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Natural Sequential Collapse Method: A Common Technique to Identify the Intersegmental Plane. 自然顺序塌陷法:一种识别节间平面的常用技术。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-01-16 DOI: 10.1055/a-2246-3927
Yuanlin Deng, Yilin Luo, Min Zhang, Mingjian Ge

The natural sequential collapse method (NSCM) can be employed during surgery to reduce the duration of segmentectomy. This method avoids inflating the lung by rapidly blocking vessels within the tumor basin. It is important to note that the color of the lungs should be used to determine the surgical procedure. The NSCM is efficient and straightforward in revealing the intersegmental plane.

在手术过程中,可以采用自然顺序塌陷法(NSCM)来缩短肺段切除术的时间。这种方法通过快速阻断肿瘤分水岭内的血管,避免肺部充气。值得注意的是,应根据肺部的颜色来确定手术方法。NSCM 可高效、直接地显示肺段间平面。
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引用次数: 0
Risk Factor Analysis for 30-day Mortality After Surgery for Infective Endocarditis. 感染性心内膜炎术后 30 天死亡率的风险因素分析。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-02-19 DOI: 10.1055/s-0044-1779709
Jill Jussli-Melchers, Christine Friedrich, Kira Mandler, Mohamad Hosam Alosh, Mohamed Ahmed Salem, Jan Schoettler, Jochen Cremer, Assad Haneya

Background:  Infective endocarditis (IE) remains a challenging disease associated with high mortality. Several scores have been suggested to assess surgical risk. None was sufficiently adequate. We therefore analyzed risk factors for 30-day mortality.

Methods:  A total of 438 consecutive patients had surgery for IE in our department between 2002 and 2020. Patients were divided into two groups, one consisting of 30-day survivors (362 patients; 82.6%) and one of nonsurvivors (76 patients; 17.4%). Logistic regression analysis on pre- and intraoperative risk factors was performed and the groups were compared by univariable analyses.

Results:  Patients in mortality group were older (69 [58, 77] vs. 63 [50, 72] years; p < 0.001), EuroSCORE II was higher (24.5 [12.1, 49.0] vs. 8.95 [3.7, 21.2]; p < 0.001) and there were more females. More frequently left ventricular function (below 30%), preoperative acute renal insufficiency, chronic dialysis, insulin-dependent diabetes mellitus, NYHA-class IV (New York Heart Association heart failure class IV), and cardiogenic shock occurred. Patients in the mortality group were often intensive care unit patients (40.8 vs. 22.4%; p < 0.001) or had a preoperative stroke (26.3 vs. 16.0%; p = 0.033). In the nonsurvivor group Staphylococcus aureus was prevalent. Streptococcus viridans was common in the survivor group as was isolated aortic valve endocarditis (32.9 vs. 17.1%; p = 0.006). Prosthetic valve endocarditis (PVE) and abscesses occurred more often in nonsurvivors. In the logistic regression analysis, female gender, chronic dialysis, cardiogenic shock, and NYHA IV and from intraoperative variables PVE, cardiopulmonary bypass time, and mitral valve surgery were the strongest predictors for 30-day mortality.

Conclusion:  This study indeed clearly indicates that significant risk factors for 30-day mortality cannot be changed. Nevertheless, they should be taken into account for preoperative counselling, and they will alert the surgical team for an even more careful management.

背景:感染性心内膜炎(IE)仍然是一种具有挑战性的疾病,死亡率很高。已经提出了几种评估手术风险的评分方法。但没有一项足够充分。因此,我们分析了30天死亡率的风险因素:方法:2002 年至 2020 年间,共有 438 名连续患者在我科接受了 IE 手术。患者分为两组,一组为 30 天存活患者(362 例;82.6%),另一组为非存活患者(76 例;17.4%)。对术前和术后风险因素进行了逻辑回归分析,并通过单变量分析对两组进行了比较:结果:死亡组患者年龄较大(69 [58, 77] 岁 vs. 63 [50, 72] 岁;p p p = 0.033)。在非死亡组中,金黄色葡萄球菌最常见。病毒性链球菌和孤立性主动脉瓣心内膜炎(32.9% 对 17.1%;P = 0.006)在幸存者组很常见。人工瓣膜心内膜炎(PVE)和脓肿在非幸存者中发生率更高。在逻辑回归分析中,女性性别、慢性透析、心源性休克和 NYHA IV 以及术中变量 PVE、心肺旁路时间和二尖瓣手术是 30 天死亡率的最强预测因素:这项研究确实清楚地表明,30 天死亡率的重要风险因素是无法改变的。尽管如此,在术前咨询时应考虑到这些因素,并提醒手术团队采取更谨慎的管理措施。
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引用次数: 0
Long-Term Outcome of Chest Wall and Diaphragm Repair with Biological Materials. 生物材料修复胸壁和膈肌的远期疗效。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2023-11-01 DOI: 10.1055/a-2202-4154
Hayan Merhej, Mohammed Ali, Tomoyuki Nakagiri, Norman Zinne, Alaa Selman, Heiko Golpon, Tobias Goecke, Patrick Zardo

