Annals of thoracic surgery short reports最新文献

Background

Primary graft dysfunction (PGD) is the leading cause of short- and long-term mortality associated with lung transplantation. The impact of pretransplantation blood transfusions for recipients is not fully elucidated.

Methods

This is a retrospective review of 206 consecutive lung transplantations performed at a single academic center (Northwestern University Feinberg School of Medicine, Chicago, IL) from January 2018 to July 2022. Data on patient characteristics, pretransplantation laboratory values, transfusion requirements, and intraoperative and postoperative outcomes were collected.

Results

PGD grade 3 (PGD 3) occurred in 13.2% of the cohort (n = 28). A total of 33 patients received a blood transfusion within 4 weeks, whereas 21 patients received a blood transfusion a week before their lung transplant. Pretransplantation transfusions were strongly associated with a higher incidence of PGD 3 (48.5% vs 6.9%; P < .001). There was no significant difference in 1-year survival between the pretransplantation transfused group and the nontransfused group (77.7% vs 88.0%; P = .478). The 1year survival was reduced in recipients with PGD 3 compared with recipients without PGD 3 (63.5% vs 89.9%; P = .0012). In univariate analysis, pretransplant and intratransplant predictors of PGD 3 included younger age (P < .01), pretransplant extracorporeal membrane oxygenation (ECMO) use (P < .001), higher lung allocation score (P < .001), coronavirus disease 2019 (COVID-19)–related acute respiratory distress syndrome (P < .01), blood transfusion within 4 weeks (P < .001), longer operative time (P < .001), intratransplant blood transfusion (P < .001), and intratransplant venoarterial ECMO use (P < .001).

Conclusions

Pretransplantation blood transfusions could be associated with a higher rate of PGD. The findings indicated the potential risks of pretransplantation blood transfusions in lung transplant recipients.

A 54-year-old man underwent right S6 segmentectomy for right lung cancer. After discharge, he presented with fever, hemoptysis, and cough, and computed tomography showed an intermediate bronchus fistula. Because direct closure or bronchoplasty was challenging, a Dumon (Novatech) stent was inserted directly into the fistula from the surgical field and covered with an autologous pericardial patch, pedicled mediastinal fat, and intercostal muscle. The Dumon stent was removed by rigid bronchoscopy 1 year later. For an intermediate bronchus fistula that was difficult to repair by bronchoplasty, a Dumon stent was effective for maintaining bronchial patency and preserving the peripheral lung.

Background

The significance of pulmonary artery (PA) diameter in patients with non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD) who undergo pulmonary resection has not been elucidated.

Methods

Data of 357 patients with NSCLC and COPD who underwent pulmonary resection were retrospectively reviewed. The main PA diameter, determined by preoperative computed tomography, relative to the body surface area (PBR), was used as an index of PA dilatation, and patients were divided into 2 groups using median values. The relationship between the PBR and short- and long-term outcomes was also analyzed.

Results

The mean age was 70.8 years, and 82% of the patients were men. The median main PA diameter was 24 mm (range, 17-43 mm), and the median PBR was 14.5 (range, 10.4-28.6). Lobectomy or more was performed in 276 patients (78%) and sublobar resection in 81 patients (22%). The postoperative complication rates did not differ between the low- and high-PBR groups (33% vs 32%, P = .91). The relapse-free survival (RFS) and overall survival (OS) rates of the low-PBR group were significantly better than those of the high-PBR group (5-year RFS: 76% vs 59%, P = .0003; 5-year OS: 88% vs 72%, P = .0010). A multivariable analysis identified high PBR as a poor prognostic factor for both RFS and OS.

Conclusions

PA dilatation was associated with poor long-term outcomes and was an independent poor prognostic factor for both RFS and OS in NSCLC patients with COPD who underwent pulmonary resection.

