Thoracic and Cardiovascular Surgeon最新文献

The aim of this study was to prospectively evaluate the feasibility and safety of intraoperative invasive coronary angiography (ICA) following coronary artery bypass grafting using a mobile angiography C-arm.Between August 2020 and December 2021, 18 patients were enrolled for intraoperative ICA following coronary artery bypass grafting. After skin closure, ICA was performed including angiography of all established bypass grafts via a mobile angiography system by an interventional cardiologist. Data on graft patency, stenosis, and kinking were assessed. Grafts were rated on an ordinal scale ranging from very poor (1) to excellent (5). Furthermore, the impact of ICA compared with flow measurement was assessed using the ordinal Likert scale ranging from (I) worse to (V) much better.The ICA was considered better (V) compared with transient flow measurement in 38 (93%) and comparable (III) in 3 (7%) distal anastomoses. ICA impacted clinical or surgical decision-making in three patients (17%). In one patient, dual antiplatelet therapy for 6 months was initiated and rethoracotomy was needed in two (11%) patients with bypass graft revision and additional bypass grafting for graft occlusion. There were no cerebral and distal embolic events or access vessel complications observed and no postoperative acute kidney injury occurred.Intraoperative angiography after coronary bypass grafting is safe. Using a mobile angiographic device, graft patency, and function assessment was superior to transit time flow measurement leading to further consequences in a relevant number of patients. Therefore, it has the potential to reduce postoperative myocardial injury and improve survival.

Minimally invasive robot-assisted esophagectomies have proven superior to traditional open surgery. While transhiatal and transthoracic approaches are common, subcostal access remains less frequent in minimally invasive esophageal surgery. Recent advancements in robotic systems, such as the da Vinci Single-Port (SP), now facilitate precise subcostal access. This innovation holds potential to reduce postoperative pain, enhance patient mobility, and broaden surgical options for patients with multiple health conditions. The Single-Port Subcostal Robot-Assisted Minimal Invasive Esophagectomy (SP SC RAMIE) utilizes an SP and laparoscopic approach, enabling effective mediastinal dissection and esophageal mobilization with radical lymphadenectomy. This novel technique shows promise, especially for frail patients with multiple comorbidities who stand to benefit greatly from expedited recovery pathways. Nonetheless, further exploration is necessary to fully assess its clinical effectiveness and reproducibility.

Coronary artery bypass grafting (CABG) is one of the revascularization modalities available in patients with left ventricular dysfunction (LVD). Multiple arterial grafting (MAG) is associated with improved long-term outcomes. Data on the benefits of MAG in patients with LVD are limited. We examined the effect of MAG on outcomes across the spectrum of left ventricle (LV) function.Retrospective cohort study of patients undergoing isolated CABG (January 1, 2009, to October 1, 2021). Patients were grouped according to revascularization strategy (single vs. MAG). The primary outcome was a composite of all-cause mortality, cerebrovascular accident, myocardial infarction, and repeat revascularization (major adverse cardiac and cerebrovascular events [MACCE]). The cumulative incidence of MACCE was plotted using Kaplan-Meier curves. Results were stratified according to LV function (<30%, 30-50%, >50%).Our cohort included 4,763 patients; 1,976 (41.4%) underwent single arterial grafting (SAG), and 2,787 (58.6%) underwent MAG; 3,976 (83.4%) were male with a median age of 64 (interquartile range [IQR] 57-71) years. Distribution of LV function was 2,539 (53.3%) with an ejection fraction (EF) >50%, 1,828 (38.3%) with an EF of 30-50%, and 396 (8.3%) with an EF <30%. Median follow-up time was 64 (37-102) months. Cumulative incidence of MACCE at 72 months was 28.7% in the MAG and 30.3% in the SAG group. Stratified by LV function, the hazard ratio for MACCE at 160 months was 0.71 (95% CI 0.54-0.93), 0.78 (95% CI 0.68-0.9), and 0.95 (95% CI 0.83-1.09) for LV function <30%, 30-50%, >50%, respectively, with no significant interaction between MAG and LV function.MAG is associated with improved outcomes following CABG across the spectrum of LV function.

Metal hypersensitivity after Nuss procedure is a known complication, but there is no accepted treatment guideline available. Patients undergoing Nuss procedure between 2013 and 2023 were examined retrospectively. Patients with known allergy, positive blood, and/or culture tests, and redo cases were excluded. Nine of 307 (2.9%) patients developed postoperative allergy. No significant difference was found between single or double bar patients. All were treated with medical protocol. No premature bar removal was necessitated. Medical treatment was successful in postoperative metal allergy after Nuss procedure. Ruling out other causes like surgical technical problems or infections is necessary for correct diagnosis and accurate treatment.