Introduction:  Chest wall and/or diaphragm reconstruction aims to preserve, restore, or improve respiratory function; conserve anatomical cavities; and upkeep postural and upper extremity support. This can be achieved by utilizing a wide range of different grafts made of synthetic, biological, autologous, or bioartificial materials. We aim to review our experience with decellularized bovine pericardium as graft in the past decade.

Patients and methods:  We conducted a retrospective analysis of patients who underwent surgical chest wall and/or diaphragm repair with decellularized bovine pericardium between January 1, 2012 and January 13, 2022 at our institution. All records were screened for patient characteristics, intra-/postoperative complications, chest tube and analgesic therapy duration, length of hospital stay, presence or absence of redo procedures, as well as morbidity and 30-day mortality. We then looked for correlations between implanted graft size and postoperative complications and gathered further follow-up information at least 2 months after surgery.

Results:  A total of 71 patients either underwent isolated chest wall (n = 51), diaphragm (n = 12), or pericardial (n = 4) resection and reconstruction or a combination thereof. No mortality was recorded within the first 30 days. Major morbidity occurred in 12 patients, comprising secondary respiratory failure requiring bronchoscopy and invasive ventilation in 8 patients and secondary infections and delayed wound healing requiring patch removal in 4 patients. There was no correlation between the extensiveness of the procedure and extubation timing (chi-squared test, p = 0.44) or onset of respiratory failure (p = 0.27).

Conclusion:  A previously demonstrated general viability of biological materials for various reconstructive procedures appears to be supported by our long-term results.

简介:胸壁和/或膈肌重建旨在保护、恢复或改善呼吸功能,保护解剖腔,维持姿势和上肢支撑。这可以通过利用由合成、生物、自体或生物人工材料制成的各种不同移植物来实现。我们的目的是回顾我们在过去十年中使用脱细胞牛心包作为移植物的经验。患者和方法:回顾性分析2012年1月1日至2022年1月13日期间在我院接受脱细胞牛心包胸壁和/或膈肌手术修复的患者。对所有记录进行了患者特征、术中/术后并发症、胸管和镇痛治疗持续时间、住院时间、是否进行了重做手术以及发病率和30天死亡率的筛查。然后,我们寻找植入移植物大小与术后并发症之间的相关性,并在术后至少两个月收集进一步的随访信息。结果:共有71名患者接受了孤立胸壁(n=51)、膈肌(n=12)或心包(n=4)切除重建或其组合。前30天内无死亡记录。主要发病率发生在12例患者中,包括8例需要支气管镜检查和有创通气的继发性呼吸衰竭,4例需要移除贴片的继发性感染和延迟伤口愈合。手术的广泛性与拔管时间(Chi检验,p=0.44)或呼吸衰竭发作(p=0.27)之间没有相关性。结论:我们的长期结果似乎支持了先前证明的用于各种重建手术的生物材料的普遍可用性。
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引用次数: 0
Impact of Surgery Timing and Malperfusion on Acute Type A Aortic Dissection Outcomes. 手术时机和灌注不良对急性 A 型主动脉夹层预后的影响
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-29 DOI: 10.1055/a-2446-9886
Xun E Zhang, Wenda Yu, Hanci Yang, Chao Fu, Bo Wang, Lu Wang, Qing-Guo Li

Objective:  This study aimed to determine the impact of symptom-to-surgery time on mortality in acute type A aortic dissection (ATAAD) patients, with and without malperfusion.

Methods:  A retrospective analysis of 288 ATAAD patients was conducted. Patients were separated into the early (≤10 h) and late (>10 h) groups by symptom-to-surgery time. Data on characteristics, surgery, and complications were compared, and multivariable logistic regression determined mortality risk factors.

