JTCVS open最新文献_第6页

Healthcare economic burden of unresolved slipping rib syndrome 未解决的滑肋综合征的医疗经济负担。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.09.022

Adam J. Hansen MD, J.W.Awori Hayanga MD, MPH, Alper Toker MD, Vinay Badhwar MD

Objective

To evaluate the healthcare costs associated with unresolved slipping rib syndrome (SRS).

Methods

Data pertaining to patients who underwent operative repair for SRS at our academic institution were analyzed retrospectively. Duration of symptoms, previous management efforts, number of healthcare provider consultations, imaging studies, adjunctive surgical and pain management procedures performed to treat the symptoms, and prior unsuccessful SRS operations were catalogued. US Medicare billing standards were used to average costs for provider visits and overall cost of surgical and interventional pain management procedures. Analgesic medication costs were determined using generic pricing.

Results

Between February 2019 and January 2024, a total of 435 consecutive patients spent a median of 36 months searching for a diagnosis and symptom relief prior to evaluation at our institution. The median number of physicians consulted was 6 (range, 0-75). The total cost of physician visits was $2,990,434 USD. The median number of imaging studies was 5 (range, 0-55), at a total cost of $965,949. Cholecystectomy was performed in 47 patients (11%), at a cost of $716,750. Previous SRS surgery had been attempted 150 times at various institutions and accounted for $4,500,000 (estimated $30,000 per operation in billing). Intercostal nerve block, ablation, and spinal cord stimulator placement had been performed in 30%, 15%, and 5% of the patients, respectively, at a total cost of $963,821. The median number of analgesic medications used per patient was 1 (mean, 1.3; range, 0-5); the total medication cost was $1,111,860. The total preoperative healthcare cost in our series was $12,445,173, for an average of $28,610 per patient.

Conclusions

SRS remains poorly understood. Symptoms can be severe and debilitating, and patients frequently consume significant healthcare resources. With recognition and definitive surgical management, SRS may be addressed successfully. Prompt treatment has the potential for significant healthcare savings.

目的：评估未解决的滑肋综合征（SRS）的医疗费用。方法：回顾性分析我院接受SRS手术修复的患者资料。对症状持续时间、以前的管理努力、医疗保健提供者咨询次数、影像学检查、为治疗症状而进行的辅助手术和疼痛管理程序以及以前不成功的SRS手术进行了分类。使用美国医疗保险计费标准来平均就诊费用和手术和介入性疼痛管理程序的总费用。镇痛药物费用采用仿制药定价。结果：在2019年2月至2024年1月期间，共有435名连续患者在我们机构评估之前花费了中位数为36个月的时间来寻找诊断和症状缓解。咨询医生的中位数为6（范围0-75）。医生就诊的总费用为2990434美元。影像学检查的中位数为5次（范围0-55次），总费用为965,949美元。47例患者（11%）接受了胆囊切除术，费用为716,750美元。以前的SRS手术在不同的机构进行了150次，费用为450万美元（估计每次手术费用为3万美元）。肋间神经阻滞、消融和脊髓刺激器放置分别在30%、15%和5%的患者中进行，总费用为963,821美元。每位患者使用的镇痛药物中位数为1种(平均为1.3种；范围0 - 5);总药费为1,111,860美元。在我们的研究中，术前医疗保健总费用为12,445,173美元，平均每位患者为28,610美元。结论：对SRS的了解仍然很少。症状可能很严重，使人虚弱，患者经常消耗大量的医疗资源。有了认识和明确的外科治疗，SRS可能会成功解决。及时治疗有可能节省大量医疗费用。

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引用次数: 0

Heart transplant survival and the use of donors with intracranial bleeding: United Network for Organ Sharing Registry propensity-score matched analysis 心脏移植生存和颅内出血供者的使用：器官共享登记联合网络倾向评分匹配分析。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.09.028

J. Sam Meyer MSc , Nancy Sweitzer MD , Dan Aravot MD , Carmelo A. Milano MD, MHS , Yaron D. Barac MD, PhD

Objective

The transplantation of hearts from donors who experienced intracranial bleeding (ICB) has been associated with inferior long-term survival in both single-center analyses and, more recently, with the United Network for Ogan Sharing Registry. The purpose of this study was to further explore this relationship through propensity score matching in recipients receiving donor hearts from ICB and non-ICB donors in a large national registry.

Methods

We performed a retrospective cohort analysis of the United Network for Organ Sharing Registry Organ Procurement and Transplantation Network between 2006 and 2018 for adult candidates wait-listed for isolated heart transplantation. Recipients were stratified into 2 groups: ICB and non-ICB donors. Propensity score matching was performed to estimate causal effects by using observational data. Kaplan-Meier analysis was used to estimate survival posttransplant. Cox proportional hazards modeling was used to evaluate the independent effect of ICB as a cause of death.

