Background: The benefits and risks of coronary artery bypass grafting (CABG) in octogenarians remain unclear. This study aimed to identify the predictors of increased risk of all-cause mortality in octogenarian patients after CABG.
Methods: We retrospectively analyzed the data of 1636 octogenarians who underwent isolated elective on-pump CABG between 2007 and 2016. The primary endpoint was mortality from any cause. The Kaplan-Meier curve was generated for mortality. A univariate Cox regression was performed for preprocedural and procedural variables. The Akaike information criterion (AIC) using the Cox proportional hazard model was applied to determine the strongest predictors. We designed a nomogram based on the selected variables to calculate the mortality risk after one, five, and ten years. The bootstrap resampling based on the C-index was performed to validate the final model. Calibration plots were created at different time points.
Results: The mean age of the patients was 82.03 years (SD = 1.74), and 74% were male. In a median follow-up of 9.2 (95% CI 9.0,9.5) years, 626 (38.2%) patients died. After the selection of best predictors based on AIC, the multivariable Cox regression showed that ejection fraction < 40 (HR 1.41, 95% CI 1.21-1.65, P < 0.001), two-vessel disease (HR: 0.59, 95% CI 0.40-0.89, P = 0.012), peripheral vascular disease (HR 1.52, 95% CI 1.05-2.21, P = 0.027), and valvular heart disease (HR 1.45, 95% CI 1.24-1.69, P < 0.001) were the significant predictors of all-cause mortality.
Conclusion: Octogenarians who undergo CABG have a high mortality risk, influenced by several preprocedural and procedural risk factors. The proposed nomogram can be considered for optimizing the management of this vulnerable age group. Clinical registration number IR.TUMS.THC.REC.1400.081.
{"title":"Coronary artery bypass grafting in octogenarians: a nomogram for predicting all-cause mortality.","authors":"Saeed Davoodi, Mohammad Sadeq Najafi, Ahmad Vakili-Basir, Arash Jalali, Zahra Karimi, Elnaz Shahmohamadi, Mohadese Dashtkoohi, Aryan Ayati, Alireza Hadizadeh, Shahram Momtahan, Mahmoud Shirzad, Jamshid Bagheri","doi":"10.1186/s13019-024-03054-6","DOIUrl":"10.1186/s13019-024-03054-6","url":null,"abstract":"<p><strong>Background: </strong>The benefits and risks of coronary artery bypass grafting (CABG) in octogenarians remain unclear. This study aimed to identify the predictors of increased risk of all-cause mortality in octogenarian patients after CABG.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of 1636 octogenarians who underwent isolated elective on-pump CABG between 2007 and 2016. The primary endpoint was mortality from any cause. The Kaplan-Meier curve was generated for mortality. A univariate Cox regression was performed for preprocedural and procedural variables. The Akaike information criterion (AIC) using the Cox proportional hazard model was applied to determine the strongest predictors. We designed a nomogram based on the selected variables to calculate the mortality risk after one, five, and ten years. The bootstrap resampling based on the C-index was performed to validate the final model. Calibration plots were created at different time points.</p><p><strong>Results: </strong>The mean age of the patients was 82.03 years (SD = 1.74), and 74% were male. In a median follow-up of 9.2 (95% CI 9.0,9.5) years, 626 (38.2%) patients died. After the selection of best predictors based on AIC, the multivariable Cox regression showed that ejection fraction < 40 (HR 1.41, 95% CI 1.21-1.65, P < 0.001), two-vessel disease (HR: 0.59, 95% CI 0.40-0.89, P = 0.012), peripheral vascular disease (HR 1.52, 95% CI 1.05-2.21, P = 0.027), and valvular heart disease (HR 1.45, 95% CI 1.24-1.69, P < 0.001) were the significant predictors of all-cause mortality.</p><p><strong>Conclusion: </strong>Octogenarians who undergo CABG have a high mortality risk, influenced by several preprocedural and procedural risk factors. The proposed nomogram can be considered for optimizing the management of this vulnerable age group. Clinical registration number IR.TUMS.THC.REC.1400.081.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"586"},"PeriodicalIF":1.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11448455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-03DOI: 10.1186/s13019-024-03101-2
Sorasicha Nithikasem, Abhishek Chakraborty, Hirohisa Ikegami, Manabu Takebe, Gengo Sunagawa, Antonio Chiricolo, Ashok Chaudhary, Alexander Rahimi, Simran Agarwala, Mark Russo, Leonard Y Lee, Anthony Lemaire
Objective: Despite key differences in pathological processes, both Intramural Hematomas and Aortic Dissections are Acute Aortic Syndromes repaired with similar surgical technique. The objective of this study was to determine differences in surgical outcomes between patients with Intramural Hematoma versus Type A Aortic Dissection undergoing Ascending Aortic Arch repair.
Methods: This retrospective review of prospectively collected data included all patients with acute Intramural Hematoma or Type A Aortic Dissection who underwent emergent Ascending- or Arch Repair from January 2018 to May 2023 at a single academic institution. Primary outcomes included intraoperative mortality, 30-Day mortality, and postoperative stay. Secondary outcomes included postoperative complications. Outcomes were analyzed using Chi-squared, Fisher's Exact, and t-tests, with significance set at p < 0.05.
