Interdisciplinary cardiovascular and thoracic surgery最新文献

Objectives: Long cardiopulmonary bypass times are associated with adverse postoperative outcomes and increased healthcare resource use. It is likely that this effect is pronounced in smaller patients. Previous studies have been criticized for not taking into consideration that prolonged bypass times are often due to higher complexity. The purpose of this study was to investigate the relationship between bypass index (bypass time/body surface area) and adverse postoperative events.

Methods: Single-centre, retrospective cohort study including 2413 patients undergoing cardiac surgery on cardiopulmonary bypass from June 2018 to April 2020. Length of hospital stay, as surrogate marker of postoperative morbidity, was selected as primary outcome. The strength of association between bypass index and the primary outcome was assessed with linear regression analysis. Secondary outcomes included new onset renal, pulmonary or cardiac rhythm dysfunction. The predictive value of bypass index was assessed with linear regression analysis; univariate and multiple regression were used to assess the strength of association between Bi and the secondary outcomes.

Results: Bypass index was predictive for length of stay at univariate (Relative Risk (RR): 1.004, P < 0.001) and at multivariable (RR: 1.003, P < 0.001) analysis. The association between bypass index and new renal (mean difference: 14.1 min/m2, P < 0.001) and cardiac rhythm dysfunction (mean difference: 12.6 min/m2) was significant. This was not true of postoperative lung dysfunction (mean difference: -1.5 min/m2, P = 0.293).

Conclusions: Bypass index, calculated as total bypass time/patient body surface area, is predictive of postoperative morbidity and resource utilization after cardiac surgery on pump.

We report the off-label application of the Castor single-branch stent graft for a complicated acute intramural haematoma involving the aortic arch. The endograft was deployed in zone 1 with the single branch in the left common carotid artery through a surgical left carotid and percutaneous right femoral artery access. The procedure was completed with the construction of a left carotid-subclavian bypass followed by plug embolization of the left subclavian artery.

Cardiac venous anomalies are rare congenital anatomical anomalies, which are most commonly found on computed tomography scans as an accidental finding. We report a case of a 14-year-old child who was operated for an atrial septal defect, and during the operation, we came across an anomalous drainage of the small cardiac vein into the inferior vena cava. The child's postoperative course was uneventful.

This case report detailed a rare case of upper limb venous outflow obstruction due to primary subclavian vein valve hypertrophy in a 26-year-old male. Misdiagnosed initially, the condition was identified through advanced Doppler ultrasound and Computed Tomography Venography (CTV) Endovascular treatment using Wallstent stents effectively resolved the obstruction, preserving collateral venous circulations. This case highlights the importance of combined colour Doppler ultrasonography for diagnosing unusual venous obstructions and demonstrates the potential of endovascular treatments in managing rare venous conditions.

Objectives: Brain-protective strategies for acute type A aortic dissection (TAAD) remain controversial. Moderate hypothermia circulatory arrest (MHCA) without cerebral perfusion is not commonly used. However, we aimed to assess its safety and efficacy in 358 patients who underwent hemiarch replacement with MHCA for acute type A aortic dissection at our institution from August 2012 to August 2022.

Methods: Clinical outcomes were compared according to circulatory arrest time [≤15 min (S group, n = 52) vs ≥16 min (L group, n = 306)]. The primary outcome was postoperative stroke.

Results: The S group had more older patients (72.5 vs 68.8 years; P = 0.04), a greater incidence of carotid artery malperfusion (21% vs 11%; P = 0.043) and a lower body mass index (21.7 vs 23.6 kg/m2; P < 0.01) and hemodynamic instability (3.8% vs 16%; P = 0.02) than the L group. The incidence of postoperative stroke (7.7% vs 12%; P = 0.33) and the rate of 30-day mortality (5.8% vs 6.5%; P = 0.83) did not significantly differ between groups. After adjusting for all potential confounding factors pre- and intraoperatively, there was no significant difference in postoperative outcomes between groups.

Conclusions: MHCA alone for TAAD had comparable postoperative outcomes with circulatory arrest times under and over 15 min. However, longer arrest times were associated with a higher risk of stroke.

