Journal of Cardiothoracic Surgery最新文献

Objective: To characterize in-hospital morbidity and mortality in patients undergoing cardiovascular surgery with and without cannabis use disorder (CUD) using a national database.

Methods: Between 2016 and 2018, 846,837 patients who underwent cardiovascular surgery were identified from the Nationwide Readmissions Database. Of these, 11,724 (1.4%) with CUD were identified. A 1:1 balancing-score matching was performed to compare outcomes while controlling baseline characteristics and comorbidities.

Results: Concomitant substance abuse, including smoking/nicotine, opioid abuse, cocaine/stimulants abuse, and alcohol abuse, was also significantly higher (P < .001 for all). Patients with CUD had a higher prevalence of deficiency anemia, congestive heart failure, chronic lung disease, depression, drug abuse, liver disease, neurological disorder, peripheral vascular disease, psychoses, pulmonary circulatory disorders and weight loss. Prior to matching, stroke (3.4% vs. 2.8%, P = .008), pneumonia (13% vs. 9.4%, P < .001), sepsis (5.5% vs. 3.2%, P < .001), and pulmonary embolism (3.6% vs. 1.8%, P < .001) were more common among patients with CUD. However, after matching, there were no differences in overall or individual complications. Mortality among patients with CUD was lower in both unmatched (1.8% vs. 3.0%, P < .001) and matched comparisons (1.8% vs. 2.7%, P < .001).

Conclusions: Cannabis abuse was not associated with additional in-hospital morbidity or mortality and may not preclude cardiovascular surgery. However, CUD is a marker for polysubstance abuse, which deserves management.

Relevance to clinical practice: Patients with CUD are a vulnerable population with concomitant smoking, opioid abuse, cocaine abuse, and alcohol abuse that deserves treatment while undergoing cardiovascular surgery.

Background: Atrial fibrillation (AF) significantly increases stroke risk, particularly through left atrial appendage (LAA) involvement. This trial evaluated the safety and efficacy of the Perclip system for LAA exclusion in Chinese AF patients.

Methods: This prospective study recruited patients with AF and CHA₂DS₂-VASc scores ≥ 2 who required conventional concomitant open-heart surgery or AF surgery through thoracoscopy at nine centers in China. The Perclip LAA occlusion system was implanted during surgery and follow-ups were scheduled at 30 days and 3, 6, and 12 months after surgery. The primary efficacy endpoint was the complete LAA closure rate at 3 months after surgery. The primary safety endpoint was the incidence of device-related serious adverse events within 30 days after surgery.

Results: Perclip implantation was performed on 76 participants (concomitantly with open-heart surgery in 65 participants). The device was successfully implanted in all subjects. The complete LAA closure rate was 98.7% (75/76) at 30 days and 100% (75/75) at 3 months post-surgery. The incidence of device-related serious adverse events within 30 days after surgery was 1.3% (1/76). One participant, who underwent left atrial plication and LAA occlusion, developed an atrial thrombus. Additionally, there were no cases of cardiovascular death, cardiac structural damage, myocardial infarction, major bleeding, stroke, or non-central nervous system embolism within 12 months post-surgery.

Conclusions: This 1-year multicenter trial supports the efficacy and safety of the Perclip system for LAA exclusion in Chinese AF patients. Long-term follow-up will provide additional insights into the outcomes of the Perclip system.

Trial registration: This trial was retrospectively registered on the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ) on January 31, 2024.

Registration number: ChiCTR2400080521.

Objective: Although the lung is the most common site of thyroid cancer metastasis, limited evidence of pulmonary metastasectomy is available. This study aimed to review the clinical course and outcomes of patients who underwent complete resection of solitary pulmonary metastases appearing during a watchful-waiting period.

Methods: We retrospectively reviewed 11 patients with pulmonary metastases from thyroid cancer who underwent pulmonary metastasectomies between January 2000 and December 2023 at Osaka International Cancer Institute.

Results: The median patient age was 73 years. Eight patients had differentiated thyroid carcinoma (DTC), and three had non-DTC. All patients had previously undergone complete resection of their primary disease. The solitary pulmonary nodules were detected during the watchful-waiting period, with six preoperatively diagnosed as primary lung cancer and five as pulmonary metastases. All patients underwent complete resection of the pulmonary nodules, with intraoperative diagnoses confirmed in 10 cases. Among the patients with DTC, four patients experienced relapse-free survival for at least 66 months without the need for additional systemic therapy after pulmonary metastasectomy. The remaining three patients also survived without recurrence during the postoperative watchful-waiting period. In contrast, among the three patients with non-DTC, only one patient underwent repeated PM and achieved 47 months of disease control, while the other two patients experienced earlier recurrence.

Conclusions: Although our data were limited to definitively conclude the efficacy of completely resecting solitary metastases, surgical resection could be recommended for a definitive diagnosis and potentially extending relapse-free survival in patients with DTC. However, given the poor and heterogeneous outcomes in non-DTC, the indication for PM should be carefully considered on a case-by-case basis. (263/350 words).