Journal of Cardiothoracic Surgery最新文献

Background: A broncho-esophageal fistula (BEF) is a medical and surgical disaster. Treatment of BEF is often limited to palliative stent treatment that may migrate or cause erosions and tissue necrosis. Surgical repair of BEF is the only established definite treatment.

Case presentation: BEF presented in a 40-year-old female patient 8 years after curative treatment with pneumonectomy and radio-chemotherapy for advanced lung cancer. She had autoimmune comorbidity, a single lung, vocal cord paralysis and an extremely hostile thorax. Multi-disciplinary collaboration, close patient involvement and evaluation by the hospital medical ethics committee were key elements in the following treatment course. After temporary stent treatment, a carefully staged surgical marathon was performed: Veno-venous ECMO was established to secure oxygenation, and bilateral thoracotomy and laparotomy performed to access structures in the frozen mediastinum. After extensive thoracoplasty and high-risk dissection, esophagectomy was performed and the 20 × 35 mm bronchial defect repaired by bronchoplasty with a latissimus muscle flap. It was complicated by thrombotic occlusion of the upper venous system, repeated postoperative bleedings and critical illness neuropathy. The patient recovered and was discharged 150 days after surgery. Within 1-2 years bronchoscopy showed a smooth undiscernible bronchoplasty with a stable open left main bronchus. At 5 years the patient lives an independent life at home with her family.

Conclusions: Surgical treatment of BEF in an extremely complex patient may turn out successfully. It demands careful ethical considerations, comprehensive surgical strategy, multi-disciplinary teamwork, and shared decision making with the patient. The patient presented in this case report is closely followed up with good life quality after 5 years.

Background: Continuous Positive Airway Pressure (CPAP) treatment brings more benefits than risks to most coronary heart disease (CHD) patients with obstructive sleep apnea (OSA). However, the pathophysiological mechanism by which CPAP treatment improves the prognosis of patients with CHD and OSA remains unclear. The purpose of this study was to clarify whether CPAP can improve arterial stiffness and inflammatory factor levels in CHD patients with OSA, and to further improve prognosis.

Method: 59 patients with coronary heart disease complicated by moderate to severe sleep apnea were divided into a CPAP treatment group (CPAP + coronary heart disease standard treatment) and a control group (only coronary heart disease standard treatment). Peripheral blood test reports were collected and pulse wave velocity (PWV) measurements were performed for each patient at the beginning, 3 months, and 6 months of treatment.

Results: After 6 months of treatment, the CPAP group showed more significant improvement in the levels of inflammatory factors such as white blood cell (WBC), neutrophil (N), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and PWV than the control group.

Conclusion: After active treatment with CPAP, arterial stiffness and inflammatory cytokine levels in patients with coronary heart disease and OSA improved. This association should be given more attention in clinical practice, and sleep apnea should be actively treated.

Background: Thoracic aortic endovascular repair (TEVAR) is the most commonly employed method for treating type B aortic dissection (TBAD). One of the primary challenges in TEVAR is the reconstruction of the left subclavian artery (LSA). Various revascularization strategies have been utilized, including branch stent techniques, fenestration techniques, chimney techniques, and hybrid techniques. Among these, the single-branched stent graft (SBSG) has emerged as one of the most promising methods. This study employs a meta-analysis to evaluate the efficacy and safety of SBSG in treating TBAD, thereby providing robust evidence to guide clinical practice.

Methods: Published literatures on the treatment of TBAD with SBSG were collected from CNKI, Wanfang Data, VIP, PubMed, Embase, Web of Science and Cochrane Library. The search period ranged from the inception of each database to December 1, 2024. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was conducted using RevMan 5.3 software.

