Journal of Cardiothoracic Surgery最新文献

Objective: This study aims to compare the effects of sevoflurane (SEV) and propofol (PRO) on postoperative cognitive dysfunction (POCD) in patients undergoing cardiac surgery (CS) under cardiopulmonary bypass (CPB), with a focus on evaluating the efficacy of these anesthetic agents in preventing POCD.

Methods: A total of 113 patients undergoing CS with CPB were grouped into two: PRO group (n = 58) and SEV group (n = 55). Baseline data, anesthesia effects (CPB duration, anesthesia time, respiratory recovery time, and anesthesia recovery time), Montreal Cognitive Assessment (MoCA) scores, POCD incidence, neurological function markers (NSE, S-100β, MMP9), and serum inflammatory markers (IL-6, IL-8, TNF-α) were analyzed. The study was conducted between March 2018 and May 2021.

Results: The PRO group showed significantly shorter anesthesia time (P < 0.05), respiratory recovery time (P < 0.05), and anesthesia recovery time (P < 0.05) compared to the SEV group. The postoperative MoCA score in the PRO group reduced markedly compared with the baseline, but still higher than that in the SEV group (P < 0.05). The incidence of POCD was significantly lower in the PRO group (5.17% vs. 27.27%, P = 0.001). The levels of NSE, S-100β, MMP9, IL-6, IL-8, and TNF-α were significantly elevated compared to baseline values, but still lower than those in the SEV group (P < 0.05 for all comparisons).

Conclusion: PRO is more effective than SEV in preventing POCD in patients undergoing CS with CPB. It provides superior anesthetic effects and offers better protection against neuronal damage and serum inflammation compared to SEV.

Clinical trial number: Not applicable.

Background: MicroRNAs (miRNAs) are closely related to cardiovascular diseases, including chronic heart failure (CHF). Endothelial dysfunction can lead to heart failure. The purpose of this study was to evaluate the clinical significance of miR-1285-3p in CHF patients, with the aim of identifying a novel and effective biomarker for CHF. At the same time, we investigated the effect of miR-1285-3p on vascular endothelial cells.

Methods: Total RNA was extracted from plasma samples of 106 CHF patients and 106 healthy individuals. Quantitative Real-time PCR (qRT-PCR) was used to detect the expression of miR-1285-3p. The diagnostic accuracy of miR-1285-3p was tested by receiver operating characteristic (ROC) curve. Evaluated the related risk factors of CHF using logistic analysis. The proliferation and apoptosis of human umbilical vein endothelial cells (HUVECs) were detected by transfecting miR-1285-3p mimic or miR-1285-3p inhibitor in vitro using CCK8 and flow cytometry. Effect of miR-1285-3p on the angiogenesis of HUVECs were detected by in vitro angiogenesis assay.

Results: miR-1285-3p is upregulated in CHF patients, demonstrating the ability to distinguish CHF patients from healthy individuals, with high sensitivity (83.0%) and specificity (93.4%). In vitro experiments revealed that transfection of miR-1285-3p mimic inhibited endothelial cell proliferation, accelerated apoptosis, and inhibited endothelial cell angiogenesis, which was reversed by transfection with miR-1285-3p inhibitor.

Conclusion: miR-1285-3p is upregulated in CHF and may serve as a new effective biomarker for CHF diagnosis, which can inhibit HUVECs angiogenesis.

Background: A patient with acute myeloid leukemia (AML) presented with a cardiac mass of unknown nature. This case underscores the importance of careful monitoring and a multidisciplinary approach in managing and differentiation of rare cardiac complications in leukemia patients. It aims to improve diagnostic accuracy and therapeutic outcomes in similar challenging scenarios. This case report discusses a 33-year-old male who was initially diagnosed with Acute Myeloid Leukemia (AML). During medical check-ups before allogeneic hematopoietic stem cell transplant (allo-HSCT), cardiac ultrasound revealed several mobile and homogenous masses of unidentified nature in his right atrium and right ventricle. The lesions presented gradually increasing calcification of the capsule, the nature of these masses remains unknown.

