Journal of Cardiothoracic Surgery最新文献

Interventional occlusion of Patent ductus arteriosus (PDA) is generally efficacious and complications such as delayed occluder displacement are infrequent. Herein, we report a case of 24-year-old female with a history of unsuccessful PDA closures, who subsequently experienced delayed occluder displacement into the left main pulmonary artery. Despite numerous unsuccessful catheter-based interventions, thoracic endovascular aortic repair (TEVAR) was successfully executed. This procedure effectively resolved the PDA without any postprocedural complications. This case highlights the efficacy and safety of TEVAR as a viable alternative for managing complex PDA cases involving occluder displacement.

Background: The left internal thoracic artery (LITA) has been widely accepted as the standard for revascularizing the left anterior descending artery during coronary artery bypass grafting (CABG) surgery. However, in 10-20% of cases, the LITA may lead to unsecured side branches to the chest wall, particularly the lateral costal artery (LCA), potentially resulting in postoperative chest angina.

Case presentation: We report the case of a 58-year-old patient who experienced persistent angina eight months after having undergone coronary artery bypass grafting (CABG) due to the steal phenomenon caused by a thick lateral costal artery (LCA). The LCA was found to be 2/3 the diameter of the left internal thoracic artery (LITA) with the decision to obliterate the LCA. Following LCA obliteration, the patient's exertional angina was resolved.

Conclusions: LCA may pose a potential issue in terms of coronary steal after CABG. Understanding the anatomy of the LITA with LCA variation and widening the opening of the pleura may be beneficial in preventing postoperative steal in selected cases.

This is a novel case of idiopathic chylopericardium and chylothorax in a young male who had no significant medical history. He first presented with dyspnea due to idiopathic chylopericardium, which was refractory to medical and surgical treatments, including a medium-chain triglyceride diet, octreotide, and video-assisted pericardial window. The chylopericardium persisted and progressed to concomitant left-sided chylothorax. He subsequently underwent multiple imaging studies, including lymphoscintigraphy and an intranodal lymphangiogram, both of which confirmed leakage in the thoracic duct. Finally, thoracic duct embolization was performed via a retrograde transvenous approach, which was successful, with good results. Although idiopathic chylopericardium and chylothorax are extremely rare, it can greatly impact patient quality of life if left undiagnosed and untreated. While surgery can relieve cardiac tamponade, lymphatic imaging and intervention are key in diagnosing and treating the root cause of the condition. This case highlights the importance of multidisciplinary efforts in managing rare cases and how interventional radiology is a minimally invasive but effective way to treat thoracic duct leakage. Retrograde thoracic duct embolization is technically challenging but safe and effective.

Aim: We developed a rapid evaluation scale for pericardiectomy through a 12-lead electrocardiogram (ECG), in order to improve the diagnostic accuracy of pericardiectomy of tuberculous constrictive pericarditis.

Method: In this study, 262 patients with tuberculous constrictive pericarditis (102 patients) and non-tuberculous constrictive pericarditis (160 patients) were selected by convenience sampling method as participants in Hangzhou Red Corss Hospital from January 2018 to April 2023. The expert validity analysis was carried out by cross-sectional investigation combined with the results of the previous expert questionnaire to establish 12-lead ECG-based the rapid evaluate scale for pericardiectomy of tuberculous constrictive pericarditis. Cronbach'α coefficient and Spearman-Brown coefficient were used for the internal consistency reliability of the scale. Exploratory factor analysis was used for structural validity. Receiver operating characteristic (ROC) was used to analyze the sensitivity and specificity of this scale.

Results: After preliminary verification, the cronbach'α coefficient and Spearman-Brown coefficient were 0.830 and 0.800, respectively. Three factors with feature roots greater than 1.0 were extracted by principal component analysis and maximum variance orthogonal rotation, and the cumulative contribution rate was 57.77%. Each loading factor ranges from 0.427 to 0.863. The sensitivity of the scale was 96.1%, the specificity was 96.9% and the Yorden Index was 93.0%.

Conclusions: The 12-lead ECG-based rapid evaluation scale for pericardiectomy of tuberculous constrictive pericarditis has high sensitivity, specificity and accuracy, and has certain scientific research and clinical application value.

