Annals of thoracic surgery short reports最新文献

Purpose: To report the outcomes of the early feasibility study of transapical transcatheter mitral valve replacement (TMVR) with the SATURN System (InnovHeart, Milano, Italy) to treat patients with severe functional mitral regurgitation.

Description: Five high surgical risk patients underwent transapical transcatheter mitral valve replacement with the SATURN System at a single center. One-year follow-up is complete for all patients.

Evaluation: The valve was implanted successfully in all patients without any major adverse events. All patients were alive at the last follow-up. Kansas City Cardiomyopathy Questionnaire improved from a median of 63.5 (interquartile range, 19.6) at baseline to 99.0 (interquartile range, 21.6) at 1 year. Echocardiographic follow-up demonstrates stable valve function, no transvalvular or paravalvular mitral regurgitation, and absence of left ventricular outflow tract obstruction.

Conclusions: At 1 year after transapical SATURN transcatheter mitral valve replacement, all patients are alive with quality of life improvement and favorable device hemodynamics. These initial results are promising and larger scale studies with continued follow-up are required to further elucidate the efficacy and safety of this novel technology.

A patient with known pulmonary atresia and intact ventricular septum and ductal stent presented with low cardiac output and arrythmia. Intraoperatively, the patient was found to have an anomalous left coronary artery arising from the pulmonary artery. After reimplantation of the left coronary artery to the aortic root and placement of a central shunt, the patient progressed well and was discharged home. A high index of suspicion and clear diagnostic visualization of both right and left coronary artery origins are needed to diagnose this highly fatal yet treatable lesion properly.

Background: The prognostic nutritional index has been identified as a predictor of postoperative outcomes in various fields. We investigated the usefulness of the prognostic nutritional index as a risk factor for postoperative complications in secondary spontaneous pneumothorax.

Methods: In this retrospective study, patients who underwent surgery for secondary spontaneous pneumothorax were reviewed. The associations among the prognostic nutritional index, body mass index, and performance status were examined, and risk factors for postoperative complications were investigated in a multivariate analysis. In the subgroup analysis, on the basis of the receiver operating characteristics, we divided patients into high- and low-prognostic nutritional index groups and investigated the utility of the prognostic nutritional index for postoperative complications.

Results: Of 91 patients who underwent surgery for secondary spontaneous pneumothorax, 34 patients with postoperative complications were included. The prognostic nutritional index was significantly positively and negatively correlated with body mass index (P < .001) and performance status (P < .001), respectively. Multivariate analysis revealed that a decreased prognostic nutritional index was an independent risk factor for postoperative complications (P = .0048). In the subgroup analysis, the postoperative outcomes, including the duration of chest tube placement (P = .042), hospital stay (P = .0014), complications (P = .0089), and mortality (P = .044), were significantly worse in the low- than in the high-prognostic nutritional index group.

Conclusions: The prognostic nutritional index may be useful for evaluating the severity of secondary spontaneous pneumothorax in preoperative patients and may be a risk for postoperative complications.

Background: The discussion of Fontan fenestration is difficult because many institutions have different strategies over time. In our institute, we performed a non-fenestrated Fontan procedure for single-ventricular physiology as our definitive strategy.

Methods: Between August 1999 and December 2007, 72 consecutive patients with single-ventricle physiology underwent extracardiac total cavopulmonary connection without fenestration as our definitive strategy. Primary outcomes were Fontan-related events, including death, reoperation, catheter intervention, and postoperative complications such as arrhythmias, protein-losing enteropathy, plastic bronchitis, thrombosis, bleeding, and drainage of pleural effusion after discharge.

Results: The median follow-up duration was 15.7 years (interquartile range, 15.3-18.4). The 1-, 2-, 3-, 5-, 10-, and 15-year occurrence of Fontan-related events was 24%, 43%, 44%, 55%, 67%, and 76%, respectively. The 1-, 2-, 3-, 5-, and 10-year occurrence of venovenous collaterals was 16%, 60%, 65%, 72%, and 81%, respectively. Ventricular end-diastolic pressure was higher in patients with venovenous collaterals (median, 5.0 mm Hg; interquartile range, 4.0-7.0 mm Hg) than in those without (median, 3.5 mm Hg; interquartile range, 3.0-4.25 mm Hg) (P = .01). Multivariable Cox regression analysis showed that higher ventricular end-diastolic pressure and younger age at Fontan completion significantly increased the risk of developing venovenous collaterals, with hazard ratios of 1.22 for each (95% CI, 1.052-1.41; P = .0085 and .016, respectively).

