ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

BackgroundAntiphospholipid syndrome and systemic lupus erythematosus are autoimmune inflammatory conditions involving multiple organs and sharing various clinical aspects. Owing to the scarcity of data about the surgical outcomes of these autoimmune disorders, we conducted a systematic review to assess the outcomes for patients with these diagnoses undergoing heart surgery and contextualize the findings regarding high-risk cardiac surgeries.MethodsA thorough search of PubMed, Embase and Scopus used Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards to find articles that involved patients who underwent heart surgery and had antiphospholipid syndrome and systemic lupus erythematosus. Inclusion criteria concentrated on a definitive diagnosis, while case reports and studies lacking data on surgical outcomes were excluded. Using the Joanna Briggs Institute's methodologies, quality evaluation categorized studies according to their risk of bias.ResultsFourteen studies with 277 patients and a prevalence of middle-aged females met the inclusion criteria out of 6381 papers. The major preoperative comorbidity in the cohort was a history of thromboembolic events (43%). Thromboembolic complications (6%) and catastrophic antiphospholipid syndrome (2%), even with appropriate anticoagulation, were notable early post-operative outcomes. Six percent of people died within 30 days. Data from follow-up studies showed a 14% death rate and a 23% frequency of thromboembolic events.ConclusionsWith the striking exception of a high frequency of thromboembolic complications and catastrophic antiphospholipid syndrome, surgical results in patients with antiphospholipid syndrome and systemic lupus erythematosus are analogous to those in high-risk cardiac procedures. Improving surgical care for this susceptible population requires an understanding of these hazards.

BackgroundRheumatic heart disease (RHD) remains a persistent public health challenge, particularly prevalent in developing and underdeveloped regions despite concerted global eradication efforts. The progressive stage of RHD, marked by valvular calcification, necessitates the imperative need to identify prognostic biomarkers. Fetuin-A, well-known for its role as a negative inhibitor of ectopic calcification, is investigated in our study as a potential biomarker for cardiac valve calcification in RHD patients.MethodsIndividuals with confirmed presence of RHD via echocardiography, who exhibited moderate to severe cardiac valve involvement, were enrolled alongside age and sex-matched healthy controls. Enzyme Linked Immunosorbent Assay was performed to analyse serum concentration of fetuin-A in healthy controls and RHD patients. Cytokine profiling was carried out using Cytometric Bead Array.ResultsSixty confirmed RHD patients along with age and sex-matched case-control were evaluated for their serum fetuin-A and serum cytokines levels. Our findings reveal significantly reduced serum fetuin-A levels in RHD patients (1.96 ± 0.608 ng/ml) compared to healthy controls (2.85 ± 0.55 ng/ml) (p < 0.0001). Cytokine profiling shows nearly two-fold elevations in interleukin (IL)-17A, tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), IL-6, IL-10, IL-4 and IL-2 levels among RHD patients versus healthy controls, with IL-6 showing the maximum elevation in serum concentration. Pearson's correlation coefficient (r) values indicate a strong negative correlation between fetuin-A levels in RHD patients and various inflammatory cytokines, including IL-17A (-0.9754), IFN-γ (-0.8142), TNF-α (-0.8281), IL-10 (-0.9183), IL-6 (-0.8479), IL-4 (-0.9182) and IL-2 (-0.9430) (p < 0.05, statistically significant).ConclusionThis study suggests that fetuin-A can be explored as a plausible biomarker for cardiac valve calcification and has an inverse correlation with inflammatory cytokines involved in RHD.

We present the case of an 83-year-old woman who presented with acute bioprosthetic valve thrombosis following surgical aortic valve replacement. On postoperative day 7, transthoracic echocardiography revealed reduced leaflet mobility in an implanted bioprosthetic valve, and contrast-enhanced computed tomography showed hypoattenuated leaflet thickening, leading to the diagnosis of prosthetic valve thrombosis. This case demonstrates that bioprosthetic valve thrombosis can occur even in the acute phase following surgical aortic valve replacement, highlighting the importance of early diagnosis and intervention. Close monitoring of leaflet mobility and thickening via transthoracic echocardiography is essential, with contrast-enhanced computed tomography serving as a valuable complementary tool.

A full-term neonate with d-transposition of the great arteries and an intact ventricular septum was referred to our institution. We successfully performed an arterial switch operation with the LeCompte maneuver. Intraoperative transesophageal echocardiography revealed moderate mitral regurgitation (MR) immediately after weaning from cardiopulmonary bypass. Indocyanine green, diluted 20 times with saline and blood, was injected through the arterial line to perform contrast imaging and check for problems with the reconstructed coronary arteries. Clear coronary visualization was achieved. MR improved over time and had almost disappeared by the time the patient returned to the intensive care unit.

Bombay blood (hh blood) is a rare blood group (4 per million), with no expression of the H antigen present in blood group O. Bombay blood patients can only receive Bombay blood, with autodonation used for elective surgery. We present a Bombay patient (haemoglobin 12.1 g/dL) who needed urgent coronary artery bypass graft surgery. In order to try and avoid transfusion, we used a multidisciplinary approach as well as the use of 'no swabs' (swab/gauze/sponge), until cardiopulmonary bypass was established. This 'experiment' demonstrates that using fewer swabs may be a simple reproducible action that may reduce the need for transfusion, which is especially useful when dealing with a patient of such a rare blood group.

