Thoracic and Cardiovascular Surgeon最新文献

Although advancements in the management of thoracic aortic disease have led to a reduction in acute mortality, individuals requiring postoperative reintervention experience substantially worse long-term clinical outcomes and increased mortality. We aimed to identify the risk factors for postoperative reintervention in this high-risk population.This prospective observational cohort study included patients who survived endovascular or open surgical treatment for thoracic aortic disease between January 2009 and June 2020. We excluded those with inflammatory or traumatic thoracic aortic diseases. The risk factors were identified using multivariate logistic regression and Cox proportional hazards regression models.The study included 95 genetically tested patients aged 54.13 ± 12.13 years, comprising 67 men (70.53%) and 28 women (29.47%). Primary open surgery was performed in 74.7% and endovascular repair in 25.3% of the patients. Of these, 35.8% required one or more reinterventions at the time of follow-up (3 ± 2.5 years, mean ± standard deviation). The reintervention rate was higher in the endovascular repair group than in the open repair group. Among the potential risk factors, only residual aortic dissection emerged as an independent predictor of reintervention (odds ratio: 3.29, 95% confidence interval: 1.25-8.64).Reintervention after primary thoracic aortic repair remains a significant clinical issue, even in high-volume tertiary centers. Close follow-up and personalized care at aortic centers are imperative. In our cohort of patients with thoracic aortic disease undergoing open or endovascular surgery, postoperative residual dissection was independently associated with the necessity of reintervention, emphasizing the importance of intensified clinical monitoring in these patients.

Respiratory muscle strength affects pulmonary function after lung resection; however, the role of diaphragm density, an emerging index of muscle quality, remains unexplored. We investigated the role of crural diaphragm density (CDD) in respiratory complications (RC) after video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer.A total of 118 patients were retrospectively enrolled between 2015 and 2022. Exclusion criteria were neoadjuvant therapy, thoracic trauma, and previous cardiothoracic and abdominal surgery. Demographic, functional, and radiological data were collected. The CDD in Hounsfield Unit (HU) was defined as the average of the density of the right and left crural diaphragm at the level of the median arcuate ligament on computed tomography axial images. RC included sputum retention, respiratory infections, atelectasis, pneumonia, respiratory failure, and acute respiratory distress syndrome.The prevalence of postoperative RC was 41% (48 of 118). RC occurred mostly in males (64.6 vs. 44.3%, p = 0.04), current smokers (41.7 vs. 21.4%, p = 0.02), a longer surgical procedure (210 vs. 180 minutes, p = 0.04), and a lower CDD (42.5 vs. 48 HU, p = 0.05). The optimal cutoff of CDD was 39.75 HU (sensitivity 43%, specificity 82%, accuracy 65%, area under the curve: 0.62, p = 0.05), slightly above the threshold for reduced muscle mass (<30 HU). By multivariable logistic regression a CDD ≤ 39.75 HU (hazard ratio [HR]: 3.134 [95% confidence interval, CI: 1.111-8.844], p = 0.03) and current smoking (HR: 2.733 [95% CI: 1.012-7.380], p = 0.05) were both independent risk factors of postoperative RC.The CDD seems to be a simple and useful tool for predicting RC after VATS lobectomy, especially among current smokers. Such patients, identified early, could benefit from preoperative functional and nutritional rehabilitation.

Although insurance status has been linked to surgical outcomes in thoracic aortic operations, its specific association with the outcomes of Type A Aortic Dissection (TAAD) repair remains underexplored. This study aimed to conduct a comprehensive, population-based analysis to assess the association between insurance status and in-hospital outcomes after TAAD repair using a national registry.Patients who underwent TAAD repair were identified in National Inpatient Sample from the last quarter of 2015 to 2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients using public and private insurance while adjusting for demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status.There were 2,380 (55.58%) and 1,468 (34.28%) patients under public and private insurance, respectively. Patients under public and private insurance had comparable time from admission to operation (p = 0.08) and adjusted in-hospital mortality rates (aOR = 1.172, 95 CI = 0.925-1.484, p = 0.19). However, patients under public insurance had higher mechanical ventilation (aOR = 1.185, 95 CI = 1.024-1.373, p = 0.02), acute kidney injury (aOR = 1.213, 95 CI = 1.052-1.399, p = 0.01), and infection (aOR = 1.428, 95 CI = 1.087-1.876, p = 0.01). Moreover, patients under public insurance had higher transfer-out rate (p < 0.01), longer length of stay (p < 0.01), and higher total hospital charge (p < 0.01).Although patients with public insurance had comparable adjusted mortality outcomes to those of privately insured patients, they experienced higher rates of postoperative complications and resource utilization. Future studies should investigate the underlying systemic reasons for these disparities and explore strategies for improving surgical outcomes and ensuring equitable healthcare delivery for these vulnerable populations.