Conclusions: The occurrence rate of Fontan-related events was acceptable with the non-fenestrated Fontan strategy, whereby venovenous collateral development was common. The results suggest that patients with high ventricle end-diastolic pressure and young patients might benefit from fenestration.

Synovial sarcoma is a rare malignant mesenchymal neoplasm primarily affecting adolescents and young adults, and it typically arises from deep soft tissues near large joints. Although commonly found in extremities, it can occur in various anatomic locations. We present a rare case of a 29-year-old man with primary pulmonary synovial sarcoma manifesting as a cystic mass masquerading as a lung hydatid cyst. Histopathologic examination, immunohistochemistry, and molecular analysis aided in accurate diagnosis. This case underscores the importance of considering synovial sarcoma in the differential diagnosis of pulmonary cysts and highlights the crucial role of pathologic examination in guiding treatment decisions.

A 44-year-old man with a history of facioscapulohumeral muscular dystrophy and pectus excavatum presented with multiyear history of progressive, severe respiratory dysfunction, pain, recurrent respiratory infection, and chest wall deformity. With bioprosthetic engineers, the surgical team customized a 3-dimensional printed model of a sternal implant interacting with the patient's anatomy. After approval from the Food and Drug Administration, the customized sternal plates were created and implanted in a sternal reconstruction operation. We report on the successful implantation of a customized sternal plate in the treatment of a patient with refractory pectus excavatum in the context of facioscapulohumeral muscular dystrophy.

Pulmonary mucormycosis is a rapidly progressive and highly morbid disease commonly found in immunosuppressed patients. Rapid diagnosis and treatment are essential, with thoracotomy and video-assisted thoracoscopic surgery techniques previously described for surgical resection of infected lobes. Here we present the case of a patient with acute myeloid leukemia and nonresolving Mucor pneumonia treated with robotic left upper lobectomy. The patient had an uneventful postoperative course and significant clinical improvement, thereby demonstrating the feasibility of the robotic approach in treating patients with invasive fungal infections of the lung.

Background: Cardiothoracic surgery (CTS) is one of the least diverse surgical specialties in both gender and race. Aside from the inherent benefits of a diverse working environment, mitigating this diversity gap improves patient care. Mentorship is important for creating a diverse, nurturing environment for trainees. This review appraises the impact of formal mentorship for trainees and specifically assesses its significance for underrepresented groups in CTS.

Methods: A literature search was performed using keywords relating to CTS, mentorship, and underrepresented groups. Principal findings were extracted and synthesized; supporting literature discussing mentorship in other surgical specialties was also included.

Results: Mentorship is desired by CTS residents. Its benefits include aiding the matching process, decreasing stress, and increasing academic productivity. Mentorship programs can be used to increase the recruitment and retention of women and others underrepresented in medicine.

Conclusions: Mentorship is a valuable tool for which implementation must be prioritized in CTS; this requires more education on mentorship for trainees. Institutions should be using mentorship programs to diversify trainees in CTS with the objective being equality.

Background: The objective of this study was to compare generative artificial intelligence-initiated care pathways, using ChatGPT, with expert-guided consensus-initiated care pathways from AskMayoExpert (AME) for symptom management of esophageal cancer patients after esophagectomy.

Methods: A formal protocol for development of 9 AME care pathways was followed for specific patient-identified domains after esophagectomy for esophageal cancer. Domain scores were measured and assessed through the Upper Digestive Disease tool. These care pathways were developed by experts validated by a consensus-driven methodology. ChatGPT was used to answer specific questions similar to the AME care pathway on April 9, 2023, and March 28, 2024. To compare outcomes, answers were recorded, and algorithms were compared with a survey tool composed of 5 questions.

Results: Both modalities were able to provide a clear definition with multidirectional management options for all 9 domains: dysphagia, generalized dumping, gastrointestinal dumping, pain, regurgitation, heartburn, nausea, physical health, and mental health. When provided with a simple prompt, ChatGPT 3.5 failed to provide a comprehensive stepwise approach for providers, any testing recommendations, or any form of triage process. However, ChatGPT 4.0 provided plans, similar to AME care pathways, when a sophisticated prompt was used.

Conclusions: Generative artificial intelligence-initiated care pathways can be used by physicians as a supplementary tool to guide provider management of patients with complex symptoms after esophagectomy. This technology will continue to advance but is currently insufficient to solely guide clinical management of complex patients with severe symptoms.