Results: A total of 107 patients were included, 27 of whom (25%) had Intramural Hematoma and 80 (75%) had Type A Aortic Dissection. There were no differences in preoperative characteristics such as age, gender, and comorbidities, and no differences in perioperative characteristics such as case length, cardiopulmonary bypass, aortic cross-clamp, and circulatory arrest times. When comparing postoperative outcomes, there was a higher rate of postoperative pericardial effusions requiring pericardial window in the Intramural Hematoma cohort compared to the Aortic Dissection cohort (15% [n = 4] vs. 3% [n = 2]; p = 0.02). There were no differences in other primary outcomes such as intraoperative mortality, 30-Day mortality, and postoperative length of stay. There were also no differences in the rates of postoperative complications such as bleeding requiring reoperation, cerebrovascular accident, atrial fibrillation, pleural effusion requiring thoracentesis, and surgery-related Emergency Department visits.
Conclusions: Our analysis demonstrates similar outcomes for patients undergoing Ascending Aortic Arch repair between patients with Intramural Hematoma and Type A Aortic Dissection. Despite the higher rate of required postoperative pericardial windows in the Intramural Hematoma cohort, the overall primary outcomes remained comparable. These findings better elucidate the standard of care for patients with acute Intramural Hematoma undergoing Ascending Aortic Arch repair.
目的:室壁内血肿和主动脉夹层都是急性主动脉综合征,尽管病理过程存在主要差异,但两者都采用类似的手术技术进行修复。本研究旨在确定壁内血肿患者与主动脉夹层患者接受升主动脉弓修补术的手术效果差异:这项对前瞻性收集数据的回顾性研究纳入了2018年1月至2023年5月期间在一家学术机构接受急诊升主动脉弓或主动脉弓修复术的所有急性壁内血肿或A型主动脉夹层患者。主要结果包括术中死亡率、30 天死亡率和术后住院时间。次要结果包括术后并发症。结果采用Chi-squared、Fisher's Exact和t检验进行分析,显著性设定为p 结果:共纳入 107 例患者,其中 27 例(25%)有壁内血肿,80 例(75%)有 A 型主动脉夹层。术前特征(如年龄、性别和合并症)无差异,围手术期特征(如病例长度、心肺旁路、主动脉交叉钳夹和循环停止时间)也无差异。在比较术后结果时,与主动脉夹层队列相比,室壁内血肿队列术后需要开心包窗的心包积液率更高(15% [n = 4] vs. 3% [n = 2];P = 0.02)。术中死亡率、30 天死亡率和术后住院时间等其他主要结果没有差异。术后并发症的发生率也没有差异,如需要再次手术的出血、脑血管意外、心房颤动、需要胸腔穿刺的胸腔积液以及手术相关的急诊就诊率:我们的分析表明,室壁内血肿和 A 型主动脉夹层患者接受升主动脉弓修补术的结果相似。尽管室壁内血肿队列中术后需要开心包窗的比例较高,但总体主要结果仍具有可比性。这些发现更好地阐明了对急性壁内血肿患者进行主动脉弓升部修补术的护理标准。
{"title":"Patients undergoing emergent surgery for type A intramural hematomas or type A aortic dissections have similar outcomes.","authors":"Sorasicha Nithikasem, Abhishek Chakraborty, Hirohisa Ikegami, Manabu Takebe, Gengo Sunagawa, Antonio Chiricolo, Ashok Chaudhary, Alexander Rahimi, Simran Agarwala, Mark Russo, Leonard Y Lee, Anthony Lemaire","doi":"10.1186/s13019-024-03101-2","DOIUrl":"10.1186/s13019-024-03101-2","url":null,"abstract":"<p><strong>Objective: </strong>Despite key differences in pathological processes, both Intramural Hematomas and Aortic Dissections are Acute Aortic Syndromes repaired with similar surgical technique. The objective of this study was to determine differences in surgical outcomes between patients with Intramural Hematoma versus Type A Aortic Dissection undergoing Ascending Aortic Arch repair.</p><p><strong>Methods: </strong>This retrospective review of prospectively collected data included all patients with acute Intramural Hematoma or Type A Aortic Dissection who underwent emergent Ascending- or Arch Repair from January 2018 to May 2023 at a single academic institution. Primary outcomes included intraoperative mortality, 30-Day mortality, and postoperative stay. Secondary outcomes included postoperative complications. Outcomes were analyzed using Chi-squared, Fisher's Exact, and t-tests, with significance set at p < 0.05.</p><p><strong>Results: </strong>A total of 107 patients were included, 27 of whom (25%) had Intramural Hematoma and 80 (75%) had Type A Aortic Dissection. There were no differences in preoperative characteristics such as age, gender, and comorbidities, and no differences in perioperative characteristics such as case length, cardiopulmonary bypass, aortic cross-clamp, and circulatory arrest times. When comparing postoperative outcomes, there was a higher rate of postoperative pericardial effusions requiring pericardial window in the Intramural Hematoma cohort compared to the Aortic Dissection cohort (15% [n = 4] vs. 3% [n = 2]; p = 0.02). There were no differences in other primary outcomes such as intraoperative mortality, 30-Day mortality, and postoperative length of stay. There were also no differences in the rates of postoperative complications such as bleeding requiring reoperation, cerebrovascular accident, atrial fibrillation, pleural effusion requiring thoracentesis, and surgery-related Emergency Department visits.</p><p><strong>Conclusions: </strong>Our analysis demonstrates similar outcomes for patients undergoing Ascending Aortic Arch repair between patients with Intramural Hematoma and Type A Aortic Dissection. Despite the higher rate of required postoperative pericardial windows in the Intramural Hematoma cohort, the overall primary outcomes remained comparable. These findings better elucidate the standard of care for patients with acute Intramural Hematoma undergoing Ascending Aortic Arch repair.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"585"},"PeriodicalIF":1.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Acute kidney injury (AKI) represents a significant post-cardiac surgery complication, particularly prevalent among individuals with pre-existing renal dysfunction. Chronic kidney disease (CKD) is frequently accompanied by persistent, low-grade inflammation, which is known to exacerbate systemic stress responses during surgical procedures. This study hypothesizes that these inflammatory responses might influence the incidence and severity of postoperative acute kidney injury (AKI), potentially serving as a protective mechanism by preconditioning the kidney to stress.
