Interdisciplinary cardiovascular and thoracic surgery最新文献

Objectives: To compare postoperative outcomes between hydrogel-coated chest drains (HCDs) and conventional non-coated drains (NCDs) in patients undergoing general thoracic surgery, using a propensity score-matched analysis.

Methods: This retrospective multi-institutional study included adult patients who underwent thoracic surgery across 4 European centres between February and September 2022. Patients were grouped according to drain type (HCD vs NCD), and a propensity score-matched analysis was performed to account for 16 preoperative and intraoperative covariates. The primary outcome was length of postoperative hospital stay (LOS). Secondary outcomes included in-hospital complications, intensive care unit (ICU) admission, chest drain reinsertion, readmission, duration of drainage, and in-hospital mortality. Subgroup analysis was performed in patients undergoing anatomical lung resections.

Results: A total of 773 patients were included (HCD n = 362; NCD n = 411). After matching, 724 patients were analysed. HCD use was associated with a significantly shorter LOS (average treatment effect of the treated population -1.87 days; 95% CI -3.04 to -0.695; P = .002), lower odds of ICU admission (odds ratio [OR] 0.29; 95% CI 0.16-0.53; P < .001), and lower in-hospital complication rates (OR 0.38; 95% CI 0.26-0.55; P < .001). Rates of pneumonia (5.2% vs 13.4%; P = .001), atrial fibrillation (2.2% vs 9.0%; P < .001), and retained pleural effusion (0.8% vs 3.6%; P = .015) were significantly lower in the HCD group. There were no significant differences in drain duration, readmission, or mortality. In the anatomical resection subgroup, HCDs were similarly associated with reduced LOS and complications.

Conclusions: Hydrogel-coated drains are associated with fewer postoperative complications and shorter hospital stay compared to conventional drains, particularly in anatomical lung resections. These findings support further prospective evaluation to define the role of HCDs in routine thoracic surgical practice.

Objectives: Lung volume reduction surgery (LVRS) is guided by strict selection criteria from the National Emphysema Treatment Trial (NETT) to minimize risk and optimize outcomes. However, emerging evidence suggests that rigid cutoffs may exclude patients who could benefit. This study aimed to identify beyond-criteria patients undergoing LVRS and compare their outcomes with standard-criteria patients.

Methods: This single-centre retrospective analysis of a prospectively maintained database included all LVRS procedures from August 2019 until November 2024. Patients were classified as beyond-criteria if they met two or more of the following: age ≥ 75 years, body mass index (BMI) < 18.5 kg/m2, forced expiratory volume in 1 second (FEV1) < 20%pred, diffusing capacity for carbon monoxide (DLCO) < 20%pred, 6-minute walk distance (6MWD) < 140 m, homogeneous emphysema, systolic pulmonary arterial pressure (sPAP) > 35 mmHg, or prior thoracic interventions. Complications (Clavien-Dindo) and functional outcomes were assessed at 3, 6, and 12 months.

Results: Twenty-one procedures were performed in 18 beyond-criteria patients versus 227 procedures in 191 standard-criteria patients. Among beyond-criteria patients: age ≥ 75 years (n = 3), BMI < 18.5 kg/m2 (n = 10), FEV1 < 20%pred (n = 5), DLCO < 20%pred (n = 1), 6MWD < 140 m (n = 1), homogeneous emphysema (n = 3), sPAP > 35 mmHg (n = 12), and prior thoracic intervention (n = 7). Complication rates were comparable (38% vs. 42%, P = .819 [95% CI, 0.93-1.10]), as were prolonged air leaks and hospital stay. One 30-day LVRS-related death (0.4%) occurred in the standard group. Functional and quality of life measures improved in both groups.

Conclusions: Beyond-criteria patients can be considered for LVRS when guided by careful multidisciplinary evaluation, with meaningful improvement in experienced centers.

Objectives: Mechanical valve replacement is often used as the therapeutic option in valvular heart surgery in children. Evidence suggests that this should change to provide optimal long-term survival for this growing population. We reviewed our current practice in valve repair in congenital heart disease and analysed its outcomes.

Methods: A total of 90 patients (30 semilunar valve and 60 atrioventricular [AV] valve) underwent valve repair between September 2020 and December 2024. Operative data and follow-up information were gathered retrospectively. Kaplan-Meier calculations were used for survival and freedom from reoperation analysis. Cox regression analysis was used to assess risk factors for mortality (single ventricle physiology, age and weight at time of surgery, bicuspid aortic valve, and complexity of repair). Complexity of repair was defined as the application of 3 or more repair techniques.

Results: Estimated survival at 12 months for semilunar and AV valve groups was 95.2% and 95%, respectively. Estimated freedom from reoperation at 12 months for repair of semilunar and AV valves was 95.8% and 95.6%, respectively. Single ventricle morphology (HR [hazard ratio], 5.2; 95% confidence interval [CI], 1.3-20.8; P = .0198) and younger age at time of surgery (HR, 0.7; 95% CI, 0.6-0.9; P = .0223) were associated with increased risk of mortality.

Conclusions: Valve repair in congenital heart disease provides reliable early outcomes in this complex population. The worst outcomes are expected in patients with single ventricle requiring surgery in early life.

Objectives: Complex tracheal stenosis poses significant treatment challenges, especially in patients deemed inoperable due to anatomical or clinical factors. This study aimed to assess the outcomes of 2 primary interventions-tracheal resection-anastomosis and tracheal stenting-in an observational, international, retrospective cohort.

Methods: Multicenter study conducted on adult patients with benign complex tracheal stenosis who underwent either tracheal resection or silicone stent placement between 2009 and 2023, and who had at least 24 months of follow-up after resection-anastomosis or 12 months of follow-up after stent removal. Complete clinical resolution, defined as the absence of symptoms and no need for reintervention 1 year after treatment, was the primary outcome. Secondary analyses assessed the impact of treatment modality and patient risk profile on outcomes.

