Pub Date : 2023-12-05DOI: 10.1186/s43057-023-00117-7
Andia Taghdiri
Millions of people throughout the world suffer from the common and fatal respiratory disorder known as chronic obstructive pulmonary disease (COPD). Lung transplantation gives hope to individuals with end-stage COPD, with both bilateral lung transplantation and single lung transplantation being effective procedures. The complexity of chronic obstructive pulmonary disease is underscored by various factors influencing transplant outcomes, including patient characteristics, donor features, and complications post-transplantation. This narrative review explores recent studies on bilateral and single lung transplantation in chronic obstructive pulmonary disease patients, focusing on research published after 2020. Databases like PubMed and Google Scholar were used with keywords such as “COPD,” “lung transplantation,” “bilateral lung transplantation,” and “single lung transplantation” guided the research, emphasizing survival rates, quality of life, and post-transplant complications. Five selected articles encompassing 63,426 patients were examined, evaluating methodological variations among the studies. The selected studies showed no unanimous agreement on whether bilateral or single lung transplantation is superior for chronic obstructive pulmonary disease patients. Bilateral lung transplantation exhibited higher mid- and long-term survival rates, influenced significantly by age, comorbidities, and disease profiles. Improved quality of life was observed with bilateral transplantation, but this outcome depended on external circumstances. Post-transplant complications emphasized the need for rigorous post-transplant care. Individualized assessments are crucial when choosing between bilateral and single lung transplantation for chronic obstructive pulmonary disease patients. Despite varying research results, bilateral transplantation generally offers better survival and quality of life. Informed decisions require personalized post-transplant care, standardized reporting, and consistent research methods. Emphasizing donor management, preventing chronic lung allograft dysfunction, and prioritizing patient-centered care is vital. Collaborative efforts and patient-focused strategies are essential for improving long-term outcomes in these patients undergoing lung transplantation.
{"title":"Exploring long-term outcomes in COPD patients: a comprehensive narrative review of bilateral and single lung transplantation","authors":"Andia Taghdiri","doi":"10.1186/s43057-023-00117-7","DOIUrl":"https://doi.org/10.1186/s43057-023-00117-7","url":null,"abstract":"Millions of people throughout the world suffer from the common and fatal respiratory disorder known as chronic obstructive pulmonary disease (COPD). Lung transplantation gives hope to individuals with end-stage COPD, with both bilateral lung transplantation and single lung transplantation being effective procedures. The complexity of chronic obstructive pulmonary disease is underscored by various factors influencing transplant outcomes, including patient characteristics, donor features, and complications post-transplantation. This narrative review explores recent studies on bilateral and single lung transplantation in chronic obstructive pulmonary disease patients, focusing on research published after 2020. Databases like PubMed and Google Scholar were used with keywords such as “COPD,” “lung transplantation,” “bilateral lung transplantation,” and “single lung transplantation” guided the research, emphasizing survival rates, quality of life, and post-transplant complications. Five selected articles encompassing 63,426 patients were examined, evaluating methodological variations among the studies. The selected studies showed no unanimous agreement on whether bilateral or single lung transplantation is superior for chronic obstructive pulmonary disease patients. Bilateral lung transplantation exhibited higher mid- and long-term survival rates, influenced significantly by age, comorbidities, and disease profiles. Improved quality of life was observed with bilateral transplantation, but this outcome depended on external circumstances. Post-transplant complications emphasized the need for rigorous post-transplant care. Individualized assessments are crucial when choosing between bilateral and single lung transplantation for chronic obstructive pulmonary disease patients. Despite varying research results, bilateral transplantation generally offers better survival and quality of life. Informed decisions require personalized post-transplant care, standardized reporting, and consistent research methods. Emphasizing donor management, preventing chronic lung allograft dysfunction, and prioritizing patient-centered care is vital. Collaborative efforts and patient-focused strategies are essential for improving long-term outcomes in these patients undergoing lung transplantation.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138535727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-04DOI: 10.1186/s43057-023-00116-8
Kanakath Sanvi, Ravneet Kaur
To the Editor,
We are writing in response to the article “Postoperative atrial fibrillation after thoracic surgery (PoAF): risk factors and outcome” by Valentina et al., published on September 21, 2023. Firstly, I would like to commend the authors for their insightful research on assessing the risk factors for and the consequences of PoAF in patients undergoing thoracic surgery for lung cancer antecedent to the COVID-19 pandemic, also allowing at least 12 months of follow-up.
