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

Background: To evaluate the effect of postoperative vitamin K antagonist (VKA) exposure on structural valve deterioration (SVD) after bioprosthetic aortic valve replacement (AVR).

Methods: We retrospectively analysed 123 patients who underwent surgical bioprosthetic AVR between 2010 and 2025 with adequate echocardiographic follow-up. VKA exposure was recorded during follow-up; for the primary time-fixed Cox model, VKA exposure was defined as cumulative postoperative use ≥3 months (yes/no), and VKA was additionally evaluated as a time-varying covariate in a time-dependent sensitivity analysis. The primary endpoint was VARC-3-defined SVD; secondary endpoints were all-cause mortality, bioprosthetic valve failure, and reoperation/valve-in-valve.

Results: Mean age was 71.3±6.1 years; 65% were male. Porcine and bovine bioprostheses accounted for 71.5% and 28.5% of implants. Median SVD-free survival was 2073 days (95% confidence interval [CI]: 0-4212) in VKA users, while the median was not reached in non-users; the difference was significant (logrank p=0.017). In the adjusted time-fixed Cox model, VKA exposure was associated with higher SVD risk (adjusted hazard ratio [aHR] 2.14; 95% CI 1.08-4.26; p=0.030). In a time-dependent sensitivity Cox model with VKA as a time-varying covariate, periods on VKA were similarly associated with higher SVD hazard (hazard ratio 2.16; 95% CI 1.10-4.23; p=0.025). Porcine bioprostheses were also independently associated with higher SVD risk (aHR 2.71; 95% CI 1.09-6.76; p=0.031).

Conclusion: After bioprosthetic AVR, VKA exposure and porcine bioprostheses were independently associated with SVD. Antithrombotic strategies should consider the potential long-term adverse effects of VKA in the context of prosthesis material and patient characteristics. Prospective multicenter studies are needed to confirm these findings.

Thoracic surgery, encompassing procedures on the lungs, esophagus, mediastinum, and chest wall, carries substantial psychiatric implications that influence outcomes, recovery, and long-term quality of life in adult and pediatric patients. This review synthesizes global evidence on the prevalence and clinical relevance of mental health issues throughout the perioperative period. In adults, preoperative anxiety and depression correlate with increased complications and readmissions, supporting routine screening and optimization of modifiable factors such as substance use and sleep disorders. Postoperatively, priorities include delirium prevention and management of post traumatic stress disorder and body-image distress, especially after extensive resections. Pediatric care demands tailored strategies, focusing on separation anxiety, perioperative preparation with child-life specialists, and recognition of emergence delirium. Overall, integrating psychiatry and enhanced recovery after surgery protocols that address mental health is essential for recovery.

Background: To examine how pathological variables affect prognosis in patients undergoing surgery for epithelioid pleural mesothelioma (PM).

Methods: The study examined 64 patients treated surgery for PM between January 2007 and October 2019, retrospectively. Clinicopathological variables including age, surgical procedure, tumor stage, and detailed histopathological features (nuclear atypia, mitotic count, necrosis, nuclear grading, and tumor grade) were evaluated. Overall survival was analyzed using Kaplan-Meier and Cox proportional hazards regression models. To avoid multicollinearity among interrelated pathological parameters, two separate multivariate Cox models were constructed.

Results: The 5-year survival rate was 8 percent, compared to 62 percent in the first year. Individuals 65 and older had no 5-year survival, whereas patients 65 and younger had a rate of 11 percent (p=0.046). In comparison to groups with mild and moderately high mitotic scores, those with a high mitotic score (p=0.019) had significantly lower median survival and 5-year survival rates. Variables (p<0.15) included in the univariate survival analysis were patients who 65 years and older, type of operation, mitosis, necrosis, tumor stage, nuclear grading, and grade of mesotheliomas. In multivariate analysis, high nuclear grade (Model 1: Hazard ratio [HR]=2.48, 95% confidence interval [CI]: 1.09-5.62, p=0.030) and high tumor grade (Model 2: HR=2.36, 95% CI: 1.05-5.31, p=0.037) were independently associated with worse overall survival.