This case report describes an 82-year-old woman with severe mitral bioprosthesis stenosis and NYHA II-III heart failure, EuroScore II of 22.54% and STS Score of 13.7%. She received innovative treatment with transatrial mitral valve-in-valve implantation of a rapid deployment balloon-expandable prosthesis via video-assisted right lateral mini-thoracotomy, with myocardial protection through ventricular fibrillation. The patient was discharged and, under cardiology follow-up, achieved NYHA I class with no angina.

Objectives: Our objective was to assess the incidence and reason of last-minute cancellations before surgery for lung cancer and their association with outcomes.

Methods: Retrospective analysis on all consecutive patients booked for elective lung cancer surgery from January 2017 through December 2022 in a single centre.Last minute cancellation: a cancellation occurring within the last 24 hours from the planned operation. Cancellation categories: process-related and patient-related.The short-term and long-term outcomes of patients who experienced a last-minute cancellation were analysed.

Results: 197 patients of 1587 (12%) had a last-minute cancellation: 156 (79%) were process-related and 41 (21%) were patient-related.3% (5/156) of patients cancelled for process reasons did not receive surgery vs 39% (16/41) of those cancelled for patient-related reasons, p < 0.0001.The 90-day mortality rates of cancelled and non-cancelled patients were similar (4.6% vs 4.7%, p = 1).Five-year overall survival of patients with cancellation was 58% (95% CI 49-66) vs 69% (95% CI 66-71) of those without cancellations, p = 0.022.Among those who had a cancellation, the 5-year OS of those with process-related cancellations was 61% (52-60) vs 35% (14-58) of those with patient-related cancellations (adjusted p value for multiple comparisons = 0.14).Cox regression analysis showed that surgery cancellations within the last 24 hours for patient-related (HR 1.87, 95% CI 1.02-3.42, p = 0.043) reasons remained a factor associated with poorer overall survival after adjusting for clinical stage, type of operation and patient related variables.

Conclusions: Implementing the patient's preoperative clinical evaluation to reduce the occurrence of related last-minute cancellations might mitigate its negative impact on survival.

Paravalvular leak after mitral valve replacement causes serious symptoms such as heart failure and haemolysis. However, whether re-replacement or direct leak site repair is the appropriate surgical treatment for this condition remains controversial. Herein, we describe a case of paravalvular leak repaired using left atrial appendage tissue with excellent results. The proposed technique enables the repair of a leak at the 9 o'clock position with healthy, full-thickness autologous tissue. For this method, the leak must be located near the left atrial appendage, and the left atrial appendage must not adhere to the pericardial sac. Although this technique can only be used under specific conditions, it is a useful option for cardiac surgeons.

Objectives: The Nuss procedure, a minimally invasive surgery for pectus excavatum, has undergone various improvements. However, the impact of using multiple bars on thoracic shape changes and surgical outcomes remains unclear.

Methods: We retrospectively evaluated patients who underwent the Nuss procedure for pectus excavatum between August 2014 and September 2021. We divided the patients into 2 groups based on the number of bars placed and identified differences in surgical outcomes and morphological characteristics.

Results: A total of 225 patients were evaluated, of whom 132 were classified into the ≤2 bar group (using 1 or 2 bars) and 93 into the ≥3 bar group (using 3 or more bars). There was no difference in the preoperative Haller index [median (interquartile range), 4.59 (3.67-6.16) vs 4.67 (4.12-6.14), P = 0.227], and asymmetric excavatum was more frequently observed in the ≥3 bar group (81% vs 51%, P < 0.001). The preoperative sternal torsion angle was larger in the ≥3 bar group, but no difference was found between the 2 groups postoperatively. The incidence of postoperative complications (≥grade 3) was comparable between groups (10% vs 17%, P = 0.105); however, postoperative pleurisy was more frequently observed in the ≥3 bar group (12% vs 4%, P = 0.021). In univariable and multivariable analyses, ≥3 bar placement was the only risk factor for postoperative pleurisy.

Conclusions: The placement of multiple bars (≥3 bars) is useful for the correction of asymmetric pectus excavatum, but attention should be paid to the potential risk of postoperative pleurisy.