Journal of Cardiothoracic Surgery最新文献

Background: Baseline systemic inflammation is associated with worse long-term outcomes after coronary artery bypass grafting [CABG], but the mechanisms of this association are unclear. This study aims to explore the association between pre-operative white blood cell [WBC] count and CABG graft failure.

Methods: We pooled individual patient data from two randomized clinical trials with systematic CABG graft imaging. The primary analysis was the association between pre-operative WBC count and graft failure, as a continuous variable, at the time of imaging after CABG, using mixed-effects multivariable logistic regression models.

Results: Overall, 910 patients and 2,036 grafts were included in the analysis [1,120 saphenous vein grafts, 828 left internal thoracic arteries, 76 right internal thoracic arteries, and 12 radial arteries]. The median time to imaging was 1.01 [interquartile range (IQR), 0.99;1.03] years and the median pre-operative WBC count was 7.1 [IQR, 6.0;8.4] x 10⁹/L. There was no association between WBC count and graft failure at both the patient and the individual graft level [adjusted odds ratio (aOR) 1.07 (95% confidence interval (CI), 0.98;1.17), p = 0.11 and aOR 1.09 (95% CI, 0.91;1.30), p = 0.37], respectively. When evaluated as a dichotomous variable [≥ 11 vs. < 11 × 10⁹/L] and by quartile, WBC count was not associated with graft failure at the patient and individual graft levels.

Conclusion: In this pooled analysis of individual patient data from two randomized clinical trials, WBC count was not associated with graft failure after CABG. The reported association between inflammation and CABG is likely mediated through other mechanisms, such as native coronary artery disease progression.

Impact on daily practice: The lack of a clear association between WBC count and graft failure suggests that pre-operative WBC count should not be routinely used as a predictor of graft failure after CABG.

Background: Solitary fibrous tumors (SFTs) of the pleura are usually benign. We present a case of SFT of the pleura which grew rapidly after slow long-term progression.

Case presentation: A 78-year-old man was referred to our hospital for left-sided back pain and shortness of breath. He was found to have a left mediastinal mass at 15 years of age. He remained asymptomatic for 60 years, and chest computed tomography (CT) during treatment of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis revealed that the mediastinal tumor was 8.0 cm in diameter. The size remained unchanged for 3 years but increased to 15.0 cm over the next 5 years. As the left main pulmonary artery was compressed by the mass, there were concerns regarding the worsening of haemodynamics and exacerbation of symptoms of respiratory distress. A sixth-rib intercostal thoracotomy with a posterolateral incision was performed to remove the large tumor. Perioperative steroid administration (methylprednisolone 125 mg/day) and positive pressure ventilation were administered to prevent re-expansion of the pulmonary oedema. The patient was discharged following an uneventful course. The tumor was pathologically diagnosed as an SFT with no malignant findings.

Conclusion: SFTs require surgical intervention because of their potential for rapid growth.

Background: To evaluate the clinical diagnostic value of third-generation dual-source CT for pulmonary embolism, focusing on the optimization of dual-source CT scanning with dynamic reconstruction in acute pulmonary embolism (PE) and various imaging manifestations.

Methods: Eighty-two patients with pulmonary embolism were enrolled and randomly divided into standard CT angiography (SCTA) and dynamic CT angiography (DCTA). DCTA patients were divided into dynamic CT angiography arterial phase (DCTAa), time phase Angiography reconstruction (TMIP-CTA), and 4D noise reduction TMIP-CTA according to the image reconstruction. The region of interest was selected in the region of the pulmonary trunk and its branches, respectively. The vessel CT value and image background noise (IN) of each subgroup were also determined, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Simultaneously two radiologists performed a subjective evaluation of the quality of the picture images.