Results:  Mortality rates did not significantly differ between early and late groups. Age (odds ratio [OR] 1.09, 95% CI 1.05-1.13, p < 0.001), extracorporeal membrane oxygenation use (OR 10.73, 95% CI 2.51-45.87, p = 0.001), and malperfusion (OR 6.83, 95% CI 2.84-16.45, p < 0.001) predicted operative death. Subgroup analysis showed cerebral (OR 3.20, 95% CI 1.11-9.26, p = 0.031), cardiac (OR 5.89, 95% CI 1.32-26.31, p = 0.020), and limb (OR 6.20, 95% CI 1.75-22.05, p = 0.005) malperfusion as predictors of operative death. One (OR 6.30, 95% CI 2.39-16.61, p < 0.001), two (OR 12.79, 95% CI 2.74-59.81, p = 0.001), and three (OR 46.99, 95% CI 7.61-288.94, p < 0.001) organs malperfusion, together with Penn B (OR 7.96, 95% CI 3.04-20.81, p < 0.001) and Penn B-C (OR 12.50, 95% CI 2.65-58.87, p = 0.001) classifications predict operative mortality. Survival analysis revealed significant differences between malperfusion and no malperfusion (34% vs. 9%, p < 0.001) but not between late and early (14% vs. 21%, p = 0.132) groups. Malperfusion remained an essential predictor of operative (OR 7.06 95% CI 3.11-17.19, p < 0.001) and midterm mortality (OR 3.38 95% CI 1.97-5.77, p < 0.001) in subgroup analysis.

Conclusion:  Preoperative malperfusion status, rather than symptom-to-surgery time, significantly impacts both operative and midterm mortality in ATAAD patients.

目的:确定急性 A 型主动脉夹层(ATAAD)患者从症状到手术时间对死亡率的影响:确定急性 A 型主动脉夹层(ATAAD)患者从症状到手术的时间对死亡率的影响,包括有无灌注不良:对 288 名 ATAAD 患者进行了回顾性分析。方法:对288例ATAAD患者进行了回顾性分析,根据症状到手术时间将患者分为早期组(≤10小时)和晚期组(>10小时)。比较了特征、手术和并发症数据,并通过多变量逻辑回归确定了死亡风险因素:结果:早期组和晚期组的死亡率无明显差异。年龄(OR 1.09,95% CI 1.05-1.13,p结论:术前灌注不良状况,而非症状到手术的时间,对ATAAD患者的手术死亡率和中期死亡率都有显著影响。
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引用次数: 0
Overall Accuracy of the Modified Duke Criteria-A Systematic Review and Meta-analysis. 改进的Duke标准的总体准确性——系统评价和荟萃分析。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-29 DOI: 10.1055/a-2462-8950
Tulio Caldonazo, Panagiotis Tasoudis, Torsten Doenst, Dimitrios Moris, Lillian Kang, Alexandros Moschovas, Hristo Kirov, Ricardo E Treml, Michel Pompeu Sá, Stefan Hagel, Mahmoud Diab

Background:  Rapid and accurate diagnosis of infective endocarditis (IE) allows timely management of this life-threatening disease and improves outcome. The Duke criteria have traditionally been the clinical method for diagnosing IE. These criteria were reformulated at different timepoints. We aimed to evaluate the real accuracy of the modified Duke criteria based on several studies that concluded the diagnosis of IE.

Methods:  Three databases were assessed. Studies were considered for inclusion if they reported the use of modified Duke criteria as the initial approach and the confirmation of the diagnosis with the gold standard methods. The meta-analysis of diagnostic test accuracy was performed after fitting the hierarchical summary receiver operating characteristic model (HSROC) with bivariate model and displaying the summarized measures of sensitivity and specificity, and positive and negative likelihood ratios.

Results:  A total of 11 studies were included. Accuracy in the included studies ranged from 62.3 to 92.2%, sensitivity ranged from 58.3 to 84.0%, and specificity ranged from 50.0 to 100%. The combined overall sensitivity and specificity were 85% (95% CI: 0.77-0.90) and 98% (95% CI: 0.89-0.99), respectively. The positive likelihood ratio was 40.2 (95% CI: 7.26-220.74) and the negative likelihood ratio was 0.15 (95% CI: 0.01-0.23).

Conclusion:  The analysis reveals that the modified Duke criteria have a high positive likelihood ratio, suggesting a robust correlation between a positive test result and the existence of IE, and a very good overall specificity at 98%. The latter aspect holds significant importance in order to prevent unnecessary overtreatment, given the intricacies involved in managing IE.

