Kardiochirurgia I Torakochirurgia Polska最新文献_第9页

Retention of temporary epicardial pacing wires: when migration causes dehiscence of a sternal wound. 临时心外膜起搏导线的保留:当迁移导致胸骨伤口裂开时。

IF 0.7 Q3 Medicine

Kardiochirurgia I Torakochirurgia Polska

Pub Date : 2023-06-01 DOI: 10.5114/kitp.2023.129547

Eleonora Latini, Dario Buioni, Paolo Nardi, Calogera Pisano, Cristina Viscogliesi, Federico Agneni, Claudia Altieri, Giovanni Ruvolo

Address for correspondence: Dario Buioni, Cardiac Surgery Division, Tor Vergata University Hospital, Viale Oxford 81, Rome, PC 00133, Italy, e-mail: docyuk@libero.it Received: 14.02.2023, accepted: 5.03.2023. Temporary epicardial pacing wires (TEPWs) have been routinely inserted in all patients undergoing cardiac surgery since the 1960s. The main purposes were, and still are, therapeutic and diagnostic, as they are mainly used to recognize and treat ventricular and/or atrial rhythm disturbances that may be a complication of cardiac interventions and to sustain the possible hemodynamic instability during post-operative intensive care [1]. However, their necessity is often discussed as their use is linked to several but unlikely complications such as cardiac tamponade and hemorrhage at the time of removal [2], or infection, wound dehiscence and migration when retained [3]. The indications for insertion of the TEPWs are several: conduction abnormalities such as AV block, prolonged AV delay, bifascicular block; bradycardia and tachycardia, especially atrial fibrillation, which is common in the period following cardiac surgery; and the need to place both atrial and ventricular wires is often dependent on the patient; furthermore, the pacing system should be checked and reassessed routinely based on the patient’s condition. The removal must be done carefully by gentle and constant traction; if too much traction is needed as they may have been caught in a tight suture, they should be cut as close to the skin as possible due to the risk of tamponade immediately after the removal procedure. For this reason, it is necessary to observe the patient and perform echocardiography a few hours after the removal [1]. Although there is a risk of hemorrhage and cardiac tamponade, to cut the wires flush with the skin is not a procedure free of adverse events such as infection and migration. An 89-year-old woman with severe aortic stenosis and aneurysm of the ascending aorta, with medical history of hypertension, dyslipidemia, obesity and chronic renal failure, underwent aortic valve replacement with a Sorin Mitroflow 21 bioprosthesis and of the ascending aorta with an Intervascular 28 prosthesis, requiring circulatory arrest during the procedure on September 2014. In the immediate post-operative period, due to massive bleeding and hemodynamic instability, it became necessary to conduct a surgical revision of the mediastinum. Two right atrial and two right ventricular epicardial pacing wires were inserted at the moment of the intervention and were not removed during the revision of the mediastinum; on the 6th postoperative day (POD), at the time of removal, only the ones placed on the right ventricle were removed without resistance, while the ones on the right atrium were cut flush with the skin. On the 8th POD, the patient presented strong chest pain, erythema and drainage from the distal third of the sternotomy wound associated with sternal instability; on the 10th

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引用次数: 0

Lung cancer invading the superior vena cava - surgical treatment. A short and up-to-date review. 肺癌侵犯上腔静脉的外科治疗。一篇简短的最新评论。

IF 0.7 Q3 Medicine

Kardiochirurgia I Torakochirurgia Polska

Pub Date : 2023-06-01 DOI: 10.5114/kitp.2023.129546

Eleftherios Nikolaidis, Nikolaos Bolanos, Dimitrios Anagnostopoulos, Vasileios Leivaditis, Konstantinos Grapatsas, Efstratios Koletsis, Athanasios Papatriantafyllou, Ioannis Panagiotopoulos, Francesk Mulita, Nikolaos Baltayiannis, Manfred Dahm, Antonios Chatzimichalis

Lung cancer is one of the leading causes of cancer-related deaths worldwide. Superior vena cava syndrome (SVCS) is a rare but potentially life-threatening complication of lung cancer, occurring in approximately 5-10% of cases. There are difficulties in the process of surgical treatment of SVC infiltrated by lung tumors but the contribution of technological evolution and innovation is promising. At the same time, the amelioration of survival rates of patients subjected to surgical treatment is equally promising. The reported outcomes of surgical treatment for SVC invasion due to lung tumors vary depending on the extent of the tumor and the patient's overall health status. However, studies clearly suggest that surgical treatment can improve survival and quality of life in selected patients. The literature review showed that the surgical approach to lung cancer invading the SVC constitutes the most indispensable treatment which helps to achieve the long-term survival of patients.