Results

A total of 25,315 candidates met inclusion criteria. ICB heart donors (n = 5529) were older (median age, 42 vs 27 years; P < .001), less likely men (54.5% vs 75.2%; P < .001), and more often had a history of smoking (20.1% vs 11.7%; P < .001), and hypertension (34.2% vs 9.5%; P < .001). Before matching there was a significant difference in long-term posttransplant survival; for example, the non-ICB (60.7% [interquartile range, 59.5%-61.9%] vs 56.8% (interquartile range, 54.7%-59.0%]; P < .0001). However, when analyzing the propensity-score matched groups for outcomes, no difference was found between the cohorts both in terms of long-term survival as well as in rates of rejection.

Conclusions

In the largest propensity score matching analysis of heart transplants from donors who had experienced ICB, we found similar survival and rejection rates in heart transplant recipients.

目的：在单中心分析和最近的器官共享登记联合网络中，来自颅内出血（ICB）供者的心脏移植与较差的长期生存率相关。本研究的目的是通过在一个大型国家登记处接受来自ICB和非ICB供体心脏的受者的倾向评分匹配来进一步探索这种关系。方法：我们对2006年至2018年器官共享登记联合网络（United Network for Organ Sharing Registry）器官获取和移植网络（Organ Procurement and Transplantation Network）中等待孤立心脏移植的成人候选人进行了回顾性队列分析。受者分为两组：ICB和非ICB供者。使用观察数据进行倾向评分匹配来估计因果效应。Kaplan-Meier分析用于估计移植后的生存。采用Cox比例风险模型评估ICB作为死亡原因的独立影响。结果：共有25315名候选人符合纳入标准。ICB心脏献血者（n = 5529）年龄较大(中位年龄42 vs 27岁；结论：在对经历过ICB的供者的心脏移植进行的最大倾向性评分匹配分析中，我们发现心脏移植受者的存活率和排异率相似。

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引用次数: 0

A posterior pericardial chest tube is associated with reduced incidence of postoperative atrial fibrillation after cardiac surgery: A propensity score–matched study 心包后置胸管与心脏手术后房颤发生率降低相关：一项倾向评分匹配研究

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.09.003

Luis Gisli Rabelo BS , Igor Zindovic MD, PhD , Daniel Oudin Astrom PhD , Egill Gauti Thorsteinsson BS , Johan Sjogren MD, PhD , Kristjana Lind Olafsdottir BS , Matthildur Maria Magnusdottir BS , Anders Jeppsson MD, PhD , Tomas Gudbjartsson MD, PhD

Objective

Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery that is associated with other adverse outcomes. Recent studies have shown that drainage of pericardial effusion by a posterior pericardial incision reduces the incidence of POAF. An alternative approach is a chest tube placed posteriorly in the pericardium. We evaluated whether the use of a posterior pericardial drain was associated with reduced risk of POAF in patients undergoing coronary artery bypass graft (CABG) and/or aortic valve replacement (AVR).

Methods

This observational study included 2535 patients who underwent CABG (n = 1997), AVR (n = 293), or combined CABG and AVR (n = 245) in Iceland from 2002 to 2020. From our study population, 553 (22%) received a 20-Fr posterior pericardial chest tube in addition to standard mediastinal and left pleural drains. The incidence of POAF in patients with and without a posterior pericardial drain was compared before and after 1:1 propensity score matching.

Results

Of 2535 patients, 1100 were included in the matched cohort. The incidence of POAF was lower in patients receiving posterior pericardial chest tube drainage compared with the control group, both before (34% vs 43%, P < .001) and after (33% vs 43%, P = .002) matching. In a multivariable analysis, posterior pericardial chest tube drainage was independently associated with a reduced risk for POAF (adjusted odds ratio 0.67; 95% confidence interval, 0.52-0.88; P = .003).

Conclusions

This observational study suggested that posterior pericardial chest tube drainage is associated with a significant reduction of POAF after routine CABG and/or AVR procedures. The results are hypothesis-generating and must be confirmed in prospective randomized trials.

目的：术后心房颤动（POAF）是心脏手术后常见的并发症，并伴有其他不良后果。最近的研究表明，心包后部切口引流心包积液可减少POAF的发生率。另一种方法是将胸管置于心包后方。我们评估了在接受冠状动脉旁路移植术（CABG）和/或主动脉瓣置换术（AVR）的患者中使用后心包引流是否与POAF风险降低相关。方法：本观察性研究纳入2002 - 2020年冰岛2535例接受CABG （n = 1997）、AVR （n = 293）或CABG + AVR联合（n = 245）的患者。在我们的研究人群中，553人（22%）在标准纵隔和左胸膜引流之外接受了20 fr后心包胸管。在1:1倾向评分匹配前后比较有和无后心包引流的患者POAF的发生率。结果：2535例患者中，1100例纳入匹配队列。与对照组相比，经后心包胸管引流的患者POAF发生率较对照组低（34% vs 43%, P P = 0.002）。在一项多变量分析中，后心包胸管引流与POAF风险降低独立相关(校正优势比0.67；95%置信区间为0.52-0.88；p = .003)。结论：这项观察性研究表明，在常规CABG和/或AVR手术后，后路心包胸管引流与POAF的显著降低有关。结果是假设产生的，必须在前瞻性随机试验中得到证实。

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引用次数: 0

Noniatrogenic hypoglycemia: A universal marker for poor outcomes 考虑低血糖心脏手术患者的并发症：术后结果的调整分析

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.05.005

Hannah Rando MD, MPH, Matthew Acton MD, Ifeanyi Chinedozi MD, Zachary Darby MD, Jin Kook Kang MD, Glenn Whitman MD

Objective

Previous retrospective studies have established a relationship between postoperative hypoglycemia and adverse outcomes after cardiac surgery, but none have accounted for the cause of hypoglycemia.

