Journal of Thoracic and Cardiovascular Surgery最新文献

Objective: Coronary artery bypass grafting (CABG) with saphenous vein graft (SVG) is a standard treatment for coronary artery disease. The no-touch harvesting technique has shown promise in improving the durability of SVGs. This study aimed to investigate clinical outcomes and morphorogy of no-touch harvested SVGs compared to the conventionally harvested SVGs.

Methods: Between January 2010 and December 2023, 979 patients underwent primary CABG for coronary artery disease using either no-touch (NT group; n=293) or conventionally harvested SVGs (CON group; n=689). Propensity score matching yielded 269 well-matched pairs. The long-term clinical outcomes were compared. We measured the SVG diameter and perimeter using CT in the postoperative periods within 1 month and beyond 6 months after surgery and calculated the graft-to-native ratio (GNR) defined as the SVG diameter divided by the coronary artery diameter, the mean adjacent difference (MAD) defined as the average difference between adjacent 1 mm slices and the coefficient of variation (CV) defined as the standard deviation divided by their mean.

Results: In the matched groups, 5-year survival and freedom from MACCE and SVG-related events demonstrated significantly higher in the NT group than the CON group (89.8% vs 79.5%, P<0.001, 85.1% vs. 74.7%, P=0.014, 84.8% vs. 64.8%, P<0.001). In the late phase, the NT group showed fewer large-GNR (≥3.2) grafts and lower MAD and CV, indicating smoother luminal surfaces.

Conclusions: In the long-term, no-touch SVGs improve clinical outcomes, provide appropriate graft diameter for coronary arteries and maintain luminal smoothness.

Objectives: Group 2 pulmonary hypertension (PH) remains a highly morbid disease, yet no specific therapy exists. We sought to determine whether total pulmonary vein banding (TPVB) in rats could reliably display the clinical features of group 2 PH, and sought to investigate potential molecular and cellular determinants associated with disease progression.

Methods: Four-week-old Sprague-Dawley rats were randomized to receive TPVB (n=18) or sham procedure (n=18). Serial hemodynamic and histological assessments were performed at post-TPVB week 1, 4, and 8. At each time point, 12 rats (6 in TPVB vs. 6 in sham group) underwent harvest for lung sectioning and transcriptomic and proteomic analysis. Weighted gene coexpression and Bayesian networks were used to explore the top hub gene associated with PH development.

Results: Comparing to the sham group, rats in the TPVB group developed PH after surgery. Mild to severe progression of PH was observed in the TPVB group from post-surgery week 1 to 8, including higher right ventricular systolic pressure (P < 0.001), impaired right ventricle (RV)-pulmonary artery coupling (P < 0.001), decreased tricuspid annular plane systolic excursion (P < 0.001) and RV fractional area change (P < 0.001). Slc2a1 was identified as a hub gene upregulated in the lungs, which was enriched in the perivascular macrophages and associated with disease progression.

Conclusions: Rodent model of TPVB provides a useful platform for modeling PV-congestion severe group 2 PH. Slc2a1 is a key regulator of perivascular macrophage infiltration, driving the disease progression. Targeting Slc2a1-mediated perivascular inflammation might have a therapeutic potential.

Objectives: Phantom lymph node collection, defined as intraoperative sampling of tissue presumed to be nodal that, on pathological review, proves to be non-nodal, is a previously understudied outcome in thoracic surgery. This study aimed to quantify its incidence, identify associated factors, and assess its relationship with cancer-specific outcomes.

Methods: We conducted a retrospective cohort study using a meticulously curated Veterans Health Administration dataset of patients undergoing curative-intent non-small cell lung cancer resection between 2018 and 2024. Our primary outcomes included frequency of phantom lymph node collection, along with covariates independently associated with it. Secondary outcomes were overall survival and recurrence-free survival.

Results: A total of 2,972 Veterans were included in this cohort. Phantom lymph node collection occurred in 327 (11.0%) patients. On multivariable analysis, phantom lymph node collection was more likely with lower-lobe tumors (odds ratio, 1.45; 95% CI, 1.13 - 1.88), and less likely among patients who received guideline-concordant nodal sampling (≥3 N2 and ≥1 N1 nodal stations) (odds ratio, 0.56; 95% CI, 0.43 - 0.74). Notably, phantom lymph node collection was not associated with overall (hazard ratio, 0.96; 95% CI, 0.77 - 1.19) or recurrence-free survival (hazard ratio, 0.86; 95% CI, 0.68 - 1.08).

Conclusions: Phantom lymph node collection is common during curative-intent resection of early-stage lung cancer. Although not prognostic, its association with guideline-concordant sampling highlights it as a potential target for surgical quality improvement initiatives.