背景:快速准确的诊断感染性心内膜炎(IE)可以及时治疗这种危及生命的疾病并改善预后。杜克标准传统上是诊断IE的临床方法。这些标准在不同的时间点重新制定。我们的目的是基于几项总结IE诊断的研究来评估修改后的Duke标准的真实准确性。方法:对三个数据库进行评估。如果研究报告使用修改的Duke标准作为初始方法,并使用金标准方法确认诊断,则考虑纳入研究。将分级汇总接收者工作特征模型(HSROC)与双变量模型拟合,并显示敏感性和特异性、阳性和阴性似然比的汇总测量值后,进行诊断试验准确性的荟萃分析。结果:共纳入11项研究。在纳入的研究中,准确率为62.3 - 92.2%,灵敏度为58.3% - 84.0%,特异性为50.0% - 100%。综合总体敏感性和特异性分别为85% (95% CI: 0.77-0.90)和98% (95% CI: 0.89-0.99)。阳性似然比为40.2 (95% CI: 7.26 ~ 220.74),阴性似然比为0.15 (95% CI: 0.01 ~ 0.23)。结论:分析表明,修改后的Duke标准具有较高的阳性似然比,表明阳性检测结果与IE存在有很强的相关性,并且具有非常好的总特异性,为98%。鉴于IE管理的复杂性,后者对于防止不必要的过度治疗具有重要意义。
{"title":"Overall Accuracy of the Modified Duke Criteria-A Systematic Review and Meta-analysis.","authors":"Tulio Caldonazo, Panagiotis Tasoudis, Torsten Doenst, Dimitrios Moris, Lillian Kang, Alexandros Moschovas, Hristo Kirov, Ricardo E Treml, Michel Pompeu Sá, Stefan Hagel, Mahmoud Diab","doi":"10.1055/a-2462-8950","DOIUrl":"https://doi.org/10.1055/a-2462-8950","url":null,"abstract":"<p><strong>Background: </strong> Rapid and accurate diagnosis of infective endocarditis (IE) allows timely management of this life-threatening disease and improves outcome. The Duke criteria have traditionally been the clinical method for diagnosing IE. These criteria were reformulated at different timepoints. We aimed to evaluate the real accuracy of the modified Duke criteria based on several studies that concluded the diagnosis of IE.</p><p><strong>Methods: </strong> Three databases were assessed. Studies were considered for inclusion if they reported the use of modified Duke criteria as the initial approach and the confirmation of the diagnosis with the gold standard methods. The meta-analysis of diagnostic test accuracy was performed after fitting the hierarchical summary receiver operating characteristic model (HSROC) with bivariate model and displaying the summarized measures of sensitivity and specificity, and positive and negative likelihood ratios.</p><p><strong>Results: </strong> A total of 11 studies were included. Accuracy in the included studies ranged from 62.3 to 92.2%, sensitivity ranged from 58.3 to 84.0%, and specificity ranged from 50.0 to 100%. The combined overall sensitivity and specificity were 85% (95% CI: 0.77-0.90) and 98% (95% CI: 0.89-0.99), respectively. The positive likelihood ratio was 40.2 (95% CI: 7.26-220.74) and the negative likelihood ratio was 0.15 (95% CI: 0.01-0.23).</p><p><strong>Conclusion: </strong> The analysis reveals that the modified Duke criteria have a high positive likelihood ratio, suggesting a robust correlation between a positive test result and the existence of IE, and a very good overall specificity at 98%. The latter aspect holds significant importance in order to prevent unnecessary overtreatment, given the intricacies involved in managing IE.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
HTK Solution Cardioplegia in Pediatric Patients: A Meta-analysis. 儿科患者的 HTK 溶液心脏麻痹:一项荟萃分析。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-29 DOI: 10.1055/a-2461-3147
Lorhayne Kerley Capuchinho Scalioni Galvao, Ana Clara Felix de Farias Santos, Nicole Pimenta Dos Santos, Fernanda Valeriano Zamora, Belisa Brunow Ventura Biavatti, João Pedro Costa Esteves Almuinha Salles, Horbert Soares Mendonca

Introduction:  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.

Methods:  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.

Results:  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).

Conclusion:  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.

