Kardiochirurgia I Torakochirurgia Polska最新文献

Introduction: The hospitalization day after non-small cell lung carcinoma surgery is important in terms of medical, financial, and social aspects.

Aim: Our study aimed to accurately and successfully predict the rate of postoperative hospitalization shorter than 9 days versus longer than 9 days using artificial intelligence algorithms.

Material and methods: The study included 953 patients who underwent surgery for non-small-cell lung carcinoma between 2001 and 2023. The patients' input data consisted of clinical data, laboratory data, respiratory parameters, and radiological and pathological data. The output data included the hospitalization date. We used a fully connected neural network and the k-layer validation method.

Results: The algorithm's training data had a sensitivity value of 90.3%, a positive predictive value of 87.8%, and an accuracy value of 82.6%. The algorithm's F1 1 score was 89.0%, the F1 0 value was 58.3%, and the F1 mean score was 73.6% for the training data. For the test data, the algorithm's sensitivity value was 83.8%, the positive predictive value was 88.6%, and the accuracy value was 78.7%. The F1 1 score was 86.1%, the test F1 0 score was 54.5%, and the F1 average score was 70.3%. The algorithm for the test data created a ROC curve with an area under the curve of 0.82 (AUC = 0.82).

Conclusions: Artificial intelligence algorithms determined the length of hospital stay after non-small cell lung carcinoma surgery with high accuracy and confidence. During the preoperative period, the estimation of hospital stay length will contribute to personalized patient care.

Introduction: Fontan-associated liver disease (FALD) is a common complication in patients with Fontan circulation.

Aim: We aimed to evaluate the red blood cell distribution width-to-platelet ratio (RPR) index as a non-invasive marker for assessing FALD severity, given its reported usefulness in in conditions such as hepatitis.

Material and methods: This retrospective, cross-sectional study included adult Fontan patients. Laboratory tests, liver elastography, and hemodynamic parameters were analyzed.

Results: Fifty-six patients (24 females, 43%; median age 24 years, interquartile range [22-28]) were enrolled. Patients were grouped by liver stiffness (LS) stage: METAVIR ≤ F2 (22 patients, 39%) and > F2 (34 patients, 61%). The RPR index was significantly higher in the > F2 group (0.08 vs. 0.12, p = 0.02), along with FIB-4 (0.68 vs. 1.06) and APRI (0.36 vs. 0.57). RPR correlated positively with liver stiffness (r = 0.27), total bilirubin (r = 0.43), cystatin C (r = 0.36), and creatinine (r = 0.38) but not with NT-proBNP, pulmonary artery pressure, or maximal oxygen consumption. The ROC curve analysis for predicting LS > F2 showed an AUC of 0.74 (95% CI: 0.61-0.87), comparable to FIB-4. Moreover, in the logistic regression model that accounted for age, gender, height, body weight, and systemic chamber morphology, RPR showed a significant association with LS > F2, with an odds ratio indicating a 1.4-fold (95% CI: 1.1-1.7) increase for every 0.01-unit increase in RPR.

Conclusions: The RPR index is a simple, helpful tool for evaluating FALD severity in Fontan patients.

The use of venous access ports carries a risk of complications, including catheter fracture with migration of catheter fragments into the pulmonary arteries. Experience in removing broken catheters is limited and there are no special tools. We present 4 cases of catheter removal using the available lassos/lasso catheter and tools designed for transvenous lead extraction and coronary sinus lead implantation via a femoral and subclavian approach. All four procedures were successful and without complications.

Introduction: Hybrid procedures encompass surgical and catheter-based interventions aimed at enhancing survival rates and provide alternative treatment options for severely ill patients.

Aim: This is a retrospective study aimed at analyzing hybrid procedures in infants with complex heart defects and duct-dependent systemic circulation at a high risk of cross-clamp circulation based on a single center's experience.

Material and methods: We included 12 infants (7 boys, 5 girls) who were admitted to our department between 2019 and 2024 and who underwent hybrid surgery due to left-sided obstructive lesions.

Results: All neonates presented progressive heart failure and multiple organ dysfunction preceding hybrid procedures. The interventions were performed at a mean age of 8.6 days, with a mean body weight of 3.3 kg. Extracorporeal membrane oxygenation was required postoperatively in 2 patients. Early and late mortality were 8.3% and 16.6%, respectively. Interstage catheterization was performed in 7 patients requiring re-dilation of pulmonary artery bands and in 2 infants with arterial duct stent stenosis. Severe tricuspid regurgitation and progressive right ventricular dysfunction due to inadequate coronary perfusion were reported in 2 patients.

Conclusions: Hybrid procedures are alternative options for infants with complex heart defects, especially when cross-clamp circulation poses high surgical risk. Multiple reinterventions are necessary to maintain stable hemodynamic status and relieve hypoxia or cardiac compromise. Future studies should aim to refine the timing and techniques of these interventions to improve survival and quality of life.