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

Background: In this review, we discuss the risk factors of intraabdominal hypertension developing after cardiac surgery.

Methods: We used records from electronic databases (PubMed, Scopus, Web of Science and Ovid) between 1980 and 2025. All studies in which possible pre- and intraoperative risk factors (age, sex, hypertension, diabetes mellitus, lung disease, coronary artery bypass grafting, body mass index and, cardiopulmonary bypass duration) were recorded were included in the analysis. The results of the studies were evaluated with a random or fixed effect model depending on the presence of heterogeneity (I² >25%).

Results: A total of 4,286 articles were found from the database search. After analyzing the abstract and full texts, six articles which met the inclusion criteria and covered 696 patients were included in the analysis. The overall rate of intraabdominal hypertension was 44.68%. Age (standardized mean difference [SMD]: 0.303, 95% confidence interval [CI]: 0.123-0.484, p<0.001), hypertension (odds ratio [OR]=0.524, 95% CI: 0.087-0.960, p=0.019), body mass index (SMD: 0.532, 95% CI: 0.004-1.061, p=0.048), and cardiopulmonary bypass duration (SMD: 0.545, 95% CI: 0.184-0.907, p=0.003) were preoperative risk factors.

Conclusion: The patient's age, hypertension, body mass index, and duration of cardiopulmonary bypass are the risk factors for the development of intraabdominal hypertension after cardiac surgery. However, larger studies are needed to avoid heterogeneity of results.

An aortic pseudoaneurysm is a rare, but serious condition which can result in life-threatening complications. It is usually caused by previous cardiac surgery, trauma, or infection. Due to the high likelihood of rupture with primary surgical intervention, endovascular closure may be performed as the standard of care in eligible cases. In this article, we present a case of a huge aortic pseudoaneurysm with a wide neck which could safely be closed using an atrial septal occluder.

Background: This study aims to evaluate the mid-term outcomes of transcatheter ventricular septal defect closure with the Konar-MF™ device and to investigate the impact of an optimized device selection strategy using a retrograde approach.

Methods: Between January 2019 and November 2023, a total of 58 patients (32 males, 26 females; median age: 4.5 years; range, 8 months to 16 years) who underwent transcatheter closure of ventricular septal defects using the Konar-MF™ device were retrospectively analyzed. Patient demographics, procedural details, and follow-up data were recorded.

Results: Procedural success was achieved in 95% of cases, with a median procedure time of 60 min and fluoroscopy time of 12.6 min. Retrograde implantation was used in 79% of patients, significantly reducing procedural time and minimizing complications associated with an arteriovenous loop. Our refined strategy of selecting smaller devices when anatomically feasible played a crucial role in reducing interference with surrounding cardiac structures, substantially contributing to the absence of complete atrioventricular block in our cohort. Major complications included device embolization, moderate aortic regurgitation due to device dislocation, and right ventricular perforation (each in 1.8% of patients). The median follow-up was 34.5 months. Residual shunt rates were initially 42% on postoperative Day 1, reducing to 1.8% by the end of the follow-up period.

Conclusion: The Konar-MF™ occluder demonstrated high procedural success and acceptable complication rates for perimembranous ventricular septal defect closure. The use of a retrograde approach and a refined device selection strategy were key factors in achieving favorable outcomes, minimizing complications such as atrioventricular block and valve interference. The device offers significant advantages, making it a suitable alternative to surgical ventricular septal defect closure.

Background: This study aims to investigate whether acute surgical manipulation of great saphenous vein grafts during coronary artery bypass grafting alters mammalian target of rapamycin (mTOR) activation and induces early histopathological damage.

Methods: Between September 2022 and September 2023, a total of 44 elective coronary artery bypass grafting patients (38 males, 6 females; mean age: 60.8±8.3 years; range, 36 to 70 years) were included in this prospective study. Saphenous vein segments were collected pre- and post-preparation. Light microscopy and enzyme-linked immunosorbent assay were used to assess structural changes and mTOR levels.

Results: Histopathological analyses revealed endothelial disruption and subendothelial inflammatory infiltration in post-preparation samples. However, mTOR protein levels showed no significant difference between pre- and post-manipulation tissues (p=0.41).

Conclusion: Mechanical stress during great saphenous vein graft preparation causes notable endothelial injury, but does not acutely activate the mTOR pathway. These findings suggest that mTOR may not participate in early responses, but could be implicated in long-term vascular remodeling.

Background: In this systematic review and meta-analysis, we discuss the estimated of global incidence, shunt related-mortality risk and factors associated with shunt blockage after modified Blalock-Taussig-Thomas (mBTT) procedure.

Methods: A systematic review and meta-analysis were conducted using PubMed, ScienceDirect, and EMBASE up to February 2024. The primary outcomes were the incidence and mortality risk associated with shunt blockage. Additional outcomes included study characteristics, surgical factors, and coagulation profiles. Single and two-group proportional meta-analyses were performed.

Results: A total of 25 studies involving 2,677 patients were included. The global incidence of shunt blockage was 7% (95% confidence interval [CI]: 0.05 to 0.10) with high heterogeneity (I² =81%; p<0.01). In 15 studies eligible for mortality analysis, patients with shunt blockage had significantly higher odds of death (odds ratio [OR]=5.04; 95% CI: 2.69 to 9.44) with low heterogeneity (I² =3%; p=0.41). Shunt size alone was not a significant predictor of blockage. However, patients with shunt blockage exhibited significantly lower partial thromboplastin time and activated partial thromboplastin time values, suggesting coagulation abnormalities. No significant difference was found in platelet counts.

