Thoracic and Cardiovascular Surgeon最新文献

This study evaluated the echocardiographic parameters and complication rates of surgical myectomy with concomitant anterior mitral leaflet extension (SM + AMLE) and isolated SM in hypertrophic obstructive cardiomyopathy (HOCM) patients.All HOCM patients undergoing SM + AMLE (2006-2015) and isolated SM (2015-2020) in our centre were analysed. The primary outcome was left ventricular outflow tract (LVOT)-gradient and surgical reoperation (SM/mitral surgery). Secondary outcomes were aortic cross-clamping (ACC) time, iatrogenic ventricular septal defect (VSD), and mortality at 30-day and 3-year follow-up. Mixed-effects models assessed postoperative changes in LVOT-gradient measurements over time until a 3-year follow-up.This cohort (n = 59) consisted of 34 (58%) SM + AMLE and 25 (42%) isolated SM procedures. There were 32 (54%) males and 27 (46%) females with a mean age of 55 ± 13 years at the time of the intervention. Postoperatively, no differences were observed over time in the median LVOT-gradient (p = 0.34). In the SM + AMLE group, 6% (n = 2) required surgical reoperation (due to patch dehiscence) versus 0% in the SM group. In the SM + AMLE group, the ACC time was significantly higher (86 minutes [interquartile range [IQR]: 74-103]) than in the isolated SM group (48 minutes [IQR: 39-57]; p < 001). In both groups, the VSD complication rate was 0%, and neither procedure led to death at 3-year follow-up.HOCM-patients who underwent SM + AMLE had comparable clinical and echocardiographic outcomes to patients who underwent isolated SM. This suggests that increasing procedural complexity may not improve outcomes. However, given potential confounding, this should be interpreted with caution, future prospective randomised controlled trials are necessary.

This study investigated the effect of preoperative fat mass index (FMI), fat-free mass index (FFMI), fat mass ratio (FMR), and fat-free mass ratio (FFMR) on postoperative morbidity and mortality in coronary artery bypass grafting (CABG) patients.About 120 patients were included in this prospective study. The patients' FMI, FFMI, FMR, and FFMR were evaluated preoperatively along with other clinically significant data. The postoperative morbidities were recorded. Receiver operating characteristic (ROC) curve analyses were made to determine threshold values of FMR, FFMR, and FMI for wound dehiscence. The multivariate logistic regression analysis was made to assess the independent risk factors for infection site leakage.ROC analysis yielded threshold values of FMR 0.26, FFMR 0.73, and FMI 7.46. FMI, FMR, and FFMR were associated with parameters including body mass index (BMI), diabetes, and wound dehiscence (80.7% sensitivity and 87.3% specificity [area under the curve = 0.600, 95% CI: 0.789-0.919, p < 0.001]). FMR >0.26 and FFMR <0.73 were associated with high pulmonary embolism risk. Patients with FFMI (men: 18.7-21 kg/m², women: 14.9-17.2 kg/m²) had significantly less postoperative atrial fibrillation and wound dehiscence. Patients with FMR >0.26 and FMI >7.46 are at a 3- to 38-fold increased risk of wound dehiscence, irrespective of their BMI. Fat mass measurements were not associated with mortality.Our study demonstrates that preoperative fat mass measurements can effectively predict postoperative morbidity in CABG patients. Fat mass measurements are valuable for risk prediction, especially in non-obese patients.

The objective of this study was to compare clinical outcomes of total arch replacement (TAR) combined with stented elephant trunk (SET) implantation and hybrid aortic arch repair (HAAR) for type A acute aortic dissection (TA-AAD) in patients older than 60 years.We studied records of patients with TA-AAD older than 60 years in our hospital between January 2016 and December 2018. About 68 patients underwent TAR combined with SET implantation (SET group), and 56 patients underwent HAAR (hybrid group). Outcomes included operative data, postoperative data, and 2 years of follow-up data.Comparing with the SET group, the hybrid group experienced shorter time on surgery duration (p < 0.001), cardiopulmonary bypass (p < 0.001), aortic cross-clamp (p < 0.001), mechanical ventilation (p < 0.001), ICU stay (p < 0.001), and hospital length of stay (p < 0.001). The hybrid group showed a lower rate of pulmonary infection and renal failure (p = 0.023; p = 0.022, respectively). Blood product use was less in the hybrid group (p < 0.001). The hybrid group had a trend toward reducing the 30-day mortality rate, stroke, and transient mental dysfunction. The hybrid group had a trend toward improving the 2-year survival rate and reintervention-free rate, but the results did not reach a significant level.Hybrid procedure could be safely performed in patients older than 60 years with TA-AAD. This procedure may be associated with encouraging surgical results and promising outcomes in the early and mid-term.

