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

Background: This study aims to evaluate surgical outcomes and prognosis in patients who underwent extended lung resection for locally advanced lung cancer.

Methods: Between January 2015 and December 2019, a total of 61 patients (60 males, 1 female; mean age: 61.7±12.2 years; range, 32 to 90 years) with locally advanced non-small-cell lung cancer who underwent extended lung resection were retrospectively analyzed. Data including age, sex, comorbid diseases, symptoms, smoking status, pulmonary function test results, tumor location, methods used for preoperative tissue diagnosis, histopathological cell type, type of surgical resection, pathological stage, nodal involvement, postoperative complications, types of adjuvant therapy, and mortality rate were recorded. Survival and the factors affecting survival were examined.

Results: Seven (11.4%) patients had Stage IIIB, 40 (65.5%) patients had Stage IIIA, and 14 (22.9%) patients had Stage IB disease. Intrapericardial pneumonectomy accounted for 30 (49.1%) of all extended lung resections. Chemotherapy was administered to 31 (50.8%) patients and chemoradiotherapy to 24 (39.3%) patients in the postoperative period. In the survival analysis, 70-month survival rate was calculated as 63.9% and the median survival was 48 months. There was a statistically significant association between survival with adjuvant chemotherapy and chemoradiotherapy (p=0.003). The mortality rate at 70 months of follow-up was 36.1%.

Conclusion: Extended lung resection contributes significantly to the improvement of survival rates in carefully selected locally advanced cases. Particularly with adjuvant chemotherapy, local recurrences can be prevented, and survival rates can be improved.

Background: In this study, we present our early results with the Ozaki procedure in the treatment of congenital aortic valve disease. Methods: Between July 2021 and July 2023, a total of 14 patients (10 males, 4 females; median age: 13.9 years; range, 8.5 to 15 years) who underwent neoaortic valve reconstruction of three leaflets using Ozaki procedure were retrospectively analyzed. Preoperative, postoperative, and follow-up echocardiogram images were evaluated. Results: Preoperative indications were aortic regurgitation (n=3) or combined aortic stenosis and regurgitation (n=11). The median aortic annular diameter was 23 (range, 19.5 to 25) mm on preoperative echocardiography. The median preoperative peak systolic aortic valve gradient for patients with aortic stenosis was 60 (range, 45 to 93) mmHg. The median preoperative aortic valve regurgitation grade was 4 (range, 3 to 4). Autologous pericardium and bovine pericardium were used in 12 and two patients, respectively. There was no conversion to valve replacement, myocardial infarction, or mortality in the early postoperative period. The median follow-up time was 8.5 (range, 6 to 19) months. One patient who performed the Ozaki procedure with bovine pericardium underwent valve replacement eight months later. Conclusion: The Ozaki procedure can be performed safely and effectively in congenital aortic valve stenosis and insufficiency with promising early results.

Background: This study aimed to compare the outcomes of minimally invasive mitral valve surgery and conventional surgery in terms of mortality and postoperative complications.

Methods: A retrospective analysis was conducted on consecutive minimally invasive and conventional mitral valve surgeries performed between January 2019 and December 2022. Patients undergoing concomitant procedures were excluded from the study, and 293 patients (149 females, 144 males; mean age: 53.8±12.9 years; range, 18 to 82 years) were included in the study. Of these patients, 96 underwent minimally invasive surgery (MI group), and 197 underwent mitral valve surgery via conventional sternotomy (CS group). Propensity score matching was utilized to minimize the biases and confounding factors. After propensity score matching, 55 patients were included in each group.

Results: There was no statistically significant difference in terms of mortality between the propensity score-matched groups (p=0.315), and no statistically significant difference in postoperative complications was observed between the groups. However, it was found that postoperative new-onset atrial fibrillation was lower in the minimally invasive group (p=0.022).

Conclusion: This study demonstrates that minimally invasive mitral valve surgery is a safe alternative with similar mortality and postoperative complication rates compared to conventional surgery. Additionally, the study suggests an association between minimally invasive surgery and postoperative new onset atrial fibrillation.

Minimally invasive methods continue to become increasingly common in cardiac surgery. In particular, the utilization of thoracotomy in multi-vessel coronary bypass grafting and valve surgery has accelerated, but sternotomy is still applied in combined pathologies. A 76-year-old male patient underwent multi-vessel coronary artery bypass grafting and mitral valve replacement without sternotomy using bilateral mini-thoracotomy, as the patient was old, frail, and had many comorbid factors. In conclusion, this minimally invasive approach can decrease all postoperative complications, accelerate patient recovery, and achieve good cosmetic results.