Methods: This retrospective study enrolled patients with preoperative renal dysfunction (eGFR between 15 and 60 ml/min/1.73 m²) who underwent cardiac surgery between January 2020 and December 2022. Preoperative inflammatory biomarkers were evaluated. The primary outcome was the incidence of postoperative AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Multivariate regression models and sensitivity analyses were conducted to ascertain the relationship between inflammatory biomarkers and AKI. Restricted cubic spines (RCS) was conducted to explore nonlinear associations between inflammatory biomarkers and AKI.
Results: AKI occurred in 53.4% (392/734) of patients, accompanied by significant mortality and length of hospital stay increases in cases of AKI (P < 0.005). After full adjustment of confounders, neutrophil percentage-to-albumin ratio (OR = 0.28), systemic inflammation response index (OR = 0.70), systemic immune inflammation index (OR = 0.69), neutrophil-to-lymphocyte ratio (OR = 0.70), monocyte/high-density lipoprotein cholesterol ratio (OR = 0.53), neutrophil/high-density lipoprotein cholesterol ratio (OR = 0.43) demonstrated an inverse association with AKI. Sensitivity analyses revealed that patients in the highest quartile of these biomarkers exhibited a significantly lower prevalence of AKI compared to those in the lowest quartile (p for trend < 0.05). The RCS analysis suggested an "Inverted U-shaped" association of both LnNPAR and LnSIRI with AKI.
Conclusions: This study identified an inverse association between preoperative inflammatory biomarkers and postoperative AKI in patients with preoperative renal dysfunction. The findings implied that preoperative inflammation may play a protective role against postoperative AKI in this patient population undergoing cardiac surgery.
背景:急性肾损伤(AKI)是心脏手术后的一种重要并发症,在原有肾功能不全的患者中尤为普遍。慢性肾脏病(CKD)经常伴有持续的低度炎症,众所周知,炎症会加剧手术过程中的全身应激反应。本研究假设,这些炎症反应可能会影响术后急性肾损伤(AKI)的发生率和严重程度,有可能通过对肾脏进行应激预处理而成为一种保护机制:这项回顾性研究纳入了 2020 年 1 月至 2022 年 12 月期间接受心脏手术的术前肾功能不全(eGFR 在 15 至 60 毫升/分钟/1.73 平方米之间)患者。对术前炎症生物标志物进行了评估。主要结果是术后 AKI 的发生率,根据肾脏疾病:改善全球预后 (KDIGO) 标准定义的术后 AKI 发生率。为确定炎症生物标志物与 AKI 之间的关系,进行了多变量回归模型和敏感性分析。为了探索炎症生物标志物与 AKI 之间的非线性关系,还进行了限制性立方棘(RCS)分析:53.4%的患者(392/734)发生了 AKI,AKI 病例的死亡率和住院时间显著增加(P 结论:该研究发现了炎症生物标志物与 AKI 之间的反向关系:本研究发现,术前肾功能不全的患者术前炎症生物标志物与术后 AKI 呈反向关系。研究结果表明,术前炎症可能对接受心脏手术的这类患者的术后 AKI 起保护作用。
{"title":"Association between inflammatory biomarkers and postoperative acute kidney injury after cardiac surgery in patients with preoperative renal dysfunction: a retrospective pilot analysis.","authors":"Wuhua Jiang, Yi Fang, Xiaoqiang Ding, Zhe Luo, Dong Zhang, Xialian Xu, Jiarui Xu","doi":"10.1186/s13019-024-03067-1","DOIUrl":"10.1186/s13019-024-03067-1","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) represents a significant post-cardiac surgery complication, particularly prevalent among individuals with pre-existing renal dysfunction. Chronic kidney disease (CKD) is frequently accompanied by persistent, low-grade inflammation, which is known to exacerbate systemic stress responses during surgical procedures. This study hypothesizes that these inflammatory responses might influence the incidence and severity of postoperative acute kidney injury (AKI), potentially serving as a protective mechanism by preconditioning the kidney to stress.</p><p><strong>Methods: </strong>This retrospective study enrolled patients with preoperative renal dysfunction (eGFR between 15 and 60 ml/min/1.73 m²) who underwent cardiac surgery between January 2020 and December 2022. Preoperative inflammatory biomarkers were evaluated. The primary outcome was the incidence of postoperative AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Multivariate regression models and sensitivity analyses were conducted to ascertain the relationship between inflammatory biomarkers and AKI. Restricted cubic spines (RCS) was conducted to explore nonlinear associations between inflammatory biomarkers and AKI.