Background

The primary treatment for hypoplastic left heart syndrome (HLHS) is the Fontan pathway, which entails performing the Glenn procedure. We hypothesized that the superior vena cava in patients with HLHS was short. As the length of the superior vena cava influences the Glenn procedure, we compared its length between patients with HLHS and those with other congenital heart diseases.

Methods

Patients with HLHS or its variant, patients with ventricular septal defects (VSD), and patients with pulmonary atresia with intact ventricular septum (PA/IVS)—including critical pulmonary stenosis—were enrolled in this study. The effective superior vena cava ratio (ESCVR), which is defined as the inferior border of the left brachiocephalic vein to the superior surface of the right pulmonary artery/height, was measured.

Results

The median ESVCR of the HLHS, VSD, and PA/IVS patients was 12.54 mm/m, 17.96 mm/m, and 18.46 mm/m, respectively. ESVCR of the HLHS group was significantly smaller than that of the other groups (P = .0013 vs VSD group, P = .0002 vs PA/IVS group).

Conclusions

Patients with HLHS have a relatively short superior vena cava, which may complicate the Glenn procedure.

Background

Pectus excavatum (PE) is the most common congenital chest wall defect and is characterized by the inward displacement of the sternum and costal cartilages. To date, there are limited data on adult patients undergoing the Nuss procedure for PE. This study aimed to assess the complication rate between the pediatric and adult populations and assess the trends in demographics.

Methods

Retrospective analysis was conducted using a global health care database, TriNetX. Current Procedural Terminology codes (21742, 21743) were used to identify all patients who underwent Nuss procedures in the years 2004 to 2023. The cohort was then subdivided on the basis of age and sex. These patients were assessed for 30-day and 90-day major and minor postoperative complications, as well as acute pain and chronic postoperative pain.

Results

A total of 2843 patients who underwent Nuss repair were identified. Patients aged >18 years had increased hemorrhagic complications (3% vs 0.86% in patients aged <18 years; P < .001) and acute pain (55% in patients aged >18 years vs 39.1% in patients aged <18 years; P < .001). Overall complication rates were 28.48% in female patients and 21.7% in male patients (P = .0014). Female patients had higher rates of respiratory complications (6% vs 2.7% in male patients; P = .001), chronic pain (5.2% in female patients vs 2% in male patients; P < .001), and hemorrhagic complications (6% in female patients vs 0.97% in male patients; P = .0042).

Conclusions

This study suggests that adults with PE experience significantly increased postoperative pain and hemorrhagic complications after the Nuss procedure when compared with the pediatric population. Female patients experience significantly higher complication rates when compared with male patients in all age groups.

Background

Tricuspid valve surgical procedures (TVS) concomitant with mitral valve (MV) surgical procedures for less than severe tricuspid regurgitation (TR) remains controversial. This study examined the long-term outcomes of patients with moderate or mild to moderate TR undergoing MV surgical procedures with or without TVS.

Methods

Patients with moderate or mild to moderate TR undergoing MV replacement or repair between January 2002 and June 2021 were included. Primary outcomes of reoperation and long-term survival were compared for patients undergoing MV replacement or repair with or without TVS before and after stratifying by mitral disease cause.

Results

The study included 505 patients. Mean age was 69 ± 12.7 years. The Society of Thoracic Surgeons Predicted Risk of Mortality for MV replacement (3.71 vs 4.39; P = .34) and repair (1.73 vs 1.67; P = .84) was similar for patients who did and did not undergo TVS. Operative mortality was similar for replacement (4.2% vs 6.1%; P = .77) or repair (0% vs 0%) with or without TVS. Patients undergoing MV replacement or repair with or without TVS had similar 10-year survival (67.1% vs 73.2% [P = .37]; 68.7% vs 78.8% [P = .052]) and rates of reoperation (2.1% vs 0.8% [P = .69]; 4.9% vs 4.6% [P = .99]). Cox proportional hazards modeling confirmed that TVS did not decrease the risk of death after MV replacement (hazard ratio, 0.839 [0.479-1.467]) or repair (hazard ratio, 0.852 [0.516-1.408]). The findings were unchanged after stratifying by MV disease cause or restricting the analysis to patients with moderate TR only, with no differences in survival or reoperation (all P > .05).

