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

Background: Due to the high mortality of lung cancer, the aim was to find convolutional neural network models that can distinguish benign and malignant cases with high accuracy, which can help in early diagnosis with diagnostic imaging.

Methods: Patients who underwent tomography in our clinic and who were found to have lung nodules were retrospectively screened between January 2015 and December 2020. The patients were divided into two groups: benign (n=68; 38 males, 30 females; mean age: 59±12.2 years; range, 27 to 81 years) and malignant (n=29; 19 males, 10 females; mean age: 65±10.4 years; range, 43 to 88 years). In addition, a control group (n=67; 38 males, 29 females; mean age: 56.9±14.1 years; range, 26 to 81 years) consisting of healthy patients with no pathology in their sections was formed. Deep neural networks were trained with 80% of the three-class dataset we created and tested with 20% of the data. After the training of deep neural networks, feature extraction was done for these networks. The features extracted from the dataset were classified by machine learning algorithms. Performance results were obtained using confusion matrix analysis.

Results: After training deep neural networks, the highest accuracy rate of 80% was achieved with the AlexNET model among the models used. In the second stage results, obtained after feature extraction and using the classifier, the highest accuracy rate was achieved with the support vector machine classifier in the VGG19 model with 93.5%. In addition, increases in accuracy were noted in all models with the use of the support vector machine classifier.

Conclusion: Differentiation of benign and malignant lung nodules using deep learning models and feature extraction will provide important advantages for early diagnosis in radiology practice. The results obtained in our study support this view.

The Cox maze procedure is the most effective treatment for atrial fibrillation with the best long-term success rate compared to any other treatment modality, particularly in persistent and long-standing persistent atrial fibrillation. Cardiac surgeons have an unparalleled opportunity to treat atrial fibrillation as a concomitant operation during the treatment of ischemic or valvular disease. In addition, there are many options for surgical ablation of atrial fibrillation. In this review, we share the anatomic basis for surgical atrial fibrillation ablation, focusing on the Cox maze procedure and discuss some key technical points and common pitfalls to provide an effective ablation of atrial fibrillation. These include a discussion of avoidance of pacemaker implantation and other complications, and also how to produce the most effective lesions from a rhythm standpoint.

Background: The aim of this study was to compare the total fluid volume performed by noninvasive Pleth Variability Index in thoracic surgery patients in comparison to conventional fluid management.

Methods: In this prospective randomized controlled study conducted between May 2019 and May 2020, 80 patients (68 males, 12 females; mean age: 58.5±6.7 years; range, 18 to 65 years) were divided into two groups: control (Group C) and the Pleth Variability Index (Group P). After performing routine anesthesia and Pleth Variability Index monitoring for all patients, fluids were given at a rate of 2 mL/kg/h with the standard anesthesia technique. Additional fluid supplementation was provided based on hemodynamic data in Group C. In Group P, 250 mL bolus crystalloid fluid was provided when Pleth Variability Index was >14%. Mean arterial pressure, heart rate, oxygen saturation, arterial blood gas, and blood biochemistry were recorded. Total fluid volumes and urinary output were also recorded.

Results: There was no significant difference between the groups in terms of total fluid volumes or urinary output. In the postoperative period, the oxygen saturation and mean arterial pressure of Group P were found to be higher than those of Group C. The postoperative creatinine and lactate values of Group P were lower than those of Group C.

Conclusion: Although there was no significant difference in the total fluid given to the patients, fluid management by Pleth Variability Index monitoring had a positive effect on mean arterial pressure, oxygen saturation, lactate, and creatinine levels.

Background: The aim of this study was to evaluate the role of radiological and clinical findings in determining lobectomy decision in undiagnosed resectable lung lesions.

Methods: Between January 2014 and April 2023, a total of 135 patients (114 males, 21 females; mean age: 60.8±11.5 years; range, 17 to 84 years) who underwent lobectomy or wedge resection based on clinical and radiological data were retrospectively analyzed. Patients with undiagnosed lung lesions, whose diagnosis could not be confirmed through transthoracic fine needle aspiration biopsy or bronchoscopic endobronchial ultrasound, were included in the study. Clinical data including age, sex, smoking status, history of extrapulmonary cancer, family history of lung cancer, and presence of chronic obstructive pulmonary disease/idiopathic pulmonary fibrosis were noted. Radiological data including lesion size, margin characteristics, internal structure of the lesion, relationship of the lesion with surrounding tissues, and nuclear imaging results were also recorded.