</p><p><strong>Results: </strong>AKI occurred in 53.4% (392/734) of patients, accompanied by significant mortality and length of hospital stay increases in cases of AKI (P < 0.005). After full adjustment of confounders, neutrophil percentage-to-albumin ratio (OR = 0.28), systemic inflammation response index (OR = 0.70), systemic immune inflammation index (OR = 0.69), neutrophil-to-lymphocyte ratio (OR = 0.70), monocyte/high-density lipoprotein cholesterol ratio (OR = 0.53), neutrophil/high-density lipoprotein cholesterol ratio (OR = 0.43) demonstrated an inverse association with AKI. Sensitivity analyses revealed that patients in the highest quartile of these biomarkers exhibited a significantly lower prevalence of AKI compared to those in the lowest quartile (p for trend < 0.05). The RCS analysis suggested an \"Inverted U-shaped\" association of both LnNPAR and LnSIRI with AKI.</p><p><strong>Conclusions: </strong>This study identified an inverse association between preoperative inflammatory biomarkers and postoperative AKI in patients with preoperative renal dysfunction. The findings implied that preoperative inflammation may play a protective role against postoperative AKI in this patient population undergoing cardiac surgery.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"583"},"PeriodicalIF":1.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11448243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-03DOI: 10.1186/s13019-024-03099-7
Philip Borkowski, Eugene Ng, Mauro Vicaretti, Noel Young
Purpose: Computed tomography aortography (CTA) is used in the assessment of aortic pathologies and planning of surgical intervention. However, its dependence on iodinated contrast can result in development of contrast-induced acute kidney injury (CI-AKI). The potential concern of CI-AKI has spurred research into the potential of administration of low contrast volumes in CTA investigations while maintaining overall diagnostic appeal. Several studies have shown that CTA using contrast volumes as low as 30 mL (equivalent to 10.5 g of iodine) can still yield scans of diagnostic quality. We present a retrospective pilot study to evaluate the feasibility of utilising an ultra-low volume of iodinated intravenous contrast in a population of patients with severe renal insufficiency with referral from our vascular surgery unit for CTA evaluation of the thoracic and abdominal aorta.
Methods: This retrospective pilot study examined 12 CTA scans performed with 20 mLs of iodinated contrast and assessed image quality with both quantitative and qualitative markers. All scans were performed on a Siemens SOMATOM Force dual-source CT scanner. Quantitative assessment values were measured via attenuation values at eight aortoiliac locations and used to calculate a signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at each location. Qualitative analysis of image quality and viability for surgical intervention was obtained from subjective clinical assessment by an interventional radiologist and vascular surgeon.
Results: Obtained quantitative assessment values included mean attenuation 189.9 HU, mean SNR 9.6 and mean CNR 8.0. All 12 scans demonstrated individual mean SNR values above predetermined quality thresholds while only five scans produced individual mean CNR values above threshold. Eleven of 12 scans were determined to be of sufficient quality for diagnosis and planning of surgical intervention.
Conclusions: Our results suggest that CTA utilising an ultra-low contrast dose of 20 mLs (6 g iodine) yields scans of diagnostic quality for therapeutic decision-making in vascular surgical intervention.
