Journal of Cardiothoracic Surgery最新文献

Objective: The prevalence and characteristics of drug-related problems (DRPs) in the cardiovascular surgery unit have not been adequately explored, leaving a gap in our understanding of this critical issue. This study aimed to address this gap by determining the prevalence, characteristics of DRPs and identifying factors associated with their occurrence.

Methods: During a non-consecutive 48-month study period, a retrospective analysis was conducted to investigate DRPs and the interventions carried out by pharmacists for patients undergoing cardiovascular surgery. The study collected data on patient demographics, clinical characteristics, and pharmacist interventions.

Results: A comprehensive data analysis revealed 671 DRPs among the 623 hospitalized patients, averaging 1.08 DRPs per patient. The most prevalent type of DRPs observed was "Unnecessary drug-treatment P3.2", accounting for 56.18% (377/671). The primary cause of DRPs was drug selection (C1), followed by dose selection (C3). Pharmacists proposed 1,628 interventions, averaging 2.43 interventions per DRP and 2.61 interventions per patient. Most interventions were accepted and fully implemented by physicians or patients, resulting in 537 (80.03%) of the total DRPs resolved. Furthermore, binary logistic regression analysis demonstrated that the frequency of DRPs was correlated with age, the length of hospitalization, diagnosis of valvular disease, presence of infectious desease and the number of different types of drugs used by the patients.

Conclusions: DRPs are a prevalent issue within the cardiovascular surgery unit, mainly due to drug selection. Clinical pharmacists' presence has proven effective in mitigating and preventing DRPs, thus optimizing medication therapy.

Abstarct: BACKGROUND: The optimal positioned double-lumen endotracheal tubes (DLT) is crucial in thoracic surgery requiring lung isolation. This study aims to compare the accuracy and complication rates of DLT placement using videolaryngoscopy (VL) versus conventional direct laryngoscopy (DL).

Methods: This retrospective single-center study included 89 patients who underwent thoracic surgery with DLT placement between July 2023 and May 2024. Patients were divided into two groups: VL (n = 45) and DL (n = 44). Patient characteristics, intubation times, malposition rates, and complications were recorded. DLT position was confirmed using fiberoptic bronchoscopy.

Results: The incidence of DLT malposition was significantly lower in the VL group (13.3%) compared to the DL group (31.8%) (p = 0.037). The overall complication rate was also lower in the VL group (4.4%) compared to the DL group (11.4%) (p = 0.024). The mean time from anesthesia induction to the first incision was shorter in the VL group (25.2 ± 6.1 min) than in the DL group (28.3 ± 6.5 min) (p = 0.02).

Conclusions: VL significantly reduces the incidence of DLT malposition and associated complications in thoracic surgery compared to DL. The improved visualization and multiple blade options of the C-MAC videolaryngoscopy set likely contribute to these findings. Further research is warranted to confirm these results in larger, multicenter studies.

Trial registration: Institutional Review Board (Registration number: 80576354-050-99/437, 27.06.2024).

Background: Malignant esophageal mediastinal fistula is a severe complication that occurs in both the advanced stages of esophageal cancer and after radiotherapy for esophageal cancer. Esophageal mediastinal fistula is very susceptible to complications such as mediastinitis and mediastinal abscess, resulting in a significantly elevated mortality rate for patients. We reported a rare case of esophageal mediastinal fistula after immunotherapy for non-small cell lung cancer (NSCLC).

Case presentation: A 74-year-old male patient with NSCLC was hospitalized in July 2023. About one week after Tislelizumab immunotherapy, the patient suddenly developed high fever accompanied by coughing and choking on water, chest tightness, shortness of breath, and hemoptysis. Following the completion of bronchial artery computed tomography angiography (CTA), imaging suggested the presence of esophageal mediastinal fistula. We opted for a conservative medical treatment instead of surgery. The patient was discharged without any complications.

Conclusions: This is the first case of NSCLC accompanied by an esophageal mediastinal fistula after treatment with tislelizumab. The occurrence of malignant esophageal mediastinal fistula is very uncommon and poses a high level of hazard. In addition, this paper provides a concise overview of cases of lung cancer complicated with esophageal fistula in the past 10 years. It offers valuable insights for diagnosis and treatment, serving as a resource for clinicians.

Background: Anomalous systemic artery to the left lower lobe (ASALLL) is a rare congenital anomaly. The primary symptoms include hemoptysis and lung infection, though some patients may remain asymptomatic. Currently, there is no consensus on the indications for treatment or the optimal choice of therapy for this condition. This case presents a case of an asymptomatic adult who underwent coil embolization.

Case presentation: A 48-year-old male was admitted to our hospital due to the discovery of a space-occupying lesion in the left hilum. The contrast-enhanced pulmonary computed tomography scan was used to diagnose the patient with an anomalous systemic artery to the left lower lobe. We performed coil embolization on this patient, who underwent a follow-up computed tomography angiography of the pulmonary and bronchial arteries one year later. Result demonstrated complete embolization of the abnormal systemic arteries and a slight reduction in the volume of the left lower lobe.

Conclusion: Coil embolization is a safe and minimally invasive procedure for adult patients who have an anomalous systemic artery to the left lower lobe.

Background: Paragangliomas are rare neoplasms arising from extra-adrenal chromaffin cells, with mediastinal paragangliomas representing an exceptionally rare subset. This report details the surgical management of a complex mediastinal paraganglioma case, presenting with refractory hypertension and invasion of critical surrounding structures. A comprehensive review of the current literature is included to underscore existing cases, enhance clinical awareness, and share our insights and experience in the diagnosis and treatment of this challenging condition.

