ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

Objective: Reporting clinical outcomes of acute type A aortic dissection.

Methods: Data derived from the survey of the Japanese Association for Thoracic Surgery, the Japan Cardiovascular Database, and the Japanese Registry of All Cardiac and Vascular Diseases were analyzed.

Results: Between 2012 and 2015, the Japanese Registry of All Cardiac and Vascular Diseases study collected 13,131 patients and the hospital mortality was 24.3%. The surgical mortality was significantly lower than medical one (11.8% vs 49.7%; p < 0.001). The Japanese Association for Thoracic Surgery survey disclosed the number of surgeries has been increased to 6157 in 2018 and the hospital death has decreased to 10.5%. The Japan Cardiovascular Database, collected 29,486 patients from 2013 to 2018. Age at surgery was 59.8  ±  14.2 years and patients younger than 65 years in 61% and 21% were older than 75 years. Ninety-four percent had surgery within 24 h after diagnosis. Antegrade cerebral perfusion was used in 74% and deep hypothermic circulatory arrest with/without retrograde cerebral perfusion in 26%. Replacement of the ascending aorta was performed in 62% and total arch replacement in 28%. The aortic valve was replaced in 7.9% and repaired in 4.4%. The hospital mortality was 11%. New stroke occurred in 12%, hemodialysis in 7.3%, paraplegia in 3.9%, and prolonged ventilation in 15%.

Conclusion: The number of operations for type A aortic dissection has increased, and hospital mortality has improved. Although the early results after surgery for type A aortic dissection are acceptable, new strategies to improve early outcomes in patients with preoperative comorbidities are required.

Background: Open surgery is still acknowledged as the gold standard for complex abdominal aortic aneurysm (c-AAA). Recently, advanced-endovascular aortic aneurysm repair (EVAR) for c-AAA has been developed, but its effectiveness compared to open surgery is still unclear.

Method: A systematic search was performed on the MEDLINE through PubMed and ScienceDirect databases. The search was aimed to investigate outcomes of both fenestrated- and chimney-EVAR (consider as advanced EVAR) compared to open surgery in c-AAA. Outcomes included postoperative complications, 30-day mortality, long-term mortality, and reintervention rate. Data were collected using the Mantel-Haenszel fixed effects model with relative risk (RR) as the effect size with 95% confidence interval (CI).

Results: A total of 25 studies (n = 12,845 patients) were included in our study. The results demonstrated that advanced-EVAR correlated with diminished postoperative complications (RR 0.53; 95% CI 0.49-0.57; p < 0.001) compared to open surgery. Advanced-EVAR was associated with lower 30-day mortality compared to open surgery (RR 0.66; 95% CI 0.53-0.82; p < 0.001). Subgroup analysis revealed that fenestrated-EVAR resulted in superior outcomes (p < 0.001), whereas the chimney-EVAR subgroup did not show significant differences (p = 0.79), compared to open surgery in terms of 30-day mortality. Unfortunately, advanced-EVAR was associated with a higher long-term mortality rate (RR 1.46; 95% CI 1.20-1.78; p < 0.001) and a higher reintervention rate (RR 1.26; 95% CI 1.01-1.59; p = 0.04) compared to open surgery.

Conclusion: Advanced EVAR, especially fenestrated-EVAR, presented better short-term outcomes compared to open surgery; however, it failed to demonstrate superiority over open surgery in improving long-term outcomes.

Inflammatory myofibroblastic tumor is considered one of the rarest benign tumors constituting 0.7% of all lung neoplasms. It was first described in 1939. We report a case of a 10-year-old child who presented with recurrent cough and fever. Chest radiography and computed tomography demonstrated complete involvement of right lung by the tumor. The tumor along with the affected lung was meticulously dissected from the surrounding structures and was delivered outside. The histopathology of the specimen revealed it to be inflammatory fibroblastoma.

Background: We aimed to investigate the incidence and risk factors of postoperative acute pancreatitis (PAP) following thoracic aortic surgery with circulatory arrest.

