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

Background: The aim of this study was to evaluate the effect of awake video-assisted thoracoscopic surgery on postoperative pulmonary complications among patients with different risk scores using the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT).

Methods: Between January 2011 and August 2021, a total of 246 patients (158 males, 88 females; mean age: 59.1±13.6 years; range, 25 to 84 years) who underwent awake video-assisted thoracoscopic surgery were retrospectively analyzed. According to the ARISCAT scores, the patients with low and intermediate scores were included in Group L (n=173), while those with high scores (n=73) were included in Group H. Sedation protocol consisted of the combination of midazolam and fentanyl with propofol infusion, if necessary. Oxygen was delivered via face mask or nasal canula (2 to 5 L/min) maintaining an oxygen saturation of >95%, and analgesia was achieved with intercostal nerve block. Demographics, operative, and postoperative data of the patients, and pulmonary complications were evaluated.

Results: Demographics, operative, and postoperative data were similar between the groups. Postoperative pulmonary complications were observed in 20 (27%) patients in Group H and 29 (17%) patients in Group L without statistically significant difference (p=0.056). Surgical approaches consisted of pleural procedures (n=194) and pulmonary resection (n=52). The incidence of pulmonary complications was significantly higher in the pulmonary resection compared to non-pulmonary procedures (p=0.027).

Conclusion: Awake video-assisted thoracoscopic surgery seems to be beneficial in reducing the incidence of postoperative pulmonary complications in high-risk patients as assessed with the ARISCAT.

Background: In this study, we aimed to investigate the prognostic value of programmed cell death protein 1 (PD-1), programmed cell death ligand 1 (PD-L1), and programmed cell death ligand 2 (PD-L2) expressions on immune and cancer cells in terms of survival in patients with lung adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

Methods: Between January 2000 and December 2012, a total of 191 patients (172 males, 19 females; mean age: 60.3±8.4 years; range, 38 to 78 years) who were diagnosed with non-small cell lung cancer and underwent anatomic resection and mediastinal lymph node dissection were retrospectively analyzed. The patients were evaluated in three groups including lung squamous cell carcinoma (n=61), adenocarcinoma (n=66), and large-cell carcinoma (n=64). The survival rates of all three groups were compared in terms of immunohistochemical expression levels of PD-1, PD-L1, and PD-L2.

Results: The mean follow-up was 71.8±47.9 months. In all histological subtypes, PD-1 expressions on tumor and immune cells were observed in 33% (61/191) and in 53.1% (102/191) of the patients, respectively. Higher expression levels of PD-L1 and PD-L2 at any intensity on tumor and immune cells were defined only in lung adenocarcinomas, and PD-L1 and PD-L2 values were detected in 36.4% (22/64) of these patients. The PD-L1 expressions on tumor and immune cells were observed in 41.7% (10/24) and 25% (6/24) of the patients, respectively. The PD-L2 expressions on tumor and immune cells were detected in 16.7% (4/24) and 8.4% (2/24) of the patients, respectively. Univariate and multivariate analyses revealed that PD-1 expression in tumor cells was an independent prognostic factor in all histological subtypes.

Conclusion: Our study results suggest that PD-1 expression is a poor prognostic factor for overall survival in patients with completely resected adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

Background: In this study, we aimed to investigate the relationship between bronchiectasis criteria, scores, and indices used today and surgical interventions due to bronchiectasis.

Methods: Between January 2009 and December 2018, a total of 106 patients (53 males, 53 females; mean age: 39.1±12.3 years; range, 14 to 68 years) with non-cystic fibrous bronchiectasis were retrospectively analyzed. We determined symptom improvement and complications as main factors. We divided the patients into two main groups: those who had symptom improvement after pulmonary resection (Group 1, n=89) and those who did not (Group 2, n=17). We further analyzed patients who had postoperative complications (n=27) with those who did not (n=79). The following scores and criteria were used in this study: modified Reiff score, Gudbjerg criteria, Naidich criteria, Bronchiectasis Severity Index, and FACED scoring.