肺癌是全球癌症相关死亡的主要原因之一。上腔静脉综合征(SVCS)是一种罕见但可能危及生命的肺癌并发症，发生率约为5-10%。肺肿瘤浸润上腔细胞的手术治疗存在困难，但技术进步和创新的贡献是有希望的。与此同时，手术治疗患者生存率的改善也同样有希望。肺肿瘤引起的SVC侵犯的手术治疗结果因肿瘤的范围和患者的整体健康状况而异。然而，研究清楚地表明，手术治疗可以改善选定患者的生存和生活质量。文献回顾表明，对于侵犯上腔细胞的肺癌，手术入路是最不可或缺的治疗方法，有助于实现患者的长期生存。

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引用次数: 0

Cardiac angiosarcoma: a formidable challenge. 心脏血管肉瘤:一个艰巨的挑战。

IF 0.7 Q3 Medicine

Kardiochirurgia I Torakochirurgia Polska

Pub Date : 2023-03-01 DOI: 10.5114/kitp.2023.126101

Daniele Trombetti, Calogera Pisano, Maria Sabrina Ferrante, Laura Asta, Claudia Altieri, Paolo Nardi, Dario Buioni, Giovanni Ruvolo

Address for correspondence: Daniele Trombetti MD, Department of Cardiac Surgery, University of Tor Vergata, Rome, Italy, e-mail: daniele.trombetti@famigliatrombetti.it Received: 2.10.2022, accepted: 6.02.2023. Primary cardiac angiosarcoma (AS) is a clinically rare (incidence of about 0.017%) and highly invasive cardiac tumor with an unfavorable prognosis. The general prognosis of patients with primary cardiac sarcoma is poor, with median overall survival which ranges from 9 to 27 months in recent case series [1]. Cases of primary cardiac angiosarcoma (PCAS) are extraordinarily rare but represent most cases of malignant cardiac cancer. PCAS originates from vascular endothelial cells or vascular endothelial cells that have differentiated from mesenteric cells. Much of the literature indicates that a majority of PCAS cases occur in the right atrium. Cardiac sarcomas usually present insidious symptoms in young and middle-aged patients. They generally have an unfavorable prognosis with an overall survival of between 6 and 12 months. The treatment of choice for these rare malignancies is a combination of surgical resection and radioand/or chemotherapy [2]. However, in most cases, and in contrast to benign cardiac tumors, surgical resection still represents a palliative strategy for many patients with cardiac sarcomas. Therefore, rapid and accurate diagnosis is necessary and can confer a survival advantage on individual patients [3]. We report our experience with a young patient treated in our unit for an undifferentiated pleomorphic sarcoma who is still alive. As this study was carried out in order to improve the management of primary cardiac angiosarcoma, local approval at the level of the surgical department was obtained prior to data collection and the patient signed the consent form for scientific purposes. In April 2020, a 41-year-old patient was admitted to the Emergency Room of Tor Vergata University for dyspnea associated with chest tightness and vertigo. The echocardiography examination showed a round-shaped hyperechoic formation (6 × 4 cm) occupying all the left atrium until the inflow tract of the left ventricle with a large base of implantation in the anterior portion of the atrial septum (Figures 1 A–C). This mass engaged the mitral valve, resulting in severe steno-insufficiency (transvalvular medium gradient 27 mm Hg). A computed tomography (CT) raised the hypothesis of a PCAS (Figures 2 A–C). After a multidisciplinary clinical discussion, the patient was transferred to our Cardiac Surgery Unit for a cardiac operation. A standard longitudinal sternotomy was performed and the patient underwent cardiopulmonary bypass for exeresis of the mass. At the opening of the left atrium the mass adhered tenaciously to the atrial septum, the left auricle, the free wall of the left atrium and the anterior flap of the mitral valve. Despite the presence of tenacious adhesions of the mass to the atrial structures, it was possible to perform a total mass ex