Chondrosarcoma, a primary malignant bone tumor, rarely occurs in the vertebrae. We report a 29-year-old female with a 6 × 4.2 cm chondrosarcoma in the posterior mediastinum originating from the left 9th costa vertebral junction involving vertabrea corpus. Surgical resection performed involving posterior thoracotomy, 8-9th rib resection, 8-9th thoracal vertebrae partial corpectomy, laminectomy, spinal instrumentation, and chest wall stabilization. Pathology confirmed chondrosarcoma with safe margins. The patient remained recurrence-free for 9 years. This case highlights the importance of wide-margin surgical resection and multidisciplinary approaches for long-term survival in chondrosarcoma patients.

Aiming at encouraging young talents to become dedicated surgeon-scientists in the field of thoracic and cardiovascular surgery, an "Oriental Rising Star Award" was established at the 32nd annual meeting of the Asian Society for Cardiovascular and Thoracic Surgery ("ASCVTS 2024") which was held in Wuhan, China, on May 23-26, 2024. The winner of the First Prize was Dr. Yuanjia Zhu from Stanford University, USA. Following the conclusion of the "ASCVTS 2024," Professor Song Wan, Chairman of the Scientific Committee of the "ASCVTS 2024," conducted an interview with Dr. Zhu. Their conversation is presented below.

BackgroundThe extent of anastomotic stenosis after sleeve lobectomy (SL) remains unclear, and there are limited reports on postoperative pulmonary function. This study aimed to compare postoperative pulmonary function between SL and standard lobectomy (STL) and to evaluate anastomotic stenosis in SL.MethodsThis study included 44 SL patients and 825 STL patients from 2012 to 2023. Post- or preoperative forced expiratory volume in 1 s (FEV1.0) values (FEV1.0 preservation rate) were analyzed and compared between the SL and STL groups. The lobe expanded rate values, calculated using volumes of the lung lobe(s) distal to the bronchial anastomosis in the SL group and the corresponding lobe(s) in the STL group, measured using three-dimensional computed tomography (3D-CT), were analyzed and compared. In the SL group, the surface area of the lumen at the site corresponding to the bronchial anastomosis was measured on 3D-CT, and the postoperative/preoperative value (bronchus stenosis rate) was calculated.ResultsThe SL and STL groups significantly differed in terms of the FEV1.0 preservation rate (84.6% vs. 87.7%, p = 0.180); however, the lobe expanded rate was significantly lower in the SL group (119.1% vs. 134.6% p = 0.009). The average bronchus stenosis rate was 64.3%, with no significant difference between wedge and circumferential bronchial resection groups (63.4% vs. 66.4%, p = 0.730).ConclusionThe volume of the lung lobe(s) distal to the bronchial anastomosis after SL was lower than that after STL. However, this did not affect postoperative pulmonary function. The type of bronchoplasty did not influence the development of anastomotic stenosis.

Objective: There is little evidence regarding the most beneficial choice between a mechanical and a bioprosthetic valve in the aortic position in dialysis patients. This meta-analysis compares the survival and freedom from reintervention rates between mechanical and bioprosthetic valves in patients on dialysis undergoing aortic valve replacement surgery.

Methods: Two databases were searched, and the systematic review was performed in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. We conducted one-stage and two-stage meta-analysis with Kaplan-Meier-derived individual patient data and meta-analysis with random-effects model.

Results: Eight studies were included, providing data about 1215 dialysis patients receiving mechanical valves and 1851 patients receiving bioprosthetic valves. During a mean follow-up of 43.1 months, overall survival rates were significantly improved in the mechanical valve group in comparison to the bioprosthetic one (hazard ratio [HR]: 0.76, 95% confidence interval [CI]: 0.69-0.84, p < 0.001). This was confirmed by the two-stage meta-analysis (HR: 0.72, 95% CI: 0.62-0.83, p = 0.00, I² = 17.79%). Regarding freedom from reintervention, no arm offered a statistically significant advantage, according to the two-stage generated analysis (HR: 1.025, 95% CI: 0.65-1.61, p = 0.914). Similarly, there was no evident superiority of a valve type for perioperative outcomes.

Conclusions: Mechanical valves are likely to be associated with a better survival outcome compared to bioprosthetic valves for patients on dialysis undergoing aortic valve replacement. However, freedom from reoperation rates and perioperative outcomes were comparable between the two valve types, with no arm exhibiting a statistically significant advantage.

Case report: A six-year-old child who had undergone cardiac surgery five years ago presented to us with severe mitral valve regurgitation. During her current surgery, the coronary artery was injured during the attempt to release extensive epicardial adhesion, resulting in very poor contractility that prompted a delay in the intended valve repair. The injured coronary vessels were successfully repaired, yet low cardiac output syndrome persisted during perioperative care, necessitating further investigation of the coronary problem. It was later discovered that the patient had anomalous left coronary artery from pulmonary artery (ALCAPA) syndrome.

Discussion: The presence of severe mitral regurgitation, pulmonary hypertension, and anatomical factors may have contributed to the delayed presentation and diagnosis in this case. The severity of mitral regurgitation and the most likely underlying mechanism indicates a low possibility of recovery following coronary repair alone, warranting the need for concomitant mitral surgery. Coronary and mitral repair were performed in this patient, resulting in a favorable outcome.

Conclusions: The management of ALCAPA presents unique challenges, especially in cases with delayed diagnosis. Proper diagnosis and tailored surgical approaches are crucial for achieving favorable outcomes in patients with ALCAPA.