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

The 7-year outcomes of the Placement of Aortic Transcatheter Valves 3 (PARTNER 3) trial comparing transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in low-risk patients indicate that the narrowing difference between the two strategies reflects study design convergence rather than true clinical equivalence. Although the composite endpoint of death, stroke, and rehospitalization appeared comparable, important asymmetries persisted. Notably, approximately one quarter of patients in the SAVR group underwent concomitant coronary artery bypass grafting, whereas no patients underwent percutaneous coronary intervention, and surgical valve types were not standardized. In contrast, the incidences of valve thrombosis and paravalvular leak remained substantially higher after TAVI. Emerging trends in late mortality and crossing hazard curves further suggest potential divergence in long-term survival. Thus, the perceived equivalence of TAVI and SAVR largely reflects trial design and endpoint framing rather than durable clinical parity. Among younger patients, lifetime risk profiles differ fundamentally. As clinical enthusiasm for transcatheter therapy expands, careful interpretation grounded in valve durability, proportional hazards, and transparent analysis remains essential. Ultimately, long-term treatment standards should prioritize biological integrity over procedural convenience.

Background: This study aimed to compare the effects of cryoablation (CrA) and radiofrequency ablation (RFA) in achieving conversion from atrial fibrillation (AF) to sinus rhythm (SR) and to evaluate factors associated with postoperative AF recurrence in patients undergoing mitral valve surgery.

Methods: A total of 88 patients diagnosed with AF who underwent mitral valve replacement combined with the Cox-Maze IV procedure between 2014 and 2020 were included in the study. CrA was performed in 48 patients (54.5%), while RFA was applied in 40 patients (45.5%). Patients were grouped according to the ablation modality used and the presence or absence of postoperative AF recurrence. All patients had AF for at least six months preoperatively, as confirmed by Holter monitoring.Associations between AF recurrence and clinical parameters, including left ventricular ejection fraction (LVEF), left atrial diameter (LAD), and body mass index (BMI), and comorbidities, were evaluated.

Results: The mean follow-up duration was 6 months, with no mortality observed during this period. At six months postoperatively, SR was maintained in 70% (n=28) of patients in the RFA group and 79% (n=38) in the CrA group, with no statistically significant difference between the two groups (p>0.05). AF recurrence was significantly associated with increased LAD (p=0.01), presence of chronic obstructive pulmonary disease (p=0.007), obesity (BMI ≥30 kg/m²; p<0.001), and reduced LVEF (p<0.001).

Conclusion: Both CrA and RFA-as alternative energy sources-were found to be effective in converting AF to SR. Additionally, our study revealed that the demographic and clinical characteristics had an influence on AF recurrence.

During anesthesia induction for urgent coronary artery bypass grafting in a 63-year-old man, endotracheal intubation was unsuccessful. Computed tomography of the neck revealed multiple calcified nodules along the tracheal wall. Bronchoscopy demonstrated whitish submucosal nodules narrowing the airway lumen. Tracheobronchopathia osteochondroplastica (TBPO) was suspected and confirmed by biopsy obtained during the same operative session. Since tracheotomy was deemed unfeasible, a 16×60 mm self-expandable Nitinol tracheal stent covered with polyurethane was inserted by the thoracic surgery team, allowing surgery to proceed uneventfully. This case highlights TBPO as a rare but important cause of unexpected difficult intubation in the perioperative setting. The stent was removed uneventfully on postoperative day 9. Following stent removal, the patient's respiratory function remained stable, with no dyspnea or obstructive symptoms during follow-up.

Background: Intraoperative transit time flow (TTF) measurement provides quantitative information regarding graft patency and anastomotic quality. However, limited data exist on the relationship between SYNTAX scores and intraoperative graft flow dynamics during coronary artery bypass grafting (CABG). This study aimed to evaluate the predictive value of SYNTAX scores for intraoperative graft flow parameters, as assessed by TTF measurements of the left internal mammary artery (LIMA) grafted to the left anterior descending (LAD) artery.

Methods: Patients with critical LAD disease who underwent CABG at a single tertiary referral center between February and October 2019 were prospectively evaluated. For each patient, the SYNTAX score, SYNTAX II score, and the LAD-specific contribution to the SYNTAX score (LAD-SYNTAX) were calculated. Correlations between these scores and TTF parameters-including mean graft flow (MGF), diastolic flow (DF), and pulsatility index (PI)-were analyzed.