To construct and internally validate a nomogram predicting postoperative delirium (POD) in patients with pulmonary malignancies undergoing lobectomy.Clinical electronic medical record data were retrospectively collected from 1,066 patients who underwent lobectomy, divided into a training cohort (746) and a validation cohort (320) using a 7:3 temporal split. A nomogram for POD was developed using Lasso regression and multivariable logistic regression analysis according to the TRIPOD statement. Performance was assessed through receiver operating characteristic curves (ROC) and calibration plots.POD occurred in 203 patients (19.04%). The nomogram incorporated predictors such as age, body mass index (BMI), education level, history of diabetes, history of cerebrovascular disease, surgical approach, duration of surgery, and time to recovery from anesthesia. The area under the ROC curve (AUC) was 0.871 (95% confidence interval [CI]: 0.841-0.901) for the training cohort and 0.914 (95% CI: 0.877-0.951) for the validation cohort. Calibration curves demonstrated good agreement between predicted and actual probabilities in both cohorts.This novel nomogram can help clinicians and patients' families predict the likelihood of developing delirium following lobectomy, enabling the implementation of targeted prevention strategies.

The possible relationships between the histopathological findings of carotid body tumors and age, gender, tumor diameter, and Shamblin classification were investigated. In addition, preoperative embolization status, development of neurological complications, need for vascular reconstruction, hemoglobin change, and discharge time were examined and the effects of these variables on each other were analyzed.Between 2008 and 2022, 46 cases who underwent carotid body tumor excision were examined retrospectively. The cases were followed for an average of 81 months postoperatively. Histopathological materials were reexamined and the effect of categorical variables was analyzed.Mean tumor diameter was 3.55 ± 1.26 cm, mean discharge time was 3.91 ± 2.37 days, and mean hemoglobin change was 1.86 ± 1.25. Neurological complications developed in 13% of cases. The amount of hemoglobin change was significantly (p = 0.003) higher in those who developed neurological complications, whereas the tumor diameter and discharge time were found to be insignificantly higher. Surgical complications requiring vascular repair occurred in 10.8% of cases. Tumor diameter (p = 0.017) and hemoglobin change (p = 0.046) were significantly higher in these patients. There were significant correlations between higher Shamblin classification and tumor diameter, discharge time, postoperative hemoglobin value, and number of surgical and neurological complications. No significant difference was found between K_i-67, capsular invasion, mitosis, pleomorphism, prominent nucleoli, mean island diameter, and tendency of islands to merge with categorical variables.As the tumor diameter increases, the operation becomes more difficult and the postoperative complication rate increases. We think that subadventitial and capsular removal of the tumor is effective in preventing recurrence. To reach a histopathological conclusion, a larger series of studies including tumors with high K_i-67 and mitosis rates, large size, and one or more of the criteria for necrosis are needed.

This study aimed to investigate if frozen elephant trunk (FET) implantation leads to negative cardiac remodeling in dissection and non-dissection patients and to determine whether there are differences when FET is implanted as an aortic redo procedure or initially.Between March 2013 and April 2022, 148 patients received FET without any concomitant procedures and therefore formed our cohort. One hundred and four were treated for dissecting and 44 for non-dissecting pathologies. Eighty-four received FET initially and 64 as an aortic redo procedure. Data were collected retrospectively using our center's dedicated aortic database as well as transthoracic echocardiographic reports of our cardiologists.In the first weeks after FET implantation, dissection and non-dissection patients show a significant increase of mild valvular insufficiencies-a significant decrease of ejection fraction is only seen in dissection patients but these changes do not stay significant during later follow-up. Patients who receive FET as an aortic redo procedure tend to have significantly larger left ventricular (LV) end-diastolic diameters and higher LV masses, however, in longitudinal analysis, there were no long-term negative effects in patients who received FET initially or as aortic redo.In the first 2 years after implantation, FET has no echocardiographically measurable effect regarding negative cardiac remodeling in dissection and non-dissection patients, independent of the fact it is implanted initially or as an aortic redo procedure.

Thoracoscopic right upper lobectomy is a demanding procedure especially in case of hilar adhesions. Herein, we reported a simple technique of simultaneous ligation of hilar structures to facilitate thoracoscopic right upper lobectomy. After resections of fissures and of hilar lymph nodes, the following structures were sequentially isolated and simultaneously resected in their natural position: V2 + A2 vessels; right upper bronchus; and V1 + V3 + A1 + A3 vessels. This technique was successfully applied in nine patients. The mean hospitalization was 5.2 ± 3.3 days. No intraoperative and major postoperative complications were observed. All patients were alive without recurrence (median follow: 34 months).

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.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).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).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.

Postinfarction left ventricular aneurysm (LVA) still remains a complication after myocardial infarction with a poor prognosis. Its incidence has decreased due to improved treatment, however, it may have experienced a renaissance due to the coronavirus disease 2019 pandemic. In this retrospective, single-center cohort study, we analyzed n = 17 patients who underwent left ventricular reconstruction after Dor. The results show a mean intensive care unit stay of 8 ± 16 days and a 30-day mortality rate of 6%. Mean postoperative ejection fraction was 44 ± 8% indicating an increase in all but three cases. This suggests that patients with an LVA can be successfully treated, and it is safe when performed by experienced surgeons. Therefore, they should still be considered for surgery early on.