Methods: One hundred fifty-two patients who underwent thoracic aortic surgery with circulatory arrest between February 2015 and March 2023 were retrospectively reviewed. Postoperative acute pancreatitis was defined as the presence of two or more of the following criteria: (1) abdominal pain, (2) postoperative amylase or lipase levels greater than three times the upper limit of normal, and (3) evidence of pancreatitis on postoperative computed tomography (CT) scan. Univariate and multivariate analyses were performed to find risk factors for PAP.

Results: Nine patients (5.9%) developed PAP without mortality. All of the nine patients had elevated pancreatic enzymes and evidence of pancreatitis on CT. They improved with conservative therapy. In multivariate analysis, only cross-clamp time was found to be a significant risk factor for PAP (adjusted odds ratio, 1.04; 95% confidence interval, 1-1.08; p = 0.042).

Conclusion: The incidence of PAP after thoracic aortic surgery with circulatory arrest was 5.9%, and cross-clamp time is an independent risk factor for PAP.

Objectives: Studies have shown exercise rehabilitation training improves exercise tolerance in pulmonary arterial hypertension (PAH) patients. However, implementing such programs in developing countries can be challenging. We investigated the benefits of short-term exercise rehabilitation training for PAH patients in a developing country.

Methods: This study was a prospective study of adult PAH patients attending the cardiology outpatient unit of a tertiary referral hospital. The patients were equally divided into an intervention group and a control group. We measured hemodynamic characteristics and six-minute walking distance (6MWD) before and after four weeks of exercise rehabilitation training. The Shapiro-Wilk normality test was performed, followed by an independent t-test or Mann-Whitney test to statistically compare the data.

Results: We included 28 patients aged 29.1 ± 11 years. We found no significant differences in all hemodynamic characteristics between the groups before and after the rehabilitation (all p-values >0.05). The intervention group showed a significant increase in 6MWD (300.6 ± 90.8 (95% CI: 248.2, 352.9) vs 436.3 ± 58.8 (95% CI: 402.3, 470.2), p-value <0.001) and consequently, the Δ6MWD in the intervention group was remarkably higher (17.1 ± 48.3 (95% CI: -10.8, 44.9) vs 115.36 ± 54.69 m (95% CI: 83.8, 146.9), p-value <0.001).

Conclusion: A short-term exercise rehabilitation training safely improved the exercise tolerance of patients with PAH. Our findings may lead to the improvement of rehabilitation strategies for this detrimental disease in countries with limited resources.

Background: The Nuss procedure is the primary treatment for pectus excavatum (PE), but patient expectations are not always met. In our unit, our standard approach in the last few years has been the routine application of two bars instead of one. We aimed to retrospectively assess the impact of this approach on patient satisfaction, quality of life (QoL) and safety.

Methods: A retrospective study included 182 patients over 16 years old who underwent the Nuss procedure for PE between January 2007 and September 2021. Patients were categorized into one-bar or two-bar correction groups. Propensity score matching (PSM) was used, resulting in 30 patients in each group. Primary endpoints were QoL and cosmetic satisfaction, while secondary endpoints included complications and recurrence.

Results: After PSM, both groups showed similar general characteristics. Patients treated with two bars reported fewer psychological complaints post-surgery (93.3% vs. 73.3%, p = 0.031). There were no significant differences in QoL improvement (96.7% in both groups, p = 0.197), perioperative complications (p = 0.771) or recurrence (one patient in the one-bar group, p = 1.000).

Conclusions: Our study reveals that patients undergoing the Nuss Procedure for PE with two bars exhibit comparable clinical outcomes and QoL to those with one bar. However, patients with two bars may have higher levels of psychological well-being and satisfaction, indicating potential benefits associated with this approach. These findings suggest potential advantages of the two-bar approach, but further research with larger sample sizes is warranted to confirm these observations.

A 6-year-old boy had previously undergone total anomalous pulmonary venous connection repair and postoperative pulmonary vein stenosis release. Magnetic resonance imaging revealed blood stasis caused by a collision between the inflow from the pulmonary veins and the outflow from the left atrial appendage. A surgical specimen revealed evidence of advanced thrombus attachment. Infra-cardiac total anomalous pulmonary venous connection with an antler appearance may be a risk factor for thrombus formation in the left atrial appendage and for postoperative pulmonary venous stenosis due to blood flow collision in the left atrium after total anomalous pulmonary venous connection repair.