Case presentation: The patient was diagnosed with Acute Myeloid Leukemia and achieved complete remission following multiple chemotherapy cycles. From a leukemia treatment perspective, an allo-HSCT was needed as soon as possible. However, several masses were found in his right heart before the transplant. A series of tests were performed to determine the nature of the cardiac mass. His echocardiograms and MRI revealed persistent mobile and nodular masses with a calcified capsule in the right atrium and right ventricular lateral wall, and no signals changes of the mass between MRI first-pass perfusion and delayed enhancement. Which complicated the differential diagnosis. Finally, considering the need for leukemia treatment, allo-HSCT was performed after extensive workup, including echocardiography, MRI, and PET/CT, which ruled out leukemic infiltration, typical infectious vegetation, and primary or metastatic cardiac tumors. The cardiac masses were first discovered during pre-transplant screening in April 2022, approximately 5 months after initial AML diagnosis in November 2021. At present, more than 2 years after transplantation, follow-up imaging examination of the masses revealed gradually increasing calcification, but of a still unknown nature.

Conclusions: The case of this 33-year-old male with AML and concomitant cardiac masses highlights a complex challenge in his diagnosis and treatment. Despite extensive imaging and multidisciplinary consultations, including echocardiography, MRI, and PET/CT, the exact nature of these calcified, mobile nodular masses in the right atrium and right ventricular lateral wall remains elusive. Their persistence and atypical imaging characteristics underscore the need for continued research and collaboration to elucidate their underlying pathology.

Background: The accuracy and reliability of identified biomarkers in differentiating early non-small cell lung cancer (NSCLC) remain suboptimal, thereby impeding the timely detection of NSCLC.The objective of this research is to examine the expression level and diagnostic utility of miR-668-3p in individuals with NSCLC, along with its effectiveness and predictive capacity in the combined diagnosis of early-stage NSCLC using serum markers.

Methods: The research included 117 NSCLC patients and 101 pulmonary nodule patients (controls). Quantitative PCR was employed to assess the expression levels of miR-668-3p in NSCLC patients. The association between miR-668-3p and clinical characteristics and serum biomarker (AFP, CEA, NSE, and CYFRA21-1) levels in NSCLC patients was examined using chi-square tests and Pearson correlation analyses. The ROC curve analysis was conducted to determine the individual and combined diagnostic efficacy of miR-668-3p and serum biomarkers. Additionally, a logistic regression model was utilized to identify risk factors for lung cancer in patients with pulmonary tuberculosis.

Results: The expression level of miR-668-3p was down-regulated in early-stage NSCLC patients compared with the control group, and showed a significant association with serum biomarkers related with disease progression, tumor staging, and lymph node metastasis. The combined detection of miR-668-3p and serum markers demonstrated robust diagnostic efficacy for early NSCLC and effective predictive capabilities for lung cancer occurrence in individuals with pulmonary nodules.

Conclusions: The miR-668-3p has the potential to be a promising biomarker for NSCLC and enhance the accuracy of early NSCLC clinical detection.

Background: Left ventricular unloading is needed in patients on extracorporeal life support (ECLS) with severely impaired left ventricular contractility to avoid stasis and pulmonary congestion, and to promote LV recovery. The presence of thrombi in the LV precludes the use of conventional active unloading methods such as transaortic microaxial pumps or apical LV vents. We describe placement of a vent cannula via the left atrial appendage (LAA) as a useful bailout option.

Case presentation: A 61-year-old patient presenting with normotensive cardiogenic shock (SCAI C) after subacute anterior wall myocardial infarction deteriorated with pulmonary edema and ventricular fibrillation, requiring veno-arterial extracorporeal life support under ongoing CPR (SCAI E). An Impella CP was placed for LV unloading, but was unable to generate flow and was thus removed. A large left ventricular thrombus was detected as the cause for insufficient Impella flow. For urgent LV unloading, we placed a vent cannula via the LAA through a thoracotomy to bridge our patient to total artificial heart implantation. However, intraoperative TEE showed resolution of the LV thrombus, enabling to change the strategy to left ventricular assist device implantation only, which was performed successfully. Our patient made a full recovery and is now doing well in regular outpatient follow ups.

Conclusions: ECLS provides excellent circulatory support at the price of a high complication burden and considerable LV afterload increase. ECLS complications often require individualized solutions not represented in current heart failure guidelines. This patient has developed a dreaded and nearly always fatal ECLS complication, which was successfully managed with vent placement via the LAA.

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: 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.

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.

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.