Results: The DCTA group had a lower contrast dose than the SCAT group, but the vessel CT value, IN, CNR, and SNR were significantly higher in the DCTA group compared with the SCTA group. CT of the vascular lumen was generally higher in all subgroups of DCTA than in SCTA, with the highest in the TMIP-CIA group. IN was significantly higher in both the DCTAa and TMIP-CTA groups than in the SCTA group. SNR and CNR were elevated in TMIP-CTA and 4D noise reduction TMIP-CTA compared to the SCTA group. In addition, the subjective image quality scores of the DCTA group were significantly higher than those of SCTA, and the 4D noise reduction TMIP-CTA had the most. However, the ED of the SCTA group was lower than that of the DCTA group.

Conclusion: 4D noise reduction TMIP-CTA based on DCTA reconstruction significantly improves the quality of pulmonary artery CTPA images and increases the clinical diagnostic rate, with potential for clinical dissemination.

Background: Lung cancer is the leading cause of cancer-related deaths worldwide. Therefore, the search for new biomarkers continues in order to diagnose lung cancer at an early stage. In this study, we investigated blood levels of G-protein associated membrane estrogen receptor (GPER)-1 and Raftlin as markers of early-stage in lung cancer.

Methods: Lung cancer cases admitted to our hospital between 2016 and 2018 were included in our study. GPER-1 and Raftlin levels were measured by Enzyme-Linked Immunosorbent Assay (ELISA) in blood samples taken from patients diagnosed with lung cancer and healthy volunteers.

Results: There were 64 cases in total, 32 cases in lung cancer group and 32 cases in control group. We evluated GPER-1 levels for each group. GPER-1 level was 2.54 (IQR: 1.08-5.78) ng/mL in the lung cancer group and 5 (IQR: 2.69-7.99) ng/mL in the control group. ROC analysis value for GPER-1, (AUC) was 0.66 (p < 0.01). Raftlin levels were 4.5 (IQR: 3.3-11.52) ng/mL in control group and 7.77 (IQR: 6.24-9.85) ng/mL in lung cancer group. ROC analysis value for Raftlin, (AUC) was 0.629(P = 0.09).

Conclusions: In our study, there was no statistically significant difference between our groups in terms of Raftlin values. Therefore, it was thought that Raftlin could not be a specific marker in the diagnosis of lung cancer. GPER-1 was found to be lower in the lung cancer group than in healthy individuals. Therefore, it was thought that GPER-1 could be evaluated as a diagnostic marker in lung cancer. However, we think that more definitive results can be obtained by determining the tissue and expression level of GPER in lung cancer with further studies.

Pulmonary vein isolation (PVI) with cryoballoon (CB) ablation technology is widely used to treat drug-resistant atrial fibrillation (AF). During CB ablation, there is a possibility of forming an ice cap of contrast-color on top of the balloon. If automatic balloon deflate occurs before the ice cap dissolves, embolization to the systemic circulation is possible. This case report describes the remaining of a contrast-colored ice cap to the systemic circulation in the left superior pulmonary vein (LSPV) and the remaining contrast-colored ice cap throughout the balloon deflate and its gradual melting a few seconds after the balloon deflate in the right superior pulmonary vein (RSPV). Additionally, a strategy for its prevention is presented.

Background: Chronic post-surgical pain (CPSP) is a common complication following video-assisted thoracoscopic surgery (VATS) that significantly impacts the quality of life of patients. Although multiple risk factors have been identified, no systematically validated prediction model exists to guide clinical decision-making.

Objectives: This study aimed to develop and validate a risk prediction model for CPSP in patients undergoing VATS for lung cancer.

Methods: This prospective cohort study included clinical data from 400 patients with non-small cell lung cancer who underwent VATS from June 2022 to June 2023. Patients were randomly assigned to a training cohort and an internal test cohort and assessed for sleep quality, psychological status, and pain levels. A nomogram prediction model was established based on variables significantly associated with CPSP in the training cohort. The model was internally validated in the internal test cohort to evaluate its discrimination, calibration, and clinical utility.

