Thoracic and Cardiovascular Surgeon最新文献

Cardioplegia, a therapy designed to induce reversible cardiac arrest, revolutionized cardiovascular surgery. Among the various pharmacological approaches is the histidine-tryptophan-ketoglutarate (HTK) solution. Despite numerous studies, no meta-analysis has investigated the efficacy of the HTK solution in the pediatric population. Therefore, we aim to conduct a meta-analysis comparing HTK and other cardioplegia solutions in pediatric patients undergoing cardiovascular surgery.PubMed, Embase, and Cochrane databases were searched from inception through April 2024. Endpoints were computed in odds ratios (OR) with 95% confidence intervals (CI) for dichotomous variables, whereas continuous variables were compared using mean differences (MD) with 95% CI.A total of 11 studies comprising 1,349 patients were included, of whom 677 (50.19%) received HTK cardioplegia. The results were similar between groups regarding mortality (OR 0.98; 95% CI 0.29, 3.29), length of hospital stay (MD 0.32 days; 95% CI -0.88, 1.51), Mechanical ventilation (MV) (MD -17.72 hours; 95% CI -51.29, 15.85), arrhythmias (OR 1.27; 95% CI 0.83, 1.95), and delayed sternal closure (OR 0.89; 95% 0.56, 1.43). However, transfusion volume was lower in the HTK group (MD -452.39; 95% CI -890.24, -14.53; p = 0.04).The use of HTK solution was demonstrated to be similar regarding its clinical efficacy to other approaches for cardioplegia, and it may present advantages to patients prone to hypervolemia.

Video-assisted minimally invasive (MIC) tricuspid valve repair or replacement through right minithoracotomy offers a less invasive option for the treatment of tricuspid valve insufficiency compared with conventional sternotomy approach.We present our postoperative results regarding the two different surgical approaches.From 2017 to 2021, 180 patients underwent isolated or combined tricuspid valve procedures in our heart center, either through median sternotomy (n = 152, group 1) or via MIC approach (n = 28, group 2). Mean age was 68 ± 11 years in group 1 and 69 ± 11 years in group 2. A propensity matching analysis was performed comparing 21 patients from each group. The majority of the patients in both groups received tricuspid valve repair (90% in unmatched group 1 and 79% in unmatched group 2). Tricuspid valve replacement was performed in 10% of group 1 versus 21% of group 2. The 30-day mortality was higher in matched group 1 patients (14%) in comparison to matched group 2 patients (5%; odds ratio [OR] = 3.00; [0.31, 28.84]; p = 0.341). Mean required packed red blood cells was 9.43 ± 11.79 units in group 1, respectively, 3.57 ± 4.75 units in group 2 (OR = 1.12; [0.98, 1.29]; p = 0.099). Postoperative echocardiography revealed excellent tricuspid valve function in both matched groups.Video-assisted minimally invasive (MIC) tricuspid valve repair or replacement through right mini-thoracotomy is a good alternative to sternotomy approach. Our postoperative results demonstrate that MIC approach is safe and feasible.

Aortic valve replacement improves and prolongs lives of patients with aortic valve disease, but requires significant healthcare resources, which are mainly determined by the length of associated hospital stays. Therefore, this study aims to identify risk factors for extended length of stay after surgical aortic valve replacement.Between 2018 and 2023, 458 consecutive patients underwent isolated surgical aortic valve replacement at our center and were included in our analysis. To identify independent predictors for hospital and intensive care unit stay, multivariable linear regression analysis using backward elimination process was performed.Upon multivariable linear regression, endocarditis (regression coefficient [β] 2.98; 95% confidence interval [CI] 1.51, 4.45; p < 0.001]) and prior aortic valve surgery (β 1.72; 95% CI 0.18, 3.26; p = 0.029) were associated with prolonged hospital stay. Prior aortic valve surgery was associated with prolonged intensive care unit stay (β 0.99; 95% CI 0.39, 1.59; p = 0.001) as well as chronic obstructive pulmonary disease (COPD) (β 1.61; 95% CI 0.66, 2.55; p = 0.001), smaller prosthetic valve sizes (β -0.18; 95% CI -0.30, -0.06; p = 0.003), preoperative atrial fibrillation (β 1.06; 95% CI 0.32, 1.79; p = 0.005), and reduced left ventricular ejection fraction (β -0.03; 95% CI -0.05, -0.01; p = 0.006).Pending further validation, structured programs aiming to accelerate intensive care unit and hospital discharge after surgical aortic valve replacement should focus on patients with prior cardiac surgery, atrial fibrillation, and COPD. Surgeons should aim to implant large-diameter valves. Furthermore, the identified predictors should be used to discuss surgical versus transcatheter procedures in the interdisciplinary heart team.