Background: Thoracotomy is a common treatment for non-small cell lung cancer (NSCLC). However, the significant trauma from this procedure can limit patients' postoperative prognosis. Therefore, it's crucial to find an easily detected indicator that can predict the prognosis of NSCLC patients undergoing thoracotomy. FAM83A-AS1 was hypothesized as a predictor for the therapeutic effectiveness of thoracotomy. We evaluated its correlation with patient outcomes and its significance in predicting postoperative prognosis, with the aim of providing a reference to improve postoperative prognosis of thoracotomy.

Materials and methods: The study enrolled patients with NSCLC who underwent thoracotomy, and tissue samples were collected during surgery. Blood samples were collected preoperatively and three days postoperatively. PCR was used to analyze plasma FAM83A-AS1 levels. The significance of these levels in the patients' postoperative prognosis was evaluated via logistic regression and ROC analyses, with a follow-up period of six months.

Results: FAM83A-AS1 was significantly upregulated in NSCLC and correlated with severe progression in patients. Thoracotomy suppressed FAM83A-AS1 expression and reduced CA50, CEA, and CYFRA21-1 levels. Postoperative plasma levels of FAM83A-AS1 positively correlated with CA50, CEA, and CYFRA21-1. Patients with worse prognoses had higher plasma FAM83A-AS1 levels. FAM83A-AS1 was identified as a risk factor for poor postoperative outcomes in NSCLC patients undergoing thoracotomy and could be used to identify patients at risk of worse prognosis.

Conclusion: An increase in FAM83A-AS1 in NSCL indicates severe disease development and can serve as a biomarker associated with thoracotomy, predicting a poor prognosis. It provides a potential indicator for patient outcomes.

Background: The impact of pulmonary hypertension (PH) on critically ill patients has not been fully understood. Our objective was to explore the possible relationship between PH and the outcomes in Intensive Care Unit (ICU) patients, and to determine risk factors of in-hospital mortality of ICU PH patients.

Methods: The Medical Information Mart for Intensive Care (MIMIC)-IV database was used. Patient characteristics and clinical outcomes of ICU patients with or without PH were compared. The primary outcome was the in-hospital-mortality, and secondary outcome was 28-day mortality. Multivariate logistic regression analysis was conducted to determine independent risk factors of in-hospital mortality.

Results: A total of 42,255 patients were included in the study, of which 1,210 patients had a diagnosis of PH and 4,262 patients died during the hospital stay. In-hospital mortality in the PH and non-PH groups were 15.1% and 9.9% respectively (P < 0.01). The length of stay in ICU and in hospital among ICU PH patients were longer than those without (P < 0.01), and PH group also showed higher 28-day mortality (P < 0.01). Multivariate logistic regression analysis indicated that PH was an independent risk factor for in-hospital mortality in critical ill patients [OR = 1.22, (95%CI: 1.02-1.46), P = 0.033]. Oxford Acute Severity of Illness (OASIS) [OR = 1.10, (95%CI: 1.08-1.12), P < 0.01] anion gap [OR = 1.07, (95%CI: 1.04-1.11), P < 0.01], and Charlson's score [OR = 1.09, (95%CI: 1.03-1.16), P < 0.01] were independent risk factors for in-hospital mortality among ICU PH patients.

Conclusions: PH diangsoed in the ICU setting has unfavorable clinical outcomes. The Bigger the value of OASIS score, anion gap, Charlson's score were the predictors for in-hospital mortality in ICU patients with PH.

Background: Individual surgeons' learning curves are a crucial factor impacting patient outcomes. While many studies investigate procedure-specific learning curves, very few carried out a longitudinal analysis of individual cardiac surgeons over the course of their career. Given the evolving landscape of cardiac surgery with the introduction of transcatheter and robotic procedures, a contemporary evaluation of the cardiac surgical learning curve is justified and a method of personal performance monitoring is proposed in this study.

Methods: A retrospective study of 1578 consecutive patients of a cardiac surgeon over ten years was undertaken. Risk adjustment was based on Euroscore. Cumulative risk adjusted morbidity (CRAM) charts of operative mortality, return to theatre and length of stay were constructed. Secondary endpoints included postoperative stroke and deep sternal wound infection. Change-point detection was applied to investigate temporal trends and identify when a significant change in outcome occurred. Multivariate analysis was performed to assess the influence of patient and system factors on operative mortality.

Results: Patient average risk profile was highest in the later years of practice. Cardiopulmonary bypass time remained stable from 86.5 to 92 min across the decade. The frequency of redo operations increased from 4.07% in the first two years of practice to 9.29% in the last two years. The proportion of aortic surgery increased from 6.98 to 10.58% of total cases. There was a significantly reduced operative mortality signalled at case 1220 with the change point identified around case 970.