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引用次数: 0

Hybrid treatment of type 2 right sided aortic arch and Kommerell's diverticulum in an octogenarian. 八旬老人2型右侧主动脉弓和Kommerell憩室的混合治疗。

IF 0.7 Q3 Medicine

Kardiochirurgia I Torakochirurgia Polska

Pub Date : 2023-03-01 DOI: 10.5114/kitp.2023.126103

Serkan Burc Deser

引用次数: 0

Unilateral pulmonary edema following minimally invasive cardiac surgery: keeping both eyes maximally open. 微创心脏手术后单侧肺水肿:保持双眼最大程度张开。

IF 0.7 Q3 Medicine

Kardiochirurgia I Torakochirurgia Polska

Pub Date : 2023-03-01 DOI: 10.5114/kitp.2023.126098

Rohan Magoon, Nitin Choudhary, Jes Jose

引用次数: 1

Surgical treatment of thoracic esophageal diverticula. 胸段食管憩室的外科治疗。

IF 0.7 Q3 Medicine

Kardiochirurgia I Torakochirurgia Polska

Pub Date : 2023-03-01 DOI: 10.5114/kitp.2023.126091

Janusz Wlodarczyk, Tomasz Smęder, Piotr Obarski

Introduction: Thoracic esophageal diverticulum (TED) is a rare benign disease associated with motility disorders of the esophagus. Surgical management is usually the definitive treatment, with traditional excision of the diverticulum via thoracotomy and minimally invasive techniques being comparable and associated with a mortality rate of between 0 and 10%.

Aim: To present the results of surgical treatment of patients with thoracic diverticula of the esophagus in a 20-year period.

Material and methods: The study presents a retrospective analysis of the results of surgical management of patients with the thoracic esophageal diverticulum. All patients underwent open transthoracic diverticulum resection with myotomy. Patients were evaluated for the degree of dysphagia before and after surgery, associated complications and overall comfort after surgical treatment.

Results: Twenty-six patients due to diverticula of the thoracic part of the esophagus underwent surgical treatment. Resection of the diverticulum with esophagomyotomy was performed in 23 (88.5%) patients, anti-reflux surgery was performed in 7 (26.9%) and in 3 (11.5%) patients with achalasia, the diverticulum was left unresected. Among the patients operated on, 2 (7.7%) patients developed a fistula, and both required mechanical ventilation. In 1 patient the fistula closed spontaneously, and the other patient required esophageal resection and colon reconstruction. Two patients required emergency treatment due to mediastinitis. There was no mortality in the perioperative period of hospital stay.

Conclusions: Treatment of thoracic diverticula is a difficult clinical problem. Postoperative complications pose a direct threat to the patient's life. Esophageal diverticula is characterized by good long-term functional results.

胸段食管憩室(TED)是一种罕见的与食道运动障碍相关的良性疾病。手术治疗通常是最终的治疗方法，传统的开胸憩室切除术与微创技术相当，死亡率在0 - 10%之间。目的:介绍近20年来胸段食管憩室的手术治疗结果。材料与方法:回顾性分析胸段食管憩室的手术治疗结果。所有患者均行开放性经胸憩室切除联合肌切开术。评估患者术前和术后的吞咽困难程度、相关并发症和手术后的总体舒适度。结果:26例因胸段食道憩室行手术治疗。23例(88.5%)患者行食管切开术切除憩室，7例(26.9%)患者行抗反流手术，3例(11.5%)贲门失弛缓症患者未切除憩室。手术患者中2例(7.7%)发生瘘管，均需机械通气。1例患者瘘管自行关闭，另1例患者需要食管切除术和结肠重建。2例患者因纵隔炎需要紧急治疗。围手术期住院无死亡病例。结论:胸憩室的治疗是一个临床难题。术后并发症直接威胁到患者的生命安全。食管憩室具有良好的长期功能效果。

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引用次数: 0

Comparison of eversion carotid endarterectomy under local anesthesia and eversion/conventional carotid endarterectomy under general anesthesia. 局麻下外翻颈动脉内膜切除术与全麻下外翻/常规颈动脉内膜切除术的比较。

IF 0.7 Q3 Medicine

Kardiochirurgia I Torakochirurgia Polska

Pub Date : 2023-03-01 DOI: 10.5114/kitp.2023.126096

Serkan Burc Deser, Berk Arapi

Introduction: Studies searching outcomes of eversion carotid endarterectomy (E-CEA) under local anesthesia are lacking.