PoAF, in fact, due to its close temporal correlation with the surgical intervention, is an event triggered by surgery-induced stress, usually self-limiting and transitory [1]. PoAF is relatively frequent after thoracic surgery, although its incidence is lower on average (10–20%) compared to cardiac surgery due to the better cardiac status of non-cardiac surgical patients [2].
The article published by Valentina et al. [3] provides a well-organized and systematic approach that advanced age and open surgery are independently associated with an increased risk of PoAF in lung cancer surgery and left atrial enlargement association. The study mentions previous research, showing other risk factors, such as male gender, history of heart disease, more advanced cancer stages, postoperative serum potassium, and transfusions.
While the study by Valentina et al. provides significant data through analysis, showcasing the multifactorial dependence, it could have included diverse populations and lifestyles. This would have helped to assess and treat people according to their specific requirements. Additionally, the paper could have discussed post-discharge risk in patients and any complications that might occur beyond the mean follow-up period. Rena et al. demonstrated that the vast majority of PoAF resolved after hospital release, while in a study by Amar et al., 50% of episodes of PoAF spontaneously converted to sinus rhythm in less than 24 h [4].
While the study claims an absence of echocardiogram details of the patient to be used for studies, there is significance of such findings to understand outcomes. Hence, despite the prevalence of a strong correlation between echocardiogram findings, the size and function of the left atrium have been studied but without ECG data. A positive correlation was found between PoAF and LA maximal volume, atrial pre-contraction volume, active stroke volume, expansion index, and volume index. Studies also showed a negative correlation between the LA total emptying fraction and the LA passive ejection fraction. Hu et al. analyzed changes with transesophageal echocardiography and found that Global Longitudinal Strain (GLS;T2) and Atrial Global Longitudinal Strain (AGLS%) were independent predictors of PoAF [1].
I highly appreciate that the authors provided substantial data and subsequent discussions, including univariable (p = 0.08) and multivariable analysis of age (OR 1.089 per year, 95% CI 1.039–1.141, p
致编辑:我们是对Valentina等人于2023年9月21日发表的文章《胸外科术后心房颤动(PoAF):风险因素和结果》的回应。首先，我要赞扬作者在评估COVID-19大流行之前接受肺癌胸外科手术的患者PoAF的风险因素和后果方面进行了富有见地的研究，并允许至少12个月的随访。事实上，由于PoAF与手术干预时间密切相关，它是由手术诱发的应激触发的事件，通常具有自限性和短暂性[1]。由于非心脏手术患者心脏状态较好，胸外科手术后PoAF发生率较低(10-20%)，但相对于心脏手术后PoAF发生率较高[2]。Valentina等[3]发表的文章提供了一种组织良好、系统的方法，认为高龄和开放手术与肺癌手术中PoAF风险增加独立相关，并与左房扩大相关。该研究提到了先前的研究，显示了其他风险因素，如男性性别、心脏病史、癌症晚期、术后血清钾和输血。虽然Valentina等人的研究通过分析提供了重要的数据，展示了多因素依赖性，但它可能包括不同的人群和生活方式。这将有助于根据人们的具体需求对他们进行评估和治疗。此外，论文还可以讨论患者出院后的风险以及平均随访期后可能出现的并发症。Rena等人的研究表明，绝大多数PoAF在出院后消退，而Amar等人的研究表明，50%的PoAF发作在不到24小时内自发转化为窦性心律[4]。虽然该研究声称缺乏用于研究的患者超声心动图细节，但这些发现对了解结果具有重要意义。因此，尽管超声心动图结果之间普遍存在很强的相关性，但人们对左心房的大小和功能进行了研究，但没有心电图数据。PoAF与LA最大容积、心房预收缩容积、活动脑卒中容积、扩张指数、容积指数呈正相关。研究还表明，LA总排空分数与LA被动射血分数呈负相关。Hu等分析了经食管超声心动图的变化，发现总纵应变(GLS;T2)和心房总纵应变(AGLS%)是PoAF的独立预测因子[1]。我非常感谢作者提供了大量的数据和随后的讨论，包括单变量(p = 0.08)和多变量年龄分析(OR 1.089 /年，95% CI 1.039-1.141, p < 0.001)和开放手术(OR 2.07 vs. VATS, 95% CI 1.0-4.29, p = 0.047)[3]。然而，需要未来的研究和荟萃分析来进一步阐明这些有趣的结果。