections.

Objectives: This study aims to investigate the indications for pneumonectomy and its short-term outcomes among patients who underwent the procedure between 2016 and 2023.

Methods and materials: A retrospective study was conducted on 112 patients who underwent pneumonectomy. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25. Univariate, bivariate, and multivariate analyses were performed to address the study's objectives. The Pearson chi-square test, crude odds ratio (COR), and adjusted odds ratio (AOR) were calculated for categorical variables where appropriate. To identify factors associated with pneumonectomy, a binary logistic regression model was used, and odds ratios with 95% confidence intervals were calculated. A p-value of < 0.25 was used as a threshold for including variables in the multivariate analysis, while a p-value of < 0.05 was considered statistically significant in the final model.

Results: The majority of patients were aged between 20 and 30 years, with 54 patients (48.2%) in this age group, and a male-to-female ratio of 1.6:1. The primary indication for pneumonectomy was inflammatory conditions, accounting for 62.5% (70 patients), followed by carcinoid tumors at 32.1% (36 patients). Lung cancer was the diagnosis in 5.4% (6 patients) of cases. Factors significantly associated with pneumonectomy included a history of tuberculosis treatment (AOR 40.3; 95% CI: 3.01, 540.2), intraoperative blood loss > 500 mL (AOR 9.07; 95% CI: 1.04, 79.13), and surgical duration > 180 min (AOR 37.9; 95% CI: 1.82, 792.3). The morbidity rate was 25%, while the mortality rate was 5.4%.

Conclusion and recommendations: In our setting, pneumonectomy is most commonly performed for inflammatory conditions. Significant factors associated with the procedure include a history of tuberculosis treatment, intraoperative blood loss > 500 mL, and surgical duration > 180 min. To reduce the need for pneumonectomy, strategies should focus on tuberculosis prevention, screening, and proper patient evaluation and diagnosis before treatment, to prevent extensive lung damage that often necessitates this procedure.

Introduction: Abnormalities of the coronary arteries, including abnormal origins, are often detected in heart patients who undergo coronary angiography. Although only a small percentage of these abnormalities lead to serious complications, the consequences can be extremely fatal.

Case presentation: We report the case of a 62-year-old woman who presented with chest pain. The patient has a history of hypertension and complains of chest pain that worsens with walking and improves with rest. A basic electrocardiogram (ECG) showed sinus rhythm with no signs of arrhythmia or ischemic changes. Coronary angiography revealed an anomalous left coronary artery originating from the right sinus of Valsalva (RSoV).

Conclusions: We report a rare case of an anomalous left coronary artery originating from the RSoV without specific clinical symptoms. The patient presented with unstable angina, and after further investigation, this anomaly was diagnosed. Investigating these abnormalities, especially in young individuals with cardiac symptoms, should be prioritized. Cardiologists should also be aware of this rare condition that can have fatal consequences.

Background: The present study aimed to critically revise the published literature on clinical outcomes and cost-effectiveness of Inspiris Resilia valve.

Methods: This work was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Full text research articles discussing clinical or cost-effectiveness aspects of Inspiris Resilia bioprosthesis published in English were included in this analysis. Studies were excluded if they weren't exclusively conducted on patients submitted to surgical aortic valve replacement using the Inspiris Resilia bioprosthesis.

Results: The technical success rate was almost perfect in all studies. Reported complications included severe prosthesis-patient mismatch, reoperation, endocarditis, and paravalvular leak. In almost all studies, there were significant improvement of NYHA at the end of follow up as compared to baseline. In all studies, there were significant improvement of one or more hemodynamic parameters at the end of follow up as compared to baseline.

Conclusions: Surgical aortic valve replacement using Inspiris Resilia tissue valve appears to be safe and effective with low rate of aortic valve and systemic complications and mortality. Its performance appears to be equal to or better than many other bioprosthetic valves. As compared to mechanical valves, its use is suggested to be more cost-effective.

