Thoracic and Cardiovascular Surgeon最新文献

Objective:  To investigate the efficacy of balloon dilatation combined with stent implantation in the treatment of iliac vein compression syndrome (IVCS).

Methods:  This research was a retrospective study that enrolled 127 IVCS patients for clinical data. The patients were divided into percutaneous transluminal angioplasty (PTA) group (n = 63) and stent implantation group (n = 64). The PTA group was treated with iliac vein balloon dilatation, and the stent implantation group was treated with combined stent implantation based on the PTA group. In both the groups, the quality of life was assessed using Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ); complications occurring during the perioperative period and at postoperative follow-up were recorded; the vascular patency rate was calculated, and patient's condition was evaluated using the Villalta scale.

Results:  The stent implantation group exhibited lower postoperative CIVIQ scores than the PTA group, and the stent implantation group (4.60%) had lower complication rate than the PTA group (19.05%). At 2 years of follow-up, the stent implantation group (92.19%) had higher vascular patency rate than the PTA group (79.37%). Villalta scores were lower in the stent implantation group than in the PTA group at 6, 12, and 24 months postoperatively.

Conclusion:  Iliac vein balloon dilatation combined with stent implantation for the treatment of IVCS can improve vessel patency rates, alleviate patients' clinical symptoms, and enhance their quality of life.

Background:  Prolonged air leak (PAL) is a major cause of morbidities and increased treatment costs following lung resection. The Goddard score (GS) quantifies pulmonary emphysema on computed tomography, a risk factor for PAL, from 0 to 24.

Methods:  We evaluated the GS as a predictor of PAL in pulmonary segmentectomies by retrospectively analyzing 131 patients with anatomical segmentectomy. We identified predictors of PAL and performed logistic regression.

Results:  Eighty-three percent of patients had a history of smoking. The mean air leak duration was 4.2 days; 16% had PAL (>7 days). Median GS was 1. The optimal cutoff was GS ≥ 6 (area under the curve AUC = 0.625). GS did not correlate with air leak duration. In combination, body mass index, cumulative pack-years, immunosuppression, adhesiolysis, operation time, and GS ≥ 6 best predicted PAL with AUC = 0.914. Omitting GS still leads to an AUC = 0.864.

Conclusion:  The GS does not add enough information to be of practical value in anatomic segmentectomies, but it is of academic significance to quantify and compare lung emphysema in the context of clinical studies.

Background:  The long-term comparative results between porcine and pericardial bioprostheses for surgical aortic valve replacement (SAVR) are debated. Scarce information exists concerning direct comparative evaluation among contemporary devices. We compared late and very late results in a single center series (n = 3,983 cases).

Methods:  From a prospectively collected database we included 3,983 recipients of two current porcine bioprostheses (porcine group) or one current pericardial bioprosthesis (pericardial group). We evaluated the long-term freedom from structural valve deterioration (SVD) with both Kaplan-Meier and competing risk methods (primary endpoint). We distinguished between SVD and patient-prosthesis mismatch (PPM). Secondary endpoints were late survival, freedom from valve-related mortality, freedom from reoperation for SVD, freedom from nonstructural valve dysfunction (NSVD) and freedom from endocarditis.

Results:  Median follow-up was 10.4 years (99.7% complete, 32,219 patients/years). Overall survival was significantly lower in the porcine group (p = 0.002), related to baseline intergroup differences. At 10 years, Kaplan-Meier freedom from SVD was significantly better in the porcine group (98.0% ± 0.3 vs. 96.3% ± 0.8; p = 0.003). Competing risk freedom from SVD at 10 years was 98.6% ± 0.2 and 97.2% ± 0.6 (porcine and pericardial group, respectively; p = 0.001). The porcine group displayed a higher rate of PPM.

Conclusion:  Despite the augmented risk of PPM compared with pericardial valves, in this series porcine bioprostheses seem to perform better concerning protection from late (>10 years) SVD. Smaller valve sizes (19-21 mm) may negatively impact the SVD risk among porcine valves but not among pericardial valves. These elements need to be considered for valve choice and surgical strategy in SAVR candidates according to their life expectancy, clinical context, and annulus size.