Background: Mitral regurgitation (MR) associated with atrial septal defect (ASD) has been observed to improve following ASD closure; however, aggravation of preexisting MR can occur post-procedure, with the underlying mechanisms of these adverse outcomes remaining poorly understood.

Method: This retrospective study evaluated 95 patients who underwent surgical secundum ASD closure, all of whom received preoperative and postoperative transthoracic echocardiography (TTE). Patient characteristics from preoperative TTE, as well as sex and age, were analyzed to identify predictors of MR. Follow-up TTE was conducted at 1 month, 3 months, 6 months, 1 year, and 2 years post-procedure, with all patients successfully completing the 2-year follow-up.

Results: The univariate logistic regression analysis indicated that age, gender, LA, RA-VD, RA-HD, RV, ASD diameter, AS diameter, PAP, and peak tricuspid regurgitation velocity may serve as predictors of MR worsening. Subsequent multiple logistic regression analysis revealed that LA size was an independent predictor of MR worsening and acted as a protective factor. Our research indicates a marked reduction in right cardiac system after ASD closure, with significant remodeling of the LA within the first 6 months. The relative size of the LV increased notably within 2 years. The postoperative changes in LA differed between the worsening MR group and the non-worsening MR group.

Conclusion: In conclusion, 'prophylactic' mitral annuloplasty during ASD surgery may prove advantageous for patients with an enlarged LA, and the presence of additional risk factors associated with mitral annuloplasty heightens the recommendation for concurrent intervention.

Despite developments in the past 20 years in the treatment of native valve (NVE) endocarditis, including the multidisciplinary endocarditis team approach and advances in perioperative care, outcome improvements are lacking. This study compares a contemporary with a historic cohort of NVE patients.All patients undergoing first-time cardiac surgery for NVE in two periods were evaluated in a retrospective observational single-center trial. The historic period included patients from 1998 to 2003 and the contemporary cohort 2021 to 2024.Of the 359 patients who were included, 155 were in the historic cohort (years 1998-2003) and 204 in the contemporary (years 2021-2024). The annual caseload increased significantly from 25.8 to 51.0 annual cases (p < 0.01). Patient baselines changed, being nowadays older (62.6 vs. 55.5 years, p < 0.001), having higher BMI (26.9 kg/m² vs. 25.3 kg/m², p < 0.01) and higher EuroSCORE II (8.7% vs. 5.0%, p < 0.001). Accordingly, the preoperative clinical presentation also worsened with an increase in septic embolizations (33.8% vs. 22.6%, p = 0.04) and acute kidney injury (15.2% vs. 1.9%, p < 0.001). Minimally invasive procedures were newly established (41.2% vs. 0%). The contemporary group faced a higher rate of postoperative dialysis, longer intensive care unit stay, and higher perioperative mortality (14.2% vs. 6.5%, p = 0.03). Nonetheless, survival at 1 year was comparable (78.4% vs. 79.9, p = 0.52).Contemporary patients have higher risk profiles and annual caseloads. This translates into increased postoperative morbidity and mortality; however long-term outcomes have remained constant.

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.