本研究的发现有助于我们对胸外科手术后PoAF的理解，并对临床实践具有指导意义。我相信这项研究将在胸外科领域激发进一步的调查和讨论。感谢您考虑发表这封给编辑的信。我们很高兴有机会为围绕PoAF管理的科学论述做出贡献。不适用。semeraro GC, Meroni CA, Cipolla CM, Cardinale DM(2021)肺癌术后房颤:预测、预防和抗凝治疗。Dobrev D, Aguilar M, Heijman J, Guichard J- b, Nattel S(2019)术后心房颤动的机制、表现和治疗。陈建军，陈建军，陈建军等(2009)胸外科手术后心房颤动的危险因素及预后分析。中华心血管病杂志，16:417 - 436。Fabiani I, Colombo A, Bacchiani G, Cipolla CM, Cardinale DM(2019)胸外科肿瘤术后房颤的发病率、管理、预防和预后。中国临床医学杂志9(1):37Article PubMed PubMed Central Google Scholar下载参考文献不适用。不适用。作者和从属关系印度喀拉拉邦爱兹哈尔医学院，印度喀拉拉邦anakath SanviLady Hardinge医学院，印度新德里avneet kaurauthorsanakath SanviView作者出版物您也可以在PubMed Google ScholarRavneet KaurView作者出版物中搜索此作者您也可以在PubMed Google scholarcontributions不适用。 两位作者都阅读并批准了最终的手稿。通讯作者:Kanakath Sanvi通讯。对参与者的伦理批准和同意不适用。发表同意不适用。竞争利益作者声明他们没有竞争利益。出版商声明:对于已出版的地图和机构关系中的管辖权要求，普林格·自然保持中立。开放获取本文遵循知识共享署名4.0国际许可协议，该协议允许以任何媒介或格式使用、共享、改编、分发和复制，只要您适当地注明原作者和来源，提供知识共享许可协议的链接，并注明是否进行了更改。本文中的图像或其他第三方材料包含在文章的知识共享许可协议中，除非在材料的署名中另有说明。如果材料未包含在文章的知识共享许可中，并且您的预期用途不被法律法规允许或超过允许的用途，您将需要直接获得版权所有者的许可。要查看该许可的副本，请访问http://creativecommons.org/licenses/by/4.0/.Reprints和permissionsite这篇文章。anvi, K.， Kaur, R.对“胸外科术后房颤:解决风险因素和结果”的回应——一封给编辑的信。心外科31,25(2023)。https://doi.org/10.1186/s43057-023-00116-8Download citation:收稿日期:2023年11月10日接受日期:2023年11月20日发布日期:2023年12月4日doi: https://doi.org/10.1186/s43057-023-00116-8Share本文任何与您共享以下链接的人都可以阅读此内容:获取可共享链接对不起，本文目前没有可共享链接。复制到剪贴板由Springer Nature shareit内容共享计划提供
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Pub Date : 2023-11-21DOI: 10.1186/s43057-023-00114-w
B. B. Turaev, Kh. K. Abralov, B. Kh. Kobiljonov, N. Sh. Ibragimov
Coarctation of the aorta (CoA) is a congenital heart disease characterized by the narrowing of the aorta, resulting in reduced blood flow to the body and increased pressure in the left ventricle. The pathophysiology of CoA is complex and involves several changes in the structure and function of the aorta. Recent studies have suggested that patients with CoA may have changes in the aortic wall beyond the site of the narrowing. Understanding these changes in the aorta is essential for optimizing the management of patients with CoA. Eighty-five patients who were diagnosed with an isolated coarctation of aorta (CoA) and underwent elective surgical repair—during the last 10 years were included in the study. Eighty-five patients (62 males, 72.9%) with a median age of 7 years old (range from 1 month to 48 years old) underwent surgical repair of CoA during the last 10 years using 4 different methods of operation. The study showed that more than a half (51.7%) of our patients with coarctation of the aorta had an enlargement of an ascending aorta, and z-score of ascending aortic size positively correlated with age, height, and weight, which means in patients with non-corrected CoA, ascending aorta tends to enlarge by time. In the present study, 31.8% of patients had an aortic arch hypoplasia, and aortic arch sizes z-score negatively correlated with ICU and hospital stay, which indicates that, patients with smaller aortic arch have poorer outcomes. Therefore, evaluating AAH before planning surgical repair is important for achieving better results. CT examination showed advantages in assessing aortic anatomy. It is suggested that an MSCT examination should be performed to take into consideration of current aortic anatomy, before planning the surgical correction of the aortic coarctation to achieve better results.