Minimally invasive repair of pectus excavatum (MIRPE) creates an iatrogenic communication between the pleural cavities, known as a "buffalo chest." Patients with pectus excavatum are also at increased risk of spontaneous pneumothorax due to congenital apical blebs. When these two conditions coexist, the risk of bilateral spontaneous pneumothorax becomes potentially life-threatening. This study aims to evaluate the incidence and characteristics of spontaneous pneumothorax following MIRPE, with particular attention to the presence and role of congenital blebs.We retrospectively reviewed patients who underwent MIRPE between 2005 and 2024 to identify cases of spontaneous pneumothorax. Only cases occurring at least 1 month postoperatively and unrelated to intraoperative thoracoscopy were included. Patients were followed for at least 10 months. We analyzed laterality, clinical presentation, presence of blebs, treatment, and outcomes. A systematic literature review was also conducted to explore the relationship between buffalo chest, pneumothorax, and pectus excavatum.Among 795 patients, 7 developed spontaneous pneumothorax: 4 unilateral, 3 bilateral. In six cases, blebs were identified and treated with thoracoscopic bullectomy and pleurodesis. Two patients with bilateral pneumothorax experienced cardiac arrest: one recovered after emergency drainage; the other died in a peripheral hospital, where blebs were suspected but not confirmed. The literature review identified nine similar cases in five reports.Bilateral spontaneous pneumothorax after MIRPE can be a life-threatening emergency due to the buffalo chest. Patients and families should be informed of this rare but serious risk to enable early recognition and prompt treatment. Preoperative detection of apical blebs may help reduce this risk.

Although left ventricular assist device implantation represents the majority of durable mechanical circulatory support implants for patients with advanced heart failure, as many as 20 to 30% will subsequently have right heart failure requiring extended inotropic support or short-term mechanical circulatory support, and the total artificial heart is an established tool in the bridge to transplant armamentarium. The aim of this short report is to present our center's experience with the use of SynCardia total artificial heart. Between November 2017 and April 2021, 10 SynCardia total artificial heart devices were implanted. Of the 10 patients who underwent total artificial heart implantation, 6 (60%) were successfully bridged to transplant with a median time of 6.5 (interquartile range [IQR] 6-8) months, and 4 patients died on device support during the index hospitalization. The 30-day, 1-year, and 3-year survival rates after heart transplantation were the same at 66.7% (4/6). Despite the uncertain future of total artificial hearts, it remains a viable option for patients who require biventricular bridge to transplant or for a select subset of patients with advance heart failure who may not otherwise survive.

Two primary techniques, namely, the conventional transfissural and the fissureless approaches, have been defined for videothoracoscopic lobectomy. We hypothesized that a videothoracoscopic fissureless, non-arterial dissection (NAD) technique-using new generation staplers-for lower lobe resections may reduce operative time and lower the intra- and postoperative complication rates.We had 69 consecutive patients assigned to a fissureless NAD or a conventional lobectomy for lower lobes. In the fissureless NAD technique, the pulmonary artery, together with the adjacent lung parenchyma along the fissure line, was divided as the last anatomical structure using staplers with tri-height cartridges. We analyzed the feasibility and safety of the fissureless NAD technique.A total of 29 (42%) patients underwent NAD lobectomy. The mean operative time was significantly shorter in the NAD group (p = 0.003). No patient had intraoperative complication, and three (10.3%) patients (p = 0.212) had postoperative complication in the NAD group. The mean time of chest tube removal (p = 0.031) and the length of hospital stay (p = 0.008) were significantly shorter in the NAD group.The fissureless NAD videothoracoscopic lobectomy is a safe and feasible technique for lower lobectomies. This technique significantly reduces the operative time with potential benefit of earlier patient discharge.

Coronary artery disease (CAD) limits life expectancy compared to the general population. Myocardial infarctions (MIs) are the primary cause of death. The incidence of MI increases progressively with age and most MI deaths occur in the population older than 70 years. Coronary artery bypass grafting (CABG) may prevent the occurrence of new MIs by bypassing most CAD lesions, providing downstream "collateralization" to the diseased vessel, and consequently prolonging survival. We systematically assessed the survival-improving potential of CABG by comparing elderly CABG patients to the age-matched general population.Three databases were assessed. The primary and single outcome was long-term all-cause mortality. Time-to-event data of the individual studies were extracted and reconstructed in an overall survival curve. As a sensitivity analysis, summary hazard ratios (HRs) and 95% confidence intervals (CIs) for all individual studies were pooled and meta-analytically addressed. The control group was based on the age-matched general population of each individual study.From 1,352 records, 4 studies (4,045 patients) were included in the analysis. Elderly patients (>70 years) who underwent CABG had a significantly lower risk of death in the follow-up compared to the general age-matched population in the overall survival analysis (HR: 0.88; 95% CI: 0.83, 0.94; p < 0.001: mean follow-up was 7 years).Elderly patients who undergo CABG appear to have significantly better long-term survival compared to the age-matched general population. This advantage becomes visible after the first year and underscores the life-prolonging effect of bypass surgery, which may eliminate the expected reduction in life expectancy through CAD.

Cardiac troponin levels might rise significantly after cardiac surgeries as a surgical outcome rather than ischemic myocardial damage alone, making the diagnosis of postoperative (type 5) myocardial infarction challenging. Previous studies have demonstrated that cardiac troponin is related to left ventricular mass, but this correlation was not investigated after cardiac surgery. We aimed to study a possible correlation between postoperative cardiac troponin levels and left ventricular mass index in patients who underwent cardiac surgery to refine the diagnosis of type 5 myocardial infarction, but observed no such correlation regardless of preoperative troponin levels or surgery type.