Case presentation: A 16-year-old female presented with recurrent headaches and persistent hypertension lasting over one year. Based on clinical findings and imaging studies, she was preliminarily diagnosed with a mediastinal paraganglioma. The patient underwent comprehensive preoperative management, including oral α- and β-adrenergic blockade, preoperative arterial embolization, and intravenous fluid volume expansion, to optimize endocrine control. Thoracoscopic resection of the mediastinal mass was initially attempted; however, the procedure became complex due to the high risk of uncontrolled hemorrhage and invasion of adjacent vital structures. Following the preoperative surgical plan, the incision was converted to a lateral thoracotomy, and cardiopulmonary bypass was initiated. Meticulous dissection enabled the complete removal of the tumor along with the affected posterior wall of the left atrium, followed by reconstruction of the left atrium and the right pulmonary vein. The surgery was successfully completed, and follow-up assessments showed no signs of tumor recurrence or metastasis.

Conclusions: Functional mediastinal paraganglioma is a rare neuroendocrine tumor, with complete surgical resection being the gold standard treatment. Stringent perioperative management is crucial to mitigate the risk of cardiovascular complications associated with functional tumors. Lifelong surveillance is recommended to detect potential recurrence or metastasis. Effective collaboration within a multidisciplinary team is essential for ensuring accurate diagnosis and delivering optimal, individualized care.

Background: Heparin, an anticoagulant used in cardiac surgery, can result in heparin rebound (HR), where it returns postoperatively despite being neutralized with protamine. This study was designed to investigate the prevalence of HR in patients undergoing off-pump coronary artery bypass grafting (OPCAB) and evaluate the impact of HR on their short-term outcomes.

Methods: HR was defined by a 10% increase in activated coagulation time (ACT) following two hours of heparin neutralization with protamine, bleeding over 200 mL/h, and abnormal laboratory coagulation examination results. We analyzed 503 OPCAB patients aged 31-80 years from September 2019 to June 2022, who were categorized into HR (n = 56) and Non-HR (n = 447) groups. The primary outcome was postoperative bleeding volume. Secondary outcomes included the incidence of postoperative reoperation for bleeding, allogenic blood transfusion incidences and volumes, and laboratory variables.

Results: Significant differences were observed in preoperative platelet counts (P < 0.001) and the ACT measured 2 h post-heparin neutralization (P = 0.012). The group HR exhibited higher 24-hour bleeding volumes, increased reoperation rates, and greater total bleeding volumes (all P < 0.001).

Conclusions: Postoperative HR was found to be prevalent in OPCAB patients and increased bleeding risks. These findings indicate the need for future randomized controlled trials to confirm the impact of HR and guide patient blood management.

Background: The medico-surgical management of cardiac tumors when there is a suspicion of malignancy is complex. Moreover, in a critically ill setting, the choice of diagnostic tools seems crucial.

Case presentation: We present the case of a sixty-four-year-old patient with no prior medical history who was admitted to the intensive care unit with obstructive shock secondary to a right heart mass and pulmonary embolism. Clinical and biological features revealed secondary hemophagocytic lympho-histiocytosis (HLH). The patient underwent a diagnostic procedure with dual thoracoscopic and mediastinoscopy with biopsies. Following the diagnosis of primary cardiac lymphoma, the patient received sequential chemotherapy without undergoing cardiac surgery leading to initial improvement, with reductions in intracardiac obstruction and in biomarkers associated with hemophagocytic lympho-histiocytosis.

Conclusion: When a cardiac mass is associated with extracardiac symptoms indicative of a hematological malignancy, the preferred treatment is chemotherapy, and cardiac surgery should be avoided.

Objective: Depression is a common comorbidity in cardiovascular disease (CVD), and both conditions are associated with chronic inflammation. The systemic immune-inflammation index (SII) has emerged as a promising marker of systemic inflammation, but its role in association with depressive symptoms, particularly in the context of CVD, remains unclear. This study aims to investigate the association of SII with depressive symptoms in individuals with and without CVD using cross-sectional data from NHANES (2005-2016).

Methods: A total of 29,479 participants from the National Health and Nutrition Examination Survey (NHANES) 2005-2016 waves were included. Depressive symptoms were assessed through Patient's Health Questionnaire (PHQ-9). SII was calculated as the platelet count × neutrophil count/lymphocyte count. In order to determine the relationships between SII and depressive symptoms in participants with and without CVD, binary logistic regression model and smooth curve fitting were used. We also performed sensitivity analyses and subgroup analysis.

Results: The total prevalence of depressive symptoms was 8.73% among the 29,479 participants analyzed. After adjusting for confounding factors, a higher SII was significantly associated with increased depressive symptoms in the total population (OR per SD increase: 1.101, 95% CI: 1.060-1.144, P < 0.0001). This association was stronger in participants without CVD (OR: 1.121, 95% CI: 1.073-1.172, P < 0.0001) compared to those with CVD (OR: 1.055, 95% CI: 0.973-1.144, P = 0.19571). Participants in the highest SII tertile had a significantly higher risk of depressive symptoms compared to those in the lowest tertile, particularly in the non-CVD group (OR: 1.161, 95% CI: 1.026-1.313, P = 0.01765).

Conclusion: The SII is independently associated with an increased risk of depressive symptoms, particularly in individuals without CVD. These findings suggest that the SII may serve as a valuable predictor of depressive symptoms in the general population, with potential implications for early screening and intervention strategies. Further research is needed to elucidate the mechanisms underlying this association and to explore the clinical utility of SII in depressive symptoms assessment, especially in the context of cardiovascular health.