Kardiochirurgia I Torakochirurgia Polska最新文献

Diabetes mellitus (DM) is one of the most common chronic diseases, affecting globally about 537 million adults. Cardiovascular disease remains the leading cause of death and medical emergencies in the DM patient population. As a result, about 40% of patients with DM undergo cardiac surgery, mainly in the coronary arteries. Uncontrolled hyperglycemia, especially the prolonged condition, is an independent factor in postoperative mortality and the cause of many serious complications, such as surgical wound infection, sepsis, renal failure or cerebral or cardiovascular incidents. Adequate glycemic control in the perioperative period is the most important way to prevent the above complications. The issue has remained an important topic of many observational and experimental studies for years. This paper summarizes the current knowledge with regard to strategies of hyperglycemic control in patients undergoing cardiac surgery.

Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm classified by the World Health Organization as an intermediate malignancy with less than a 5% chance of metastasis. IMTs consist of myofibroblastic and spindle fibroblastic cells accompanied by inflammatory infiltration, primarily affecting patients under 16 years old, though they can also occur in adults. The etiology and pathogenesis of IMTs remain unclear, with possible contributing factors including inflammation, trauma, autoimmune diseases, prior surgery, viral infections, and uncontrolled myofibroblast proliferation. The primary treatment is complete surgical resection, which is associated with long-term survival and a significantly reduced recurrence rate of 2%, compared to 60% for incomplete resections. Chemotherapy is generally not recommended but may be necessary for unresectable tumors. Advances in histopathological diagnosis provide deeper insights into IMT biology, aiding in the selection of appropriate treatments. This paper presents a comprehensive review of the literature on this rare clinical entity.

The application of TachoSil adhesive is becoming increasingly popular in surgical procedures. A special area of surgical medicine is cardiac surgery, where the adhesive makes it possible to provide hemostasis when classic anastomotic methods are insufficient. There are numerous studies available demonstrating the perioperative efficacy of TachoSil, and its ease of use in the human population. However, studies on the inflammation caused by TachoSil are widely limited to animal experiments. There is a lack of studies on human groups on TachoSil-induced inflammation in cardiac surgery. The purpose of our paper is to review the current knowledge on the use of TachoSil in animals and the incidence of inflammation, in order to determine whether there is a need for similar human studies in cardiac surgery. The paper discusses the details of this problem based on recent scientific reports.

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.