Journal of Cardiothoracic Surgery最新文献

Background: He's team have recently developed a new Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system, which is capable of accounting for the variability in coronary anatomy, and risk-stratifying patients with coronary artery disease. Preliminary studies have demonstrated its superiority over the the Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery (SYNTAX) score with respect to outcome predictions for acute myocardial infarction (AMI) patients. However, there are fewer studies on the prognostic in chronic coronary artery disease(CAD). This study aimed to clarify whether the CatLet score had a predictive value for in-stent restenosis(ISR) in patients with chronic coronary artery disease undergoing percutaneous coronary intervention with drug-eluting stent(DES).

Methods: A total of 260 patients who were diagnosed with chronic CAD and underwent coronary DES implantation at the second affiliated Hospital of Wannan medical college in China were consecutively enrolled from January 2020 to June 2021.Finally, 164 patients underwent the second angiography after 2 years.According to whether ISR was detected at follow-up angiography, patients were divided into the ISR group (n = 26) and the non-ISR group (n = 139).

Results: A total of 165 patients (46 women and 119 men) with a mean ages of 66.19 ± 10.54 years were finally enrolled in this study. Of these, ISR occurred in 26/165 chronic CAD patients (15.76%) by follow-up angiography. Univariate analysis showed that most baseline characteristics of the ISR and non-ISR group were similar. Patients in the ISR group had significantly the history of chronic obstructive pulmonary disease(COPD), adverse lesion characteristic, higher Catlet score compared with patients in the non-ISR group.The CatLet score was capable of predicting in-stent restenosis after adjustment for risk factors; The Multivariable-adjusted model showed good calibration and good discrimination (area under ROC curve = 0.7164) for ISR.

Conclude: CatLet score is a new predictor of ISR in patients with chronic CAD after coronary DES implantation.

Introduction: Sarcomas are rare cancers originating from mesenchymal tissues, manifesting in diverse anatomical locations, but notably in connective tissue, muscles and the skeleton. Thoracic sarcomas present a unique diagnostic and surgical challenge attributable to their rarity and pathoanatomy. Standard practice currently comprises wide surgical excision, often accompanied by adjuvant chemotherapy and/or radiotherapy. This approach necessitates a multidisciplinary team, ideally in specialised cancer centres. The Oxford Bone and Soft Tissue Tumour Service is one such centre, and routinely treats such cancers through collaboration between orthopaedic oncology and cardiothoracic surgeons, as well as members of the wider MDT. This study reports the current management and outcomes of primary thoracic sarcoma patients at the Oxford Sarcoma Service over a seven-year period.

Objectives: Given the rarity of thoracic sarcomas, and their associated diagnostic and management complexities, our aim is to report on the treatment strategies and outcomes of primary thoracic sarcoma patients treated at the Oxford Sarcoma Service from 2017 to 2023.

Methods: Data pertaining to all thoracic sarcoma cases discussed in multidisciplinary meetings at the Oxford tertiary centre from 2017 to 2023 were retrieved from the local electronic database. These were analysed using appropriate statistical tests to determine significance of the various observations made.

Results: Of 113 identified cases, chondrosarcoma emerged as the most prevalent histological subtype among 22 distinct varieties. 58% of cases exhibited high-grade features. 32 sarcoma-related deaths occurred, with a mean time from diagnosis to death of 23.16 months. A notable association was observed between high-grade sarcomas and mortality (p = 0.0280). Surgical resection was performed in 77 cases, with 49% of these undergoing surgical resection alone i.e. the patient received no radio- or chemotherapy. Both surgical intervention (p < 0.0001) and clear margins (p = 0.0051) were significantly linked to improved survival. Local recurrence was noted in 28.6% of the 77 surgical cases, and predominantly in the high-grade sarcomas (81.8%). However, no statistical association was found between recurrence and margin status in our data.

Conclusion: Our results indicate that primary resection remains the cornerstone of thoracic sarcoma treatment, representing the single strongest independent factor for survival in treatable cases. Variability in outcomes and overall survival likely stems from factors such as histological diversity, predominance of high-grade sarcomas, and wide age range at diagnosis. Ongoing prospective database update and collaborative efforts across centres would further clarify prognoses and recommendations for specific tumours, based on observational data.

Background: Penetrating neck injuries are rare and require urgent surgical intervention to prevent life-threatening complications. This report highlights a unique case involving complex surgical repair of tracheal, esophageal, and vascular injuries following a homicidal assault, emphasizing the challenges and techniques used in managing such severe trauma.

