Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery最新文献

Background: This study aims to identify main factors playing a role in patient's selection of a thoracic surgeon in Türkiye.

Methods: Between July 2022 and June 2024, a total of 147 patients (96 males, 41 females; mean age: 56.1±14.7 years; range, 19 to 93 years) who underwent lung resection and completed an anonymous questionnaire sent via e-mail or cell-phone were included. Demographic data of the patients, surgeon's educational and medical background, advertisements and popularity, age and sex, appearance and communication skills, and surgeon's working center were evaluated.

Results: "Spending adequate time with patients" had the highest score, while "the distance between surgeon's center and patient's home" had the lowest score. In general, criteria about surgeon's appearance and communication skills, and surgeon's working center had significantly the highest rates, whereas those of surgeon's advertisements and popularity had the lowest rates (p<0.05). Recommendation by another doctor or family doctor was insignificantly more important than by non-medical person. Patients were not influenced with internet reviews or scoring about the surgeon, presence of surgeon's personal web page, or social media accounts, or age/sex of the surgeon (p>0.05).

Conclusion: Turkish patients mostly take into consideration the attitudes of the surgeon rather than surgeon's reputation and professional experience, while selecting a thoracic surgeon. Surgeon-patient interaction is highly important for Turkish patients. Social media and advertisements are not important criteria in the selection of thoracic surgeon in Türkiye.

Background: This study aimed to investigate the effect of operative and postoperative parameters on late-onset hyperlactatemia (LOHL) after cardiac surgery in the pediatric patient population.

Methods: One hundred fifty-nine ventricular septal defect patients (77 males, 82 females; mean age: 8.0±8.6 years; range, 1 to 48 years) were retrospectively examined between August 2020 and February 2023. Patients with the highest lactate value measured between 6 to 12 h postoperatively <3 mmol/L were defined as Group 1, and those with lactate values ≥3 mmol/L (LOHL) were included in Group 2.

Results: Cardiopulmonary bypass (CPB) time, aortic cross-clamp time, and CPB flow did not differ between groups (p=0.916, p=0.729, and p=0.699, respectively). The difference between partial oxygen pressure (PaO₂) in the first blood gas obtained after CPB was statistically significant (p=0.017). The lactate level measured in the first arterial blood gas obtained after CPB was 1.74±0.61 mmol/L in Group 1 and 3.01±1.63 mmol/L in Group 2 (p<0.001). The PaO₂ in the arterial blood gas measured at 6 h postoperatively was 129.22±61.20 mmHg in Group 1 and 156.07±64.49 mmHg in Group 2 (p=0.046).

Conclusion: The development of hyperlactatemia due to ischemia in the early post-CPB period may affect the development of LOHL. Microcirculatory changes at the tissue level may play a role in the etiology of LOHL.

Background: The aim of this study was to evaluate the surgical outcomes of patients who underwent tracheal resection due to post-intubation tracheal stenosis.

Methods: Between January 2014 and December 2021, a total of 44 patients (32 males, 12 females; median age: 48.2 years; range, 13 to 68 years) who underwent tracheal resection and reconstruction for post-intubation tracheal stenosis in our clinic were retrospectively analyzed. Demographic and clinical data of the patients, radiological imaging, and laboratory results and operative and postoperative follow-up data were recorded.

Results: The most common reason for intubation among the patients included in the study was trauma. All patients had stridor. Twenty-six (59.1%) patients had at least one comorbidity. Stenosis was located in the upper half of the trachea in 33 (75%) and in the lower half of the trachea in 11 (25%) patients. The length of the tracheal segment removed during surgery was <3 cm in 26 (59.1%) and >3 cm in 18 (40.9%) patients. A total of 16 (36%) patients developed complications. Complications were more frequent in patients with a history of preoperative tracheostomy, presence of comorbidities and resection of the upper half of the trachea. The patients did not receive jaw-neck sutures thanks to the use of retention sutures in our clinic. The median length of stay in the hospital was 5 (range, 4 to 16) days.

Conclusion: Significant predisposing factors for complications include preoperative tracheostomy history, comorbidities and resection of the upper half of the trachea. In our study, the patients did not receive jaw-neck sutures thanks to the use of retention sutures, which increased patient comfort in the postoperative period and decreased the frequency of anastomosis-related complications.