{"title":"Use of ultra-low contrast dose CT aortography for the management of aortic aneurysmal disease.","authors":"Philip Borkowski, Eugene Ng, Mauro Vicaretti, Noel Young","doi":"10.1186/s13019-024-03099-7","DOIUrl":"10.1186/s13019-024-03099-7","url":null,"abstract":"<p><strong>Purpose: </strong>Computed tomography aortography (CTA) is used in the assessment of aortic pathologies and planning of surgical intervention. However, its dependence on iodinated contrast can result in development of contrast-induced acute kidney injury (CI-AKI). The potential concern of CI-AKI has spurred research into the potential of administration of low contrast volumes in CTA investigations while maintaining overall diagnostic appeal. Several studies have shown that CTA using contrast volumes as low as 30 mL (equivalent to 10.5 g of iodine) can still yield scans of diagnostic quality. We present a retrospective pilot study to evaluate the feasibility of utilising an ultra-low volume of iodinated intravenous contrast in a population of patients with severe renal insufficiency with referral from our vascular surgery unit for CTA evaluation of the thoracic and abdominal aorta.</p><p><strong>Methods: </strong>This retrospective pilot study examined 12 CTA scans performed with 20 mLs of iodinated contrast and assessed image quality with both quantitative and qualitative markers. All scans were performed on a Siemens SOMATOM Force dual-source CT scanner. Quantitative assessment values were measured via attenuation values at eight aortoiliac locations and used to calculate a signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at each location. Qualitative analysis of image quality and viability for surgical intervention was obtained from subjective clinical assessment by an interventional radiologist and vascular surgeon.</p><p><strong>Results: </strong>Obtained quantitative assessment values included mean attenuation 189.9 HU, mean SNR 9.6 and mean CNR 8.0. All 12 scans demonstrated individual mean SNR values above predetermined quality thresholds while only five scans produced individual mean CNR values above threshold. Eleven of 12 scans were determined to be of sufficient quality for diagnosis and planning of surgical intervention.</p><p><strong>Conclusions: </strong>Our results suggest that CTA utilising an ultra-low contrast dose of 20 mLs (6 g iodine) yields scans of diagnostic quality for therapeutic decision-making in vascular surgical intervention.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"582"},"PeriodicalIF":1.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11448089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1186/s13019-024-03088-w
Jiafang Xu, Qingjie Hu, Siqi Yin, Huifang He, Hai Li, Ruiqi Yang, Meizi Song, Chaoqun Wang, Yu Liu
Stage I non-small cell lung cancer (NSCLC) accounts for about 15% of incident cancer cases. Prognosis is poor, with a metastasis and recurrence rate of 38% within 2 years of surgery and an overall 5-year survival rate of 54-60%. Here, we report successful apatinib monotherapy of early NSCLC in a patient who had declined surgery, radiofrequency ablation, and immunotherapy. The patient received apatinib for 64 months without clinical, laboratory, or radiographic evidence of disease progression. The curative effect was judged to be stable and safe.The role of apatinib as monotherapy for patients with early stage NSCLC who are not candidates for surgery or radiotherapy, or as an adjunct to standard therapy, deserves further study.
I 期非小细胞肺癌(NSCLC)约占癌症病例的 15%。其预后较差,手术后两年内的转移和复发率为 38%,总体 5 年生存率为 54-60%。在此,我们报告了一位拒绝手术、射频消融和免疫疗法的患者成功接受阿帕替尼单药治疗早期NSCLC的情况。该患者接受阿帕替尼治疗 64 个月,没有出现临床、实验室或影像学上的疾病进展迹象。阿帕替尼作为不适合手术或放疗的早期NSCLC患者的单药治疗,或作为标准疗法的辅助治疗,其作用值得进一步研究。
{"title":"Apatinib monotherapy for early non-small cell lung cancer: a case report.","authors":"Jiafang Xu, Qingjie Hu, Siqi Yin, Huifang He, Hai Li, Ruiqi Yang, Meizi Song, Chaoqun Wang, Yu Liu","doi":"10.1186/s13019-024-03088-w","DOIUrl":"10.1186/s13019-024-03088-w","url":null,"abstract":"<p><p>Stage I non-small cell lung cancer (NSCLC) accounts for about 15% of incident cancer cases. Prognosis is poor, with a metastasis and recurrence rate of 38% within 2 years of surgery and an overall 5-year survival rate of 54-60%. Here, we report successful apatinib monotherapy of early NSCLC in a patient who had declined surgery, radiofrequency ablation, and immunotherapy. The patient received apatinib for 64 months without clinical, laboratory, or radiographic evidence of disease progression. The curative effect was judged to be stable and safe.The role of apatinib as monotherapy for patients with early stage NSCLC who are not candidates for surgery or radiotherapy, or as an adjunct to standard therapy, deserves further study.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"557"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1186/s13019-024-03111-0
Long Yu, Yang Lou, Dan Zhu
Background: In this paper, a rare case is reported, where the patient is a 74-year-old man. He suffered from recurrent pneumothorax within half a year and experienced a relapse after receiving conservative treatments.
Case presentation: Diagnostic workup revealed a cystic lesion in the right middle lobe, which has been interpreted as a bulla during the initial chest CT scan. Due to recurrent pneumothorax and poor response to the conservative treatments, the patient underwent bullectomy and pleurodesis. The pathology showed that the wall of the cystic lesion was invasive adenocarcinoma.
Conclusions: This case highlights the importance of monitoring cystic lesions in the lungs, especially in patients with a history of smoking and emphysema.
{"title":"A case of adenocarcinoma presenting with cystic lesion and recurrent pneumothoraces.","authors":"Long Yu, Yang Lou, Dan Zhu","doi":"10.1186/s13019-024-03111-0","DOIUrl":"10.1186/s13019-024-03111-0","url":null,"abstract":"<p><strong>Background: </strong>In this paper, a rare case is reported, where the patient is a 74-year-old man. He suffered from recurrent pneumothorax within half a year and experienced a relapse after receiving conservative treatments.</p><p><strong>Case presentation: </strong>Diagnostic workup revealed a cystic lesion in the right middle lobe, which has been interpreted as a bulla during the initial chest CT scan. Due to recurrent pneumothorax and poor response to the conservative treatments, the patient underwent bullectomy and pleurodesis. The pathology showed that the wall of the cystic lesion was invasive adenocarcinoma.</p><p><strong>Conclusions: </strong>This case highlights the importance of monitoring cystic lesions in the lungs, especially in patients with a history of smoking and emphysema.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"576"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1186/s13019-024-03082-2
Li-Jun Cao, Wen-Juan Wang, Qin-Xue Zhou
Objective: This study aimed to evaluate the efficacy of six non-invasive remote ischemic preconditioning (RIPC) interventions during the nursing care of patients with heart failure (HF) prior to cardiac catheterization.