Conclusion: Shunt blockage is a critical complication following mBTT shunt, significantly increasing mortality risk. While shunt size is not independently predictive, multiple factors, including patient weight, underlying pathology, coagulation profile, surgical factors, and shunt size-to-weight ratio, may contribute to thrombosis risk and warrant further investigation.

Background: The aim of our study was to evaluate the hemodynamic effects and clinical outcomes of transcatheter fenestration in patients who developed Fontan failure.

Methods: Between January 2014 and December 2022, among a total of 187 patients undergoing the Fontan operation, 10 (6 males, 4 females; median age: 10.9 years; range, 4.2 to 23 years) who underwent transcatheter creation or dilation of a Fontan fenestration due to the development of Fontan failure were retrospectively analyzed. Demographic data, laboratory results, echocardiographic findings, and catheterization parameters of the patients were recorded. The patients were classified into two groups based on the timing of Fontan failure: those who underwent fenestration before hospital discharge constituted the early-stage group, while those who underwent fenestration after discharge were assigned to the late-stage group. These two groups were compared in terms of hemodynamic parameters, changes in oxygen saturation, and complication rates.

Results: Transcatheter fenestration was performed in five patients due to Fontan failure in the early postoperative period, and in five patients in the late period. The median follow-up duration was 2.2 (range, 0.1 to 6) years. Following the procedure, pleural effusion regressed in four patients; median systemic venous pressure decreased by 3.4 (range, 2 to 9) mmHg, while median oxygen saturation dropped by 5.9% (range, 3 to 9%). Clinical improvement was observed in 70% of the patients within the first month. However, one patient died on postoperative Day 44 due to low cardiac output. Fenestration was performed in three patients with protein-losing enteropathy, and clinical improvement was achieved in all of them.

Conclusion: Transcatheter Fontan fenestration is a reliable therapeutic option for reducing systemic venous pressure and achieving hemodynamic improvement in symptomatic Fontan patients. Our study highlights the low complication rates and the potential of this procedure to yield favorable clinical outcomes. Transcatheter fenestration plays an important role in the management of high-risk Fontan patients.

Background: This study aims to evaluate the effectiveness of application of physiotherapy via remote telerehabilitation in the early postoperative period following thoracic surgery.

Methods: Between October 2020 and July 2024, a total of 40 patients (25 males, 15 females; mean age: 57.8±9.6 years; range, 42 to 77 years) who underwent thoracic surgery due to Stage 1A-3B non-small cell lung cancer were included in this randomized-controlled clinical study. The patients were divided into two groups: the telerehabilitation group (TG, n=20) and the control group (CG, n=20). Patients in the TG participated in a teleconference-based exercise program supervised by a physiotherapist, starting the day before surgery and continuing daily until discharge. Patients in the CG received a single preoperative exercise session and an educational brochure. All patients were assessed at five time points: preoperatively, immediately after surgery, prior to discharge, at one to three months post-discharge, and at six months post-discharge. Outcome measures included the duration of intensive care unit stay, total hospital stay, chest drain duration, postoperative complications, inflammatory biomarkers, pain, dyspnea, fatigue, spirometry, and State-Trait Anxiety Inventory (STAI) scores.

Results: Both groups had similar baseline characteristics including comorbidities and types of surgery (p>0.05). There were no significant differences in the intensive care unit stay duration (p=0.739), total hospital stay (p=0.311), or chest drain duration (p=0.431) between the groups. However, TG showed significantly lower pain and fatigue levels compared to CG (p<0.05).

Conclusion: Telerehabilitation effectively reduced pain and fatigue in patients after thoracic surgery. The lack of significant differences in other outcomes may be attributed to variations in patient compliance. These findings suggest that telerehabilitation can be a valuable alternative to traditional rehabilitation, particularly during pandemic or isolation.

Background: This study aim to evaluate the feasibility of threedimensional (3D) modeling using open-source free software for preoperative planning and intraoperative guidance in uniportal video-assisted thoracoscopic segmentectomies.

Methods: Between October 2020 and November 2023, 50 patients (27 males, 23 females; mean age: 60±11.1 years; range, 34 to 78 years) who underwent uniportal video-assisted thoracoscopic pulmonary segmentectomy with preoperative 3D modeling were retrospectively analyzed. Preoperative 3D modeling was performed using computed tomography with an open-source 3D software program. The virtual models exported to the mobile device were compared with the anatomical structures of the patient intraoperatively. The patients were divided into two groups as simple and complex segmentectomy according to the characteristics of the surgical procedures.

Results: The overall matching success rate of the virtual 3D models with intraoperatively identified bronchovascular structures was 99.27%. The overall variation rate was 36% (n=18) among all patients. There was a significant difference between the two groups in terms of the bronchovascular variation. The bronchovascular variation rate was 11.1% (n=2) in Group 1 and 50% (n=16) in Group 2 (p=0.006).

Conclusion: Three-dimensional modeling using open-source software for preoperative planning and intraoperative guidance is a reliable method for detecting bronchovascular structures of the target segment with high accuracy in uniportal video-assisted thoracoscopic surgery segmentectomy.