简介心脏麻痹是一种旨在诱导可逆性心脏停搏的疗法,它彻底改变了心血管外科手术。组氨酸-色氨酸-酮戊二酸(HTK)溶液是各种药理学方法中的一种。尽管有许多研究,但还没有一项荟萃分析调查了 HTK 溶液在儿科人群中的疗效。因此,我们旨在对接受心血管手术的儿科患者进行一项荟萃分析,比较 HTK 和其他心脏麻痹溶液:方法:检索了从开始到 2024 年 4 月的 PubMed、Embase 和 Cochrane 数据库。对于二分变量,终点以几率比(OR)和95%置信区间(CI)计算,而连续变量则以平均差(MD)和95%置信区间进行比较:结果:共纳入了 11 项研究,1,349 名患者,其中 677 人(50.19%)接受了 HTK 心脏麻痹。在死亡率(OR 0.98;95% CI 0.29,3.29)、住院时间(MD 0.32 天;95% CI -0.88,1.51)、MV(MD -17.72小时;95% IC -51.29,15.85)、心律失常(OR 1.27;95% CI 0.83,1.95;)和胸骨闭合延迟(OR 0.89;95% 0.56,1.43)方面,各组结果相似。然而,HTK 组的输血量较低(MD -452.39;95% CI -890.24,-14.53;P=0.04):结论:HTK溶液的临床疗效与其他心脏麻痹方法相似,对易发生高血容量的患者有一定优势。
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引用次数: 0
A Predictive Model Integrating AI Recognition Technology and Biomarkers for Lung Nodule Assessment. 结合人工智能识别技术和生物标志物的肺结节评估预测模型
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-26 DOI: 10.1055/a-2446-9832
Tao Zhou, Ping Zhu, Kaijian Xia, Benying Zhao

Background:  Lung cancer is the most prevalent and lethal cancer globally, necessitating accurate differentiation between benign and malignant pulmonary nodules to guide treatment decisions. This study aims to develop a predictive model that integrates artificial intelligence (AI) analysis with biomarkers to enhance early detection and stratification of lung nodule malignancy.

Methods:  The study retrospectively analyzed the patients with pathologically confirmed pulmonary nodules. AI technology was employed to assess CT features, such as nodule size, solidity, and malignancy probability. Additionally, lung cancer blood biomarkers were measured. Statistical analysis involved univariate analysis to identify significant differences among factors, followed by multivariate logistic regression to establish independent risk factors. The model performance was validated using receiver operating characteristic curves and decision curve analysis (DCA) for internal validation. Furthermore, an external dataset comprising 51 cases of lung nodules was utilized for independent validation to assess robustness and generalizability.

Results:  A total of 176 patients were included, divided into benign/preinvasive (n = 76) and invasive cancer groups (n = 100). Multivariate analysis identified eight independent predictors of malignancy: lobulation sign, bronchial inflation sign, AI-predicted malignancy probability, nodule nature, diameter, solidity proportion, vascular endothelial growth factor, and lung cancer autoantibodies. The combined predictive model demonstrated high accuracy (area under the curve [AUC] = 0.946). DCA showed that the combined model significantly outperformed the traditional model, and also proved superior to models using AI-predicted malignancy probability or the seven lung cancer autoantibodies plus traditional model. External validation confirmed its robustness (AUC = 0.856), achieving a sensitivity of 0.80 and specificity of 0.86, effectively distinguishing between invasive and noninvasive nodules.

Conclusion:  This combined approach of AI-based CT features analysis with lung cancer biomarkers provides a more accurate and clinically useful tool for guiding treatment decisions in pulmonary nodule patients. Further studies with larger cohorts are warranted to validate these findings across diverse patient populations.

背景:肺癌是全球发病率和致死率最高的癌症,需要准确区分肺结节的良性和恶性,以指导治疗决策。本研究旨在开发一种将人工智能(AI)分析与生物标志物相结合的预测模型,以加强肺结节恶性肿瘤的早期检测和分层:研究对经病理确诊的肺结节患者进行了回顾性分析。采用人工智能技术评估 CT 特征,如结节大小、实性和恶性可能性。此外,还测量了肺癌血液生物标志物。统计分析包括单变量分析以确定各因素之间的显著差异,然后进行多变量逻辑回归以确定独立的风险因素。利用接收器操作特征曲线和决策曲线分析(DCA)对模型的性能进行了内部验证。此外,还利用由 51 例肺结节组成的外部数据集进行独立验证,以评估稳健性和可推广性:结果:共纳入 176 例患者,分为良性/浸润前组(76 例)和浸润癌组(100 例)。多变量分析确定了八个独立的恶性肿瘤预测因子:分叶征、支气管膨胀征、人工智能预测的恶性肿瘤概率、结节性质、直径、实性比例、血管内皮生长因子和肺癌自身抗体。综合预测模型的准确性很高(曲线下面积 [AUC] = 0.946)。DCA显示,组合模型的表现明显优于传统模型,也优于使用人工智能预测恶性肿瘤概率的模型或七种肺癌自身抗体加传统模型的模型。外部验证证实了其稳健性(AUC = 0.856),灵敏度为 0.80,特异性为 0.86,能有效区分浸润性和非浸润性结节:基于人工智能的 CT 特征分析与肺癌生物标志物相结合的方法为指导肺结节患者的治疗决策提供了更准确、更实用的临床工具。为了在不同的患者群体中验证这些研究结果,有必要进行更大规模的研究。
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引用次数: 0
Lactate Dehydrogenase Levels after Aortic Valve Replacement: What Do They Tell Us? 主动脉瓣置换术后的乳酸脱氢酶水平:它们能告诉我们什么?
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-26 DOI: 10.1055/a-2454-9020
Laura Rings, Loreta Mavrova-Risteska, Achim Haeussler, Vasileios Ntinopoulos, Matteo Tanadini, Hector Rodriguez Cetina Biefer, Omer Dzemali