Results: A total of eight studies involving 660 participants were included in this meta-analysis. The results demonstrated that, compared to other surgical methods, SBSG significantly reduced the perioperative neurological complication rate (OR = 0.23, 95%CI(0.07, 0.76), P = 0.02), type I endoleak rate (OR = 0.30, 95%CI(0.15, 0.61), P = 0.001), and left upper limb ischemia rate (OR = 0.06, 95%CI(0.01, 0.49), P = 0.008). Additionally, SBSG was associated with a shorter operation time (SMD = 0.59, 95%CI(0.04, 1.14), P = 0.04). However, no significant differences were observed between SBSG and other surgical methods in terms of technique success rate (OR = 1.51, 95%CI(0.55, 4.14), P = 0.42), hospital length of stay (OR = 1.51, 95%CI(0.55, 4.14), P = 0.42), aortic false lumen thrombosis rate (OR = 1.30, 95%CI(0.55, 3.07), P = 0.56), pulmonary infection rate (OR = 0.50, 95%CI(0.16, 1.58), P = 0.24), and 30-day postoperative mortality (OR = 0.41, 95%CI(0.12, 1.35), P = 0.41).

Conclusion: SBSG demonstrates safety and efficacy in the treatment of TBAD by significantly reducing the perioperative neurological complexity rate, type I leakage rate, and left upper limb ischemia rate, while also decreasing operative time.

Objective: In this study, we aimed to screen the risk factors for delayed extubation after surgery for Ebstein's anomaly (EA), determine the diagnostic cut-off values, and develop a prediction equation to accurately encourage rapid recovery after surgery.

Methods: The perioperative data of 76 pediatric patients undergoing EA surgery in the Surgical Department of the Pediatric Heart Center of Anzhen Hospital from September 2013 to September 2021 were retrospectively analyzed.

Results: Among these cases, 37 (48.6%) were male, with an average age of 4.67 (2, 11.19) years and an average weight of 18 (12.4, 37) kg. The median postoperative duration of mechanical ventilation was 18 (10, 24) h, and the duration of mechanical ventilation ≥ 24 h (75th percentile) was defined as delayed extubation. Body weight (11.25 kg) and preoperative oxygen saturation (SpO₂) (95.5%) were protective factors, while the simplified Great Ormond Street Echocardiogram (GOSE) value (0.995) and the intraoperative cardiopulmonary bypass (CPB) time (135 min) were the risk factors. The prediction model was developed based on these indexes: logit (P) = 8.9 + (0.02 × CPB time) + (2.2 × simplified GOSE) - (0.14 × preoperative SpO₂) - (0.06 × body weight), and the area under the receiver operator characteristic (ROC) curve was 83.4% (P < 0.01). Patients with delayed extubation had a longer intensive care unit stay and a higher incidence of adverse events (P < 0.01).

Conclusion: Low body weight, low preoperative SpO₂, high GOSE value, and long intraoperative CPB time for pediatric patients with EA are likely to lead to prolonged postoperative duration of mechanical ventilation. For low-risk children, early extubation after surgery can be more actively encouraged; however, more care should be taken to avoid the risk of re-intubation.

Objective: This study aims to compare the effects of sevoflurane (SEV) and propofol (PRO) on postoperative cognitive dysfunction (POCD) in patients undergoing cardiac surgery (CS) under cardiopulmonary bypass (CPB), with a focus on evaluating the efficacy of these anesthetic agents in preventing POCD.

Methods: A total of 113 patients undergoing CS with CPB were grouped into two: PRO group (n = 58) and SEV group (n = 55). Baseline data, anesthesia effects (CPB duration, anesthesia time, respiratory recovery time, and anesthesia recovery time), Montreal Cognitive Assessment (MoCA) scores, POCD incidence, neurological function markers (NSE, S-100β, MMP9), and serum inflammatory markers (IL-6, IL-8, TNF-α) were analyzed. The study was conducted between March 2018 and May 2021.

Results: The PRO group showed significantly shorter anesthesia time (P < 0.05), respiratory recovery time (P < 0.05), and anesthesia recovery time (P < 0.05) compared to the SEV group. The postoperative MoCA score in the PRO group reduced markedly compared with the baseline, but still higher than that in the SEV group (P < 0.05). The incidence of POCD was significantly lower in the PRO group (5.17% vs. 27.27%, P = 0.001). The levels of NSE, S-100β, MMP9, IL-6, IL-8, and TNF-α were significantly elevated compared to baseline values, but still lower than those in the SEV group (P < 0.05 for all comparisons).

Conclusion: PRO is more effective than SEV in preventing POCD in patients undergoing CS with CPB. It provides superior anesthetic effects and offers better protection against neuronal damage and serum inflammation compared to SEV.