Results: There was a statistically significant difference between the groups in terms of the modified Reiff scores and FACED scores. As the modified Reiff score increased, there was a higher rate of symptom relief (p=0.04). Contrary to this, an increase in the FACED score predicted a poorer postoperative outcome (p=0.03). Considering complications, a significant difference was observed in the Gudjberg criteria, and higher grade suggested a higher risk of complication (p=0.02).

Conclusion: The grading and scoring systems related to bronchiectasis may have some predictive value in terms of surgical outcomes. A high modified Reiff score and a low FACED score can predict postoperative success, whereas Gudbjerg criteria can indicate postoperative complications.

Background: This study aims to report the incidence of acute kidney injury following surgical reconstruction after a failed endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysms.

Methods: This retrospective study included 44 patients (39 males, 5 females; mean age: 70±11.3 years; range, 35 to 84 years) who underwent emergency or elective surgical reconstruction after failed EVAR between February 2015 and January 2019. Patients were divided into two groups: acute kidney injury group and no acute kidney injury group. The primary end-point of the study was to evaluate the development of acute kidney injury following surgery. The secondary end-points included the 30-day and one-year mortality rates.

Results: Surgical reconstruction of the abdominal aorta was performed electively in 29 (65.9%) patients and urgently in 15 (34.1%) patients. Acute kidney injury occurred in 12 (27.3%) patients. The interval from endovascular aneurysm repair to surgical reconstruction was statistically significantly higher in the no acute kidney injury group than in the acute kidney injury group (24.6±11.5 and 18.1±13.3 months, respectively; p=0.145). The mean abdominal aortic aneurysm diameter, neck angulation, and neck diameter were statistically significantly higher in the acute kidney injury group than in the no acute kidney injury group (p=0.001, p=0.009, and p<0.001, respectively). No statistically significant difference was observed between the acute kidney injury and no acute kidney injury groups for the overall 30-day mortality (p=0.185) and oneyear mortality (p=0.999).

Conclusion: Acute kidney injury is not uncommon after the surgical reconstruction of a failed EVAR. Aneurysm-related anatomical factors may have an impact on the development of postoperative acute kidney injury. Comprehensive surgical planning should be performed for open abdominal aortic surgery after a failed EVAR.

Background: This study aims to evaluate clinical and radiological characteristics of the patients with cough-induced rib fractures.

Methods: Between January 2008 and December 2022, a total of 90 patients (35 males, 55 females; mean age: 58±20 years; range, 20 to 92 years) who had cough-induced rib fractures were retrospectively analyzed. Patients' characteristics, findings of physical and radiological examination, and patients' outcomes were recorded.

Results: Of the patients, 64% were postmenopausal, 37% had metabolic disease of the bone, and 21% had chronic cough. Cough etiology was acute upper respiratory tract infection (32%), followed by chronic obstructive pulmonary disease. Thoracic computed tomography documented 154 fractures. Cough-induced rib fractures were mostly on the right side (58%). Multiple fractures were more commonly seen in older patients (p=0.007), in the presence of novel coronavirus disease-2019 (COVID-19) pneumonia (p=0.03), and metabolic disease of the bone (p=0.01). Mostly the sixth rib was affected (23%). Most fractures (81.3%) affected the fourth to ninth ribs. Most fractures developed on the anterolateral aspect of the rib (51%). The mean duration of hospital stay was 5.0±1.6 days. Morbidity developed in one patient (1.1%) (hemothorax). Mortality occurred in two patients (2.2%) due to COVID-19 pneumonia and acute myocardial infarction.

Conclusion: Localized pain after cough should be investigated in terms of cough-induced rib fractures. Cough-induced rib fractures are mostly seen in the presence of acute upper respiratory tract infection, chronic obstructive pulmonary disease, and pneumonia. Postmenopausal women are more risky to develop cough-induced rib fractures. Multiple cough-induced rib fractures are common in the presence of metabolic disease of the bone, older age, COVID-19 pneumonia.

Background: In this study, the flip technique was compared with the classical method in terms of procedural success and procedure time during ductal stent implantation (DSI) via the carotid artery in patients whose pulmonary blood flow is dependent on the vertical type of ductus arteriosus (DA).