Conclusion: Pathological grading, represented by either nuclear grade or tumor grade, is the strongest independent prognostic factor for survival in patients with epithelioid PM.

Background: Acute aortic wall failure (AAWF), including rupture and/or dissection phenotypes, represents a rare but often fatal acute aortic event that may develop without overt aneurysmal dilatation. The underlying pathological substrate remains incompletely characterized, although standardized histopathological criteria proposed by the Society for Cardiovascular Pathology (SCVP) have recently improved the consistency of aortic wall assessment in forensic investigations.

Methods: In this retrospective autopsy-based study, 5,277 adult autopsies performed between 2013 and 2023 were reviewed. Non-traumatic fatal AAWF, confirmed by macroscopic and histopathological examination, was included. A total of 93 cases were identified, of which 78 were evaluable histologically according to the SCVP criteria. Cases were classified as rupture without dissection, dissection with rupture, and dissection without rupture. The latter was included as a comparative subgroup to contextualize medial degeneration patterns within the spectrum. Demographic characteristics, comorbidities, event location, cardiac findings, and toxicological results were recorded.

Results: AAWF accounted for 6.7% of cardiovascular deaths. Median age was 58 years (interquartile range 49-67), and 68.8% were male. Eighty cases demonstrated rupture (rupture without dissection or dissection with rupture). Younger decedents (19-45 years) had lower rates of documented hypertension and atherosclerosis, while a comparable proportion met ≥3 SCVP medial degeneration criteria. The ascending aorta was most frequently involved (62.4%). Among histologically examined cases, mucoid extracellular matrix accumulation (65.4%), elastic fiber fragmentation (60.3%), and smooth muscle cell depletion (55.1%) was the most prevalent SCVP features; 43.6% met ≥3 SCVP criteria. Documented hypertension was associated with more advanced medial degeneration on univariable analysis (p=0.002) and was interpreted as pathological coexistence rather than an independent causal determinant. Increased heart weight consistent with cardiac hypertrophy was observed in 80.5% of cases.

Conclusion: Fatal AAWF is characterized by structural medial degeneration identifiable using SCVP criteria and frequently coexists with hypertensive cardiac remodeling in forensic autopsy findings. Standardized SCVP-based assessment may improve diagnostic consistency in forensic practice. Molecular autopsy, particularly in younger decedents, may further clarify etiopathogenesis and support targeted evaluation.

Cardiac herniation is a rare but potentially fatal complication following thoracic or cardiovascular procedures involving pericardial defects. We systematically reviewed 29 reported cases to evaluate causes, presentations, and outcomes. Most occurred after right intrapericardial pneumonectomy, though mediastinal tumour resections, transplantation, and trauma were also implicated. Clinical features included hypotension, superior vena cava syndrome, and cardiac arrest. Diagnosis was achieved by radiography, computed tomography, or echocardiography. Emergent re-thoracotomy with cardiac repositioning and pericardial repair was essential for survival, while delayed recognition was often fatal. Vigilant monitoring and preventive pericardial reinforcement are recommended.

Gorham-Stout disease (GSD), also known as vanishing bone syndrome, is an extremely rare, non-malignant condition marked by progressive osteolysis due to abnormal intraosseous lymphatic and vascular proliferation. Extensive chest wall involvement is particularly uncommon and can present without symptoms, complicating diagnosis and management. In this study, a review of similar cases in the literatures is tabulated with comparison of this case to other articles is presented. A 24-year-old male presented with an incidental finding of "hollowness" in his right chest wall following a muscle strain, but remained asymptomatic otherwise. Imaging revealed near-total disappearance of the right 4th to 6th ribs anterolaterally, and partial resorption of the 7^th and 8^th ribs laterally. MRI confirmed extensive osteolysis with prominent lymphatic and vascular malformations. Histopathologic evaluation showed degenerative bony trabeculae with fibrous tissue and lymphovascular proliferations, confirming GSD. The patient was managed conservatively-vitamin D and calcium supplementation. No progression of disease was detected at subsequent follow-ups. This case underscores the need for high clinical suspicion and comprehensive evaluation in unexplained rib osteolysis. While various medical (bisphosphonates, sirolimus, interferon-α2b) and surgical interventions have been employed, no standard therapy is established. In asymptomatic patients without life-threatening complications, conservative management may be appropriate. The treatment should be personalized based on disease course and complications. The unpredictable prognosis mandates long-term monitoring.

