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

Background: This study aims to emphasize the features that should be considered in the follow-up of patients with solitary fibrous tumors by analyzing the clinical and pathological parameters that are effective in the prognosis.

Methods: In this study, 53 patients (28 males, 25 females; mean age: 56.2±5 years; range, 24 to 76 years) diagnosed with solitary fibrous tumor and operated on between 2009 and 2023 were retrospectively examined. The patients included in the study were followed for at least one year. Patients with complete clinical and pathological data records were included in the study. Survival and recurrence rates were analyzed in relation to clinical and pathological parameters.

Results: The median follow-up was 44.9 months. Eight (15%) patients underwent anatomic resection, 23 (35.8%) patients underwent wedge resection, five (5.6%) patients underwent total pleurectomy, 26 (41.5%) patients underwent mass excision, and three (1.8%) underwent mass excision and chest wall resection. Survival analyses were conducted using the Kaplan-Meier method. Overall survival and disease-free survival were calculated in months from the date of surgery until the date of death or recurrence, respectively. Low mitotic rate was found to be a significant independent predictor of reduced mortality (odds ratio [OR]=0.46, 95% confidence interval [CI]: 0.243-0.877, p=0.018), indicating better survival outcomes in patients with low mitotic activity. In contrast, low Ki-67 expression was not a statistically significant predictor (OR=0.9, 95% CI: 0.880-1.116, p=0.885). Pleomorphism was strongly associated with increased mortality (OR=10.0, 95% CI: 1.316-76.081, p=0.026), highlighting the importance of pleomorphism as an important prognostic marker. Necrosis, although not statistically significant (OR=6.3, 95% CI: 0.497-79,123, p=0.156), showed a trend indicating worse outcomes. Similarly, CD34 negativity showed a trend in favor of mortality (OR=3.5, 95% CI: 0.429-28.990, p=0.241.

Conclusion: Solitary fibrous tumors are generally benign and have low recurrence and high survival rates. However, the recurrence rate is higher in malignant solitary fibrous tumors. According to the results of our study, high mitosis rate and pleomorphism are important independent predictors of increased mortality in solitary fibrous tumors. These findings emphasize the importance of detailed histopathological examination in prognostic evaluation.

Cardiac fibromas are rare primary cardiac tumors. Although they constitute a small portion of cardiac neoplasms, they are the most common primary cardiac neoplasm group in childhood after rhabdomyomas. Cardiac fibromas, composed of connective tissue and fibroblasts, are benign. They may be asymptomatic, cause symptoms such as intracavitary obstruction, coronary artery compression, thromboembolic events, and conduction defects, or result in sudden death. Approximately 180 to 200 cases of cardiac fibromas have been reported in the literature, and most are located in the ventricles. Since fibromas are rare, optimal treatment strategies are unclear. Surgical excision is recommended for tumors that cause arrhythmias, heart failure, or intracavitary obstruction. This video article presented the surgical excision of a 6.2×5×4.3 cm cardiac fibroma originating from the anterior wall of the right ventricle in an 11-month-old infant. Postoperative transesophageal echocardiography showed that the tumor was completely removed and that the right ventricular and tricuspid valve functions were good.

Background: This study aims to compare the effectiveness of negative-pressure wound therapy (NPWT) compared to conventional methods for the treatment of mediastinitis following coronary artery bypass grafting.

Methods: Between January 2010 and January 2023, a total of 87 patients (47 males, 40 females; mean age: 62.0±10.2 years; range, 35 to 80 years) who developed mediastinitis following sternotomy were retrospectively analyzed. The patients were divided into two groups: those treated with conventional methods (n=39) from January 2010 to February 2015 and those treated with NPWT (n=48) from March 2015 to January 2023. Clinical outcomes, including treatment duration, infection resolution time, hospital stay, and mortality rate, were recorded.

Results: The NPWT group had significantly shorter treatment durations (20.1±4.0 days) than the conventional group (58.6±17.1 days, p<0.001). The time to achieve negative cultures was also significantly reduced in the NPWT group (15.3±3.6 days) compared to the conventional group (36.7±8.1 days, p<0.001). The length of hospital stay was shorter in the NPWT group (34.3±12.8 days) compared to the conventional group (88.0±21.1 days, p<0.001). The NPWT group had a lower hospital mortality rate (4.2%) than the conventional group (17.9%, p=0.049).

Conclusion: The NPWT demonstrated superior efficacy in managing postoperative mediastinitis compared to conventional methods, highlighting its potential as a preferred treatment option for this serious complication.

Background: This study aims to encourage the use of percutaneous transthoracic biopsies by thoracic surgeons as a diagnostic method.