An anomalous origin of the pulmonary artery (AOPA) from the ascending aorta is a relatively rare but important cardiac malformation that frequently involves the right pulmonary artery (RPA). Its clinical manifestations depend mainly on the associated significant pulmonary hypertension, with an extremely high mortality rate in the first year of life. Here, we present a rare survival case of an 11-year-old child with the disease, who was hospitalized due to intermittent abdominal pain, but without any apparent signs of chest tightness or shortness of breath. The low oxygen saturation as discovered during the physical examination. Subsequent examination with transthoracic echocardiography (TTE) and pulmonary artery computed tomography angiography (CTA) revealed this unexpected congenital malformation. Although the estimated mean pulmonary artery pressure (MAP) from the TTE was 51 mmHg, which seemed to contraindicate corrective cardiac surgery, the limitations of TTE were considered. Consequently, after multidisciplinary consultation, surgical intervention was ultimately decided upon, resulting in a favorable prognosis for the patient. This case provides a new insight for clinicians in the diagnosis and treatment of complex congenital heart diseases.

Purpose: Aortic dissections and repairs are associated with high rates of mortality. The aim of this review is to summarize the literature concerning the prognostic ability of various preoperative biomarkers for patients undergoing surgical repair of the thoracic and abdominal aorta to elucidate whether these biomarkers could improve the selection of surgical candidates.

Methods: Relevant biomarkers were selected if they had predictive value in inflammatory disease processes and/or cardiovascular disease. Full-text articles available in English on PubMed that related these biomarkers to the prognosis of aortic repair following aortic dissection were examined.

Results: For patients who underwent repair for type A dissection, a preoperative elevated SII was associated with inferior 30-day survival (hazard ratio: 3.532, 95% confidence interval: 1.719-7.255, p = 0.001) and increased rates of adverse cardiovascular events. Elevated preoperative IL-6 and D-dimer levels were independently associated with single-organ dysfunction, multiorgan dysfunction, and death. The use of a combination of markers was a stronger predictor. The areas under the curve (AUCs) for the specified IL-6 and D-dimer cutoff values were 0.901 and 0.817, respectively, whereas the AUC reached 0.936 when IL-6 was combined with D-dimer. For patients who underwent thoracic endovascular aortic repair (TEVAR) for type B dissection, an elevated postoperative systemic immune-inflammation index (SII) was an independent risk factor for aorta-related complications, graft failure, and significantly inferior freedom from aortic-related mortality. A combination of elevated preoperative and postoperative SII values was again predictive of in-hospital adverse outcomes and follow-up complications, including endoleaks, branch artery stenosis, distal aortic expansion, aortic rupture, and death (p = 0.0016). An elevated preoperative neutrophil‒leukocyte ratio (NLR) is associated with an increased incidence of early postoperative adverse events and poor survival.

Conclusions: Inflammatory markers seem to have predictive ability for postoperative outcomes after aortic repair in type A dissections. Further studies should compare these biomarkers to determine the best predictive marker for individual disease states and surgeries.

Background: Myocardial ischemia/reperfusion injury (MIRI) secondary to acute myocardial infarction (AMI) can lead to cardiomyocyte death and impaired cardiac function. Studies have confirmed that circular RNAs (circRNAs) play an important role in MIRI. In this study, the role and mechanism of circHIPK2 in MIRI were evaluated.

Methods: Human cardiac myocytes (HCM) were cultured under Hypoxia/Reoxygenation (H/R) condition to establish a MIRI model in vitro. Expression of circHIPK2, SRSF1 and TXNIP was assessed using RT-qPCR. Protein levels of autophagy markers (LC3II/LC3I, Beclin1, p62) and ferroptosis markers (GPX4, FTH1, ACSL4) were detected by Western blot. Cell viability and apoptosis were assessed by CCK-8 and flow cytometry. Levels of oxidative stress markers (MDA, SOD) and inflammatory factors (IL-6, IL-1β, TNF-α) were tested by ELISA assay. Iron concentration was measured with an iron detection kit. Location of circHIPK2 in cells was detected by RNA-nucleosome separation assay. RIP and ChIP assays verified the relationship between circHIPK2, SRSF1 and TXNIP. TXNIP mRNA stability was dertermined by actinomycin D. Infarct area was examined by TTC staining in myocardial ischemia/reperfusion (I/R) mouse model. HE staining evaluated myocardial injury.

