Journal of Thoracic and Cardiovascular Surgery最新文献

Objectives: The aim of this study is to analyze the accuracy of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and the unsuspected (u) N2/3 rates in patients with non-small cell lung cancer (NSCLC) and normal mediastinum by integrated positron emission tomography-computed tomography.

Methods: Prospective observational single-center study of 603 consecutive VAMLAs from 2010 to 2022.

Exclusion criteria: other indications (n = 32), tumors different from NSCLC (n = 91), and clinical (c) N2/3 tumors by positron emission tomography-computed tomography (n = 46). Systematic nodal dissection was the gold standard to validate negative VAMLAs. Those patients with negative VAMLA and missing reference standard test were excluded. uN2/3 rates were analyzed in the global series and in the subgroups of tumors according to their clinical nodal and tumor categories. Pathologic findings were reviewed, and staging values were calculated.

Results: Three hundred eighty-three patients with cN0/1 NSCLC underwent VAMLA. Staging values of VAMLA were: sensitivity, 0.98 (95% CI, 0.92-0.99); negative predictive value, 0.99 (95% CI, 0.98-1); and diagnostic accuracy, 0.99 (95% CI, 0.98-1). The uN2/3 rate for the whole series (N = 383) was 18.8%. The uN2/3 rates according to presurgical nodal and tumor categories determined by positron emission tomography computed tomography were: 3.6% (4 out of 111) in cT1N0; 16.3% (18 out of 110) in cT2N0; 10.25% (4 out of 39) in cT3N0; and 32% (7 out of 22) in cT4N0. Forty-two percent (39 out of 93) in cN1; complication rate was 7%.

Conclusions: This series of NSCLC with normal mediastinum staged by VAMLA demonstrates a high accuracy of this technique and a high rate of uN2/3 disease (specially in cN1 and cT4N0). VAMLA could be considered the reference staging procedure for staging cN0/1 NSCLC.

Objective: To compare the clinical outcomes of aortic valve replacement (AVR) using bovine pericardial and porcine bioprostheses, utilizing a nationwide administrative claims database.

Methods: Adult patients (age ≥40 years) who underwent bioprosthetic AVR, without other valve replacements, between 2003 and 2018 were identified from the Korean National Health Insurance Service database. The outcomes of interest were all-cause mortality, cardiac mortality, and valve-related events, including the incidence of reoperation, endocarditis, systemic thromboembolism, and major bleeding. Baseline adjustment was performed using propensity score matching. Time-related outcomes were evaluated using a competing risk analysis, with death as a competing risk.

Results: Among the 7714 patients who underwent bioprosthetic AVR, 5621 (72.9%) received bovine pericardial prostheses and 2093 (27.1%) received porcine bioprostheses. After matching, 1937 pairs were included in the final analysis. During follow-up (median, 4.49 years; interquartile range, 2.83-8.20 years), the use of porcine bioprostheses was associated with a higher risk of aortic valve reoperation (adjusted hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.16 to 3.01); however, no significant differences were observed in cumulative incidences of all-cause mortality, cardiac mortality, thromboembolism, or major bleeding. Subgroup analyses revealed that the use of bovine valves was associated with improved survival in patients with diabetes mellitus, whereas in patients undergoing dialysis, porcine valves exhibited better survival than bovine valves.

Conclusions: In this large nationwide cohort study of patients undergoing bioprosthetic aortic valve replacement, the use of porcine prostheses was significantly associated with an increased risk of reoperation compared with the use of bovine prostheses, supporting previous findings.

Objective: This study aimed to assess the effect of the lesion sets for surgical ablation (SA) of atrial fibrillation (AF) on long-term outcomes and identify the optimal lesion set.

Methods: Between 2005 and 2017, 1825 patients underwent SA concomitant to mitral valve (MV) surgery in the participating institutions. Of these, 529 underwent left atrial (LA) ablation, whereas the remainder had biatrial (BA) ablation. The clinical and rhythm outcomes were compared, considering death as a competing event. Inverse probability treatment weighting (IPTW) was used to mitigate the selection bias.

Results: The patients undergoing LA ablation were younger and less frequently had long-standing AF with a shorter duration or required concomitant tricuspid valve surgery. Adjusted analysis showed that LA ablation was associated with a lower risk of early pacemaker implantation (odds ratio, 0.16; 95% confidence interval [CI], 0.07-0.38; p<0.001) than BA ablation. Over a median follow-up of 70.4 months (interquartile 44.1-111.2 months), the LA ablation group presented a higher risk of AF recurrence (subdistribution hazard ratio [SHR]1.26; 95% CI 1.12-1.41; p<0.001), with a 5-year cumulative incidence of 34.2% compared to 28.6% in the BA group. The risk of late mortality (SHR, 1.17; 95% CI, 0.74-1.86; p=0.507) and stroke (SHR, 1.21; 95% CI, 0.82-1.79; p=0.345) did not differ between the groups CONCLUSION: In patients undergoing SA concomitant to MV surgery, both lesion sets provided comparable incidence of mortality and stroke. However, BA ablation was associated with a superior rhythm outcome at the expense of a higher risk of early pacemaker implantation.