Results: Malignant lesions were detected in 74 patients, while benign lesions were detected in 61 patients. Comparing benign and malignant lesions, age, lesion size, lesion localization, presence of pleural retraction, and moderate-to-high maximum standardized uptake value (SUV_max) on positron emission tomography-computed tomography were found to be correlated with malignancy.

Conclusion: The accurate assessment of lung lesions and prompt identification of possible malignancy are of paramount importance for implementing appropriate treatment strategies.

Background: This study aims to classify wound complications after median sternotomy and provide an up-to-date reconstructive algorithm for multidisciplinary use.

Methods: A total of 15 patients (9 males, 6 females; mean age: 68±5 years; range, 60 to 75 years) who underwent sternal reconstruction for wound complications following median sternotomy between August 2020 and October 2023 were retrospectively analyzed. Wound complications requiring reconstruction were classified into three categories based on the extent of the dead space caused by sternal debridement. Type 1, 2, and 3 wounds presented with only skin defects and an intact sternum, with partial and total sternectomy, respectively. The time to consultation for plastic surgery and the duration of hospitalization were compared.

Results: Among the wounds, type 2 wounds were the most common type seen in 11 patients. Two patients each had type 1 and type 3 wounds. A superior epigastric artery perforator skin flap was used for type 1 wounds. Bilateral pectoral and split pectoral turnover muscle flaps from the side where the internal mammary artery was intact were used for type 2 wounds. A rectus abdominis muscle flap was used for type 3 wounds. Early consultation from plastic surgery reduced the length of hospital stay.

Conclusion: For type 1 wounds, skin flaps ensured sufficient coverage as they involved skin and subcutaneous fat, matching the defect. However, sternal excision required muscle flaps to fill the dead space, in which the vital organs were exposed.

Background: This study aimed to review our institutional experience with the Fontan operation, the adverse severe events we encountered during mid-term follow-up, and the associated risk factors.

Methods: In the study, the medical records of 40 patients (22 males, 18 females) who underwent Fontan operation between August 1993 and August 2020 were retrospectively reviewed. The patients were followed up for at least six months.

Results: The Fontan operation was performed at a median age of 6.5 years (range, 3 to 22 years), and the mean follow-up time was 4.1±3.8 years (range, 0.5 to 17 years). The most frequently occurring defect was tricuspid atresia (45.0%). Fifteen (37.5%) patients experienced 24 late adverse events. Late complications and severe side effects, in order of frequency, were arrhythmia in eight (53.3%) patients, hypoxia in five (33.3%) patients, and ventricular dysfunction in three (20%) patients. While protein-losing enteropathy and mortality were each observed in two (13.3%) patients, Fontan failure, thromboembolic event, pulmonary arteriovenous fistulae, and ascites were each observed in one (6.6%) patient. When possible risk factors for late complications were examined, a statistical significance was not found.

Conclusion: Life expectancy and quality of life of patients with Fontan circulation have increased with advances in surgical technique and increased management success. However, complications are not uncommon after the Fontan operation, and late events remain a significant problem. The results of our study indicate that in mid-term follow-up of patients who underwent Fontan surgery at our institution, although not statistically significant, those who underwent fenestration and those operated at a later age tended to experience more severe events and late complications.

Background: This prospective study aimed to validate the prognostic value of Prevent III (PIII) risk score in patients undergoing aortoiliac revascularization, both in limb-related outcomes and cardiovascular risk.

Methods: The prospective cohort study included 130 consecutive patients (122 males, 8 females; mean age: 62.1±9.2 years; range, 53 to 71 years) undergoing elective aortoiliac revascularization between January 2013 and September 2022. Patients' demographic and clinical characteristics were retrieved and PIII scores were calculated. A risk category was assigned according to the total points: low-risk (score ≤3), medium-risk (score 4-7), or high-risk (score ≥8).

Results: The median follow-up period was 55 months (interquartile range, 39 to 70 months). Twenty-four (18.5%) patients had a PIII score ≥4. Regarding short-term outcomes, patients with PIII scores ≥4 exhibited lower ankle-brachial index changes at 30 days and more extended hospital stays. There were no significant associations between PIII scores and major adverse events at 30 days. However, during follow-up, a PIII score ≥4 was associated with increased major adverse limb events (p=0.036) and all-cause mortality (p=0.007).

Conclusion: The PIII score is a reliable predictor of long-term limb and mortality risk in patients undergoing aortoiliac revascularization procedures, leveraging five user-friendly clinical parameters. More research with larger cohorts and studies comparing PIII with other validated scores should be performed in the future.