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

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.

Background: This study aims to examine factors influencing mortality and reintervention among endovascular aortic aneurysm repair patients treated over nearly two decades in the first hybrid operating room of Türkiye.

Methods: Between December 2006 and December 2020, a total of 372 patients (349 males, 23 females; mean age: 70.4±8.2 years; range, 45 to 89 years) who underwent endovascular aortic aneurysm repair were retrospectively analyzed. Independent predictors of 30-day, one-year, and five-year mortality rate were identified. The Kaplan-Meier analyses compared outcomes across surgical approaches and graft types.

Results: Mortality rates were 6.5% at 30 days, 14.2% at one year, and 21.8% at five years. Multivariate analysis identified postoperative complications (hazard ratio [HR]=3.68, p=0.034), elevated creatinine (HR=1.58, p=0.004), prolonged intubation (HR=1.01, p<0.001), and increased blood transfusion volume (HR=1.17, p=0.003) as independent predictors of 30-day mortality. Advanced age emerged as a significant predictor of five-year mortality (HR=1.09, p<0.001). Elective procedures and bi-iliac grafts demonstrated significantly improved survival across all timeframes (p<0.001).

Conclusion: This real-world analysis identifies several procedural and patient-related factors associated with mortality following endovascular aortic aneurysm repair. Postoperative care indicators consistently demonstrated stronger independent associations with mortality than anatomical or demographic factors, highlighting the importance of comprehensive perioperative care optimization in endovascular aortic aneurysm repair management.

Background: In this meta-analysis, we compare total arterial revascularization versus non-total arterial revascularization coronary artery bypass grafting in diabetic patients and discuss long-term survival rate and early mortality rate, cerebrovascular accident, myocardial infarction, sternal wound infection.

Methods: We searched the Cochrane Library, PubMed, Thieme-Connect and Sage Pub databases for studies which were published from January 2003 to October 2023. Observational studies with propensity-score matched analysis comparing total arterial revascularization versus non-total arterial revascularization coronary artery bypass grafting in diabetic patients were included. The risk of bias was analyzed. Fixed-effects model and random-effects meta-analysis with leave-one-out method as sensitivity analysis were performed.

Results: Six observational studies which were published involving a total of 15,336 patients were included in the meta-analysis. There were significant differences in the long-term survival rates and early myocardial infarction. Total arterial revascularization had higher survival rate (incidence rate ratio [IRR]=0.85, 95% confidence interval [CI]: 0.74-0.98, p=0.02) and lower myocardial infarction event than non-total arterial revascularization (odds ratio [OR]=0.45, 95% CI: 0.22-0.92, p=0.03).

Conclusion: Total arterial revascularization is significantly associated with higher survival rate and lower early myocardial infarction than non-total arterial revascularization in diabetic patients undergoing coronary artery bypass grafting.