ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

IntroductionCoronary artery bypass graft (CABG) surgery is performed globally around 400,000 times annually. Despite its benefits, CABG can lead to complications, including chylothorax, a rare condition where chyle accumulates in the pleural cavity due to thoracic duct trauma. Currently, there are no international guidelines for traumatic chylothorax management post-CABG. This is the first systematic review to provide a comprehensive overview of the current state of management for chylothorax post-CABG.MethodsThis systematic review was conducted by searching EMBASE, Cochrane, Ovid and PubMed databases on 16 June 2024. The inclusion criteria focused on studies addressing post-CABG chylothorax management and reporting clinical outcomes. Data was extracted from 11 studies focusing on graft type, complications and management strategies.ResultsThis review included 11 case report studies with 14 cases of post-CABG chylothorax. Conservative management was attempted in all cases, with varying components such as total parenteral nutrition, nil by mouth, octreotide and low-fat diets. High-output chylothorax (>1000 mL/day) often necessitated surgical intervention after an average of 12.5 days of conservative management. Surgical approaches included thoracic duct ligation, embolisation and pleurodesis. Surgical ligation was effective in three cases, while thoracic duct embolisation was successful in one case.ConclusionsChylothorax post-CABG is managed initially with conservative strategies, but high-output cases often necessitate surgical intervention. This review highlights the need for standardised guidelines, regarding the timing of surgical escalation and the use of octreotide and somatostatin. Further research should focus on higher-powered studies to validate these findings and establish clinical guidelines for managing chylothorax post-CABG.

BackgroundEndovascular abdominal aneurysm repair (EVAR) offers a less invasive approach to treating abdominal aortic aneurysms (AAA) compared to open repair. However, EVAR is associated with higher rates of reintervention. This study investigates the early and mid-term outcomes of patients who underwent late open conversion including aneurysmorrhaphy after EVAR at our institution.MethodsWe conducted a retrospective cohort study of 29 patients who underwent late open conversion for AAA dilatation after EVAR between April 2015 and March 2022 at Chiba University Hospital. Surgical strategies included an artificial graft replacement for Type Ia endoleak (EL), Type III EL from stent graft main body, ruptured cases, and aneurysmorrhaphy with branch ligation for Type II EL.ResultsThe average time from EVAR to open conversion was 4.1 ± 2.3 years. There have been no reported cases of in-hospital mortality to date. Aneurysmorrhaphy demonstrated shorter operative times (239 ± 65 min) and lower red blood cell transfusion volumes (2.7 ± 4.2 units) compared to graft replacement. Postoperative complications included spinal cord ischemia in one patient and three patients requiring reintervention due to persistent or new ELs, who underwent angiography. The seven-year all-cause mortality rate was 78.5%. Among cases that underwent aneurysmorrhaphy, postoperative computed tomography scans showed a reduction in the maximum aortic diameter from 65 ± 6 mm preoperatively to 42 ± 10 mm postoperatively and 36 ± 11 mm at follow-up.ConclusionsLate open conversion including aneurysmorrhaphy after EVAR appears to be safe and effective, with no in-hospital mortality and low complication rates. Careful preoperative planning and appropriate surgical techniques are essential for optimizing outcomes.

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.