Conclusion: This prompts training colleges to consider application of sequential performance monitoring in surgical training programs, to confirm the progress of trainees and identify early evolving patterns that suggest support is required or milestones are being achieved.

Background: Coarctation of the aorta (CoA) in adults is rare. usually combined with dilatation of the ascending aorta. Further disease progression complicated by hematoma or dissection of the ascending aorta is even more complicated and dangerous.

Case presentation: A 58-year-old male patient with CoA complicated by acute type A aortic intramural hematoma (IMH), who was treated with a two-stage hybrid approach involving an urgent Bentall repair procedure and subsequent endovascular stenting. A 4-year follow-up showed a good prognosis for the patient.

Conclusion: For patients with aortic coarctation combined with ascending aortic dissection/IMH, life-threatening proximal aortic lesions may be treated first. Secondary stent implantation can then be performed after stabilization to treat the congenital aortic coarctation.

Objective: This study aims to investigate the clinical application value of the central venous-arterial carbon dioxide partial pressure difference (Pv-aCO2) in postoperative cognitive dysfunction(POCD) in patients with acute aortic dissection.

Methods: A retrospective analysis was conducted on the general data of 236 patients. Blood gas samples were collected from the arterial and venous lines at various time points during the surgery, including before and after the initiation of cardiopulmonary bypass (CPB), immediately after CPB initiation, before and after deep hypothermic circulatory arrest, 30 min after rewarming, and 5 min before weaning from CPB. The partial PV-aCO2 was calculated. Based on the average PV-aCO2 value, patients were divided into an observation group (PV-aCO2 > 6 mmHg, n = 112) and a control group (PV-aCO2 < 6 mmHg, n = 124). The perioperative data and Mini-Mental State Examination (MMSE) scores were compared between the two groups to assess the incidence and severity of POCD. Additionally, the expression levels of peripheral serum S100β in the two groups were compared 6 h postoperatively.

Results: The incidence of POCD was higher in the observation group compared to the control group, while MMSE scores and serum S100β levels were lower in the observation group. Additionally, the observation group patients with POCD had lower MMSE scores and serum S100β levels compared to the control group patients. In addition, logistic regression analysis revealed that advanced age, serum S100β levels, female gender, CPB time, unilateral brain perfusion time, hyperlipidemia, diabetes, and smoking history were all independent risk factors for postoperative POCD (all P < 0.05).

Conclusion: Pv-aCO2 can effectively reflect the intraoperative cerebral metabolic level in patients with acute aortic dissection and can serve as an intraoperative warning indicator for cognitive dysfunction. Its clinical recommendation for use is warranted.

Background: Lung adenocarcinoma (LUAD) is a high-risk malignancy. Telomeres- (TRGs) and aging-related genes (ARGs) play an important role in cancer progression and prognosis. This study aimed to develop a novel prognostic model combined TRGs and ARGs signatures to predict the prognosis of patients with LUAD.

Methods: LUAD patient's sample data and clinical data were obtained from public databases. The prognostic model was constructed and evaluated using the least absolute shrinkage and selection operator (LASSO), multivariate Cox analysis, time-dependent receiver operating characteristic (ROC), and Kaplan-Meier (K-M) analysis. Immune cell infiltration levels were assessed using single-sample gene set enrichment analysis (ssGSEA). Antitumor drugs with significant correlations between drug sensitivity and the expression of prognostic genes were identified using the CellMiner database. The distribution and expression levels of prognostic genes in immune cells were subsequently analyzed based on the TISCH database.

Results: This study identified eight characteristic genes that are significantly associated with LUAD prognosis and could serve as independent prognostic factors, with the low-risk group demonstrating a more favorable outcome. Additionally, a comprehensive nomogram was developed, showing a high degree of prognostic predictive value. The results from ssGSEA indicated that the low-risk group had higher immune cell infiltration. Ultimately, our findings revealed that the high-risk group exhibited heightened sensitivity to the Linsitinib, whereas the low-risk group demonstrated enhanced sensitivity to the OSI-027 drug.

Conclusion: The risk score exhibited robust prognostic capabilities, offering novel insights for assessing immunotherapy. This will provide a new direction to achieve personalized and precise treatment of LUAD in the future.