Clinical trial number: Not applicable.

Background: MicroRNAs (miRNAs) are closely related to cardiovascular diseases, including chronic heart failure (CHF). Endothelial dysfunction can lead to heart failure. The purpose of this study was to evaluate the clinical significance of miR-1285-3p in CHF patients, with the aim of identifying a novel and effective biomarker for CHF. At the same time, we investigated the effect of miR-1285-3p on vascular endothelial cells.

Methods: Total RNA was extracted from plasma samples of 106 CHF patients and 106 healthy individuals. Quantitative Real-time PCR (qRT-PCR) was used to detect the expression of miR-1285-3p. The diagnostic accuracy of miR-1285-3p was tested by receiver operating characteristic (ROC) curve. Evaluated the related risk factors of CHF using logistic analysis. The proliferation and apoptosis of human umbilical vein endothelial cells (HUVECs) were detected by transfecting miR-1285-3p mimic or miR-1285-3p inhibitor in vitro using CCK8 and flow cytometry. Effect of miR-1285-3p on the angiogenesis of HUVECs were detected by in vitro angiogenesis assay.

Results: miR-1285-3p is upregulated in CHF patients, demonstrating the ability to distinguish CHF patients from healthy individuals, with high sensitivity (83.0%) and specificity (93.4%). In vitro experiments revealed that transfection of miR-1285-3p mimic inhibited endothelial cell proliferation, accelerated apoptosis, and inhibited endothelial cell angiogenesis, which was reversed by transfection with miR-1285-3p inhibitor.

Conclusion: miR-1285-3p is upregulated in CHF and may serve as a new effective biomarker for CHF diagnosis, which can inhibit HUVECs angiogenesis.

Background: A patient with acute myeloid leukemia (AML) presented with a cardiac mass of unknown nature. This case underscores the importance of careful monitoring and a multidisciplinary approach in managing and differentiation of rare cardiac complications in leukemia patients. It aims to improve diagnostic accuracy and therapeutic outcomes in similar challenging scenarios. This case report discusses a 33-year-old male who was initially diagnosed with Acute Myeloid Leukemia (AML). During medical check-ups before allogeneic hematopoietic stem cell transplant (allo-HSCT), cardiac ultrasound revealed several mobile and homogenous masses of unidentified nature in his right atrium and right ventricle. The lesions presented gradually increasing calcification of the capsule, the nature of these masses remains unknown.

Case presentation: The patient was diagnosed with Acute Myeloid Leukemia and achieved complete remission following multiple chemotherapy cycles. From a leukemia treatment perspective, an allo-HSCT was needed as soon as possible. However, several masses were found in his right heart before the transplant. A series of tests were performed to determine the nature of the cardiac mass. His echocardiograms and MRI revealed persistent mobile and nodular masses with a calcified capsule in the right atrium and right ventricular lateral wall, and no signals changes of the mass between MRI first-pass perfusion and delayed enhancement. Which complicated the differential diagnosis. Finally, considering the need for leukemia treatment, allo-HSCT was performed after extensive workup, including echocardiography, MRI, and PET/CT, which ruled out leukemic infiltration, typical infectious vegetation, and primary or metastatic cardiac tumors. The cardiac masses were first discovered during pre-transplant screening in April 2022, approximately 5 months after initial AML diagnosis in November 2021. At present, more than 2 years after transplantation, follow-up imaging examination of the masses revealed gradually increasing calcification, but of a still unknown nature.

Conclusions: The case of this 33-year-old male with AML and concomitant cardiac masses highlights a complex challenge in his diagnosis and treatment. Despite extensive imaging and multidisciplinary consultations, including echocardiography, MRI, and PET/CT, the exact nature of these calcified, mobile nodular masses in the right atrium and right ventricular lateral wall remains elusive. Their persistence and atypical imaging characteristics underscore the need for continued research and collaboration to elucidate their underlying pathology.

Background: The accuracy and reliability of identified biomarkers in differentiating early non-small cell lung cancer (NSCLC) remain suboptimal, thereby impeding the timely detection of NSCLC.The objective of this research is to examine the expression level and diagnostic utility of miR-668-3p in individuals with NSCLC, along with its effectiveness and predictive capacity in the combined diagnosis of early-stage NSCLC using serum markers.