Aim: To evaluate the postoperative outcomes of E-CEA under local anesthesia and compare it with E-CEA/Conventional CEA under general anesthesia in symptomatic or asymptomatic patients.

Material and methods: From February 2010 to November 2018 a total of 182 patients (143 males, 39 females; mean age: 69.69 ±9.88 years; range: 47 to 92 years) who underwent eversion CEA or conventional CEA with patchplasty under general or local anesthesia in two tertiary centers were included in this study.

Results: Overall in-hospital stay (p = 0.01), postoperative in-hospital stay (p = 0.022) took significantly less time in favor of E-CEA under local anesthesia. Overall, 6 patients developed major stroke (3.2%), among them 4 (2.1%) patients passed away, 7 (3.8%) patients developed cranial nerve injury (the marginal mandibular branch of the facial nerve and hypoglossal nerve), 10 (5.4%) patients developed a hematoma in the postoperative period. No difference was found in terms of postoperative stroke (p = 0.470), postoperative death (p = 0.703), postoperative bleeding rate (p = 0.521) or postoperative cranial nerve injury (p = 0.481) between the groups.

Conclusions: The mean operation time, postoperative in-hospital stay, overall in-hospital stay, and need for shunting were lower in patients who underwent E-CEA under local anesthesia. E-CEA under local anesthesia seemed to do better in stroke, death, and bleeding rate, however, this difference was not significant.

引言:局部麻醉下外翻颈动脉内膜切除术(E-CEA)的研究缺乏。目的:评价局麻下E-CEA的术后效果，并与全麻下E-CEA/常规CEA在有症状或无症状患者中的效果进行比较。材料与方法:2010年2月至2018年11月共182例患者，其中男性143例，女性39例;平均年龄:69.69±9.88岁;范围:47 - 92岁)，在两个三级中心全麻或局麻下接受外翻CEA或常规CEA补片成形术的患者纳入本研究。结果:局麻下E-CEA总住院时间(p = 0.01)和术后住院时间(p = 0.022)均显著缩短。术后发生脑卒中6例(3.2%)，死亡4例(2.1%)，颅内神经损伤(面神经下颌缘支及舌下神经)7例(3.8%)，术后发生血肿10例(5.4%)。两组在术后卒中(p = 0.470)、术后死亡(p = 0.703)、术后出血率(p = 0.521)和术后颅神经损伤(p = 0.481)方面均无差异。结论:局麻下行E-CEA患者的平均手术时间、术后住院时间、总住院时间和分流需求均较低。局部麻醉下的E-CEA似乎在卒中、死亡和出血率方面表现更好，但这种差异并不显著。