Introduction:  Lactate dehydrogenase (LDH) is a standard postoperative marker for hemolysis in the presence of paravalvular leakage (PVL) after replacement of the aortic valve (AVR). LDH is elevated in certain valves by a fluttering phenomenon. Previous studies suggested a correlation between microparticles (MPs) and LDH elevation after AVR. Thus, we analyze the postoperative relevance of LDH after AVR with transapical transcatheter aortic valves (TA-TAVs) or rapid deployment valves (RDVs).

Methods:  We retrospectively analyzed the data from patients who received an AVR with the RDV and TA-TAV groups between 2015 and 2018. We compared PVL and LDH levels before and after surgery, transvalvular gradients, heart block that required pacemaker implantation, and 30-day mortality.

Results:  In total, 138 consecutive patients were selected for the study: 79 patients in the RDV group (37 Sorin Perceval valve, 42 Edwards Intuity valve) and 59 in the TA-TAV group (Edwards Sapien valve). TA-TAV group was older (median 10 years) and had a higher incidence of PVL (odds ratio 11, 95% confidence interval [CI] 2.5-73.2, p = 0.04)). Interestingly, the TA-TAV group showed lower levels of LDH despite higher rates of PVL. Of note, the Perceval valve trended toward higher LDH values. Additionally, the RDV group showed an increased arrhythmia profile (p = 0.0041); however, the results show lower incidence in pacemaker implantation (95% CI 0.05-1.65, p = 0.635). The 30-day mortality was similar between groups.

Conclusion:  Our data do not support the association between hemolysis and PVL despite elevated LDH in suture-free valves. Our results suggest that LDH could be a marker of extreme heart muscle output or fluttering phenomenon and not a marker of hemolysis after sutureless AVR.