Background:  Segmentectomy operation became a preferable operation for small lesions due to the importance of saving lung parenchyma. Using robotic technology has too many advantages for segmentectomy operations. Web sites such as YouTube have become educational tools for surgical trainees. The aim of our study is to analyze YouTube videos for accurate and up-to-date information about robotic segmentectomy operations.

Methods:  The videos on www.youtube.com, which were reached on July 11, 2024, by using the keywords "robot segmentectomy" and "robotic segmentectomy lung," were evaluated in this research. The videos were evaluated by using the Journal of the American Medical Association (JAMA) scoring system, Critical View of safety (CVS), and LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS).

Results:  Eighty-one videos were included. Almost half of the videos (n = 42) were affiliated with university hospitals. Preoperative imaging was seen in 49% of all videos; however, the rates were 32% and 20.9% for patients' demographics and preoperative assessment information, respectively. Only 29.6% of the videos presented the placement of trocars during the presentation.

Conclusion:  It has become possible to record high-quality videos easily with developing technology. However, our results showed that many of the videos do not include the parameters especially related to education. Our findings suggest that those videos are inadequate for trainees.

Thoracoscopic right upper lobectomy is a demanding procedure especially in case of hilar adhesions. Herein, we reported a simple technique as the simultaneous ligation of hilar structures to facilitate thoracoscopic right upper lobectomy. After resections of fissures and of hilar lymph nodes, the following structures were sequentially isolated and simultaneously resected in their natural position: V2+A2 vessels; right upper bronchus; and V1+V3+A1+A3 vessels. This technique was successfully applied in 9 patients. The mean hospitalization was 5.2±3.3 days. No intraoperative and major postoperative complications were observed. All patients were alive without recurrence (median follow: 34 months).

There have been few recent innovations since the introduction of cardioplegia more than 50 years ago. Surprisingly, cardioplegia as one of the most essential steps in terms of heart muscle protection during a surgical procedure requiring cardiac arrest has never been really standardized. As a consequence, a considerable variety of cardioplegic solutions and applications have developed: cold versus warm, crystalloid versus blood cardioplegia, antegrade versus retrograde or both, as well as different time schedules for repeated administration. A new cardioplegia solution, called Cardioplexol™, has recently received CE marking approval as a drug following two phase III studies. Cardioplexol™ shows several advantages: the administration follows a very simple protocol, minimizing the risk of errors in manipulation, and diastolic arrest occurs immediately, thus allowing immediate start of the cardiac work once the aorta has been cross clamped. The very low volume of crystalloid solution (e.g., 100 mL as induction and a second application of 100 mL following 45-60 minutes of ischemia) avoids hemodilution and therefore the need for filtration during surgery. In addition, the injection through the aortic root canula eliminates the need for an additional cardioplegia pump and its disposable tubing system. This simplified cardioplegia that is not inferior to Buckberg solution has the potential for standardization of myocardial protection protocols.

Background:  Although patient-reported outcome measures (PROMs) as an integral part of value-based healthcare have important potential for clinical issues, e.g., for shared decision-making, data are limited. Thus, the aim of this study was to report initial results when introducing PROMs in the setting of cardiac surgery.

Methods:  Patients undergoing elective coronary artery bypass grafting (CABG) were included. Three questionnaires (Seattle Angina Questionnaire 7 [SAQ-7], Rose Dyspnea Scale [RDS], and Patient Health Questionnaire 2 [PHQ-2]) were either administered via iPad (in-hospital) or via a web-based tool (at home). Baseline PROMs were completed at admission. Follow-ups were conducted at 30 days, 1 year, and 2 years postoperatively. We investigated the probability of improvement using multilevel, mixed-effects, ordered logistic regression.