Results: Independent risk factors for CPSP included female gender, severe acute pain post-surgery, lymph node dissection, and cold pain sensation, while paravertebral nerve block was identified as a protective factor. The AUC values were 0.878 in training cohort and 0.805 in internal test cohort, respectively, indicating that the model performed well in identifying patients at risk for CPSP. The calibration curves in both cohorts showed a good fit, indicating that the model's predictions were reliable. And the DCA curve showed that using our model to guide decisions resulted in a higher net benefit compared to a strategy of not screening or treating all patients.

Conclusion: An effective risk prediction model for CPSP was successfully developed and validated in this study. This model can aid physicians in conducting more accurate assessments of CPSP risk in patients prior to surgery and in offering personalized strategies for managing CPSP.

Clinical registration number: Registration website: https://www.chictr.org.cn/ . Registration date: 2022/5/21.

Registration number: ChiCTR2200060196.

Background: Severe pneumonia is a common disease in children, with rapid progression and easy complications of respiratory failure, endangering the lives of children. This study aimed to elucidate the clinical significance of miR-193a-5p in severe pneumonia and to provide a new biomarker for the disease.

Methods: A total of 150 children with severe pneumonia and an equal number of healthy children were selected for analysis. Serum miR-193a-5p levels were detected by RT-qPCR. The correlation of miR-193a-5p with CRP, WBC, neutrophil count, and NLR was assessed by Spearman analysis. The diagnostic and prognostic value of miR-193a-5p in severe pneumonia was analyzed using ROC curves. The relationship between miR-193a-5p and the prognosis of severe pneumonia was evaluated using the Kaplan-Meier curve and a multivariate logistic analysis.

Results: Serum levels of miR-193a-5p were markedly elevated in children with severe pneumonia and exhibited a positive correlation with CRP, WBC, neutrophil count, and NLR. miR-193a-5p could effectively distinguish children with severe pneumonia from healthy children, with an AUC, sensitivity, and specificity of 0.862, 70.67%, and 88.67%, respectively. Serum miR-193a-5p expression was increased in children with poor prognosis and had a predictive value for patient prognosis. High expression of miR-193a-5p was linked to survival in children with severe pneumonia and was a risk factor for adverse prognosis.

Conclusion: Serum levels of miR-193a-5p were markedly elevated in children with severe pneumonia, which may be of significance for the early diagnosis of the disease and prognostic assessment.

Background: Dextrocardia is a rare cardiac malposition where the heart's normal orientation is reversed and is most commonly associated with situs inversus totalis (SIT). Such cases are technically challenging when heart surgery is needed, especially re-do surgery.

Case presentation: A 72-year-old female patient was referred to our hospital with complaints of chest tightness and reduced activity tolerance. The patient had a history of mitral valve replacement (MVR) with a bioprosthesis ten years prior. Chest X-ray showed dextrocardia with SIT in the patient. Structural valve degeneration of the mitral bioprosthesis and moderate tricuspid regurgitation were observed by transthoracic echocardiography. The patient underwent a successful re-do mitral valve replacement under ventricular fibrillation (VF) via a left anterolateral mini-thoracotomy. The recovery of the patient was uneventful.

Conclusions: Redo MVR under VF without aortic cross-clamping through a mini-thoracotomy can be safely and effectively carried out in patients with SIT.

