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

Background: In this study, we aimed to evaluate one-year clinical follow-up of patients who underwent bilateral ovarian vein embolization using crossover maneuvers between the ovarian veins via unilateral puncture.

Methods: Between January 2017 and September 2022, a total of 34 women (mean age: 39.6±4.9 years; range, 26 to 52 years) who had pelvic venous disease and underwent bilateral embolization of ovarian veins with unilateral puncture and collateral crossover were retrospectively analyzed. The patients were followed at one, six, and 12 months postoperatively. Symptoms were evaluated using physical examination findings and Visual Analog Scale scores and the need for reintervention was assessed.

Results: Of a total of 34 patients, 21 (61.8%) reported dysmenorrhea and 18 (53%) reported both dyspareunia and lower limb varices. There were no major complications during the procedure. The mean preoperative Visual Analog Scale score was 8.1±0.8, which decreased to 2.1±0.6 at 12 months. Reintervention was necessary for only one patient during one-year follow-up.

Conclusion: Although bilateral ovarian vein embolization with crossover to the contralateral side poses greater technical challenges than unilateral ovarian vein closure, it remains a viable technique with favorable outcomes and lower complication rates.

Background: This study aims to investigate the challenges that female thoracic surgeons in Türkiye faced to due to gender bias in their professional lives.

Methods: Between January 2024 and April 2024, a total of 73 female thoracic surgeons (mean age: 37.1±7.4 years; range, 25 to 53 years) who were working in Türkiye and completed a 44-question survey were included. The online questionnaire was sent by email. It was also shared and disseminated in communication groups (WhatsApp).

Results: Of the 73 participants, 45.2% thought that their academic progress was made more difficult due to being women, 49.3% thought that female surgeons were less likely to have influence in their department, and this perception was more prevalent among specialists than among residents (p=0.029). A total of 64.4% of the participants reported being subjected to mobbing in their professional life due to being women. In addition, 56.2% participants thought that they were taken less seriously by patients, as they were women, and this thought was particularly more prevalent among resident physicians (p=0.038). Totally 75.3% of the participants were subjected to verbal or physical violence by patients or their relatives, and 85% thought that the career of female surgeons would be more affected when they had children compared to male surgeons with children. Also, 42.5% of the participants postponed or would postpone pregnancy to a later time.

Conclusion: Our study highlights the urgent need for change by revealing the challenges faced by female thoracic surgeons in Türkiye, including obstacles in training, professional advancement, and achieving a balance between work, children, and family life, all of which are exacerbated by gender bias.

Hemophilia is a genetic disorder that mainly affects males and leads to a higher risk of bleeding. There is a lack of clarity regarding the safety of coronary artery bypass grafting (CABG) surgery in patients with hemophilia. In this case series, real-life data of four male hemophilia patients aged 45 to 66 years who underwent CABG was presented. One patient needed to undergo reexploration due to nonsurgical bleeding. However, all patients were discharged in good condition. The current experience revealed that CABG in hemophilia patients is safe to perform with a multidisciplinary approach involving hematologists, anesthesiologists, and cardiovascular surgeons.

Background: This study aims to identify predictors of postoperative atrial fibrillation in coronary artery bypass grafting patients using routinely collected preoperative tests.

Methods: Between January 2020 and December 2023, a total of 50 patients with postoperative atrial fibrillation (POAF group; 39 males, 11 females; mean age: 65.9±8.3 years; range, 38 to 77 years) and 50 without postoperative atrial fibrillation (non-POAF group; 41 males, 9 females; mean age: 61.8±10.0 years; range, 41 to 81 years) were randomly selected from a group of patients undergoing two or three-vessel coronary artery bypass grafting. We analyzed preoperative laboratory, demographic and intraoperative data using machine learning models.

Results: The overall incidence of postoperative atrial fibrillation was 21.69%. The three most effective biomarkers were magnesium, total iron binding capacity, and albumin, respectively. A total of 2.0 mg/dL value of magnesium was identified as a threshold value. Magnesium values below 2.0 mg/dL were considered atrial fibrillation-positive, accounting for 25% of the dataset. Total iron binding capacity values higher than 442 µg/dL were considered atrial fibrillation-positive, accounting for 12% of the dataset. The threshold value for albumin was 29 g/dL, and patients with values under this value were considered atrial fibrillation-positive, accounting for 4% of the dataset.

Conclusion: Machine learning models demonstrate encouraging results in identifying risk factors for many entities. It is of utmost importance to establish a ranking among risk factors and determine threshold values to support clinicians in decision making. This is our first experience with machine learning in this patient group after cardiac surgery. Further studies are warranted to confirm these data.

Background: The aim of the study was to evaluate preoperative anxiety, postoperative pain and functional impairment using Brief Pain Inventory (BPI) in patients undergoing surgery for malignancy.