Results: The SYNTAX score demonstrated a negative correlation with MGF (r =-0.118, p=0.313) and DF (r =-0.026, p=0.828), and a positive correlation with PI (r =0.131, p=0.264). Similarly, the SYNTAX II score showed negative correlations with MGF (r=-0.040, p=0.735) and DF (r=-0.246, p=0.037), and a positive correlation with PI (r=0.168, p=0.149). Consistent trends were observed with LAD-SYNTAX, with MGF and DF showing negative correlations and PI showing a positive correlation; notably, the correlation between LAD-SYNTAX and MGF was statistically significant (r=-0.288, p=0.012).

Conclusion: SYNTAX scores are associated with intraoperative TTF measurements of the LIMA-LAD graft. These findings suggest that both the atherosclerotic burden of the target vessel and patient-specific factors may influence LIMA graft flow dynamics during CABG.

Background: Extracorporeal membrane oxygenation (ECMO) provides life-saving support but carries considerable risks, particularly in neonates and postcardiotomy patients. The vasoactive inotropic score (VIS), which measures cardiovascular support, shows potential as a prognostic marker; however, its role in ECMO remains underexplored. This study aims to assess the impact of vasoactive inotropic score values on mortality and ECMO-related complications in patients undergoing ECMO due to cardiopulmonary failure.

Methods: We analyzed 106 pediatric patients who underwent ECMO between January 2011 and January 2021. The demographics, ECMO indications, cannulation strategies, VIS at initiation, complications, and outcomes were reviewed. The primary endpoint was in-hospital mortality. ROC curve analysis and multivariate logistic regression evaluated the prognostic utility of VIS and ECMO-related complications.

Results: The in-hospital mortality rate was 57.5%, which was higher among neonates (78.6%), infants (62.0%), and patients who underwent central VA ECMO. VIS at cannulation was independently associated with mortality in multivariate analysis (median VIS: 28 in non-survivors vs. 20 in survivors; p<0.001). A VIS value ≥28 demonstrated strong predictive ability for mortality (area under the curve: 0.815; sensitivity: 82%, specificity: 78%). ECMO-related complications occurred in 62.3% of patients, with renal complications requiring dialysis emerging as the strongest mortality predictor (odds ratio [OR]: 3.40; p<0.001), followed by neurological complications (OR: 2.01; p=0.027).

Conclusion: A VIS score ≥28 at ECMO initiation strongly predicted in-hospital mortality. Renal complications substantially worsen clinical outcomes. Incorporating VIS into risk stratification protocols and implementing strategies to prevent major complications may improve prognosis of pediatric patients on ECMO.

In this new case study, we report a successful percutaneous transcatheter right atrioventricular (AV) valve closure procedure using a patent foramen ovale occluder (Occlutech International AB, Helsingborg, Sweden) in an 11-year-old boy who had previously undergone a Fontan procedure and surgical right AV valve closure for double-inlet left ventricle, hypoplastic right ventricle, ventricular arterial discordance and coarctation of the aorta and developed severe right AV valve regurgitation during follow-up. We aimed to share our experience regarding the difficulties encountered during the procedure.

Background: Cytomegalovirus (CMV) infection is a significant concern during the post-transplant period in heart transplant recipients. Both preemptive and prophylactic approaches are used to prevent CMV infection. This study evaluates the impact of these CMV-targeted strategies on infection rates and graft outcomes, reflecting real-world clinical experience.

Methods: The prophylactic strategy was defined as initiating antiviral therapy in all at-risk recipients immediately post-transplantation. The preemptive strategy involved administering antiviral treatment only to patients with detected viremia, identified through regular virological monitoring.

Results: CMV infection occurred in 50.0% (30/60) of patients in the preemptive group and 20.8% (5/24) in the prophylactic group, representing a statistically significant reduction with prophylaxis (p=0.014). Graft rejection occurred in 16.7% (10/60) of preemptive patients and 20.8% (5/24) of prophylactic patients, with no significant difference between the groups (p=0.652).

Conclusion: Prophylactic CMV prevention in heart transplant recipients significantly lowers the incidence of CMV infection compared to preemptive strategies. However, graft rejection rates did not differ significantly between the two approaches.

Background: The shortage of donor hearts has led to the increased use of left ventricular assist devices (LVADs) as an alternative treatment for advanced heart failure. As the population of LVAD recipients grows, so does the demand for non-cardiac surgical interventions in this group. This study aims to share our experience with non-cardiac surgeries performed in patients supported by long-term LVADs.

Methods: We retrospectively analyzed 72 patients who underwent LVAD implantation at our clinic between 2017 and 2024. Among them, 53 received the HeartMate 3 (Abbott Inc., Chicago, IL) and 19 received the HeartWare (Medtronic Inc., Minneapolis, MN).