Introduction: Thoracic outlet syndrome (TOS) caused by superior mediastinal soft tissue mass has never been reported in the literature, the aim of this study is to discuss a case of TOS caused by a superior mediastinal mass in which the histopathological examinations of the mass showed vascular malformation.

Case report: A 45-year-old female presented with left upper limb pain and numbness for three months, associated with swelling and attacks of shortness of breath. Imaging studies showed soft tissue mass involving the superior mediastinum. The condition of the patient deteriorated and the signs and symptoms of TOS became clearer, all provocative tests and nerve conduction studies were positive. The patient underwent thoracic outlet decompression. The patient did not respond and the symptoms deteriorated further. After a multidisciplinary board discussion, the patient was prepared for median sternotomy under general anesthesia. A total resection of the mass was done. The patient was totally relieved a few hours after the operation.

Discussion: The etiology of TOS can be multifaceted. Several factors contribute to its onset, and these can be categorized as congenital or acquired. Congenital causes include anatomical anomalies such as a cervical rib, or an elongated transverse process of the cervical vertebrae. These anatomical deviations can reduce the size of the thoracic outlet and make it prone to compression.

Conclusion: Although it is rare, TOS could be due to superior mediastinal mass and the treatment of choice is total resection either through median sternotomy or thoracoscopic procedure.

Objective: Partial upper sternotomy is preferred for isolated aortic valve replacement because of its optimal surgical visibility and favorable cosmetic outcomes; however, it is not commonly used for aortic root surgery, and the conventional median sternotomy is still the preferred method for most surgeons. We aimed to compare the safety and effectiveness of a minimally invasive approach (partial sternotomy [PS]) and conventional approach (median sternotomy [FS]) for aortic root surgery.

Methods: Patients who underwent aortic root surgery at our hospital from 2016 to 2021 were retrospectively enrolled and divided into two groups. After propensity score matching, the conventional group included 156 patients and the minimally invasive group-57 patients.

Results: Bicuspid aortic valves were observed in 63 (40.4%) and 33 (57.9%) patients in the FS and PS groups, respectively. Valve-sparing surgery was performed on 69 (44.2%) and 30 (52.6%) patients in the FS and PS groups, respectively. The minimally invasive approach was beneficial in terms of blood loss during the first 24 h after surgery (p = 0.029) and postoperative blood transfusion (p = 0.023). The survival rates and freedom from reoperation or severe aortic regurgitation after the David procedure were comparable between the standard and minimally invasive groups (p = 0.25; p = 0.66) at mid-term follow-up.

Conclusions: A minimally invasive approach for aortic root surgery can be safely performed as the standard approach. Partial upper sternotomy has the advantage of lower blood loss in the early postoperative period and does not negatively affect the results of valve-sparing root replacement.

Background: The usefulness of autologous blood pleurodesis for air leak after pulmonary resection is well known; however, factors predicting the therapeutic efficacy are poorly understood. Herein, we aimed to examine the predictors of early autologous blood pleurodesis for air leak following pulmonary resection.

Methods: Patients who underwent pulmonary resection and autologous blood pleurodesis with thrombin for postoperative air leak between January 2016 and October 2022 were retrospectively analyzed. Patients received 50-100 mL of autologous blood and 20,000 units of thrombin on postoperative days 1-4. If necessary, the same procedure or pleurodesis with other chemical agents was repeated until the air leak stopped. Patients were divided into single-dose and multiple-dose groups based on the number of times pleurodesis had occurred before the air leak stopped and were statistically analyzed. Logistic regression analysis was performed to identify predictors of treatment efficacy.

Results: Of the 922 patients who underwent pulmonary resection, 57 patients (6.2%) were included and divided into single-dose (n = 38) and multiple-dose (n = 19) groups. The amount of air leaks was identified as a significant predictor of multiple dosing, with a cutoff of 60 mL/min, in multivariate logistic regression analyses (odds ratio 1.13, 95% CI 1.03-1.24, p = 0.0065). The multiple-dose group showed a significantly higher recurrence of air leak (p = 0.0417).

Conclusions: The amount of air leaks after pulmonary resection is the only significant factor predicting whether multiple autologous blood pleurodesis is required, and the recurrence rate of pneumothorax is significantly higher in such cases.