Proximal circumflex coronary artery in the atrioventricular groove usually has large diameters. Arterial diameters in this region vary from 2.5 to 5 mm. Revascularization of this part of the circumflex artery allows good distal anastomosis configuration and better long-term patency rate.

Systemic capillary leak syndrome is defined as excessive fluid and protein extravasation caused by microvascular hyperpermeability. It is a very rare condition, and may occur during or after any surgery without preceding symptoms or a suggestive history. It has been reported in pediatric cardiac surgery patients, and is not expected in adults. In this article, we present a 75-year-old female case of severe systemic capillary leak developed during coronary artery bypass grafting combined with dual valve replacement. To the best of our knowledge, this is the first adult case in the literature having an acute attack of systemic capillary leak syndrome during cardiac surgery.

Background: The aim of this study was to evaluate our 30 years of surgical experience and outcomes in management of anomalous origin of left coronary artery from the pulmonary artery with various age groups. Methods: Between March 1992 and August 2022, a total of 21 patients (10 males, 11 females; mean age: 16.3±15.9 years; range, 1 to 64 years) diagnosed with anomalous origin of left coronary artery from the pulmonary artery who underwent successful surgical repair were retrospectively analyzed. An initial diagnosis was made with two-dimensional echocardiography. Cardiac catheterization and angiography were performed in all our patients. Results: The median follow-up was five (range, 1 to 14) years. The mean left ventricular ejection fraction was 43.47±14.30% with associated moderate-to-severe mitral regurgitation in seven (33.33%) patients. Coronary button transfer was performed in 15 (71.42%) patients, Takeuchi repair in four (19.04%) patients, and ligation of anomalous left main coronary artery and ligation with great saphenous venous graft in one (4.76%) patient. There was no mortality. However, two (9.52%) patients had prolonged intensive care unit stay (>7 days). At the final follow-up, the mean left ventricular ejection fraction improved to 57.47±4.97%. Regression of moderate mitral regurgitation was observed in four (66.6%) patients. Conclusion: Preoperative left ventricular function is a major risk factor of perioperative mortality and morbidity. Mitral valve intervention is not warranted concomitantly in patients with moderate mitral regurgitation, if there are no structural lesions. Early diagnosis and meticulous surgical technique can yield excellent results and good long-term outcomes.

Background: This study aims to assess the complications in post-novel coronavirus disease 2019 (COVID-19) thoracotomy patients and to evaluate the time interval between infection and surgery and the effect of vaccine timing and vaccine type in these patients.

Methods: Between May 2020 and January 2022, a total of 74 patients (34 males, 40 females; mean age: 54.5±13.7 years; range, 22 to 27 years) who had COVID-19 infection and underwent thoracic surgery were retrospectively analyzed. Data including demographic and clinical characteristics, the surgery type, length of intensive care unit and hospital stay, and postoperative complications were recorded. Complications were defined as respiratory, cardiac, thrombotic, and other complications. The time period between COVID-19 infection and surgery was noted. All patients were questioned regarding their vaccination status.

Results: Having a symptomatic COVID-19 infection did not significantly affect the development of postoperative complications and length of intensive care unit or hospital stay. Thoracic involvement was the main factor which affected the length of intensive care unit and hospital stay during COVID-19 infection (p=0.004 and p=0.003, respectively).

Conclusion: Our study results suggest that the length of hospital and intensive care unit stay is related to the time period between infection and surgery. The longer that the patient waits after COVID-19 infection, the less time that the patient stays in the hospital.

Background: This study aims to evaluate the outcomes of bronchoscopic lung volume reduction coil treatment in patients with severe emphysema.

Methods: Between February 2016 and March 2019, a total of 20 severe emphysema patients (19 males, 1 female; mean age: 65.2±5.2 years; range, 52 to 73 years) who underwent bronchoscopic lung volume reduction coil treatment were included. Each patient underwent pre- and post-treatment (6 and 12 months) pulmonary function tests, 6-min walking distance, modified Medical Research Council dyspnea scores, and diffusing capacity of the lung for carbon monoxide tests.

Results: An mean number of 12.0±3.8 coils was placed in each lobe. There were significant improvements in the patients' pulmonary function tests and quality of life 12 months after the treatment. There was a significant difference in dyspnea as assessed by the modified Medical Research Council dyspnea scores 12 months after treatment compared to pre-treatment scores (p<0.05). There was no change in the pulmonary function tests six months after treatment, while a significant improvement was seen at 12 months (p<0.05).

Conclusion: Bronchoscopic lung volume reduction coil treatment seems to be a promising modality for severe emphysema patients with significant improvements in the pulmonary function test results, modified Medical Research Council dyspnea scores, and 6-min walking distance.