Results: Patients were followed for a mean duration of 48.5 months (range: 1-78 months). During this period, 19 non-cardiac surgical procedures were performed in 13 patients; some patients underwent more than one procedure. A total of 12 procedures were conducted under general anesthesia, while 7 was performed under sedation. No perioperative deaths, thromboembolic events, or device malfunctions occurred. Minor complications included one case of re-intubation and one surgical site infection, associated with repeated amputations in a patient with peripheral arterial disease.

Conclusion: Non-cardiac surgery in patients with long-term LVAD support appears to be safe when carefully planned. Larger studies are warranted to validate these findings.

Background: Anomalous aortic origin of coronary arteries (AAOCA) is the second leading cause of sudden cardiac death in young athletes and poses significant diagnostic and management challenges due to its variable anatomy and unpredictable clinical course.

Methods: We retrospectively analyzed 17 pediatric patients (10 male, 7 female; median age 12 years) diagnosed with AAOCA between 2016 and 2025. All patients underwent echocardiography and electrocardiogram-gated computed tomography angiography. Risk stratification considered interarterial course, intramural segment, and ostial morphology.

Results: Anomalous right coronary artery was most common (n=11, 64.7%), followed by anomalous left coronary artery (ALCA) (n=4, 23.5%) and anomalous circumflex arteries (n=3, 17.6%). Interarterial course was present in 12 patients (70.6%), and intramural course in 9 patients (52.9%). The main presenting symptoms were exercise-induced chest pain (n=10, 58.8%), syncope (n=8, 47.1%), dizziness (n=7, 41.2%), and palpitations (n=6, 35.3%). Syncope was predominantly observed in ALCA patients with interarterial course. Among 15 patients aged ≥8 years who underwent exercise stress testing, 6 (40%) showed inducible ischemia. Nine patients (52.9%) underwent surgical intervention, including unroofing (n=7), ostial reimplantation (n=1), and pulmonary artery translocation (n=1). The remaining eight patients (47.1%) were managed conservatively, six of whom received beta-blocker therapy.

Conclusion: Transthoracic echocardiography reliably identified AAOCA, showing excellent concordance with computed tomography and surgical findings. Standardized echocardiographic protocols are crucial, especially for children presenting with unexplained syncope or exertional symptoms, and can guide optimal management strategies.

Background: Adenocarcinoma is the most common subtype of lung cancer. Histopathologically, lung adenocarcinoma is classified into five distinct patterns: lepidic, acinar, papillary, solid, and micropapillary. In 80-90% of cases, heterogeneous histopathological patterns are observed. This study aimed to evaluate the impact of predominant histological patterns on survival in surgically treated patients, as well as to identify other clinical, demographic, and histopathological factors affecting prognosis.

Methods: In this retrospective cohort study, 499 patients who underwent surgery for primary lung adenocarcinoma were evaluated. Survival data were obtained from electronic medical records. Demographic, clinical, and histopathological parameters were analyzed for both surviving and deceased patient groups. Univariate and multivariate Cox regression analyses were conducted to determine independent predictors of mortality.

Results: A total of 499 patients who underwent anatomical resection for primary lung adenocarcinoma and had complete medical data were retrospectively analyzed. The mean age was 61±8.1 years, and 77.6% of patients were male. The median tumor size was 3.5 cm (range: 2.30-5.20 cm), and the median Charlson comorbidity index was 3 (range: 2-4). The 5-year overall survival (OS) rate was found to be 64.5%. The 5-year OS was 59.8% in males and 77.7% in females (p=0.001). Regarding the side of surgery, the 5-year OS was 57.8% for left-sided resections and 67.9% for right-sided resections (p=0.024). The presence of a micropapillary pattern and acinar predominance were both identified as negative prognostic factors for survival (p=0.017, p=0.024, respectively). Additionally, lymphatic invasion and postoperative complications were found to be independent prognostic factors adversely affecting survival in multivariate analysis (p=0.014, p=0.011).

Conclusion: This study demonstrates that predominant histological patterns significantly influence survival in lung adenocarcinoma. The presence of a micropapillary component and acinar predominance were identified as negative predictive factors in multivariate analysis. We believe that relying solely on the TNM staging system may be insufficient for survival prediction; factors such as predominant histological pattern, lymphatic invasion, gender, Charlson comorbidity index, and postoperative complications should also be taken into account. These criteria may also be considered in planning oncological treatment strategies.