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Pub Date : 2023-11-16DOI: 10.1186/s43057-023-00115-9
Yasmin Abdelrazek Ali, Alaa Roushdy, Mohammed Abdullah Hegab, Amr Mansour Mohammed
Surgery for congenital heart disease has progressed by leaps and bounds in the last few decades, but the right ventricular outflow tract continues to pose a challenge to the congenital heart surgeon. We aim to describe the outcomes of patients with CHD who had surgical placement of right ventricle to pulmonary artery conduits with a focus on the risk factors for redo-surgery. We performed a retrospective single-center clinical data review of patients who had RVOT surgery using RV-to-PA conduits Thirty-three patients (54.5% males) were included. The mean age at first conduit placement was 3.57 ± 3.18 years, mean conduit size conduit was 14.45 ± 3.85 mm. 51.5% of patients received Contegra tubes. On a mean follow-up of 2.07 ± 2.36 years, 45.5% of patients underwent RV-to-PA conduits redo replacement after 5.67 ± 3.25 years from the first surgery, 2 patients underwent re-intervention for the second time, 7 patients had transcatheter interventions on RVOT or branch PAs. The main mode of conduit failure was stenosis. The median survival without the need for surgical reintervention was 2.5 years for the non-contegra subgroup versus 3 years for the contegra subgroup (P = 0.59). we predicted that 100% of the study group would require redo surgery for conduit replacement within the first 11 years post-initial surgery. For every year of age increase at follow-up, the hazard ratio for redo surgery increases by a factor of 1.47. For every year of age increase at the time of first operation, the hazard ratio for redo surgery decreases by a factor of 0.7. The use of conduits to treat the RV to PA discontinuity is a cornerstone in treating congenital heart diseases. Nevertheless, conduit failure and replacement are inevitable. In our experience the higher the age at the first conduit, the longer the re-intervention-free survival period.
在过去的几十年里，先天性心脏病的外科手术取得了突飞猛进的发展，但右心室流出道仍然是先天性心脏外科医生面临的一个挑战。我们的目的是描述手术放置右心室至肺动脉导管的冠心病患者的结果，重点是再手术的危险因素。我们对使用rv - pa导管进行RVOT手术的患者进行了回顾性的单中心临床资料回顾，包括33例患者(54.5%为男性)。首次放置导管的平均年龄为3.57±3.18岁，平均导管尺寸为14.45±3.85 mm, 51.5%的患者使用Contegra导管。在平均2.07±2.36年的随访中，45.5%的患者在第一次手术后5.67±3.25年进行了rv - pa导管重做置换术，2例患者进行了第二次再干预，7例患者在RVOT或分支pa上进行了经导管干预。导管衰竭的主要形式为狭窄。非整合亚组无需再手术干预的中位生存期为2.5年，整合亚组为3年(P = 0.59)。我们预测，100%的研究组在首次手术后的前11年内需要重新手术进行导管置换术。随访时年龄每增加一年，重做手术的风险比增加1.47倍。第一次手术时年龄每增加一岁，重做手术的风险比降低0.7倍。使用导管治疗左心室到左心室的不连续性是治疗先天性心脏病的基石。然而，水管故障和更换是不可避免的。根据我们的经验，第一次导管的年龄越高，无再介入生存期越长。
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