Kardiochirurgia I Torakochirurgia Polska最新文献

Introduction: Thoracoabdominal injuries are associated with significant morbidity and mortality, and their diagnosis and treatment remain complex and controversial.

Aim: This study evaluated the effectiveness of endovideosurgery and enhanced surgical techniques for the diagnosis and treatment of hemodynamically stable and unstable patients with thoracoabdominal injuries.

Material and methods: This study included 190 cases of thoracoabdominal injuries treated between June 2017 and June 2022. Patients were divided into three groups: those with thoracic injuries, abdominal injuries, and combined thoracoabdominal injuries. The main group underwent endovideosurgery and improved surgical techniques, while the comparison group was treated with traditional methods. The outcomes of the advanced surgical approach and endovideosurgery were assessed and compared with traditional methods to evaluate their clinical significance.

Results: The use of endovideosurgery and enhanced surgical techniques reduced the rate of exploratory surgery for abdominal injuries from 25.4% to 3.6% (a sevenfold reduction) and for combined thoracic and abdominal injuries from 28.2% to 5.0%. Postoperative complications also showed a significant decrease: in thoracic injuries, from 29.0% to 5.0%; in abdominal injuries, from 30.5% to 7.1%; and in combined thoracoabdominal injuries, from 37.5% to 10.0%.

Conclusions: Dividing patients based on hemodynamic stability is crucial in the surgical management of thoracoabdominal injuries, facilitating the effective use of endovideosurgical techniques in appropriate patient categories.

Introduction: Pulmonary artery (PA) repair in pediatric cardiac surgery often utilizes the transannular patch (TAP) technique, which, while effective, is associated with complications such as right ventricular (RV) dysfunction and pulmonary valve (PV) regurgitation.

Aim: Recent findings highlight the need for improved strategies to address these issues and enhance long-term outcomes.

Material and methods: This retrospective cohort study analyzed 16 pediatric patients who underwent PA repair between December 2023 and April 2024. Patients were divided into two groups: right atrial appendage (RAA) neovalve (n = 8) and TAP (n = 8). Key procedural metrics, RV function, and postoperative outcomes were evaluated using standard statistical methods.

Results: The RAA neovalve group demonstrated significantly reduced severe PV regurgitation compared to the TAP group (p < 0.001). Additionally, the RAA neovalve group exhibited improved RV function, with more patients showing no RV dysfunction (p = 0.014). The RAA neovalve group also experienced shorter ICU stays (3.88 ±0.84 days vs. 6.13 ±2.75 days, p = 0.044) and hospital stays (10.1 ±1.25 days vs. 13.2 ±3.19 days, p = 0.029).

Conclusions: The RAA neovalve technique presents a significant improvement over traditional TAP in reducing severe PV regurgitation and enhancing RV function. The shorter ICU and hospital stays associated with the RAA neovalve suggest better postoperative recovery. These results indicate that the RAA neovalve could be a superior alternative to TAP for PA repair, warranting further research to confirm these benefits and explore long-term outcomes.

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.