Methods: Between September 2020 and May 2022, a total of 94 patients (60 males, 34 females; mean age 59.5±12.2 years; range, 32 to 84 years) who underwent surgery for lung cancer were prospectively analyzed. The patients were evaluated using the BPI preoperatively and on postoperative Days 0, 3, and 30. The preoperative emotional impacts of patient variables and the influence of surgical management on postoperative pain were examined.

Results: Females experienced more preoperative emotional distress and insomnia (p=0.046, p=0.033, respectively). Patients diagnosed with cancer and had a history of surgery or thoracotomy demonstrated higher preoperative emotional distress (p=0.001, p<0.001, p<0.001, respectively). Postoperatively, patients who underwent thoracotomy reported greater pain with higher functional impairment compared to the video-assisted thoracoscopic surgery group (p=0.002, p=0.018, respectively). Patients whose drains were completely removed by the postoperative Day 3 had reduced discomfort and improved ability to perform breathing exercise (p=0.005, p=0.045, respectively). Thoracotomy and the placement of double drains were identified as independent factors contributing to difficulties in performing breathing exercises and coughing on Day 30 (p<0.05 for all). There was no significant difference in the pain scores and affected functions between the patients with a thoracotomy incision size of <10 cm and ≥10 cm (p=0.200, p=0.113, respectively).

Conclusion: Our study results indicate that a preference for minimal invasive procedures, the use of a single thoracic drain, and the prompt removal of the drain minimize pain and functional impairment. Women, patients with a preoperative diagnosis of malignancy requiring metastasectomy, and history of thoracotomy or surgery experience elevated levels of anxiety. Therefore, consistent monitoring and psychological support may be recommended to improve the quality of life for this patient population.

Background: This study aims to evaluate the mid- and long-term outcomes of patients who underwent carotid endarterectomy with double-layer primary arteriotomy closure technique.

Methods: Between January 2011 and January 2021, a total of 94 patients (58 males, 36 females; mean age: 66.5±8.5 years; range, 40 to 82 years) who underwent carotid endarterectomy were retrospectively analyzed. Doppler ultrasonography, computed tomography or magnetic resonance angiography, and digital subtraction angiography were utilized during follow-up. Stenoses of 50% and above were defined as restenosis.

Results: The mean carotid clamp time was 11.72±2.30 and the mean follow-up was 54.18±27.71 months. Two patients (2.1%) underwent revision due to bleeding and hematoma. No new cerebrovascular events were observed in the postoperative period (<30 days). During the follow-up, six (6.4%) patients with ≥50% stenosis on the same side and 14 (14.9%) patients with stenosis on the opposite side were identified. Primary patency rates were found to be 99% at one year, 95.4% at three years, 90% at five years, 71% at seven years, and 71% at nine years. Age was the only independent risk factor affecting survival.

Conclusion: Our study results suggest that this technique can be used safely in patients with appropriate internal carotid artery diameter with favorable mid- and long-term patency rates.

Background: In this study, we aimed to investigate the prognostic value of the tricuspid annular systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio as a marker of right ventricle-pulmonary artery uncoupling in patients listed for lung transplantation.

Methods: Between January 2011 and December 2020, a total of 173 patients (114 males, 59 females; mean age: 53.1±12.5 years; range, 18 to 77 years) who had advanced lung disease or pulmonary vascular disease and were included in the lung transplant list were retrospectively analyzed. Demographic characteristics, laboratory values, long-term mortality data, and clinical and cardiac catheterization data of the patients were compared using a TAPSE/PASP cut-off value of 0.55 mm/mmHg. The univariate and multivariate regression analyses were performed to identify the value of TAPSE/PASP ratio in predicting long-term mortality. The maximal selective rank test was carried out to determine the optimal cut-off value for TAPSE/PASP ratio.

Results: The univariate regression analysis revealed that the TAPSE/PASP ratio, six-minute walk distance, and albumin level were found to be predictors of mortality (hazard ratio [HR]=0.61, 95% confidence interval [CI]: 0.46-0.80, p=0.007; HR=0.72, 95% CI: 0.56-0.91, p=0.007; and HR=0.77, 95% CI: 0.59-0.99, p=0.04, respectively). In the multivariate regression analysis, the TAPSE/PASP ratio, body mass index, and six-minute walk distance were the predictors of mortality (HR=0.49, 95% CI: 0.34-0.70, p=0.004; HR=0.71, 95% CI: 0.51-0.97, p=0.03; and HR=0.71, 95% CI: 0.54-0.94, p=0.01, respectively).Through the maximal selective rank test, the optimal threshold value for TAPSE/PASP ratio was found to be 0.29 mm/mmHg. Patients with TAPSE/PASP >0.29 mm/ mmHg had an average life expectancy of 47.8 months, while the patients with TAPSE/PASP <0.29 mm/mmHg had an average life expectancy of 17.2 months.

Conclusion: Our study results suggest that a TAPSE/PASP ratio of <0.29 mm/mmHg is a poor prognostic factor for long-term mortality in patients on the waiting list for lung transplantation.