{"title":"Comparison of eversion carotid endarterectomy under local anesthesia and eversion/conventional carotid endarterectomy under general anesthesia.","authors":"Serkan Burc Deser, Berk Arapi","doi":"10.5114/kitp.2023.126096","DOIUrl":"https://doi.org/10.5114/kitp.2023.126096","url":null,"abstract":"Introduction: Studies searching outcomes of eversion carotid endarterectomy (E-CEA) under local anesthesia are lacking.Aim: To evaluate the postoperative outcomes of E-CEA under local anesthesia and compare it with E-CEA/Conventional CEA under general anesthesia in symptomatic or asymptomatic patients.Material and methods: From February 2010 to November 2018 a total of 182 patients (143 males, 39 females; mean age: 69.69 ±9.88 years; range: 47 to 92 years) who underwent eversion CEA or conventional CEA with patchplasty under general or local anesthesia in two tertiary centers were included in this study.Results: Overall in-hospital stay (p = 0.01), postoperative in-hospital stay (p = 0.022) took significantly less time in favor of E-CEA under local anesthesia. Overall, 6 patients developed major stroke (3.2%), among them 4 (2.1%) patients passed away, 7 (3.8%) patients developed cranial nerve injury (the marginal mandibular branch of the facial nerve and hypoglossal nerve), 10 (5.4%) patients developed a hematoma in the postoperative period. No difference was found in terms of postoperative stroke (p = 0.470), postoperative death (p = 0.703), postoperative bleeding rate (p = 0.521) or postoperative cranial nerve injury (p = 0.481) between the groups.Conclusions: The mean operation time, postoperative in-hospital stay, overall in-hospital stay, and need for shunting were lower in patients who underwent E-CEA under local anesthesia. E-CEA under local anesthesia seemed to do better in stroke, death, and bleeding rate, however, this difference was not significant.","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/33/a2/KITP-20-50409.PMC10107416.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9384310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Robotic thymectomy: a review of techniques and results. 机器人胸腺切除术:技术和结果综述。

IF 0.7 Q3 Medicine

Kardiochirurgia I Torakochirurgia Polska

Pub Date : 2023-03-01 DOI: 10.5114/kitp.2023.126097

Danilo Coco, Silvana Leanza

Thymectomy is a well-established therapeutic option in the multidisciplinary treatment of nonthymomatous myasthenia gravis (MG) and in thymoma treatment. Although many surgical procedures for thymectomy have been identified, the transsternal method is still regarded as the gold standard. Minimally invasive procedures, on the other hand, have achieved popularity in the last decades and are now extensively used in this field of surgery. Among them, robotic thymectomy has been the most cutting-edge surgical procedure. Several authors and meta-analyses have shown that a minimally invasive approach to thymectomy is associated with improved surgical results and fewer complications in surgery compared to transsternal open thymectomy, without any substantial changes in myasthenia gravis complete rates of remission. Hence, in the present review of the literature, we aimed to describe and delineate the techniques, advantages, outcomes, and future perspectives of robotic thymectomy. Existing evidence suggests that robotic thymectomy will likely become the gold standard for thymectomy in early stage thymomas and MG subjects. Many of the drawbacks related to other minimally invasive procedures appear to be resolved by robotic thymectomy, and long-term neurological outcomes are satisfactory. In addition, improved vision and high dexterity of instrument movements enable safe and complete thymic tissue dissection, superior to standard thoracoscopic procedures. The access with minimally invasive surgery VATS (video-assisted thoracoscopic surgery) or RATS (robot-assisted thoracic surgery) access in its various variants allows the extent of mediastinal fat resection due to the possibility of ectopic thymic foci in the mediastinum determining the long-term outcome in the group of patients operated on for myasthenia gravis. However, it was recommended to carry out better designed, multi-centre, randomized studies to arrive at definitive conclusions on robotic thymectomy for thymomas and myasthenia gravis treatment.

胸腺切除术在非胸腺瘤性重症肌无力(MG)和胸腺瘤治疗的多学科治疗中是一种行之有效的治疗选择。虽然许多胸腺切除术的手术方法已经确定，经胸骨法仍然被认为是金标准。另一方面，微创手术在过去的几十年里得到了普及，现在广泛应用于这一外科领域。其中，机器人胸腺切除术一直是最尖端的外科手术。几位作者和荟荟性分析表明，与经胸骨切开胸腺切除术相比，微创胸腺切除术可改善手术效果，减少手术并发症，重症肌无力完全缓解率无实质性变化。因此，在目前的文献综述中，我们旨在描述和描述机器人胸腺切除术的技术、优势、结果和未来的前景。现有证据表明，机器人胸腺切除术可能成为早期胸腺瘤和MG患者胸腺切除术的金标准。机器人胸腺切除术解决了其他微创手术的许多缺点，并且长期的神经预后令人满意。此外，与标准胸腔镜手术相比，视力的改善和器械移动的高度灵活性使胸腺组织解剖更加安全和完整。微创手术VATS(视频辅助胸腔镜手术)或RATS(机器人辅助胸外科手术)在其各种形式的进入允许纵隔脂肪切除的程度，因为纵隔胸腺病灶异位的可能性决定了重症肌无力手术组患者的长期预后。然而，建议进行更好的设计，多中心，随机研究，以得出机器人胸腺切除术治疗胸腺瘤和重症肌无力的明确结论。

