Annals of thoracic surgery short reports最新文献

The Y-incision aortic annular enlargement (AAE) has been established as a safe and effective technique for upsizing the aortic annulus by 3 to 4 valve sizes. However, concerns have been raised regarding its technical complexity during reoperations, particularly given the extensive enlargement of the aortic annulus and root. We present a case of reoperative aortic valve replacement after previous Y-incision AAE for prosthetic valve endocarditis and aortic root abscess. Our case highlights the simplicity and effectiveness of using a rectangular patch for root reconstruction and implanting the "roof" technique for aortotomy closure in reoperations after Y-incision AAE.

We report a case of a woman who underwent mitral ring and tricuspid annuloplasty. Two months later, she presented with acute heart failure secondary to severe aortic regurgitation, which was a complication of the cardiac surgery. Given the high surgical risk of reoperation in this the patient, she underwent transcatheter aortic valve implantation, with a good result. Aortic regurgitation is a rare and severe complication after valve repair surgery. Our case showed that off-label transcatheter aortic valve implantation in a high-risk patient after iatrogenic aortic regurgitation is safe and feasible.

Advanced-stage atypical carcinoid tumors are seldom seen in the teenaged population. Comprehensive care, extending beyond mere cancer treatment, is essential. A 16-year-old boy received a diagnosis of a 13-mm nodule in the left S⁵ lung segment with signs suggesting interlobar pleural indentation. A surgical biopsy revealed a neuroendocrine tumor, which led to lingular segmentectomy and lymph node dissection. The pathologic diagnosis was atypical carcinoid with intrapulmonary metastasis, classified as pT3 N0 M0 stage IIB. In addition to oncologic management for the advanced-stage atypical carcinoid, genetic counseling and meticulous mental support were provided. The accumulation of clinical data on teenaged patients with lung cancer is urgently needed.

Background: Rising rates of substance use (SU) have resulted in an increasing need for left-sided valve surgery for SU-associated infective endocarditis (SU-IE). We compared outcomes, readmissions, and costs between IE patients with and without SU-IE in a national cohort.

Methods: Using the Nationwide Readmissions Database (2016-2018), we identified 10,098 patients with infective endocarditis (IE) who underwent isolated aortic or mitral valve replacement. Outcomes within the same calendar year as the index operation were compared between patients with and without SU-IE. Multivariable logistic regressions were used to identify factors associated with in-hospital mortality and 30-day and 90-day readmissions. Kaplan-Meier analysis and a Cox proportional hazards model were used to compare freedom from calendar-year readmission between the groups.

Results: Of the 10,098 patients with IE, 2145 (21%) had SU-IE. Although patients with SU-IE were younger (38 years vs 60 years; P < .001) and had fewer comorbidities (Elixhauser score: 12 vs 20; P < .001) than patients who did not have SU-IE, patients with SU-IE had longer hospital stays (25 days vs 18 days; P < .001) and costlier admissions ($84,949 vs $74,122; P < .001). Patients with SU-IE had less in-hospital mortality (3.0% vs 5.8%; P < .001) but more often died when readmitted (9.6% vs 4.6%; P < .001). Readmissions were similar at 30 days (18.5% vs 18.9%; P = .8) and 90 days (31.8% vs 29.3%; P = .2), but patients with SU-IE had more calendar-year readmissions (35.1% vs 31.0%; P < .018).

Conclusions: Despite their younger age and fewer comorbidities, patients who undergo valve surgery for SU-IE use more resources and more often have calendar-year readmissions than patients with IE but without SU. Strategies are needed to expedite discharge and prevent readmission in patients with SU-IE.

The mortality rate of postcardiotomy cardiogenic shock after cardiovascular surgery is quite high, and the only way to avoid this serious complication is to initiate a preemptive strategy during surgery. The Impella 5.5 device with the SmartAssist system (Abiomed) is mainly used to prevent or to treat cardiogenic shock in cardiac surgery, but it is not often used in aortic surgery. We present the technique of preemptive insertion of the Impella 5.5 device through the ascending aorta intraoperatively to prevent the onset of postcardiotomy cardiogenic shock after cardiac or aortic surgery.

The double-lumen endotracheal tube (DLT) was introduced by Carlens in 1949 and became widely used for single-lung ventilation. DLTs have since become standard for most pulmonary resections. Although the use of DLTs is routine and safe in experienced hands, it is not without risk. Airway injury is an uncommon but potentially fatal complication. Complications of DLT placement are infrequently reported. The incidence of postintubation tracheobronchial rupture is estimated to be 1 in 20,000 to 1 in 75,000 among all intubations (single-lumen endotracheal tubes and DLTs). The estimated incidence after DLT insertions is significantly higher than that of single-lumen endotracheal tube injury, with DLT airway injury incidence ranging from 0.05% to 0.19%.

Background: The rate of permanent pacemaker implantation after tricuspid valve (TV) operation is thought to be high, with some studies quoting rates of 20% to 30%. We identified the rate of pacemaker implantation after TV operation at a high-volume regional reference center to better characterize the contemporary risk of pacemaker.

Methods: All adult patients without preexisting pacemakers undergoing TV operation from 2011 to 2022 were included. Patients were categorized by type of tricuspid operation and concomitant procedures. Bivariable analysis and multivariable logistic and Cox regression were performed to compare outcomes and to identify covariates independently associated with pacemaker implantation and long-term mortality.

Results: A total of 1346 patients with no history of pacemaker underwent TV operation. The overall rate of pacemaker was 11% (142/1346), with a 9.2% (113/1235) pacemaker rate with TV repair vs 26% (29/111) rate with TV replacement (P < .001). For isolated TV operations, permanent pacemaker rate was 3.7% (5/135) for repairs vs 23% (18/79) for replacement (P < .001). Need for pacemaker implantation varied significantly by type of operation. Adjusting for patient and operative characteristics, combined aortic root and valve operation, combined mitral and tricuspid surgery, longer cross-clamp time, and tricuspid replacement were independent risk factors for pacemaker. There was no difference in long-term mortality between the groups.

Conclusions: In this large data series, the rate of pacemaker with any TV operation was 11% and ranged from 0% to 33% according to concomitant procedures. Contemporary risk of pacemaker after TV operation at a high-volume center may be lower than previously thought.