Methods: A comprehensive search of nine Chinese and English online databases was conducted from the date of their inception to June 2023 to identify randomized controlled trials (RCTs) investigating RIPC in patients with HF prior to cardiac catheterization. Two independent investigators screened the articles, extracted data, and assessed their quality. The risk of bias was evaluated using the Cochrane risk-of-bias tool, and a network meta-analysis was conducted using R software.
Results: Four trials involving 511 patients with a low risk of bias were included in the analysis. Six non-invasive RIPC interventions were identified, all demonstrating effectiveness in reducing the incidence of contrast-induced acute kidney injury (CI-AKI). Among these, Intervention F (applying up to 50 mmHg above the resting systolic pressure for 5 min to the dominant leg or upper limb, repeated three times with an 18-minute interval) was deemed optimal, although the timing of the procedure was not specified. Intervention D (applying up to 200 mmHg pressure to the upper limb for 5 min, repeated four times with 5-minute intervals, within 45 min prior to cardiac catheterization, ) was considered suboptimal.
Conclusion: Although Intervention D was recommended as the preferred option, none of the four trials examined its impact on the cardiac function of patients with HF. Large-scale, multi-center RCTs are required, with outcome indicators including cardiac function and the occurrence of CI-AKI, to better understand the therapeutic effects of RIPC on HF and reduce the incidence of CI-AKI. This will provide a more robust foundation for clinical practice.
{"title":"Non-invasive remote ischemic preconditioning for patients with heart failure undergoing cardiac catheterization: a network meta-analysis of randomized controlled trials.","authors":"Li-Jun Cao, Wen-Juan Wang, Qin-Xue Zhou","doi":"10.1186/s13019-024-03082-2","DOIUrl":"10.1186/s13019-024-03082-2","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the efficacy of six non-invasive remote ischemic preconditioning (RIPC) interventions during the nursing care of patients with heart failure (HF) prior to cardiac catheterization.</p><p><strong>Methods: </strong>A comprehensive search of nine Chinese and English online databases was conducted from the date of their inception to June 2023 to identify randomized controlled trials (RCTs) investigating RIPC in patients with HF prior to cardiac catheterization. Two independent investigators screened the articles, extracted data, and assessed their quality. The risk of bias was evaluated using the Cochrane risk-of-bias tool, and a network meta-analysis was conducted using R software.</p><p><strong>Results: </strong>Four trials involving 511 patients with a low risk of bias were included in the analysis. Six non-invasive RIPC interventions were identified, all demonstrating effectiveness in reducing the incidence of contrast-induced acute kidney injury (CI-AKI). Among these, Intervention F (applying up to 50 mmHg above the resting systolic pressure for 5 min to the dominant leg or upper limb, repeated three times with an 18-minute interval) was deemed optimal, although the timing of the procedure was not specified. Intervention D (applying up to 200 mmHg pressure to the upper limb for 5 min, repeated four times with 5-minute intervals, within 45 min prior to cardiac catheterization, ) was considered suboptimal.</p><p><strong>Conclusion: </strong>Although Intervention D was recommended as the preferred option, none of the four trials examined its impact on the cardiac function of patients with HF. Large-scale, multi-center RCTs are required, with outcome indicators including cardiac function and the occurrence of CI-AKI, to better understand the therapeutic effects of RIPC on HF and reduce the incidence of CI-AKI. This will provide a more robust foundation for clinical practice.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"573"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1186/s13019-024-03063-5
Basel A Jobeir, Abdelkarim E De Vol, Ziyad M Alanazi, Domenico Galzerano, Anas A Jobeir, Aly M Alsanei, Bandar Alamro, Mohammed Alamri, Zohair Y AlHalees, Feras H Khaliel
Background: The incidence of infective endocarditis (IE) in patients undergoing redo mitral valve (MV) surgery was evaluated. The outcomes of all the patients and the patients' specific characteristics were recorded. The patients were analyzed to further the research of IE in this population.
Method: This was a retrospective review of patients admitted for redo MV surgery with a prospective follow-up of electronic medical records at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, from 2009 to 2019. Pre/intra/post-operative factors contributing to mortality, morbidity, and freedom of adverse events were analyzed.
Result: A total of 211 patients underwent redo MV surgery, and 41 patients (19.4%) had IE; and 51% of this subset of patients, 21 individuals, developed IE after the initial MV surgery. MV stenosis was moderate/severe in 50 patients. Furthermore, MV regurgitation was present in 89 patients. Multivariate analysis of the data revealed multiple factors influencing mortality: age, peripheral vascular disease, concomitant procedures, peripheral vascular disease, red blood cell transfusions, preoperative mechanical valves, and active IE. In-hospital Mortality was 10.9%. The one-, five-, and ten-year survival was 88%, 79%, and 69% across all patients.