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引用次数: 0

Bibliometric spotlight on thoracic surgery specialization theses in Turkey. 土耳其胸外科专业论文的文献计量分析。

IF 0.7 Q3 Medicine

Kardiochirurgia I Torakochirurgia Polska

Pub Date : 2023-03-01 DOI: 10.5114/kitp.2023.126093

İbrahim Sarbay, İsmail Sarbay

Introduction: Scientific publications originating from medical specialty theses are seen as a start to an academic career for clinicians and a criterion to work in academia in Turkey.

Aim: To evaluate thoracic surgery theses in the period 2001-2019 in publication and other bibliometric parameters.

Material and methods: Our study investigated 319 theses prepared in the thoracic surgery field between January 2001 and December 2019 and registered in the National Thesis Center. We identified and recorded the author's gender, institution, research method, publication status, time, citations, journals' index, and author's order using Google Scholar, Web of Science Basic Search, and Master Journal List.

Results: Of the 319 evaluated, 262 theses were from universities, and 57 were in Training and Research Hospitals. Thirty-two studies (10%) were experimental or prospective clinical. The number of published studies (38.5%) in journals was 123 (66 SCI/SCI-E, 8 ESCI, three other international indexes, and 46 national indexes). Sixty (18.8%) authors were women. The mean time to publication was 4.31 ±2.95 years. It was 3.3 years for female researchers (p = 0.029). Experimental/prospective studies in universities were relatively higher. The number of citations in SCI/SCI-E journals was significantly higher (p < 0.001). The time to the publication of experimental/prospective studies was shorter (p = 0.039).

Conclusions: The publication rate of thoracic surgery theses was 38.5%. Female researchers published their studies earlier. Articles in SCI/SCI-E journals had a higher number of citations. The time to publication was significantly shorter in experimental/prospective studies. This study is the first in the literature as a bibliometric report of the thoracic surgery thesis.

导言:在土耳其，来自医学专业论文的科学出版物被视为临床医生学术生涯的开始，也是在学术界工作的标准。目的:评价2001-2019年胸外科论文发表情况及其他文献计量学参数。材料和方法:本研究调查了2001年1月至2019年12月在国家论文中心登记的胸外科领域的319篇论文。我们使用Google Scholar、Web of Science Basic Search和Master Journal List识别并记录了作者的性别、机构、研究方法、发表状态、发表时间、被引次数、期刊索引和作者顺序。结果:319篇论文中，高校论文262篇，培训研究型医院论文57篇。32项研究(10%)是实验性或前瞻性临床研究。期刊发表论文123篇，占38.5%，其中SCI/SCI- e 66篇，ESCI 8篇，其他国际指标3篇，国内指标46篇。60位(18.8%)作者为女性。平均发表时间为4.31±2.95年。女性为3.3年(p = 0.029)。大学的实验/前瞻性研究相对较高。SCI/SCI- e期刊的被引次数显著高于SCI/SCI- e期刊(p < 0.001)。实验/前瞻性研究的发表时间较短(p = 0.039)。结论:胸外科论文发表率为38.5%。女性研究人员更早发表了他们的研究。SCI/SCI- e期刊的文章被引次数较高。在实验/前瞻性研究中，发表时间明显更短。本研究是文献中第一个作为文献计量学报告的胸外科论文。

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引用次数: 0

Treating Mitroflow dysfunction by means of an open valve-in-valve Perceval implantation. 利用瓣内直视植入治疗血流功能障碍。

IF 0.7 Q3 Medicine

Kardiochirurgia I Torakochirurgia Polska

Pub Date : 2023-03-01 DOI: 10.5114/kitp.2023.126105

Daniele Trombetti, Calogera Pisano, Claudia Altieri, Paolo Nardi, Sabrina Maria Ferrante, Laura Asta, Dario Buioni, Giovanni Ruvolo

引用次数: 0