Methods: This retrospective study was conducted between January 1, 2015, and January 31, 2024, with 793 patients (632 males, 160 females; mean age: 65±12 years; range, 11 to 93 years) who underwent lung tru-cut biopsy under computed tomography guidance. Patients whose radiologic and pathology records were accessible via the Hospital Information System and the Picture Archiving and Communication System were included.

Results: A total of 973 tru-cut biopsy procedures were performed. There was no statistically significant difference in age distribution between sexes (p=0.15). Most biopsies were performed on the upper lobes, predominantly the right upper lobe (33.2%). The supine position was the most commonly used during the procedure (49.4%). The mean lesion diameter and distance from the chest wall were 49±17 mm and 51±16 mm, respectively. A definitive diagnosis was obtained on the first attempt in 78.6% of patients, while repeat biopsies were required in 21.4%. Primary lung malignancy was diagnosed in 63% of cases. Postprocedural complications included pneumothorax in 16.1%, intraparenchymal hemorrhage in 0.1%, hemoptysis in 0.1%, and hemothorax in 0.1% of patients. Complications were most frequently observed following biopsies of the left lower lobe (32.4%). Lesions located in the upper lobes were significantly more likely to be malignant (p=0.01). A significant increase in complication rates was observed with greater parenchymal tissue penetration during the procedure (p=0.001).

Conclusion: Computed tomography-guided percutaneous lung biopsies can be performed more safely by thoracic surgeons due to their procedural experience. Additionally, in the event of complications, thoracic surgeons are more capable of providing prompt and effective intervention, thereby enhancing patient safety. Thoracic surgeons should be actively involved in all diagnostic stages of pulmonary or mediastinal nodules or masses, including procedures such as tru-cut lung biopsy and endobronchial ultrasonography.

Background: This study aims to evaluate the long-term rhythm outcomes of the Cox-Maze IV procedure in patients undergoing complex cardiac surgery, where atrial fibrillation ablation was performed as a second, third, or fourth-and-beyond concomitant operation.

Methods: Between October 2018 and February 2025, a total of 71 patients (24 males, 47 females; mean age: 59±10 years; range, 36 to 80 years) who underwent a complete Cox-Maze IV lesion set and achieved at least six months of rhythm follow-up were retrospectively analyzed. The patients were grouped by the number of concomitant cardiac procedures performed: Group 1 (one procedure, n=16), Group 2 (two procedures, n=43), and Group 3 (≥3 procedures, n=12). Rhythm monitoring included 24-h Holter and pacemaker interrogation.

Results: At a mean follow-up of 26±2 months, overall freedom rate from atrial tachyarrhythmias was 88.7%. Group-specific freedom rate from atrial tachyarrhythmias at 36 months was as follows: 100% in Group 1, 80.0% in Group 2, and 87.5% in Group 3. No significant intergroup differences were observed. Pacemaker implantation was needed in 7.0% of the patients. Higher procedural complexity did not adversely affect rhythm outcomes.

Conclusion: Our study results suggest that Cox-Maze IV provides excellent long-term rhythm control even in complex cardiac surgeries involving multiple concomitant procedures. The effectiveness of the procedure appears to be preserved across increasing surgical complexity, supporting its broader application.

Background: This study aims to evaluate the effect of off-pump coronary artery bypass grafting on neurological causes of mortality.

Methods: Between November 1^st, 2014 and December 31^st, 2022, a total of 1,154 off-pump coronary artery bypass grafting patients (963 males, 191 females; mean age: 64±10.9 years; range, 13 to 95 years) were retrospectively analyzed. Demographic characteristics, preexisting comorbidities, perioperative status, and postoperative clinical outcomes of the patients were recorded. Survival analysis was carried out.

Results: No-touch aorta coronary artery bypass grafting was performed 958 (83%) patients and single side-biting clamp was used in 196 (17%) patients. Two-hundred seventy-one (23.5%) patients were in an emergent condition, and 63 (5.5%) patients had a history of stroke and/or transient ischemic attack preoperatively. Concomitant carotid endarterectomy was performed in 50 (4.3%) patients. Postoperatively, 139 (12%) patients had atrial fibrillation and five (0.4%) patients had stroke. Seven patients (0.6%) died in the hospital and one (0.08%) patient died in the postoperative 30-day period. One-year, three-year, and five-year survival rates were 98.7%, 97.4%, and 96.5%, respectively.

Conclusion: Off-pump coronary artery bypass grafting is associated with a low incidence of perioperative stroke. Avoidance of aortic manipulation in off-pump coronary artery bypass grafting may reduce the risk of adverse neurological effects of cardiopulmonary bypass. We attribute the long-term survival to shorter lengths of stay in the intensive care unit and hospital and less need for blood products after surgery.