简介:乳酸脱氢酶(LDH)是主动脉瓣置换术(AVR)术后出现腔室旁渗漏(PVL)时溶血的标准标志物。某些瓣膜会出现瓣膜扑动现象,从而导致 LDH 升高。以前的研究表明,微颗粒(MP)与主动脉瓣置换术后 LDH 升高之间存在相关性。我们分析了使用经心尖经导管主动脉瓣(TA-TAV)或快速展开瓣(RDV)进行 AVR 术后 LDH 的相关性:我们回顾性分析了2015-2018年间接受RDV和TA-TAV组AVR的患者数据。我们比较了手术前后的 PVL 和 LDH 水平、跨瓣梯度、需要植入起搏器的心脏传导阻滞以及 30 天死亡率:我们选取了138例连续患者:79例RDV组(37例Sorin Perceval瓣膜、42例Edwards Intuity瓣膜)和59例TA-TAV组(Edwards Sapien瓣膜)。TA-TAV 组患者年龄较大(中位数为 10 岁),PVL 发生率较高(Odds ratio 11,95% CI 从 2.5 到 73.2,p-value 0.04)。TA-TAV 组尽管 PVL 发生率较高,但 LDH 水平较低,而 Perceval 瓣膜的 LDH 值则呈上升趋势。此外,尽管结果显示起搏器植入发生率较低(95 % CI 0.05 - 1.65,p=0.635),但RDV组的心律失常情况有所增加(p=0.0041)。两组患者的30天死亡率相似:结论:尽管无缝合瓣膜的 LDH 升高,但我们的数据并不支持溶血与 PVL 之间的关联。LDH可能是无缝线自体瓣膜置换术后心肌极度输出或扑动现象的标志,而不是溶血的标志。
{"title":"Lactate Dehydrogenase Levels after Aortic Valve Replacement: What Do They Tell Us?","authors":"Laura Rings, Loreta Mavrova-Risteska, Achim Haeussler, Vasileios Ntinopoulos, Matteo Tanadini, Hector Rodriguez Cetina Biefer, Omer Dzemali","doi":"10.1055/a-2454-9020","DOIUrl":"10.1055/a-2454-9020","url":null,"abstract":"<p><strong>Introduction: </strong> Lactate dehydrogenase (LDH) is a standard postoperative marker for hemolysis in the presence of paravalvular leakage (PVL) after replacement of the aortic valve (AVR). LDH is elevated in certain valves by a fluttering phenomenon. Previous studies suggested a correlation between microparticles (MPs) and LDH elevation after AVR. Thus, we analyze the postoperative relevance of LDH after AVR with transapical transcatheter aortic valves (TA-TAVs) or rapid deployment valves (RDVs).</p><p><strong>Methods: </strong> We retrospectively analyzed the data from patients who received an AVR with the RDV and TA-TAV groups between 2015 and 2018. We compared PVL and LDH levels before and after surgery, transvalvular gradients, heart block that required pacemaker implantation, and 30-day mortality.</p><p><strong>Results: </strong> In total, 138 consecutive patients were selected for the study: 79 patients in the RDV group (37 Sorin Perceval valve, 42 Edwards Intuity valve) and 59 in the TA-TAV group (Edwards Sapien valve). TA-TAV group was older (median 10 years) and had a higher incidence of PVL (odds ratio 11, 95% confidence interval [CI] 2.5-73.2, <i>p</i> = 0.04)). Interestingly, the TA-TAV group showed lower levels of LDH despite higher rates of PVL. Of note, the Perceval valve trended toward higher LDH values. Additionally, the RDV group showed an increased arrhythmia profile (<i>p</i> = 0.0041); however, the results show lower incidence in pacemaker implantation (95% CI 0.05-1.65, <i>p</i> = 0.635). The 30-day mortality was similar between groups.</p><p><strong>Conclusion: </strong> Our data do not support the association between hemolysis and PVL despite elevated LDH in suture-free valves. Our results suggest that LDH could be a marker of extreme heart muscle output or fluttering phenomenon and not a marker of hemolysis after sutureless AVR.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Distal Aortic Events following Emergent Aortic Repair for Acute DeBakey Type I Aortic Dissection: An Inverse Probability of Treatment Weighting Analysis. DeBakey I型主动脉夹层紧急手术后的远端事件。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-26 DOI: 10.1055/a-2454-8883
Shunsuke Miyahara, Gaku Uchino, Yoshikatsu Nomura, Hiroshi Tanaka, Hirohisa Murakami

Objective:  The goal of this study is to examine early and midterm results after surgical treatment of acute DeBakey type I aortic dissection (AIAD) and the effect of the range of aortic arch replacement on overall survival and prevention of distal aortic events.

Methods:  Between March 2002 and July 2020, a total of 374 AIAD aortic repairs were reviewed. A total of 154 (41.2%) patients had total arch replacement (TAR), whereas 220 (58.8%) had hemi- or partial arch replacement (PAR).

Results:  Operative mortality did not show a significant difference (7.7% in PAR, 13.0% in TAR, p = 0.096). Survival at 5 years showed no difference (77.8% in TAR, 72.6% in PAR, p = 0.14). Freedom from reoperations and reinterventions, as well as composite aortic events in the distal aorta, were comparable across groups (p = 0.21, 0.84, and 0.91, respectively). The inverse probability of treatment weighting-adjusted model displayed higher 5-year freedom from reoperations and aortic events in the TAR group (p = 0.029 and 0.054, respectively).

Conclusion:  The extent of arch replacement is determined based on the patient background, making it difficult to compare the superiority of both surgical methods. However, TAR for appropriately selected patients may provide the benefit of avoiding aortic events in the long term.