The Cox-Maze IV (CMIV) procedure is the mainstay in surgical treatment of atrial fibrillation (AF), but the rate of AF recurrence after the CMIV procedure in patients with persistent AF is difficult to accurately evaluate. In this study, we aimed to develop and validate a risk prediction model of AF recurrence within 1 year after undergoing the Cox-Maze IV procedure. We retrospectively enrolled 303 consecutive patients who underwent the Cox-Maze IV procedure for persistent AF concomitant with other cardiac procedures at our institute between 2019 and 2021. A nomogram was developed using multivariate logistic regression analysis, and the concordance statistic (C-statistic) was computed. Differentiation, calibration, clinical suitability, and bootstrapping were performed to verify the model. Among the 303 patients, 71 developed recurrent AF within 1 year of CMIV. Factors predictive of postoperative AF recurrence included age, left ventricular hypertrophy (LVH), early atrial tachyarrhythmias (ATAs), and congenital heart disease surgery (namely, ventricular septal defect repair and atrial septal defect repair). Based on the training dataset, the nomogram had a C-statistic of 0.864 (95% CI 0.811-0.918) for predicting AF recurrence. According to the receiver operating characteristic curve, (ROC curve), the cutoff value of the model was 0.293, and the specificity and sensitivity were 0.841 and 0.789, respectively. This model can predict the risk of AF recurrence after the CMIV procedure. Its discrimination, calibration, and clinical applicability are strong, and its clinical application is simple and easy to promote.

Objective: it was to evaluate the efficacy and safety of rapamycin-eluting stents at different doses in the treatment of coronary artery narrowing in miniature pigs.

Methods: a total of 20 miniature pigs were randomly assigned into four groups: S1 group (low-dose rapamycin-coated stent, 55 µg/mm²), S2 group (medium-dose rapamycin-coated stent, 120 µg/mm²), S3 group (high-dose rapamycin-coated stent, 415 µg/mm²), and D0 group (bare metal stent). The stent size was 3.0 mm × 18 mm, with an over-expansion ratio of 1.1. Each group consisted of five pigs. Stent implantation was followed by euthanasia and tissue collection after 1 month. Vascular measurements, inflammatory response scores, cardiovascular injury scores, endothelialization scores, liver and kidney function indices, and myocardial injury markers were compared among the groups.

Results: the neointimal thickness in the S2 and S3 groups was significantly lower than that in the S1 and D0 groups (S1 group: 24.08 ± 3.95, S2 group: 1.86 ± 0.28, S3 group: 2.72 ± 0.74, D0 group: 22.85 ± 3.15, P < 0.05). The residual lumen area in the S2 and S3 groups was significantly larger than that in the S1 and D0 groups (S1 group: 2.73 ± 0.51, S2 group: 4.25 ± 0.78, S3 group: 3.91 ± 0.73, D0 group: 2.91 ± 0.44, P < 0.05). The neointimal area in the S2 and S3 groups was significantly smaller than that in the S1 and D0 groups (S1 group: 3.44 ± 0.84, S2 group: 1.78 ± 0.25, S3 group: 2.07 ± 0.41, D0 group: 3.43 ± 0.72, P < 0.05). The degree of lumen narrowing in the S2 and S3 groups was significantly lower than that in the S1 and D0 groups (S1 group: 44.25 ± 3.66%, S2 group: 14.19 ± 2.01%, S3 group: 15.29 ± 2.45%, D0 group: 21.79 ± 3.51%, P < 0.05). The inflammation scores of coronary artery walls in the S2 and S3 groups of miniature pigs were markedly lower than those in the S1 and D0 groups (P < 0.05). The cardiovascular injury scores (P = 0.072) and endothelialization scores (P = 0.085) differed slightly among the four groups (P > 0.05). Post-operative liver function indicators (alanine transaminase, aspartate transaminase), kidney function indicators (blood urea nitrogen, serum creatinine), and myocardial injury markers (creatine kinase, creatine kinase-MB) also showed neglectable differences among the four groups (P > 0.05).

Conclusion: medium and high doses of rapamycin-eluting stents effectively inhibit neointimal hyperplasia and local vascular inflammatory response in miniature pigs without causing damage to liver and kidney functions or myocardial cells. These stents demonstrate high efficacy and safety. Rapamycin-coated coronary stents, as an effective treatment for coronary artery stenosis, may achieve further improvement in therapeutic efficacy through optimization of drug dosage and stent design.