Conclusion: Although redo MV surgery has acceptable outcomes; the presence of IE or concomitant procedures is a significant health detriment in these patients. Our study highlights the need for careful patient management and more in-depth research in this area to improve patient outcomes.
{"title":"Outcome of patient undergoing redo mitral valve surgery with incidence rate of mitral valve infective endocarditis.","authors":"Basel A Jobeir, Abdelkarim E De Vol, Ziyad M Alanazi, Domenico Galzerano, Anas A Jobeir, Aly M Alsanei, Bandar Alamro, Mohammed Alamri, Zohair Y AlHalees, Feras H Khaliel","doi":"10.1186/s13019-024-03063-5","DOIUrl":"10.1186/s13019-024-03063-5","url":null,"abstract":"<p><strong>Background: </strong>The incidence of infective endocarditis (IE) in patients undergoing redo mitral valve (MV) surgery was evaluated. The outcomes of all the patients and the patients' specific characteristics were recorded. The patients were analyzed to further the research of IE in this population.</p><p><strong>Method: </strong>This was a retrospective review of patients admitted for redo MV surgery with a prospective follow-up of electronic medical records at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, from 2009 to 2019. Pre/intra/post-operative factors contributing to mortality, morbidity, and freedom of adverse events were analyzed.</p><p><strong>Result: </strong>A total of 211 patients underwent redo MV surgery, and 41 patients (19.4%) had IE; and 51% of this subset of patients, 21 individuals, developed IE after the initial MV surgery. MV stenosis was moderate/severe in 50 patients. Furthermore, MV regurgitation was present in 89 patients. Multivariate analysis of the data revealed multiple factors influencing mortality: age, peripheral vascular disease, concomitant procedures, peripheral vascular disease, red blood cell transfusions, preoperative mechanical valves, and active IE. In-hospital Mortality was 10.9%. The one-, five-, and ten-year survival was 88%, 79%, and 69% across all patients.</p><p><strong>Conclusion: </strong>Although redo MV surgery has acceptable outcomes; the presence of IE or concomitant procedures is a significant health detriment in these patients. Our study highlights the need for careful patient management and more in-depth research in this area to improve patient outcomes.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"581"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11445961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1186/s13019-024-03039-5
Saiyu Li, Bing Ding, Duanli Weng
Objective: This study aimed to develop a prognostic cell death index (CDI) based on the expression of genes related with various types of programmed cell death (PCD), and to assess its clinical relevance in lung squamous cell carcinoma (LUSC).
Methods: PCD-related genes were gathered and analyzed in silico using the transcriptomic data from the LUSC cohorts of The Cancer Genome Atlas (TCGA) and Clinical Proteomic Tumor Analysis Consortium (CPTAC). Differentially expressed PCD genes were analyzed, and a prognostic model was subsequently constructed. CDI scores were calculated for each patient, and their correlations with clinical features, survival outcomes, tumor mutation burden, gene clusters, and tumor microenvironment were investigated. Unsupervised consensus clustering was performed based on CDI model genes. Furthermore, the correlation of CDI for sensitivity of targeted drugs, chemotherapy efficacy, and immunotherapy responses was assessed.
Results: Based on 351 differentially expressed PCD genes in LUSC, a CDI signature comprising FGA, GAB2, JUN, and CDKN2A was identified. High CDI scores were significantly associated with poor survival outcomes (p < 0.05). Unsupervised clustering revealed three distinct patient subsets with varying survival rates. CDKN2A exhibited significantly different mutation patterns between patients with high and low CDI scores (p < 0.01). High CDI scores were also linked to increased immune cell infiltration of specific subsets and altered expression of immune-related genes. Patients with high-CDI showed reduced sensitivity to several chemotherapeutic drugs and a higher Tumor Immune Dysfunction and Exclusion (TIDE) score, indicating potential resistance to immunotherapy.
Conclusion: The CDI signature based on PCD genes offers valuable prognostic insights into LUSC, reflecting molecular heterogeneity, immune microenvironment associations, and potential therapeutic challenges. The CDI holds potential clinical utility in predicting treatment responses and guiding the selection of appropriate therapies for patients with LUSC. Future studies are warranted to further validate the prognostic value of CDI in combination with clinical factors and to explore its application across diverse patient cohorts.