This case report presents a rare occurrence of both subcutaneous and cardiac hydatid cysts in a pediatric patient. A 10-year-old girl admitted with a rapidly enlarging, painful mass in the right dorsal scapular region. During a biopsy procedure under sedation, the patient developed an anaphylactic reaction and subsequent cardiopulmonary arrest. After successful resuscitation, cardiac echocardiography revealed a large hydatid cyst in the interventricular septum. In conclusion, potential complications should always be considered during invasive procedures. In addition, in patients with musculoskeletal masses, a whole-body magnetic resonance imaging may detect and prevent potential complications at an early stage.

Background: This study aims to analyze the early- and long-term outcomes of concomitant off-pump coronary artery bypass grafting and pulmonary resection for lung cancer or a thoracic mass.

Methods: Twenty-three patients (17 females, 6 males; mean age: 69.7±6.5 years; range, 59 to 83 years) who underwent concomitant off-pump coronary artery bypass grafting and thoracic surgery procedures for lung cancer or a thoracic mass between March 2018 and February 2024 were included in the retrospective study. The surgical approach was median sternotomy for off-pump coronary artery bypass grafting, and video-assisted thoracoscopic surgery was preferred for lung tumor resections. Mortality, major adverse cardiac events, cerebrovascular events, and duration of hospital stay were evaluated.

Results: There were no postoperative deaths or perioperative myocardial infarctions. None of the patients experienced pneumothorax or atelectasis. None of the patients sustained excessive blood loss requiring reoperation. Arterial grafts were the first choice during coronary artery bypass grafting. Wedge resections, lobectomies, segmentectomies were performed in the subsequent video-assisted thoracic surgery. All patients were followed for six to 86 months. Four patients died during the postoperative one-year period, and one patient died at postoperative 29 months due to cancer relapse. The overall one-year survival rate was 86.5%, and three- and five-year survival rates were 74% and 74%, respectively.

Conclusion: The video-assisted thoracoscopic surgery approach provides a more favorable perspective for pulmonary resection and mediastinal lymph node dissection, which has importance in patients' final diagnosis, than the sternal view due to more ample, wider workspace. Combined off-pump coronary artery bypass grafting and pulmonary resection in patients with lung cancer is safe and effective and reduces possible complications of a second major surgery.

Background: The aim of this study was to evaluate patients with traumatic vertebral fractures and accompanying rib fractures in terms of complication development and need for surgery.

Methods: Between January 2019 and September 2022, a total of 173 patients (138 males, 35 females; mean age: 53.0±18.5 years; range, 17 to 95 years) who had vertebral and accompanying rib fractures due to blunt and penetrating trauma were retrospectively examined. The patients were divided into three groups: upper cervical (n=8), lower cervical (n=31), and thoracolumbar (n=134). Among the groups, trauma mechanisms, rib fracture numbers, accompanying thoracic pathologies, complication developments, and need for surgery were compared.

Results: There was a significant difference between men and women in terms of trauma mechanisms (p=0.001). The mean number of accompanying rib fractures was 5.03±3.19. Number of accompanying rib fractures was higher in patients who developed complications compared to those who did not develop complications (p=0.007). Accompanying hemothorax was significantly higher in patients with upper cervical vertebral fractures (p=0.019). Need for spinal surgery to be significantly higher in patients with upper cervical vertebral fractures (p<0.01). Development of complications was higher in patients with burst fracture than in those without (p=0.004). There was a significantly higher need for spinal surgery in patients with burst fractures and lamina fractures (p<0.001 for both).

Conclusion: Identification of risk groups is critical for the management of trauma patients. The type and level of vertebral fractures are related to the presence of hemothorax, the development of complications, and the need for surgery.

Background: The study aims to identify factors associated with mortality in elderly patients undergoing surgery for acute limb ischemia.

Methods: Between October 2010 and January 2024, a total of 205 patients (106 males, 99 females; mean age: 77.7±8.0 years; range, 65 to 98 years) who underwent embolectomy for acute limb ischemia were retrospectively analyzed. Postoperative mortality and one-year mortality were designated as primary outcome measures. Multiple regression analyses were performed for variables related to postoperative mortality, and cut-off values for numeric variables were determined. The Kaplan-Meier survival analyses were performed using one-year mortality data.

