Journal of Cardiothoracic Surgery最新文献

Background: Acute kidney injury (AKI) following lung transplantation (LTx) is correlated with high mortality rates. We aimed to establish a risk-score model for AKI prediction in LTx.

Methods: We retrospectively reviewed data from the Institutional Lung Transplant Database from 2016 to 2022. The primary endpoint was to establish a risk-score model to predict AKI. The secondary endpoint was the impact of AKI on postoperative rehabilitation and survival incidence at the 1-year follow-up.

Results: Of 415 patients, 27% (n = 112) developed AKI within 48 h after LTx. Multivariable analysis revealed that body mass index, diabetes, plasma infusion, surgical time, and postoperative extracorporeal membrane oxygenation (ECMO) assistance were risk factors for AKI. This risk score was created and calibrated based on these five factors, ranging from 0 to 16 points, with the associated prediction of postoperative AKI ranging from 3 to 99% (Hosmer-Lemeshow χ² = 7.502; P = 0.484). Good discrimination was verified by developing and validating the datasets [Area Under the Curve (AUC) = 0.813 and 0.782, respectively]. Based on score distribution, patients were classified into three risk levels: low risk (0-3), moderate risk (3-7), and high risk (7-16). AKI is associated with prolonged stay length of intensive care unit and postoperative hospital (P < 0.001 and P = 0.003), and has an impact in the 3-to-6-month survival (P = 0.008 and P = 0.006).

Conclusions: A risk-score model based on perioperative variables effectively predicted the risk of AKI within 48 h after LTx. This model may be useful in early decision-making regarding AKI treatment.

Background: The "No-touch" technique has demonstrated efficacy in enhancing both short-term and long-term patency of great saphenous vein grafts (SVG) for coronary heart disease (CHD) treatment. Nevertheless, its widespread use is constrained by the method's limitations. Therefore, we modified it by using a harmonic scalpel to harvest SVG and verified its patency rate.

Methods: 156 patients who underwent coronary artery bypass grafting (CABG) were consecutively recruited between November 2018 and July 2019. Patients were allocated to 2 groups of 78 each, according to two SV harvesting techniques (modified no-touch [M group] and conventional technique [C group]). SVG samples were taken for pathological examination. This study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of Shanghai Tenth People's Hospital (ChiCTR1800018433). All patients underwent follow-ups for at least 2 years.

Results: The modified no-touch technique reduced graft acquisition time (P < 0.001) and the pulsatility index (PI) (P < 0.001). No difference was detected in the average flow of grafts and procedural complication rate. At 24 months, the left ventricular ejection fraction (LVEF) was higher in the M-group (P < 0.001).

Conclusions: The use of the harmonic scalpel to harvest SVG is safe and effective, and may contribute to better postoperative cardiac function recovery, as reflected by satisfactory short- and mid-term outcomes.

Objectives: The frozen elephant trunk (FET) technique during total arch replacement (TAR) in patients with acute type A aortic dissection (ATAAD) has been shown to promote favorable aortic remodeling. However, few reports have compared the morphological assessments between the conventional elephant trunk (CET) and FET procedures. Here, we investigated whether the FET technique during TAR for the patients with ATAAD could affect aortic remodeling through morphological analysis.

Methods: In total, 464 patients diagnosed with ATAAD underwent emergency ascending aorta or TAR between 2010 and 2023. We retrospectively analyzed the clinical data of 28 patients who underwent TAR and postoperative contrast-enhanced computed tomography. We assigned 28 patients to either the CET group (n = 11) or FET group (n = 17). Patient characteristics, postoperative outcomes, and aortic remodeling analysis were collected.

Results: Aortic remodeling analysis showed that the expansion rate of the true lumen (TL) in the descending thoracic aorta was significantly greater in the FET group early and 1 year after surgery. Meanwhile, the shrinkage rate of the false lumen (FL) in the descending thoracic aorta was significantly greater in the FET group early after surgery and tended to be greater in the FET group even 1 year after surgery. Remarkably, the incidence of reintervention of the descending aorta was significantly lower in the FET group.

Conclusions: The FET technique with TAR in patients with ATAAD could improve aortic remodeling through improved TL expansion and preventive FL dilatation in the descending thoracic aorta and reduce the need for surgical reintervention.

Introduction: Aortopulmonary window (APW) is a rare congenital heart defect that causes left-to-right shunting and pulmonary overcirculation. Appropriate intervention prevents long-term complications.

Case presentation: We report a 3-year-old Iranian girl (weight ~ 14 kg, height ~ 95 cm) presenting with exertional dyspnea, systolic murmur, and bounding pulses. Echocardiography showed a 3 mm Type I APW with mild pulmonary hypertension. Pre-procedure catheterization revealed a mean pulmonary artery pressure (PAP) of 26 mmHg and a Qp/Qs ratio of 1.8. The defect was closed percutaneously using a 5 × 4 mm PFM coil. No pre-procedure CT scan was performed. Post-procedural evaluation demonstrated complete closure, mean PAP reduced to 18 mmHg, Qp/Qs normalized to 1.0, and no residual shunt.

Conclusion: Transcatheter coil occlusion can be a safe and effective option for small APWs, offering favorable outcomes without the risks of open-heart surgery.

Introduction: Tension hydrothorax is a life-threatening condition caused by a massive buildup of fluid in the pleural space, compressing the mediastinum and compromising cardiac output. It causes obstructive shock and can lead to cardiac arrest. Early detection and rapid intervention are essential to prevent cardiorespiratory collapse.

Case series: This is a case series of three patients who presented with a tension hydrothorax and signs of hemodynamic instability. Initial imaging showed a complete white-out of the chest with a mediastinal shift, which required an emergent chest tube thoracostomy.

Conclusion: Although decompressive interventions are common, courses and awareness can minimize potential complications when managing emergency conditions such as tension hydrothorax, which remains a medical challenge.

The brachial artery is the most commonly injured artery in the upper extremities because of its vulnerability. This case report presents our experience with managing brachial artery injury using an improvised vascular shunting technique. A 38-year-old man presented to the emergency department with a penetrating bullet wound on the forearm, resulting in a 10 cm transection of the brachial artery, brachial vein injury, and small medial epicondyle fracture. Emergency surgery was performed following resuscitation. Intraoperatively, a temporary vascular shunt was created using an intravenous drip to maintain distal perfusion before definitive repair. The brachial artery was reconstructed using a graft from the great saphenous vein harvested from the thigh. The brachial vein was ligated and two K-wires were used to stabilize the medial epicondyle fragment. Postoperatively, the patient showed good recovery, with proper wound healing, intact hand sensation, and distal blood supply, and was discharged after two weeks.