{"title":"Characterization of prognostic signature related with twelve types of programmed cell death in lung squamous cell carcinoma.","authors":"Saiyu Li, Bing Ding, Duanli Weng","doi":"10.1186/s13019-024-03039-5","DOIUrl":"10.1186/s13019-024-03039-5","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop a prognostic cell death index (CDI) based on the expression of genes related with various types of programmed cell death (PCD), and to assess its clinical relevance in lung squamous cell carcinoma (LUSC).</p><p><strong>Methods: </strong>PCD-related genes were gathered and analyzed in silico using the transcriptomic data from the LUSC cohorts of The Cancer Genome Atlas (TCGA) and Clinical Proteomic Tumor Analysis Consortium (CPTAC). Differentially expressed PCD genes were analyzed, and a prognostic model was subsequently constructed. CDI scores were calculated for each patient, and their correlations with clinical features, survival outcomes, tumor mutation burden, gene clusters, and tumor microenvironment were investigated. Unsupervised consensus clustering was performed based on CDI model genes. Furthermore, the correlation of CDI for sensitivity of targeted drugs, chemotherapy efficacy, and immunotherapy responses was assessed.</p><p><strong>Results: </strong>Based on 351 differentially expressed PCD genes in LUSC, a CDI signature comprising FGA, GAB2, JUN, and CDKN2A was identified. High CDI scores were significantly associated with poor survival outcomes (p < 0.05). Unsupervised clustering revealed three distinct patient subsets with varying survival rates. CDKN2A exhibited significantly different mutation patterns between patients with high and low CDI scores (p < 0.01). High CDI scores were also linked to increased immune cell infiltration of specific subsets and altered expression of immune-related genes. Patients with high-CDI showed reduced sensitivity to several chemotherapeutic drugs and a higher Tumor Immune Dysfunction and Exclusion (TIDE) score, indicating potential resistance to immunotherapy.</p><p><strong>Conclusion: </strong>The CDI signature based on PCD genes offers valuable prognostic insights into LUSC, reflecting molecular heterogeneity, immune microenvironment associations, and potential therapeutic challenges. The CDI holds potential clinical utility in predicting treatment responses and guiding the selection of appropriate therapies for patients with LUSC. Future studies are warranted to further validate the prognostic value of CDI in combination with clinical factors and to explore its application across diverse patient cohorts.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"569"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1186/s13019-024-03108-9
Jian-Jun Gu, Xiao-Chao Tian, Ji-Qiang Bu, Zi-Ying Chen
Background: To investigate the clinical effects and safety of the hybrid debranching technique for patients with acute Stanford type A aortic dissection (AD).
Methods: One hundred nine patients with acute Stanford type a AD were selected and divided into observation group and control group according to the different surgical methods. Fifty-five patients in the observation group were treated with hybrid debranching, and 54 patients in the control group were treated with Sun's operation. The operation duration, clamp time, cardiopulmonary bypass duration, volume of blood transfusion, ventilator application duration, duration of stay in the intensive care unit, aortic rupture, second thoracotomy due to hemorrhage, gastrointestinal hemorrhage, stroke, paraplegia, renal failure, and all-cause mortality were recorded. Postoperative follow-up was conducted. The number of cases that underwent follow-up and the number of cases with complete thrombosis of the false aneurysm cavity detected by computed tomography angiography (CTA) was recorded.
Results: The surgical success rate was 100% in both groups, and there were no cases with unplanned secondary surgery. Compared with the control group, only the difference in the volume of blood transfusion was not significantly significant between the two groups (P = 0.052), while the rest of the observation indicators were significantly lower in the observation group than in the control group (P < 0.001 for all). The proportion of cases with complete thrombosis of the false aneurysm cavity was significantly higher in the observation group than in the control group at 3 and 6 months after surgery (P < 0.05).
Conclusion: In patients with acute Stanford type A AD involving the arch, the hybrid debranching technique was safe and effective. It was recommended for patients with advanced age and a high risk of intolerance to deep hypothermic circulatory arrest.
{"title":"Clinical effects of hybrid debranching technique for acute Stanford type A aortic dissection.","authors":"Jian-Jun Gu, Xiao-Chao Tian, Ji-Qiang Bu, Zi-Ying Chen","doi":"10.1186/s13019-024-03108-9","DOIUrl":"10.1186/s13019-024-03108-9","url":null,"abstract":"<p><strong>Background: </strong>To investigate the clinical effects and safety of the hybrid debranching technique for patients with acute Stanford type A aortic dissection (AD).</p><p><strong>Methods: </strong>One hundred nine patients with acute Stanford type a AD were selected and divided into observation group and control group according to the different surgical methods. Fifty-five patients in the observation group were treated with hybrid debranching, and 54 patients in the control group were treated with Sun's operation. The operation duration, clamp time, cardiopulmonary bypass duration, volume of blood transfusion, ventilator application duration, duration of stay in the intensive care unit, aortic rupture, second thoracotomy due to hemorrhage, gastrointestinal hemorrhage, stroke, paraplegia, renal failure, and all-cause mortality were recorded. Postoperative follow-up was conducted. The number of cases that underwent follow-up and the number of cases with complete thrombosis of the false aneurysm cavity detected by computed tomography angiography (CTA) was recorded.</p><p><strong>Results: </strong>The surgical success rate was 100% in both groups, and there were no cases with unplanned secondary surgery. Compared with the control group, only the difference in the volume of blood transfusion was not significantly significant between the two groups (P = 0.052), while the rest of the observation indicators were significantly lower in the observation group than in the control group (P < 0.001 for all). The proportion of cases with complete thrombosis of the false aneurysm cavity was significantly higher in the observation group than in the control group at 3 and 6 months after surgery (P < 0.05).</p><p><strong>Conclusion: </strong>In patients with acute Stanford type A AD involving the arch, the hybrid debranching technique was safe and effective. It was recommended for patients with advanced age and a high risk of intolerance to deep hypothermic circulatory arrest.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"577"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}