Background: Left atrial invasion is classified as T4 non-small cell lung cancer (NSCLC). Surgical outcomes vary in selected patients. This study presents outcomes of left atrial resection at our center.

Methods: Between August 2008 and May 2022, surgical outcomes of 41 NSCLC patients with left atrial invasion were retrospectively analyzed. Demographics, tumor characteristics, surgical procedures (pneumonectomy, lobectomy), nodal status (N0, N1, N2), and margin status (complete [R0], incomplete [R1]) were recorded. In-hospital mortality, morbidity, and long-term survival were evaluated. Cox proportional hazards regression model was used to assess all-cause mortality.

Results: Mean age was 61.8 (±11.6) years, and 90.2% of patients were male. Median tumor diameter was 4.5 cm (interquartile range, 3.5-5.5 cm), 53.7% of tumors were right-sided. Squamous cell carcinoma was the predominant subtype (78%). Pathological nodal status was N0 in 25 patients and N1/N2 in 8 patients each. Complete resection was achieved in 35 patients (85.4%). In-hospital mortality was 4.8%, and long-term mortality was 70.8%. Median overall survival was 2.11 years (95% confidence interval [CI], 1.17-3.05). Multivariate Cox regression analysis identified N2 disease and incomplete (R1) resection as independent predictors of poor survival (N2: hazard ratio [HR], 3.7; 95% CI, 1.22-11.19; p=0.021; incomplete R1 resection: HR, 4.46; 95% CI, 1.42-14; p=0.010). Age (≥65 vs. <65), smoking, tumor size, side of surgery and neoadjuvant therapy were not significant in either univariate or multivariate analyses (all p>0.05).

Conclusion: In NSCLC with left atrial invasion, surgery is feasible in selected patients, and long-term survival depends on excluding N2 disease and achieving complete resection.

Background: Hypotension during anesthesia induction is a clinically significant event linked to perioperative complications. This study aimed to assess if arterial stiffness and stiffness index, measured by Doppler ultrasonography (USG), can predict hypotension during anesthesia induction in cardiac surgery patients. Secondary objectives included exploring the relationship between arterial stiffness parameters and intraoperative hemodynamics, vasoactive drug use, length of hospital and intensive care unit (ICU) stays, and mortality.

Methods: This prospective, single-center observational study included patients undergoing elective open cardiac surgery between 1^st October 2022, and 1^st May 2023. Arterial stiffness was assessed preoperatively using carotid-femoral pulse wave velocity (PWV) and β-index via Doppler USG. The primary outcome was the development of hypotension during anesthesia induction.

Results: A total of 121 patients were enrolled. The mean PWV was 8.1±3.2 m/s and the median β-index was 8 (range: 1-67). No significant association was found between PWV or β-index and the incidence of induction-related hypotension (p>0.05). PWV showed weak positive correlations with age (r=0.204; p=0.025) and minimum carotid diameter (r=0.219; p=0.016), while the β-index was positively correlated with baseline systolic pressure (ρ=0.260; p=0.004) and minimum carotid diameter (ρ=0.278; p=0.002). No significant correlation was observed with vasoactive drug use, ICU/hospital stay, or mortality (10%).

Conclusion: Preoperative arterial stiffness and stiffness index measured by Doppler USG did not predict anesthesia induction hypotension in cardiac surgery patients. Their clinical utility in this context appears limited, warranting further investigation.