Results: Clinical resolution was achieved in 110 of 125 patients. Resection-anastomosis was associated with significantly higher hazard risk of resolution compared to stenting (adjusted HR = 2.0; 95% CI, 1.26-3.33; P = .003). In low-risk patients, surgery was notably superior (crude resolution HR = 3.01; 95% CI, 1.37-7.93, P = .004), while outcomes were not significantly different between the two treatments in high-risk patients with cardiorespiratory comorbidities or extended stenosis. Approximately 70% of patients treated with stenting remained symptom-free after 1 year.

Conclusions: Resection-anastomosis remains the preferred treatment for operable complex tracheal stenosis, offering the highest likelihood of long-term resolution. However, in high-risk or inoperable patients, endoscopic stenting provides a valuable alternative with acceptable outcomes. A tailored, multidisciplinary approach is essential to optimize treatment selection and avoid unnecessary tracheotomies.

Objectives: The treatment of metastatic thymic epithelial tumors (TET) remains challenging with no established protocol, particularly regarding the feasibility of complete surgical resection. This study aimed to elucidate the long-term outcomes and identify risk factors influencing overall survival (OS) and progression-free survival (PFS) following surgical intervention.

Methods: Between July 2000 and November 2021, 149 patients underwent surgery for metastatic TET with intrathoracic metastases at a single center. Of these patients, 121 met the inclusion criteria. Among them, 93 had thymoma including World Health Organization (WHO) types A, AB, and B1-B3, and 28 had thymic carcinoma. While 73 patients had pleural or pericardial seeding, 48 had lymph node or pulmonary metastasis. Synchronous metastasis was present in 72 patients, whereas 49 had metachronous metastasis.

Results: The 5- and 10-year OS rates for the entire cohort were 76.4% and 55.1%, respectively. Multivariable analysis identified WHO type as a significant factor affecting OS (HR 4.260; 95% CI 2.139-8.482; p < 0.001). The 5- and 10-year PFS rates were 32.4% and 20.1%, respectively. In multivariable analysis, myasthenia gravis (MG) (HR 0.362; 95% CI 0.185-0.851; p = 0.018), WHO cell type (HR 3.071; 95% CI 1.857-5.079; p < 0.001), and number of metastases (HR 2.396; 95% CI 1.273-4.512; p = 0.007) emerged as risk factors for PFS.

Conclusions: Surgical resection for metastatic TET with intrathoracic dissemination demonstrated favourable OS; however, high progression rates necessitated repeated treatments. Factors including the number of metastases, WHO cell type, and the presence of MG were identified as significant determinants influencing PFS.

Microwave ablation, as a minimally invasive treatment, is commonly used for local lung nodules. However, complications such as tension pneumothorax can lead to life-threatening consequences. We present a case of delayed tension pneumothorax that occurred 24 hours post-procedure, which required urgent intervention to prevent further deterioration and reduce mortality risk.

Chest wall deformities are considered a risk factor for lung transplantation. A 5-year-old girl with protein surfactant C deficiency, interstitial lung disease, pulmonary hypertension, and pectus excavatum (Haller 5.9) underwent lung transplantation and Nuss bar placement. Correction of her pectus was necessary to accommodate donor lungs. She was discharged after 18 days. We hope this youngest described child who underwent simultaneous transplant and pectus correction with excellent outcomes will lead others to consider concomitant surgeries.

A 7-month-old girl with false Taussig-Bing anomaly and partial atrioventricular septal defect (AVSD) was initially considered for the single-ventricle pathway. However, preoperative evaluation using a holographic workstation enabled precise ventricular volume assessment and intraventricular rerouting simulation. A virtual baffle confirmed the feasibility of biventricular repair. Volumetric analysis and cardiac magnetic resonance imaging predicted sufficient right ventricular volume post-baffle placement. The patient underwent successful biventricular repair via the Rastelli procedure and AVSD repair. Postoperative imaging verified adequate ventricular function. The holographic workstation proved cost-effective and may help determine biventricular repair viability in complex congenital heart diseases.

Objectives: Pectus carinatum is the second most common congenital chest wall deformity. While open thoracic reconstruction surgeries like the Ravitch procedure remain a treatment option, minimally invasive techniques such as the Abramson procedure are increasingly preferred. This study presents our clinical experience with the Abramson procedure for pectus carinatum.

Materials and methods: A retrospective review was conducted on 86 patients who underwent the Abramson procedure in the Department of Thoracic Surgery at Dokuz Eylul University between 2011 and 2021. Data were collected on age, gender, the number of bars and stabilizers used, postoperative complications, associated anomalies, hospitalization, and bar removal time. All patients completed the newly developed Single Step Questionnaire (SSQ) by Krasopoulos to assess their satisfaction.

Results: All patients underwent bilateral 2-incision procedures using 1 bar and 2 stabilizers. Early postoperative complications were absent in 94.2% (n = 81) of patients, while late complications were not recorded in 91.8% of patients (n = 79). Associated anomalies included scoliosis (n = 5), kyphosis (n = 1), and kyphoscoliosis (n = 1). The mean hospitalization was 3.7 days. Bars were removed in 75 patients (87.2%), most commonly between the 25th and 36th months postoperatively. The mean satisfaction score was 88.56.

Conclusions: The Abramson technique is a safe, minimally invasive option for selected pectus carinatum cases, offering shorter hospital stays and better aesthetic outcomes compared to open techniques. This study is the first to report satisfaction survey results for the Abramson procedure, highlighting its high patient satisfaction rates.