Results:  Overall, 99 patients answered the questionnaires preoperatively, 84 of whom answered at least one questionnaire postoperatively. No patient died within the hospitalization. Median (IQR) length of stay in the intensive care unit (ICU) was 1.0 (1.0 to 2.0) days. In all dimensions of any PROMs questionnaire, OR was above 1, indicating that most patients reported improvement 1 to 2 years after surgery by at least 1 grade. In the exploratory analysis we found age ≥75 years positively associated with a significantly greater improvement of the SAQ-7 angina frequency and SAQ-7 quality of life score. Length of stay in the ICU showed no significant association with any PROMs at midterm follow-up.

Conclusion:  In patients undergoing CABG, after a decline within 30 days postoperatively, quality of life-related outcomes improved markedly in a midterm follow-up compared with the preoperative state.

Background: The survival advantages of bilateral internal thoracic artery (BITA) grafts in coronary artery bypass surgery (CABG) remain unclear. Therefore, this study aims to systematically evaluate the time-dependent influence of BITA on long-term survival in elective CABG patients presenting with stable multi-vessel coronary artery disease.

Methods: Data from 3,693 patients undergoing isolated CABG with single internal thoracic artery (SITA) or BITA, with or without additional vein grafts, between 2002 and 2012 were retrospectively analyzed. The entire cohort was divided into BITA and SITA groups (830 vs. 2,863 patients). A 1:3 propensity score matching was performed. Subsequent analysis of a subgroup meeting ROMA trial criteria (n=1,339) followed a 1:1 matching. Differences in restricted mean survival time (RMST) estimates were used to assess the time-varying association of BITA with long-term survival.

Results: In-hospital mortality (SITA 1.8% vs. BITA 1.1%, p=0.2) and major postoperative complications were similar between the matched groups. However, long-term survival was significantly higher in BITA patients for the matched whole cohort (15-year survival: 64% vs. 51%, respectively; P<0.001) and the ROMA-like population (76% vs. 60%, respectively; P<0.001). RMST demonstrated an incremental survival advantage of BITA over SITA grafting over time for both the whole and ROMA-like populations (0.1, 0.5, and 1.1 years, and 0.1, 0.4, and 1.0 years at 5-, 10-, and 15-year follow-up, respectively) Conclusions: BITA grafting is safe and associated with superior long-term survival compared to SITA and vein grafts, with benefits extending beyond 5 years for the entire cohort and beyond 10 years for ROMA-criteria patients.

Background:  The long-term outcomes of combined rapid-deployment aortic valve replacement (RDAVR) with coronary artery bypass graft surgery (CABG) are not well explored. We report 3-year results from the INCA registry on combined RDAVR with CABG.

Methods:  INCA is a prospective, multicenter registry that enrolled 224 patients undergoing RDAVR with CABG at 10 cardiac institutions in Germany. Prosthetic valve hemodynamics, clinical outcomes, and quality of life (QoL) up to 3 years were assessed.

Results:  The mean age of patients was 73.6 ± 6.1 years, and the mean logistic EuroSCORE was 7.8 ± 6.0%. The mean number of distal arterial and venous anastomoses was 3.13 ± 1.56, aortic cross-clamp time was 79.4 ± 24.1 minutes, cardiopulmonary bypass time was 109.6 ± 34.5 minutes, and operation time was 224.2 ± 62.7 minutes. The majority of implanted valve size was 25 mm. At baseline, 11 patients (4.9.%) had a permanent pacemaker. Postoperatively, 17 patients (7.6%) required a new pacemaker implantation (5.4% valve-related). All-cause mortality at 30 days was 2.2%, and 11.2% at 3 years. Patient QoL (SF-12v2) was significantly restored and maintained for up to 3 years (p < 0.001). Five patients (0.9%) underwent reoperation related to endocarditis. The postimplant mean gradient was 9.2 ± 3.7 at discharge and 8.9 ± 4.6 mm Hg at 3 years.

Conclusion:  Combined RDAVR with CABG procedure is safe and effective over time. It offers stable and low transvalvular gradients with satisfactory clinical outcomes at 3 years. The pacemaker rate appears to be slightly increased, with no significant clinical effect at 3 years.