研究目的本研究旨在探讨急性德巴克I型主动脉夹层(AIAD)手术治疗后的早期和中期效果,以及主动脉弓置换术的范围对总体存活率和预防远端主动脉事件的影响:2002年3月至2020年7月期间,共对374例AIAD主动脉修复术进行了回顾性研究。154名患者(41.2%)进行了全弓置换术(TAR),220名患者(58.8%)进行了半弓或部分弓置换术(PAR):结果:手术死亡率无明显差异(PAR为7.7%,TAR为13.0%,P = 0.096)。5年存活率无差异(TAR为77.8%,PAR为72.6%,P = 0.14)。各组的再手术和再干预以及远端主动脉复合事件发生率相当(p=0.21、0.84 和 0.91)。治疗加权调整模型的逆证明性显示,TAR 组的 5 年免再手术率和主动脉事件发生率更高(p 分别为 0.029 和 0.054):拱门置换的范围是根据患者的背景决定的,因此很难比较两种手术方法的优劣。不过,对于经过适当选择的患者,TAR 可在长期内避免主动脉事件的发生。
{"title":"Distal Aortic Events following Emergent Aortic Repair for Acute DeBakey Type I Aortic Dissection: An Inverse Probability of Treatment Weighting Analysis.","authors":"Shunsuke Miyahara, Gaku Uchino, Yoshikatsu Nomura, Hiroshi Tanaka, Hirohisa Murakami","doi":"10.1055/a-2454-8883","DOIUrl":"10.1055/a-2454-8883","url":null,"abstract":"<p><strong>Objective: </strong> The goal of this study is to examine early and midterm results after surgical treatment of acute DeBakey type I aortic dissection (AIAD) and the effect of the range of aortic arch replacement on overall survival and prevention of distal aortic events.</p><p><strong>Methods: </strong> Between March 2002 and July 2020, a total of 374 AIAD aortic repairs were reviewed. A total of 154 (41.2%) patients had total arch replacement (TAR), whereas 220 (58.8%) had hemi- or partial arch replacement (PAR).</p><p><strong>Results: </strong> Operative mortality did not show a significant difference (7.7% in PAR, 13.0% in TAR, <i>p</i> = 0.096). Survival at 5 years showed no difference (77.8% in TAR, 72.6% in PAR, <i>p</i> = 0.14). Freedom from reoperations and reinterventions, as well as composite aortic events in the distal aorta, were comparable across groups (<i>p</i> = 0.21, 0.84, and 0.91, respectively). The inverse probability of treatment weighting-adjusted model displayed higher 5-year freedom from reoperations and aortic events in the TAR group (<i>p</i> = 0.029 and 0.054, respectively).</p><p><strong>Conclusion: </strong> The extent of arch replacement is determined based on the patient background, making it difficult to compare the superiority of both surgical methods. However, TAR for appropriately selected patients may provide the benefit of avoiding aortic events in the long term.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Impact of Multiarterial Grafting in Patients with Left Ventricular Dysfunction. 多动脉移植对左心室功能障碍患者的影响
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-21 DOI: 10.1055/a-2446-9960
Tom Ronai, Dana Abraham, Ely Erez, Guy Witberg, Yaron Yishai, Erez Sharoni, Dror B Leviner

Background:  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.

Methods:  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%).

Results:  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.

Conclusion:  MAG is associated with improved outcomes following CABG across the spectrum of LV function.

背景:冠状动脉旁路移植术(CABG)是左心室功能障碍(LVD)患者可采用的血管重建方式之一。多支动脉移植术(MAG)可改善长期预后。有关多支动脉移植对 LVD 患者益处的数据还很有限。我们研究了MAG对左心室(LV)功能各方面预后的影响:对接受孤立 CABG(2009 年 1 月 1 日至 2021 年 10 月 1 日)的患者进行回顾性队列研究。根据血管再通策略(单次与 MAG)对患者进行分组。主要研究结果是全因死亡率、脑血管意外、心肌梗死和重复血管再通(主要心脑血管不良事件 [MACCE])的综合结果。MACCE 的累积发生率采用 Kaplan-Meier 曲线绘制。结果根据左心室功能(50%)进行分层:我们的队列包括 4,763 名患者,其中 1,976 人(41.4%)接受了单动脉移植术 (SAG),2,787 人(58.6%)接受了 MAG;3,976 人(83.4%)为男性,中位年龄为 64 岁(四分位数间距 [IQR] 57-71)。左心室功能分布情况为:射血分数(EF)>50%的有2539人(53.3%),EF为30%-50%的有1828人(38.3%),EF为50%的有396人(8.3%),MAG与左心室功能之间无显著交互作用:结论:无论左心室功能如何,MAG 都与 CABG 术后预后的改善相关。
{"title":"The Impact of Multiarterial Grafting in Patients with Left Ventricular Dysfunction.","authors":"Tom Ronai, Dana Abraham, Ely Erez, Guy Witberg, Yaron Yishai, Erez Sharoni, Dror B Leviner","doi":"10.1055/a-2446-9960","DOIUrl":"https://doi.org/10.1055/a-2446-9960","url":null,"abstract":"<p><strong>Background: </strong> 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.</p><p><strong>Methods: </strong> 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%).</p><p><strong>Results: </strong> 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.</p><p><strong>Conclusion: </strong> MAG is associated with improved outcomes following CABG across the spectrum of LV function.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Thoracic and Cardiovascular Surgeon
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