Results: Postoperative mortality rate was 35.1% and oneyear mortality rate was 56.6%. A total of 52.8% of the patients who died postoperatively were functionally dependent and 72.2% had no history of atrial fibrillation. Multivariate analysis revealed that a neutrophil-to-lymphocyte ratio above 5.91 increased mortality by 9.1 times, functional dependency by 7.3 times, and absence of a history of atrial fibrillation by 3.3 times. Functional dependency, absence of atrial fibrillation, and neutrophil-to-lymphocyte ratio greater than 5.85 negatively affected one-year mortality.

Conclusion: Our study results indicate that absence of atrial fibrillation, functional dependency, and neutrophil-to-lymphocyte ratio can be used to predict postoperative mortality.

Background: This study aimed to assess the outcomes of valve-in-valve implantation within previously placed bioprosthetic valves.

Methods: This single-center retrospective study included patients who underwent percutaneous valve-in-valve procedures between July 2014 and September 2023. These patients had previously received pulmonary bioprosthetic valves via surgical or transcatheter methods.

Results: The study included 20 patients (13 males, 7 females; mean age: 20.4±7.1 years; range, 10.8 to 35.8 years). Preprocedural assessment revealed stenotic dysfunction in 12 patients, regurgitant dysfunction in two patients, and a combination of both in six patients. Following implantation, there was a notable improvement in invasive measurements; systolic right ventricular pressure decreased from 64.0±24.5 mmHg to 31.3±6.7 mmHg (p<0.001), right ventricular outflow tract gradient from 44.0±23.2 mmHg to 7.6±5.8 mmHg (p<0.001), and echocardiographic pulmonary regurgitation grade from 2.1±1.2 to 0.2±0.4 (p<0.001). The median time between initial bioprosthetic pulmonary valve placement and valve-in-valve procedure was 8.2 years (IQR, 6.2 to 9.9 years). The median follow-up duration was 24.8 months (IQR, 8.3 to 40.2 months). Only one patient required a repeat PPVI procedure 10 years after the valve-in-valve procedure, while no other patients required reintervention during the follow-up period.

Conclusion: Valve-in-valve implantation within previously placed bioprosthetic valves is a feasible and safe approach, offering symptom relief and eliminating the need for further surgical interventions.

Background: This study aims to evaluate the long-term results of patients with non-small cell lung cancer who underwent pulmonary artery resection and reconstruction.

Methods: Between January 2010 and January 2023, a total of 50 patients (47 males, 3 females; mean age: 60.5±8 years; range, 43 to 83 years) who underwent lobectomy and pulmonary artery resection and reconstruction due to invasion of the pulmonary artery were retrospectively analyzed. Partial resection was performed in 45 patients. Circular pulmonary artery resection was performed in the remaining five patients. Demographic data of the patients, histopathology, lymph node metastasis, tumor size, T status, stage, comorbidity, neoadjuvant treatment and adjuvant treatment were recorded. Survival analysis was performed.

Results: All patients were operated via thoracotomy. Except for those who underwent tangential resection with a stapler, the proximal and distal parts of the artery were resected by placing a Satinsky clamp. In 35 (70%) patients, pulmonary artery invasion originated from the tumor itself, while in 15 (30%) patients, it originated from the lymph node. The five-year survival rate was 46%, with an operative mortality rate of 6% and a morbidity rate of 24%. Cox regression analysis identified neoadjuvant treatment and N2 disease as statistically significant factors influencing survival. The median disease-free survival time for all patients was 27.9 (range, 4.5 to 51.2) months. Operated side, neoadjuvant treatment, N status, reason for pulmonary artery resection, sleeve resection and type of pulmonary artery resection showed statistically significant differences in the Kaplan-Meier analysis.

Conclusion: Our study results suggest that pulmonary artery resections and reconstructions are feasible with acceptable morbidity and mortality rates. Neoadjuvant treatment, N2 disease, and the reason and type of pulmonary artery resection are potential factors influencing long-term survival. Pulmonary artery reconstruction is safe in experienced clinics with promising long-term survival outcomes.