Kardiochirurgia I Torakochirurgia Polska最新文献

Introduction Smoking cessation remains a global challenge due to the complex and individualized nature of addiction. Understanding the interplay of psychological, social, and biological factors is crucial for developing effective, personalized cessation strategies.

Aim: This study investigated the factors influencing the success of smoking cessation efforts among patients visiting thoracic surgery outpatient clinics.

Material and methods: Between October 2022 and October 2023, 355 smokers sought assistance at thoracic surgery outpatient clinics, with 231 patients included in the study after exclusions. Data on demographics, comorbidities, cessation attempts, and Fagerström addiction scores were analyzed. Patients received nicotine replacement therapy (NRT), medical therapy (bupropion), and behavioral therapy. Follow-ups were conducted at 1, 3, and 6 months to assess cessation outcomes.

Results: The cohort included 137 males and 94 females, with an average age of 45 years. Overall, 81 patients (35.06%) quit smoking in the first month, and 15 (6.49%) additional patients quit by the third month. Relapse occurred in 36 (15.58%) patients, and 99 (42.86%) patients failed to quit. Success rates were similar between genders and unrelated to age, comorbidities, previous attempts, or smoking intensity. The success rate was slightly higher among those who received pharmacotherapy, but the difference was not statistically significant. However, full adherence to behavioral suggestions was significantly associated with increased cessation success (p < 0.001).

Conclusions: Behavioral therapy plays a critical role in smoking cessation success. Tailored behavioral strategies significantly enhance outcomes, highlighting the need for personalized approaches in cessation programs. Patients in thoracic surgery outpatient clinics benefit from comprehensive support, emphasizing behavioral adaptation to improve cessation rates.

Introduction: Patients who need tricuspid valve replacement (TVR) surgery often have permanent transvalvular pacemaker (PM) leads, which pose an important challenge in lead management.

Aim: The objective of this study was to evaluate the results of paravalvular positioning of a permanent pacemaker lead during TVR surgery.

Material and methods: Between 2014 and 2024, a total of 15 patients who had previously had a transvenous pacemaker system underwent TVR. Relevant information, with a focus on pacemaker characteristics, was collected retrospectively.

Results: A total of 15 patients with PM lead previously implanted underwent TVR during the study period. The median time interval between pacemaker implantation and TVR was 8.5 years (5.7-10.5 years). The preoperative median threshold amplitude and impedance values were 1 V (0.68-1.25 V) and 518 Ω (377.5-598.7 Ω), whereas the postoperative median threshold amplitude and impedance values were 0.73 V (0.5-1 V) and 460 Ω (378.5-550). During the midterm follow-up, there were no mortalities or significant morbidities, and no patients required pacemaker lead revision.

Conclusions: We concluded that paravalvular positioning of the PM lead is an acceptable option during TVR surgery, since this technique enables better function of the prosthetic valve and pacemakers at mid-term follow-up.

Surgical treatment of lung metastases originating from head and neck tumors has shown favorable outcomes with low incidence of complications and mortality. This study aims to investigate survival and prognostic factors following pulmonary metastasectomy for head and neck cancers. A comprehensive review of the literature was conducted through the Medline database, focusing on English-language studies related to surgical treatment of lung metastases from head and neck cancers. Lung metastases occur frequently in patients with head and neck tumors, significantly impacting overall survival. Multidisciplinary assessment is crucial in determining treatment strategies, with notable improvements in survival rates observed over recent decades. Various studies have reported survival outcomes and prognostic factors, highlighting the significance of factors such as primary tumor localization, histology, and completeness of resection. Pulmonary metastasectomy with curative intent for head and neck cancers is a safe and effective treatment option that can prolong survival in selected patients.

Introduction: Spontaneous pneumothorax is a life-threatening thoracic condition that could be either primary spontaneous pneumothorax (PSP) in the absence of an underlying lung disease or secondary spontaneous pneumothorax (SSP) in the presence of an underlying lung disease. In the case of recurrent, contralateral spontaneous pneumothorax or persistent air leak with a chest drain, surgery with bullectomy associated with pleurectomy or pleurodesis is the gold standard management.

Aim: To compare two different techniques for bullectomy, either by using staplers or by hand sewing.

Material and methods: Retrospective review of all patients with spontaneous pneumothorax who underwent bullectomy and pleurectomy by thoracotomy. Group A (30 patients) had repair by using staplers and group B (30 patients) had repair using the hand sewing technique.

Results: The mean operative cost was 4400 ±433.4 Egyptian pounds (EGP) versus EGP 2733.3 ±253.7 in group A and group B respectively (p = 0.001). Mean post-operative cost was 1000 ±100 EGP in group A compared to EGP 2060 ±154.4 in group B (p = 0.0001). Duration of air leak was 1.8 ±1.095 and 9.1 ±3.2 days in group A and group B, respectively (p = 0.0001). Re-exploration occurred in 1 patient in group A (3.3%) and 2 patients in group B (6.6%) (p = 0.5).

Conclusions: The operative cost was significantly higher in the stapler group compared to the hand sewing technique group. However, the duration of post-operative air leak, post-operative hospital stay and post-operative cost were significantly lower in the stapler group. There was no significant difference between the 2 groups in the re-exploration rate after surgery.

Introduction: Coarctation of the aorta (CoA) patients often experience recoarctation, the reoccurrence of aortic narrowing, presenting a considerable clinical challenge.

Aim: This study aims to investigate the triggers or contributing factors associated with the development of recoarctation (reCoA) following the initial repair of CoA.

Material and methods: The retrospective cohort study includes information about 120 patients, who underwent 4 different types of surgical repairs of coarctation of the aorta through left thoracotomy in the period 2012-2022. Recoarctation was evaluated using the pressure gradient on the coarctation site measured by echocardiography (echoCG). A threshold of more than 20 mm Hg was employed to define recoarctation. All statistical analysis was performed using SPSS and Jamovi applications.

Results: The study revealed that 30 (25%) patients experienced early recoarctation, while 52 (43.7%) patients encountered late recoarctation. Among the 28 (23.3%) patients who had arch hypoplasia, 12 experienced early recoarctation, and 22 exhibited late recoarctation. Correlation tests demonstrated a strong negative correlation of the z-score of the arch size with both early recoarctation (r = -0.229, p = 0.013) and late recoarctation (r = -0.421, p < 0.001). Resection and end-to-end anastomosis (EEA) displayed the highest proportions of early (59%) and late (77%) recoarctation.

Conclusions: Aortic arch hypoplasia emerges as a significant risk factor for both early and late recoarctation. Additionally, while all coarctation repair methods carry some risk of recoarctation, resection and end-to-end anastomosis and prosthetic patch aortoplasty may pose a higher risk compared to extended end-to-end anastomosis.