Conclusions

Concomitant TVS for moderate or mild to moderate TR did not improve survival or decrease reoperation. Parameters beyond the degree of TR may aid in surgical decision-making.

Background

Online resources are becoming the primary educational resource for patients. Quality and reliability of websites about coronary artery bypass graft (CABG) procedures are unknown.

Methods

We queried 4 search engines (Google, Bing, Yahoo!, and Dogpile) for the terms coronary artery bypass, coronary artery bypass graft, coronary artery bypass graft surgery, and CABG. The top 30 websites from each were aggregated. After exclusions, 85 websites were graded with the DISCERN instrument, patient-focused criteria, and readability calculators by a 2-reviewer system.

Results

Accessibility was low; 34.1% of websites disclosed authorship, and 23.5% were available in Spanish. Median total score was 55 of 95 (interquartile range [IQR], 44-68); this score varied by website type (P = .048). Professional medical society (median, 76; IQR, 76-76) and governmental agency (median, 69; IQR, 56.6-75.5) scored higher, whereas industry (median, 51.8; IQR, 47.1-56.4) and hospital/health care (median, 49; IQR, 40-61) scored lower. Readability was low, with median Flesch-Kincaid grade level score of 11.1 (IQR, 9.5-12.6) and 75.3% of websites written above eighth-grade reading level.

Conclusions

Accessibility of online patient educational resources for CABG procedures is limited by language and reading level despite being widely available. Quality and reliability of the information offered varied between website types. Improving readability to ensure patients’ understanding and comprehensive decision-making should be prioritized.

Osteosarcoma, the most common primary bone tumor in young individuals, frequently metastasizes hematogenously to the lungs, necessitating pulmonary metastasectomy as a common surgical procedure. While sublobar and lobar resections are accepted approaches, pneumonectomy is considered a major intervention. In this report, we present 2 intriguing cases of patients who underwent pneumonectomy for pulmonary osteosarcoma metastases, emphasizing the challenges of careful patient selection and surgical planning.

Coronary-pulmonary artery fistulas (CPAFs) are rare entities that can cause significant left-to-right shunting and complicate routine coronary artery bypass grafting. There are no best practice guidelines and a scarcity of reports regarding concomitant treatment of CPAF with coronary artery disease. We present a case of bilateral CPAFs in a 60-year-old man with symptomatic coronary artery disease treated successfully with coronary artery bypass, epicardial ligation, and transpulmonary closure of CPAF with patch reconstruction. This case highlights the importance of optimal myocardial protection and complete closure of the fistula to prevent risk of coronary steal.

Background

The aortoesophageal fistula (AEF) caused by thoracic endovascular aortic repair is a challenging condition. Traditional treatment approaches have been associated with high mortality and morbidity. This study introduces a modified single-stage surgical strategy that aims to optimize outcomes and to reduce the risk of recurrence for AEF.

Methods

Our method involving mediastinal infection clearance, direct esophageal repair, aortic remnant cavity isolation with omental refilling, and aortic reconstruction with a Dacron graft (alongside the native aorta) was applied to all the patients.

Results

None of the patients experienced intraoperative or in-hospital mortality. All 3 patients recovered well and exhibited successful repair and functionality at discharge. Our approach effectively controlled infection, repaired aortic and esophageal defects, and prevented future complications. Our experiences indicate a positive impact of this management strategy.

Conclusions

Our single-stage surgical approach offers a promising solution for AEF after thoracic endovascular aortic repair, enhancing patients' quality of life. It achieves excellent outcomes in infection control and aortic and esophageal repair while avoiding the need for multiple staged surgical procedures.