Thoracic and Cardiovascular Surgeon最新文献

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.

The aim of this study is to compare the insertion sites of drainage tubes placed in the left thorax after elective coronary artery bypass grafting (CABG) surgeries.Patients were divided into two groups based on the site of tube insertion into the left hemithorax: those with a tube inserted from the subxiphoid region and those with a tube inserted from the left intercostal region. Comparative analyses between these two groups and factor analyses contributing to the outcome were performed.There were no significant differences observed in terms of age, gender, height, and weight among patients undergoing coronary artery bypass surgery based on the site of drain placement. Twelve patients (5.2%) required re-drainage procedures, with five (41.7%) for pneumothorax and seven (58.3%) for pleural effusion. Atelectasis was absent in 144 patients (62.1%) while present in 88 patients (37.9%). The frequency of atrial fibrillation (AF) was significantly higher in the group with intercostal drains. Additionally, pain scale scores were significantly higher in patients with intercostal drains. Path analysis revealed that the visual pain scale value played a full mediating role in the effect of the drain site on AF.The statistically significant occurrence of pain and higher rates of postoperative AF in patients with intercostal tube placement are noteworthy. We believe that in patients undergoing elective coronary artery bypass surgery, the drain placed in the left hemithorax should be inserted from the subxiphoid region, if there are no contraindications.

Delayed sternal closure (DSC) is a well-established strategy used to manage patients with hemodynamic instability and perioperative coagulopathy following cardiac surgery. The study aims to present our 15-year surgical experiences with DSC.Between 2007 and 2022, DSC was performed in 227 out of 14,210 patients (1.7%) who underwent cardiac surgery at our institution. Perioperative data, outcomes, and long-term survival were analyzed. Quality of life (QoL) was assessed utilizing the EuroQol-5D-5L questionnaire.Indications for DSC included low cardiac output syndrome (LCOS) (44.1%) and coagulopathy during the index procedure (32.2%), as well as postoperative tamponade (22.9%). In coronary artery bypass grafting, LCOS was the primary indication for DSC (72.7%), whereas in acute type A aortic dissection, coagulopathy was the leading indication (70.6%). For other procedures, DSC indications were more evenly distributed. The overall 30-day survival was 57.5%, with survival rates of 43.3% for LCOS, 72.0% for coagulopathy, and 65.4% for tamponade. Multivariate logistic regression identified body mass index, postoperative renal replacement therapy, aggravated heart failure, and intraoperative packed red blood cell transfusion as negatively associated with 30-day survival. The mean follow-up period was 6.58 ± 3.19 years. Younger patients and DSC patients upon bleeding related indications reported higher QoL in comparison to older patients and patients with LCOS. Longer follow-up interval correlated with higher QoL.The study emphasizes the significant impact of LCOS on outcomes in patients undergoing DSC. We provide QoL data demonstrating good rehabilitation potential upon survival of the acute phase.

The survival advantages of bilateral internal thoracic artery (BITA) grafts in coronary artery bypass grafting (CABG) surgery 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 multivessel coronary artery disease.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 Randomized comparison of the clinical Outcome of single versus Multiple Arterial grafts (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.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)BITA grafting is safe and associated with superior long-term survival compared with SITA and vein grafts, with benefits extending beyond 5 years for the entire cohort and beyond 10 years for ROMA criteria patients.

Atrial fibrillation is associated with an increased risk of embolic strokes and is present in about one-fourth of all patients undergoing cardiac surgery. Closure of the left atrial appendage (LAA) can effectively reduce the risk of neurological events and is now a class IB recommendation in the most recent ESC/EACTS AF guidelines. The working group "Heart Rhythm Disorders" of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) evaluates the current state of clinical research and recommends concomitant LAA closure in patients with preoperative atrial fibrillation as a routine part of heart surgeries.

This single-center, retrospective analysis presents data from 611 patients with a secundum type atrial septal defect (ASD II) closure. Included were patients >2 years of age. Patients presented at a median (range) age of 6.95 (2-86) years for interventional closure of ASD II. Out of 611 patients, 215 underwent intracardiac repair based on transthoracic echocardiography (ECHO) findings. Transcatheter device closure was attempted and successfully performed in 300 out of 396 patients (Amplatzer™ Septal Occluder [ASO], n = 290 patients). Follow-up was 3.3 years (1 day-21.8 years) in patients with interventional closure of ASD II and 0.7 years (3 days-14.7 years; p < 0.001; Mann-Whitney) in patients after surgical closure. There was no in-hospital mortality in both groups. One patient, after Amplatzer device closure with an absent aortic rim, developed erosion, which was treated by cardiac surgery and patch closure of ASD II. Two patients showed dislocation of the device. In 231 out of 396 patients, right ventricular dimension normalized completely as determined on the last follow-up visit. Six patients at a median age of 60 (49.4-68.7) years presented with atrial fibrillation, which persisted after ASD II closure. About 26 patients (6.6%) showed pulmonary hypertension (PH), with 1 presenting with coincidental ASD II and severe PH. Closure of ASD II can be accomplished safely by interventional catheterization and intracardiac repair. In most cases, perioperative transthoracic and transesophageal ECHO is sufficient to decide whether a surgical approach or interventional closure is the best option to close the defect.

Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. We investigated how POAF affects the manifestation of atrial fibrillation (AF) during long-term follow-up.We conducted a prospective all-comers investigation involving patients undergoing cardiac surgery. In propensity score-matched cohorts (POAF vs. sinus rhythm [SR]), ECGs were evaluated regarding P-wave duration (PWD), amplitude (PWA), morphology, variability, and their dynamics preoperatively pre-POAF and at follow-up. Predictive value of these parameters regarding the development of manifest AF after POAF was analyzed.Of 212 patients included, 50 patients (23.6%) developed POAF. Ninety patients underwent propensity score matching (PSM), 64 (71%) participated in follow-up, 21 (23%) died prior to follow-up (POAF: 13 vs. SR: 8), and 5 (6%) withdrew consent. No patient developed persistent AF. In nine patients, paroxysmal AF (pAF) events were detected (POAF: 6 vs. SR: 3). PWD, P-dispersion (PD), PWA, and interatrial block differed between POAF and SR. From pre- to postoperative ECGs, PD and P-wave peak time (PWPT) increased, and P-amplitude decreased in these. Preoperative β-blockers had only minor modulating potency. P-wave modulation was pronounced in POAF patients.Patients with POAF are prone to episodes of pAF. P-wave indices and perioperative dynamics of these indices may indicate a higher risk of manifest AF initiation among POAF patients.