Methods: The research included 117 NSCLC patients and 101 pulmonary nodule patients (controls). Quantitative PCR was employed to assess the expression levels of miR-668-3p in NSCLC patients. The association between miR-668-3p and clinical characteristics and serum biomarker (AFP, CEA, NSE, and CYFRA21-1) levels in NSCLC patients was examined using chi-square tests and Pearson correlation analyses. The ROC curve analysis was conducted to determine the individual and combined diagnostic efficacy of miR-668-3p and serum biomarkers. Additionally, a logistic regression model was utilized to identify risk factors for lung cancer in patients with pulmonary tuberculosis.

Results: The expression level of miR-668-3p was down-regulated in early-stage NSCLC patients compared with the control group, and showed a significant association with serum biomarkers related with disease progression, tumor staging, and lymph node metastasis. The combined detection of miR-668-3p and serum markers demonstrated robust diagnostic efficacy for early NSCLC and effective predictive capabilities for lung cancer occurrence in individuals with pulmonary nodules.

Conclusions: The miR-668-3p has the potential to be a promising biomarker for NSCLC and enhance the accuracy of early NSCLC clinical detection.

Background: Left ventricular unloading is needed in patients on extracorporeal life support (ECLS) with severely impaired left ventricular contractility to avoid stasis and pulmonary congestion, and to promote LV recovery. The presence of thrombi in the LV precludes the use of conventional active unloading methods such as transaortic microaxial pumps or apical LV vents. We describe placement of a vent cannula via the left atrial appendage (LAA) as a useful bailout option.

Case presentation: A 61-year-old patient presenting with normotensive cardiogenic shock (SCAI C) after subacute anterior wall myocardial infarction deteriorated with pulmonary edema and ventricular fibrillation, requiring veno-arterial extracorporeal life support under ongoing CPR (SCAI E). An Impella CP was placed for LV unloading, but was unable to generate flow and was thus removed. A large left ventricular thrombus was detected as the cause for insufficient Impella flow. For urgent LV unloading, we placed a vent cannula via the LAA through a thoracotomy to bridge our patient to total artificial heart implantation. However, intraoperative TEE showed resolution of the LV thrombus, enabling to change the strategy to left ventricular assist device implantation only, which was performed successfully. Our patient made a full recovery and is now doing well in regular outpatient follow ups.

Conclusions: ECLS provides excellent circulatory support at the price of a high complication burden and considerable LV afterload increase. ECLS complications often require individualized solutions not represented in current heart failure guidelines. This patient has developed a dreaded and nearly always fatal ECLS complication, which was successfully managed with vent placement via the LAA.

Background and aim: Removing the chest tube in cardiac patients after surgery is one of the worst experiences of hospitalization in the intensive care units. Various pharmacological and non-pharmacological methods are available to control pain in these patients. This study aimed to investigate the combined effect of reflexology massage and respiratory relaxation on pain following chest tube removal in cardiac surgery patients of Shahid Beheshti Hospital in Shiraz, Iran, in 2023.

Methods: This was a double-blind randomized clinical trial performed on 140 patients who underwent heart surgery and had a chest tube in Shiraz, Iran. The samples were randomly divided into four groups: 1- control group, 2- respiratory relaxation group, 3- foot reflex massage group, and 4- a combination of respiratory relaxation and reflexology massage. To collect data, two demographic questionnaires, and a visual analog scale were used.

Results: The participants of the four groups were not meaningfully different in terms of age, BMI, duration of surgical operation, gender, job, education, place of residency, number of chest tubes, history of operation (P = 0.99, 0.31, 0.06, 0.81, 0.97, 0.96, 0.17, 0.10, 0.89 respectively). The mean scores of pain intensity during chest tube removal, and 15 min after chest tube removal were not statistically different among the four groups of study (P = 0.15, 0.54 respectively); However, just after chest tube removal, the mean scores of pain intensity differed meaningfully among four groups (P = 0.008).

Conclusion: The results showed that reflexology massage and respiratory relaxation both reduce pain immediately after chest tube removal in heart surgery patients. Also, the combination of these two techniques was more effective in reducing patients' average pain.