A single-center retrospective study was initialized to investigate the occurrence of acute kidney injury (AKI) and its impact on short- and long-term outcomes after aortic valve replacement in patients with aortic stenosis (AS) and complex coronary artery disease (CAD).Between January 2010 and December 2020, 1,232 patients with severe AS and CAD were treated. Propensity score matching generated 40 patient pairs with intermediate Society of Thoracic Surgeons (STS) risk scores (3.2 ± 0.3) and EuroSCORE II (4.1 ± 0.3) undergoing percutaneous (transcatheter aortic valve replacement [TAVR] + percutaneous coronary intervention [PCI]) or surgical (surgical aortic valve replacement [SAVR] + coronary artery bypass grafting [CABG]) combined procedures. The renal function-corrected ratio of contrast medium to body weight was calculated to determine the risk of postprocedural contrast medium-associated AKI. Renal retention values were recorded daily until the 7th day after the procedure.The overall incidence of postprocedural AKI was similar between the groups. There was no correlation between the contrast medium volume to serum creatinine to body weight ratio and AKI occurrence. During the first 7 postprocedural days, creatinine clearance values were comparable: 68.97 ± 4.92 mL/min (SAVR + CABG) vs. 64.95 ± 9.78 mL/min (TAVR + PCI), mean difference 4.02, 95% CI (-24.5 to 16.4), p = 0.691. On the 7th day after the procedure, 35% (8/23) of patients with renal impairment had improved renal function. No correlation between impaired renal function and short- or long-term mortality was found in multivariable models.Contrast agents may temporarily impair renal function during a minimally invasive percutaneous approach; however, occurrence of AKI was not related to the amount of contrast medium, and AKI was not associated with short- and long-term mortality.

There is uncertainty regarding the impact of high-intensity statins on postoperative outcomes in patients undergoing surgical myocardial revascularization. This study was conducted to evaluate the impact of high-intensity statin treatment on the occurrence rate of new-onset postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass grafting (OPCAB).Six hundred and thirteen patients (66.8 ± 9.8 years, male:female = 476:137) who underwent isolated OPCAB were retrospectively enrolled. Hypertension (n = 409, 66.7%), diabetes mellitus (n = 343, 59.6%), and chronic kidney disease (n = 138, 22.5%) were common comorbidities. Statins and beta-blockers were administered to all patients until the day of surgery and resumed within 6 hours after surgery. Risk factors associated with POAF were analyzed, including the use of high-intensity statins (atorvastatin 40-80 mg or rosuvastatin 20 mg), as well as baseline characteristics and preoperative risk factors.High-intensity statins were used in 158 patients (25.8%). POAF occurred in 184 patients (30.0%). The use of high-intensity statins was not correlated with preoperative levels of low-density lipoprotein (p = 0.446) or high-sensitivity C-reactive protein (p = 0.478). Multivariate logistic regression analysis revealed that the use of high-intensity statins was significantly associated with a reduced occurrence of POAF (p = 0.022, odds ratio [95% confidence interval] = 0.592 [0.378-0.926]). Age, acute coronary syndrome, insulin-dependent diabetes mellitus, and chronic kidney disease were also significantly associated with POAF.Preoperative administration of high-intensity statins was associated with a 41% reduction in the occurrence rate of POAF in patients who underwent OPCAB.

Single-incision thoracoscopic surgery (SITS) for primary spontaneous pneumothorax offers advantages over multiport video-assisted thoracoscopic surgery, but lesion retraction remains challenging. We describe a modified SITS technique using spinal needle anchoring for precise lung stabilization. A bent spinal needle inserted through an intercostal space mimics a second-port grasper, enabling multiple re-hooking maneuvers for optimal lesion alignment. This technique allows for a smaller incision, minimizes instrument crowding, and reduces postoperative pain. The needle insertion site leaves no visible scar. Additionally, it is beneficial in cases with multiple bullae or challenging lung anatomy. SPINAL NEEDLE ANCHORING MAY REPRESENT A SIMPLE AND EFFECTIVE MODIFICATION OF THE SITS TECHNIQUE: .

Metastasectomy is a recommended and widely used operation for pulmonary metastases from colorectal cancer (CRC). The main disadvantage of pulmonary metastasectomy is the high rate of metastasis recurrence, which occurs in almost half of patients. To suppress residual pulmonary microfoci, isolated lung chemoperfusion (ILuP) is used, but its effectiveness has not been studied.The results of pulmonary metastasectomy were studied in 160 patients. In 65 patients of the main group, open metastasectomy with isolated chemoperfusion of the lungs was performed; in 95 patients of the control group, standard open or thoracoscopic metastasectomy was performed. The study design included 1:1 pseudorandomization using the nearest neighbor method. For 17 patients who underwent standard metastasectomy and then metastasectomy with ILuP for recurrent pulmonary metastases, these patients themselves were used as the nearest neighbor. For the remaining patients, the matching pairs were selected by the Propensity Score Matching method. After balancing the sample, the main and control groups comprised 41 pairs of observations, which were subjected to further analysis with assessment of relapse-free pulmonary survival according to Kaplan-Meier. Factors influencing survival were studied in the Cox's model.The median recurrence-free survival in patients of the main group who underwent metastasectomy with ILuP was 22.3 months versus 9.1 months in the control group. One-year recurrence-free survival in the main group was 77.5 ±  6.6% versus 38.1 ± 9.1% in the control group.Isolated lung chemoperfusion increases median recurrence-free survival after pulmonary metastasectomy by more than one year for colorectal cancer.