Case presentation: A 45-year-old female presented with a severe penetrating neck injury after an alleged homicidal assault with a knife. The patient was in hypovolemic shock and required immediate resuscitation. Endotracheal intubation was performed through the transected tracheal segment, followed by surgical exploration in the operating room. Findings included partial transection of the carotid sheath, complete transection of the trachea, and oesophagus. Surgical repair involved using lateral polypropylene 5-O sutures for the carotid sheath, end-to-end oesophageal repair with absorbable 3 - 0 polygalactin sutures. As tracheal repair was not possible posterior wall was approximated with 3 - 0 polypropylene and size 7 tracheostomy tube was inserted and secured. The patient was managed post-operatively in the ICU and was discharged in stable condition on the 25th day adviced regular follow-up. This case underscores the importance of prompt airway management and surgical intervention in penetrating neck injuries. The meticulous repair of all injured structures and diligent post-operative care are crucial to a successful outcome. This report contributes to the limited literature on managing complex penetrating stab injuries to the neck and highlights the importance of a multidisciplinary approach in such cases.

Background: Fibrous dysplasia (FD) is the most common benign tumor of the ribs, with surgical resection being the preferred treatment modality for rib FD, leading to enhanced quality of life and favorable outcomes. The complexity of surgical intervention varies depending on the location of costal FD, presenting challenges for both open surgical and thoracoscopic approaches. In this study, we present a novel technique for three-port robotic-assisted costectomy utilizing a Gigli saw, detailing our initial findings and outcomes.

Methods: We reviewed five patients with benign rib tumors who underwent three-port robotic-assisted rib resection using a Gigli saw between May 2021 and December 2022. Data on patient characteristics, relevant short-term surgical outcomes and clinical long-term treatment effects were collected.

Results: The surgery was successful in all five patients without any need for an additional port and emergency conversion to open surgery. Median operative time was 76.8 min (range, 73-116 min), and the median intraoperative blood loss volumes was 75 ml (range, 40- 105 mL). On average, chest tubes were removed 1.2 days postoperatively (range, 1-2 days), with a mean drainage volume of 93 ml on postoperative day 1 (range, 70-135 ml). Patients were discharged between the 2nd and 4th postoperative day. During 1-year follow-up period, no recurrence was observed in either patient.

Conclusions: The utilization of a three-port robotic-assisted costectomy in conjunction with a Gigli saw represents a viable, secure, and efficient approach for treating isolated benign rib lesions. Our aim is to provide clinical guidance on this technique and promote its broader application.

Background: End-Stage Renal Disease (ESRD) is an independent risk factor in outcomes for traditional coronary artery bypass grafting (TRAD-CAB) utilizing aortic cross-clamping and cardioplegic arrest. In order to determine if Beating-Heart CABG (BH-CABG) techniques offer benefit in patients with ESRD, an analysis of the Society of Thoracic Surgeons (STS) predicted risk versus the actual outcomes was performed.

Methods: Between March 2017 - October 2023, all ESRD patients underwent BH-CABG by a single surgeon at a single institution. Patients were kept normothermic, ventilation was maintained, and intra-coronary shunts with flow-probe graft assessment were utilized during the procedure. The STS predicted risk calculator was used to compare outcomes with actual results.

Results: There were 55 patients- 37 men and 18 women with a mean age of 61.5 years (41-77 years). Co-medical conditions consisted of the following: HTN (100%), DM (85%), Pulmonary HTN (49%), PVD (45%), CVD with CVA (18%), and COPD (9%). Fifty-one patients underwent Pump-Assisted Direct Coronary Artery Bypass Grafting (PADCAB) and four underwent Off-Pump CABG (OP-CAB). There were 16 Elective, 35 Urgent, and 4 Emergent cases. Case presentation included: 24 NSTEMI, 4 STEMI, 6 Unstable Angina, 7 CHF, 1 Cardiac Arrest, and 13 with a positive exercise stress test (EST) for renal transplant screening. The mean EF was 47% (range: 15-75%). The mean number of grafts was 2.4 (1-4) and CPB time was 78 min (34-128 min) for the PAD-CAB group. Nine of the thirteen patients (69%) listed for kidney transplant underwent the transplant, one of whom was a combined liver-kidney. There was 1 hospital mortality (1.8%) compared to a predicted 6.2%. There was 1 stroke (1.8%) compared to a predicted 3.3%. There was 1 prolonged ventilation (1.8%) compared to a predicted 20.2%. There were no return to OR and no sternal wound infections. Prolonged Lengths of Stay occurred in 3 patients (5.5%) compared to a predicted 16.9%. One-year mortality occurred in 8 patients (14.5%). The observed-to-expected outcomes was < 1 in all categories.