Methods: Between January 2019 and June 2023, 40 patients (24 males, 16 females; mean age: 15.9±15.4 days; range, 1 to 68 days) with vertical ductus-dependent pulmonary circulation who underwent patent DA stent implantation via the carotid artery were included in the study. Patients were divided into two groups: those who underwent the flip technique (Group 1) and those who did not undergo the flip technique (Group 2). Data were retospectively compiled by reviewing patient files and catheter images.

Results: Demographic findings were similar in the groups. The distribution of the DA in terms of tortuosity index was also similar in the groups. The procedure was successful in 18 (90%) patients in Group 1 and 20 (100%) patients in Group 2. There was no procedure-related mortality in both groups. The frequency of procedure-related complications was similar. Procedure duration was 53.6±18.4 min in Group 1 and 41.5±9.1 min in Group 2; the difference was significantly lower in Group 2 (p=0.028). The shorter follow-up in Group 2 was attributed to the flip method starting to be used later in the clinic. During follow-up, stent dilatation was required in two patients in Group 1 and one patient in Group 2, and a second stent implantation was needed in one patient in Group 2. No significant difference was observed between the two groups in terms of reintervention.

Conclusion: The success rate of DSI using the carotid artery access is high with both the classical and the flip method in patients with vertical DA. However, the use of the flip technique could be preferred in terms of operator habituation, ergonomic use of the catheter, guidewires, and shorter procedure time.

Background: In this meta-analysis, we aimed to systematically examine the relationship between body mass index and major adverse cardiovascular events in acute coronary syndrome patients and to provide theoretical guidance for body weight management in these patients.

Methods: A comprehensive analysis of applicable research published between 2008 and 2021 was conducted using the PubMed, Cochrane, Web of Science, Wanfang, and CNKI databases. Extracted odds ratios from the randomized-controlled studies were pooled using fixed-effects meta-analysis. Publication bias was addressed through evaluation methods such as funnel plot or sensitivity analysis.

Results: Ten studies with a total of 58,992 individuals were included. The consequences of this meta-analysis confirmed that, compared to normal body mass index, patients with acute coronary syndrome significantly increased the risk of major adverse cardiovascular events (odds ratio= 1.20; 95% confidence interval: 1.12-1.29, p<0.001).

Conclusion: Patients with acute coronary syndrome being overweight or obese significantly increased the risk of major adverse cardiovascular events compared to those with normal body mass index. The results suggest that patients may focus on weight management to reduce the risk of major adverse cardiovascular events in acute coronary syndrome.

A 67-year-old female patient presented with a lung nodule one month ago which was detected by physical examination. She was diagnosed with tracheobronchopathia osteochondroplastica complicated with right lower lobe nodules by chest computed tomography, bronchoscopy, and pathological examinations of the biopsy specimens. We performed lobectomy and lymphadenectomy by video-assisted thoracoscopic surgery and small pulmonary lesions were diagnosed as pulmonary adenocarcinomas. At 36 months of follow-up, the patient was free from recurrence. In conclusion, tracheobronchopathia osteochondroplastica complicated with a pulmonary adenocarcinoma is rare, and clinicians should be aware of this possibility, particularly in patients with pulmonary malignancy and tracheal irregularities on chest imaging. Otherwise, tracheobronchopathia osteochondroplastica can be easily misdiagnosed as malignant invasion of the trachea.

Failed midline ventral fusion of sternal bars is the cause of complete sternal cleft, which is a rare congenital anomaly that may cause cardiopulmonary compromise. Very few cases of complete sternal cleft have been reported so far in the literature. Surgical correction is recommended to protect mediastinal structures and to restore respiratory dynamics. Herein, we present a case of complete sternal cleft in a five-month-old female infant which was repaired using patch, titanium plate, and bilateral pectoralis muscular flap.

Carotid body tumors are rarely encountered pathologies in the pediatric age group but still exist in the differential diagnosis of cervical painless masses. Genetic and familial background should be studied in addition to contrast imaging studies. Complete subadventitial resection, with or without prior embolization, which is still controversial, is the mainstay of therapy. Follow-up gains importance due to its nature. Herein, we report a nine-yearold girl presented with a unilateral asymptomatic mass on the neck with a diagnosis of carotid body tumor treated surgically without embolization. We emphasize the specific aspects of the pediatric age group.