Results: CircHIPK2 was increased in H/R-induced HCM cells. CircHIPK2 downregulation suppressed oxidative stress, inflammatory factors and autophagy-dependent ferroptosis in HCM cells induced by H/R. Additionally circHIPK2 recruited SRSF1 to target TXNIP and stabilized TXNIP mRNA expression. We further demonstrated that TXNIP upregulation overturned the therapeutic effects of circHIPK2 silencing on H/R model cells. In vivo, downregulation of circHIPK2 improved myocardial dysfunction caused by I/R.

Conclusion: Our results demonstrate that circHIPK2 contributes to MIRI through inducing oxidative stress and autophagy-dependent ferroptosis via SRSF1/TXNIP axis, offering new insights into MIRI treatment.

Objective: Drainless minimally invasive anatomical lung resection surgery for pulmonary malignancies is safe and feasible in terms of early postoperative outcomes. However, the quality of surgery in the long term remains uncertain. This study aimed to investigate the perioperative outcomes, 3-year overall, and disease-free survival rates of patients who underwent minimally invasive anatomical lung resection surgery with the drainless technique for pulmonary malignancies.

Methods: Fifty-eight patients who underwent drainless minimally invasive anatomical lung resection surgery for pulmonary malignancies (36 -lobectomy; 22 -segmentectomy) between November 2017 and June 2022 by a single surgeon were enrolled. Patients' characteristics and perioperative, early postoperative, and long-term data were collected. The lymph node dissection stations and number, resection margin, 3-year overall and disease-free survival rates were assessed.

Results: The median age was 64 years. Forty-four patients were females (76%) and forty-seven patients were non-smokers (81%). The median five-factor modified frailty index was 1. Most patients had primary lung cancer; four (7%), 43 (74%), seven (12%), and three (5%) had stage 0, I, II, and III, respectively. The median lymph node dissection stations was four, and the number was 17. The resection margin was free in 98% of the cases. The 3-year overall survival rate was 98.3% in all patients, and 97.2% and 100% in the lobectomy and segmentectomy subgroups, respectively. The 3-year disease-free survival rate was 85.3% in all patients and 80.5% and 92.9% in the lobectomy and segmentectomy subgroups, respectively.

Conclusion: The drainless technique is safe and feasible for minimally invasive anatomical lung resection surgery for pulmonary malignancies in terms of early postoperative and long-term outcomes. However, further randomized controlled studies are warranted.

Background: Intraoperative tracheobronchial injury is a rare but serious complication of lung surgery. With the increasing number of segmentectomies, surgeons need to locate finer and less easily identified segmental bronchi or even subsegmental bronchi. However, there is no simple or feasible method for visualizing the bronchus during surgery.

Case presentation: Herein, we report a case in which indocyanine green (ICG) inhalation was used to visualize the pulmonary bronchus during video-assisted thoracoscopic surgery. The patient was a woman with a GGO located in the anterior segment of the right upper lobe, and thoracoscopic segmentectomy was scheduled. ICG (3.75 mg/ml) was inhaled into the lung on the operative side after single-lung ventilation for 5 min. During surgery, the anterior segmental bronchus was difficult to locate accurately. Under the overlay imaging window of the NIF imaging system, the bronchus was shown in green, indicating the bronchi in contrast to the surrounding lung tissue. We dissected the bronchi with the assistance of fluorescence imaging and were surprised to find that the bifurcation of the anterior and apical bronchi could be clearly identified by navigation via the inhaled ICG and NIF system. Segmentectomy was successfully performed, and no adverse events were recorded.

Conclusion: This case showed that ICG nebulization is feasible and safe for visualizing the pulmonary bronchus during thoracoscopic surgery. This method has great application potential for reducing intraoperative tracheobronchial injury.