Conclusions: The BH-CABG appears to demonstrate superior outcomes compared to the STS predicted risk for CABG. The Beating-Heart technique may offer advantages by avoidance of aortic cross-clamping and cardioplegia, maintenance of normothermia and ventilation, as well as preservation of coronary blood flow during construction of bypass grafting.

Background: Lymph node upstaging represents a quality criterion for standardized lymphadenectomy in lung cancer surgery. The aim of the study was to compare whether the quality of standardized lymphadenectomy in lung cancer surgery is comparable in minimally invasive (video-assisted thoracoscopic surgery) and the open approach (thoracotomy). Furthermore, factors associated with lymph node upstaging were assessed, as was its impact on overall survival and progression-free survival.

Methods: This retrospective study reviewed data of all patients undergoing lobectomy at the Lung Tumor Center Munich between 2011 and 2020. Inclusion factors were non-small cell lung cancer without nodal involvement (N0) or metastasis (M0) and standardized lymphadenectomy. A propensity score matched analyses was performed. Frequency of categorical outcomes was compared with Chi [2]-test, mean values with t-test. We used logistic and Cox regression models to assess factors associated with upstaging, overall survival and progression-free survival, restrictively.

Results: Of 1691 patients undergoing lobectomy, 637 met our inclusion criteria. After propensity score matching 198 patients remained in each group. Univariate analysis showed no significant difference in lymph node upstaging between the two groups. (p = 0.12). Overall affected lymph nodes (p = 0.45) and overall affected lymph node stations (p = 0.26) were not significantly different. Multivariate Cox regression analysis showed that overall survival and progression free survival were also independent of the surgical approach. L1 status was the only factor associated with progression-free survival.

Conclusion: Minimally invasive approaches achieves comparable lymph node upstaging in patients undergone standardized lymphadenectomy.

Background: Interventricular septal dissection is a critical disease characterized by the separation of the intraventricular septum into two layers, forming an intermediate layer with a cystic cavity that communicates with the root of the aorta or ventricle. It has low morbidity and high mortality rates.

Case presentation: Case 1: A 58-year-old male with a history of hypertension and smoking presented to a local hospital due to chest tightness and pain for 4 days. Coronary angiography revealed diffuse lesions from the proximal to the middle segment of the left circumflex branch, with 80% stenosis at its most severe point, and complete occlusion of the proximal segment of the right coronary artery. A stent was implanted in the middle of the right coronary artery. Three months later, the patient was misdiagnosed with an aneurysm of the membranous ventricular septum with defect via echocardiography at the local hospital. After the implantation of a stent in the left circumflex branch, the patient came to our hospital for further diagnosis and treatment. The first ultrasound of our hospital misdiagnosed it as ventricular septal rupture, and a senior ultrasound doctor diagnosed the patient with interventricular septal dissection secondary to myocardial infarction. The patient underwent follow-up echocardiography every 1-2 months for 6 months. The patient remains asymptomatic with stable hemodynamics. The original treatment regimen and follow-up continues. Case 2: A 70-year-old male was admitted to a local hospital due to repeated chest distress for more than 20 years that worsened over several hours. Coronary angiography revealed complete occlusion of the right coronary artery. Cardiogenic shock occurred after percutaneous coronary intervention. The initial several echocardiography of the local hospital and our hospital misdiagnosed it as interventricular septal rupture secondary to myocardial infarction. The later echocardiography diagnosed it as interventricular septal dissection with rupture secondary to myocardial infarction. The patient underwent interventricular septal repair and mitral valvuloplasty after 25 days of medical treatment and died of multiple organ failure on the fourth day after the operation.

Conclusions: These two cases illustrate a complication of acute myocardial infarction and highlight the importance of echocardiography in its diagnosis. By exploring the etiology, pathogenesis, and key diagnostic points of IVSD, this study aims to provide valuable insights for clinical practice.

