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

Background: This study aims to investigate whether acute surgical manipulation of great saphenous vein grafts during coronary artery bypass grafting alters mammalian target of rapamycin (mTOR) activation and induces early histopathological damage.

Methods: Between September 2022 and September 2023, a total of 44 elective coronary artery bypass grafting patients (38 males, 6 females; mean age: 60.8±8.3 years; range, 36 to 70 years) were included in this prospective study. Saphenous vein segments were collected pre- and post-preparation. Light microscopy and enzyme-linked immunosorbent assay were used to assess structural changes and mTOR levels.

Results: Histopathological analyses revealed endothelial disruption and subendothelial inflammatory infiltration in post-preparation samples. However, mTOR protein levels showed no significant difference between pre- and post-manipulation tissues (p=0.41).

Conclusion: Mechanical stress during great saphenous vein graft preparation causes notable endothelial injury, but does not acutely activate the mTOR pathway. These findings suggest that mTOR may not participate in early responses, but could be implicated in long-term vascular remodeling.

Background: In this systematic review and meta-analysis, we discuss the estimated of global incidence, shunt related-mortality risk and factors associated with shunt blockage after modified Blalock-Taussig-Thomas (mBTT) procedure.

Methods: A systematic review and meta-analysis were conducted using PubMed, ScienceDirect, and EMBASE up to February 2024. The primary outcomes were the incidence and mortality risk associated with shunt blockage. Additional outcomes included study characteristics, surgical factors, and coagulation profiles. Single and two-group proportional meta-analyses were performed.

Results: A total of 25 studies involving 2,677 patients were included. The global incidence of shunt blockage was 7% (95% confidence interval [CI]: 0.05 to 0.10) with high heterogeneity (I² =81%; p<0.01). In 15 studies eligible for mortality analysis, patients with shunt blockage had significantly higher odds of death (odds ratio [OR]=5.04; 95% CI: 2.69 to 9.44) with low heterogeneity (I² =3%; p=0.41). Shunt size alone was not a significant predictor of blockage. However, patients with shunt blockage exhibited significantly lower partial thromboplastin time and activated partial thromboplastin time values, suggesting coagulation abnormalities. No significant difference was found in platelet counts.

Conclusion: Shunt blockage is a critical complication following mBTT shunt, significantly increasing mortality risk. While shunt size is not independently predictive, multiple factors, including patient weight, underlying pathology, coagulation profile, surgical factors, and shunt size-to-weight ratio, may contribute to thrombosis risk and warrant further investigation.

Background: The aim of our study was to evaluate the hemodynamic effects and clinical outcomes of transcatheter fenestration in patients who developed Fontan failure.

Methods: Between January 2014 and December 2022, among a total of 187 patients undergoing the Fontan operation, 10 (6 males, 4 females; median age: 10.9 years; range, 4.2 to 23 years) who underwent transcatheter creation or dilation of a Fontan fenestration due to the development of Fontan failure were retrospectively analyzed. Demographic data, laboratory results, echocardiographic findings, and catheterization parameters of the patients were recorded. The patients were classified into two groups based on the timing of Fontan failure: those who underwent fenestration before hospital discharge constituted the early-stage group, while those who underwent fenestration after discharge were assigned to the late-stage group. These two groups were compared in terms of hemodynamic parameters, changes in oxygen saturation, and complication rates.

Results: Transcatheter fenestration was performed in five patients due to Fontan failure in the early postoperative period, and in five patients in the late period. The median follow-up duration was 2.2 (range, 0.1 to 6) years. Following the procedure, pleural effusion regressed in four patients; median systemic venous pressure decreased by 3.4 (range, 2 to 9) mmHg, while median oxygen saturation dropped by 5.9% (range, 3 to 9%). Clinical improvement was observed in 70% of the patients within the first month. However, one patient died on postoperative Day 44 due to low cardiac output. Fenestration was performed in three patients with protein-losing enteropathy, and clinical improvement was achieved in all of them.

Conclusion: Transcatheter Fontan fenestration is a reliable therapeutic option for reducing systemic venous pressure and achieving hemodynamic improvement in symptomatic Fontan patients. Our study highlights the low complication rates and the potential of this procedure to yield favorable clinical outcomes. Transcatheter fenestration plays an important role in the management of high-risk Fontan patients.

Background: This study aims to evaluate the effectiveness of application of physiotherapy via remote telerehabilitation in the early postoperative period following thoracic surgery.

Methods: Between October 2020 and July 2024, a total of 40 patients (25 males, 15 females; mean age: 57.8±9.6 years; range, 42 to 77 years) who underwent thoracic surgery due to Stage 1A-3B non-small cell lung cancer were included in this randomized-controlled clinical study. The patients were divided into two groups: the telerehabilitation group (TG, n=20) and the control group (CG, n=20). Patients in the TG participated in a teleconference-based exercise program supervised by a physiotherapist, starting the day before surgery and continuing daily until discharge. Patients in the CG received a single preoperative exercise session and an educational brochure. All patients were assessed at five time points: preoperatively, immediately after surgery, prior to discharge, at one to three months post-discharge, and at six months post-discharge. Outcome measures included the duration of intensive care unit stay, total hospital stay, chest drain duration, postoperative complications, inflammatory biomarkers, pain, dyspnea, fatigue, spirometry, and State-Trait Anxiety Inventory (STAI) scores.

