Kardiochirurgia I Torakochirurgia Polska最新文献

Introduction: Chest wall tumors, though rare, represent a significant subset of thoracic neoplasms, accounting for approximately 5% of thoracic and 2% of overall body neoplasms. Their management has historically posed challenges for surgeons, often leading to misdiagnosis, incomplete resection, and high complication rates. An individualized surgical approach, tailored to the specific characteristics of the disease, is crucial for optimizing outcomes.

Aim: To evaluate the outcomes of chest wall masses and report on individual cases.

Material and methods: This retrospective cohort study included 131 patients diagnosed with chest wall masses at Ghaem University Hospital between 2011 and 2021. Data on demographics (age, gender), pre- and post-operative pathology, specific surgical procedures performed, duration of hospitalization, need for post-surgical reconstruction (e.g., flap reconstruction), and history of pre-operative chemotherapy/radiotherapy were collected from medical records. Data were analyzed using descriptive statistics and appropriate inferential tests depending on the variable type. Potential limitations such as missing data or selection bias were acknowledged.

Results: A total of 131 patient records were examined, with an average age of 17.35 ±38.51 years. Of these, 50 (38.2%) were female and 81 (61.8%) were male. It was found that 54.2% of patients had benign tumors, while 45.8% had malignant tumors. Sarcoma (26%) and fibromatosis (21.4%) were the most common tumor types. No significant associations were observed between gender or history of chemotherapy and radiotherapy and the type of surgery performed (p > 0.05). However, a significant association was found between tumor histology and the type of surgery performed (p < 0.05).

Conclusions: The majority of procedures performed were for fibromatous and benign tumors, while the most common malignant tumors were sarcomas, with chondrosarcoma being the predominant subtype. Tumor type significantly influenced the extent of resection and need for chest wall reconstruction.

Introduction: The Perceval sutureless biological prosthesis for aortic valve replacement has been introduced with the rationale for shortening surgical, extracorporeal circulation and aortic cross-clamping times, in order to reduce postoperative complications.

Aim: To evaluate early hemodynamic performance and immediate outcomes of implantation of the Perceval sutureless bioprosthesis in comparison with the St. Jude Trifecta sutured bioprosthesis for aortic valve replacement (Perfecta study).

Material and methods: Between December 2014 and June 2023, 281 patients underwent St. Jude Trifecta implantation (n = 220, mean age: 75.2 ±6.5 years) and Perceval implantation, when indicated (n = 61, mean age: 77.9 ±5.1 years). Concomitant CABG was performed in 73 (33%) and in 27 (44%) patients, respectively.

Results: Extracorporeal circulation and cross-clamp times were significantly shorter in Perceval patients in all aortic valve replacements (61 ±23 and 49 ±18 minutes vs. 96 ±36 and 67 ±21 minutes), and in isolated procedures (54 ±10 and 43 ±8 minutes vs. 84 ±28 and 66 ±21 minutes) (p < 0.0001, for all comparisons). Operative mortality was absent and 2.7%, respectively (p = 0.2). Postoperatively, low output cardiac syndrome (0% vs. 4.5%) and total rate of major cardiac and non-cardiac related complications (6.6% vs. 18.6%) were significantly lower in Perceval patients (p = 0.01). Echocardiography at discharge in comparison with preoperatively showed a relevant and similar decrease of mean and peak trans-aortic valve gradients for the Trifecta prosthesis (11.6 ±4.3 vs. 50 ±15.2 mm Hg; 21.6 ±7.3 vs. 78.8 ±24 mm Hg) and for the Perceval prosthesis (12.6 ±4.8 vs. 52 ±12.5 mm Hg; 22.6 ±7.9 vs. 77.8 ±16 mm Hg) (p < 0.00001, for all comparisons). Better global cardiac function was observed in Perceval patients. Concomitant multi-vessel and left main coronary artery disease (p = 0.046; HR = 4.6) and chronic pulmonary disease (p = 0.006; HR = 5.6) were detected as independent predictors of death and postoperative major complications.

Conclusions: Early hemodynamic performance appears to be satisfactory with the use of Trifecta sutured and Perceval sutureless bioprostheses. Perceval implantation allows reduction of surgical times, better preservation of myocardial contractile function and, consequently, reduction of the risk of postoperative complications.

Melanoma is an aggressive neoplasm mainly affecting the skin. It has a predisposition to metastasis and it presents the highest propensity to spread to the heart, mostly through the hematologic route. Cardiac metastases frequently remain asymptomatic, even though the metastatic process to other organs is described as an advanced stage of the melanoma. Treatment methods include conservative and surgical management. Surgeries should be preferably performed at the early stages of the disease, when physicians can achieve total resections with clear margins. In some cases palliative procedures are also implemented. In 26 patients analyzed in this review, eleven cases presented favorable results of the surgery. In majority of the patients the diffuse metastatic disease led to their decease despite the surgery.