Monitoring perioperative tissue perfusion is crucial in clinical anesthesia to protect organs and ensure patient safety. Indicators like hemodynamic parameters, tissue metabolism, and microcirculation markers are used for assessment. Studies show intraoperative hypotension negatively impacts outcomes, though blood pressure alone may not reflect tissue perfusion accurately. Cardiac output is a more direct measure, with adequate levels generally indicating good perfusion. However, some conditions cause adequate cardiac output but inadequate perfusion. Non-quantitative markers like skin color and temperature, and quantitative indicators like tissue oxygen saturation and laser Doppler flowmetry, help assess microcirculation but can't fully evaluate systemic perfusion. Near-Infrared Spectroscopy (NIRS) monitors tissue oxygen metabolism, reflecting oxygen supply and consumption balance. Central venous oxygen saturation offers a better systemic overview but may not always indicate good perfusion, especially in sepsis. Lactic acid levels closely correlate with tissue perfusion and outcomes, with dynamic changes being more indicative than single measurements. Effective monitoring requires evaluating both macro- and microcirculation states and systemic metabolic levels to ensure optimal outcomes. Combining these measures provides a more accurate assessment of tissue perfusion and patient prognosis.

Objective: The objective of this study is to assess the predictive utility of perioperative P-wave parameters in patients with paroxysmal atrial fibrillation (PAF) undergoing catheter ablation, and to develop a predictive model using these parameters.

Methods: A total of 213 patients with PAF undergoing catheter ablation were retrospectively analyzed. P-wave parameters were measured within 3 days preoperatively and on the day postoperatively to determine their predictive significance for postoperative PAF recurrence.

Results: Post-ablation, PAF did not recur in 168 patients, while 45 experienced recurrence. Significant differences were observed in preoperative P-wave parameters as Maximum P Wave Duration(Pmax), absolute value of P Wave Terminal Force of V1 (PtfV1) and P Wave Dispersion(Pd), postoperative P-wave parameters as P Wave Duration (PWD_{II, III, aVF}), Pmax, P Wave Area(P-area), absolute value of PtfV1 and Pd, and changes in perioperative P-wave parameters (Delta-Pmax, Delta-PtfV1 absolute value, Delta-Pd, Delta-PWD_{II, III, aVF}). Univariate logistic regression, receiver operating characteristic (ROC) curve analysis, and hazard ratio assessment identified predictive indicators for postoperative recurrence, including Pmax, PtfV1 absolute value, Pd, post-P area, post-PWD_{II, III, aVF} and Delta-pwd_{II, III, aVF}). A personalized nomogram model based on these P-wave parameters was developed. Calibration curve assessment demonstrated that the predictive performance of the nomogram for PAF recurrence following catheter ablation closely matched actual observed outcomes. ROC curve analysis indicated a sensitivity of 89.3% for the model, and decision curve analysis confirmed its significantly favorable predictive use and clinical benefits.

Conclusions: P-wave parameters like PWD_Ш, PWDaVF, Pmax, Pd, and PtfV1 serve as predictors of PAF recurrence following catheter ablation. The nomogram model constructed using these P-wave parameters demonstrates robust predictive performance.

Objective: To study the effect of heart-collateral-based enlightenment words intervention on anxiety and depression in patients following percutaneous coronary intervention (PCI).

Methods: In this class experimental study, one hundred patients who were hospitalized after PCI from May 2020 to October 2021, were included in this interventional study. They were divided into the test group (n = 50) and the control group (n = 50) based on the random number table. The heart-collateral-based enlightenment words intervention was used in the test group versus routine nursing in the control group. Data was collected using a self-rating anxiety scale (SAS), self-rating depression scale (SDS), and an independently developed satisfaction questionnaire. Psychological indicators and satisfaction were compared between the two groups before and after the intervention.

Results: After 3 months of intervention, the test group scored significantly lower in SDS and SAS than the control group (SDS score: [55.06 ± 8.63] vs. [62.90 ± 9.52]; SAS score: [46.83 ± 10.24] vs. [56.02 ± 8.92]) (P < 0.05 for both SDS and SAS difference). The satisfaction rate of the test group vs. control group was 96% vs. 82% after the intervention, with a statistically significant difference (P < 0.05).

Conclusion: Heart-collateral-based enlightenment words intervention can effectively alleviate anxiety and depression in patients after PCI and increase their satisfaction with nursing services. To develop the theory and guide clinical practice, future research in different treatment area with larger sample size should be conducted.