Results: Both groups had similar baseline characteristics including comorbidities and types of surgery (p>0.05). There were no significant differences in the intensive care unit stay duration (p=0.739), total hospital stay (p=0.311), or chest drain duration (p=0.431) between the groups. However, TG showed significantly lower pain and fatigue levels compared to CG (p<0.05).

Conclusion: Telerehabilitation effectively reduced pain and fatigue in patients after thoracic surgery. The lack of significant differences in other outcomes may be attributed to variations in patient compliance. These findings suggest that telerehabilitation can be a valuable alternative to traditional rehabilitation, particularly during pandemic or isolation.

Background: This study aim to evaluate the feasibility of threedimensional (3D) modeling using open-source free software for preoperative planning and intraoperative guidance in uniportal video-assisted thoracoscopic segmentectomies.

Methods: Between October 2020 and November 2023, 50 patients (27 males, 23 females; mean age: 60±11.1 years; range, 34 to 78 years) who underwent uniportal video-assisted thoracoscopic pulmonary segmentectomy with preoperative 3D modeling were retrospectively analyzed. Preoperative 3D modeling was performed using computed tomography with an open-source 3D software program. The virtual models exported to the mobile device were compared with the anatomical structures of the patient intraoperatively. The patients were divided into two groups as simple and complex segmentectomy according to the characteristics of the surgical procedures.

Results: The overall matching success rate of the virtual 3D models with intraoperatively identified bronchovascular structures was 99.27%. The overall variation rate was 36% (n=18) among all patients. There was a significant difference between the two groups in terms of the bronchovascular variation. The bronchovascular variation rate was 11.1% (n=2) in Group 1 and 50% (n=16) in Group 2 (p=0.006).

Conclusion: Three-dimensional modeling using open-source software for preoperative planning and intraoperative guidance is a reliable method for detecting bronchovascular structures of the target segment with high accuracy in uniportal video-assisted thoracoscopic surgery segmentectomy.

Background: This study aims to identify prognostic factors in operated patients with non-small cell lung cancer staged as T3N0M0 according to the 8^th edition of the Tumor, Node, Metastasis (TNM) staging system.

Methods: Between January 2010 and June 2023, a total of 79 patients (67 males, 12 females; mean age: 62.9±8.7; range, 40 to 80 years) who underwent surgery for non-small cell lung cancer and were pathologically staged as T3N0M0 were retrospectively analyzed. The patients were divided into two groups: the first group included 56 patients with a single T3 factor, while the second group included 23 patients with multiple T3 factors. Survival analysis was performed.

Results: The five-year overall survival rate for the first group was 79.0%, with a mean overall survival of 107.76±8.44 months (95% confidence interval [CI]: 91.21-124.32), while the second group had a five-year overall survival rate of 48.9%, with a mean overall survival of 69.19±12.60 months (95% CI: 44.48-93.91). This difference was statistically significant (p=0.02). In the multivariate analysis, multiple T3 factors (p=0.003) and the presence of comorbidity (p=0.004) were found to be independent poor prognostic factors.

Conclusion: Our study results suggest that having multiple T factors significantly and adversely affect survival of patients with surgically treated pT3 non-small cell lung cancer.

Background: In this study, we aimed to compare the outcomes of patients who underwent surgery after neoadjuvant chemoradiotherapy versus primary surgery in locally advanced T4 non-small cell lung cancer.

Methods: Between January 2010 and January 2020, a total of 71 non-small cell lung cancer patients (63 males, 8 females; mean age: 57.9±9.6 years; range, 34 to 76 years) diagnosed with T4 tumors and underwent surgery were retrospectively analyzed. Of these patients, 50 underwent neoadjuvant therapy before surgical resection (Group 1), while 21 underwent surgical resection alone (Group 2). Demographic characteristics, complications, mortality and pathological examination results of the patients were recorded.

Results: The neoadjuvant therapy group exhibited a significantly lower mortality rate (odds ratio=4.3). Age and neoadjuvant treatment were the most significant factors on mortality. Overall survival was longer among patients receiving neoadjuvant chemoradiotherapy, but not statistically significant (80.5±9.9 months vs. 60.9±7.9 months, p=0.081).

Conclusion: Our study results indicated a substantial reduction in mortality rates among patients with T4 tumors who underwent concurrent neoadjuvant chemoradiotherapy. Based on these results, neoadjuvant treatment serves as a beneficial preoperative intervention for eligible patients and should be considered before surgical resection.

Background: In this study, we aimed to evaluate one-year clinical follow-up of patients who underwent bilateral ovarian vein embolization using crossover maneuvers between the ovarian veins via unilateral puncture.

Methods: Between January 2017 and September 2022, a total of 34 women (mean age: 39.6±4.9 years; range, 26 to 52 years) who had pelvic venous disease and underwent bilateral embolization of ovarian veins with unilateral puncture and collateral crossover were retrospectively analyzed. The patients were followed at one, six, and 12 months postoperatively. Symptoms were evaluated using physical examination findings and Visual Analog Scale scores and the need for reintervention was assessed.

Results: Of a total of 34 patients, 21 (61.8%) reported dysmenorrhea and 18 (53%) reported both dyspareunia and lower limb varices. There were no major complications during the procedure. The mean preoperative Visual Analog Scale score was 8.1±0.8, which decreased to 2.1±0.6 at 12 months. Reintervention was necessary for only one patient during one-year follow-up.

Conclusion: Although bilateral ovarian vein embolization with crossover to the contralateral side poses greater technical challenges than unilateral ovarian vein closure, it remains a viable technique with favorable outcomes and lower complication rates.