Methods

A retrospective review was performed of patients who underwent cardiac surgery at a single institution between 2016 and 2021. Patients were categorized as hypoglycemic if they had 1 or more postoperative blood glucose measurement less than 70 mg/dL and normoglycemic otherwise. Hypoglycemia was subcategorized as noniatrogenic (underlying liver failure, adrenal insufficiency, sepsis, or shock) or iatrogenic (insulin infusion continued while nil per os or infusion protocol violated) via manual chart review. Baseline characteristics were compared between groups using Pearson χ², analysis of variance, and Kruskal-Wallis testing, and outcomes were compared using multivariable logistic regression.

Results

In total, 5373 patients and 183,346 glucose measurements were included. Hypoglycemia occurred in 5% (267) of patients, of whom 63% (169) were iatrogenic and 37% (98) were noniatrogenic. In a multivariate analysis adjusting for age, sex, case urgency, pre-existing diabetes, and bypass time, both iatrogenic and noniatrogenic hypoglycemia were associated with greater odds of renal failure, prolonged ventilation, and prolonged intensive care unit length of stay relative to normoglycemia, but the magnitude was substantially lower in iatrogenic hypoglycemia. Patients with noniatrogenic hypoglycemia had 68.6 times greater odds of mortality relative to patients who were normoglycemic (odds ratio, 68.6; confidence interval, 39.5-119), but patients with iatrogenic hypoglycemia had no increased odds of mortality (odds ratio, 1.45; confidence interval, 0.77-2.73).

Conclusions

When excluding patients with conditions known to cause hypoglycemia from the analysis, the morbidity and mortality of iatrogenic hypoglycemia from tight postoperative glycemic control is dramatically attenuated.

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引用次数: 0

Commentator Discussion: Establishment of Mongolia's first independent and sustainable minimally invasive general thoracic surgery program: A Mongolian-Canadian initiative 讲述者讨论：建立蒙古第一个独立和可持续的微创普通胸外科项目：蒙古-加拿大倡议。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.10.019

引用次数: 0

Commentator Discussion: Impact of lung allocation policy change on Hispanic lung transplant outcomes: Addressing disparities and improving access 评论员讨论：肺分配政策变化对西班牙肺移植结果的影响：解决差异和改善获取。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.10.008

引用次数: 0

Commentator Discussion: Pediatric cardiac surgical site infections: A single center quality improvement initiative 讲解员讨论：儿童心脏手术部位感染：单中心质量改进倡议。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.09.017

引用次数: 0

Three-dimensional morphometry of the human thoracic aorta using centerline analysis based on least-squares plane fitting 基于最小二乘平面拟合中心线分析的人胸主动脉三维形态测量。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.09.016

Hiroshi Nagamine MD, Kenji Kishita MD, Yuta Tsukada MD, Hiroshi Nagano MD, Mitsuru Asano MD

Objective

A novel approach to 3-dimensional morphometry of the thoracic aorta was developed by applying centerline analysis based on least-squares plane fitting, and a preliminary study was conducted using computed tomography imaging data.

Methods

We retrospectively compared 3 groups of patients (16 controls without aortic disease, and 16 cases each with acute type B aortic dissection and congenital bicuspid aortic valve). In addition to the standard assessment indices for curvature κ and torsion τ, we conducted coordinate transformation based on the least-squares plane, divided the centerline into 3 representative features (transverse, anterior-posterior, and longitudinal displacements), and analyzed the overall and local displacement in each direction. The transverse displacement, represented by the distance of the centerline from the least-squares plane, was curve-fitted to the damped oscillation waveform. Thereafter, damped oscillation parameters were compared for each group.

Results

Curvature κ exhibited a bimodal distribution, with peaks observed in the ascending aorta and aortic arch, and torsion τ exhibited a transition from positive to negative values in the arch. There were significant differences in the mean displacement between the groups for each direction (transverse P = .0083, anteroposterior P = .010, longitudinal P = 1.32 × 10⁻⁶). Furthermore, interval integral analysis revealed that several intervals exhibited significant differences between groups in each direction. The amplitude of damped oscillation parameters was significantly larger in the bicuspid aortic valve group than in the control and type B aortic dissection groups.

Conclusions

The novel analytical approach permitted a quantitative assessment of the 3-dimensional morphological differences between the control, type B aortic dissection, and bicuspid aortic valve groups.

目的：应用基于最小二乘平面拟合的中心线分析方法，建立胸主动脉三维形态测量新方法，并利用计算机断层成像数据进行初步研究。方法：回顾性比较3组患者（无主动脉疾病的对照组16例，急性B型主动脉夹层合并先天性双尖瓣主动脉瓣各16例）。除了曲率κ和扭转τ的标准评价指标外，我们基于最小二乘平面进行坐标变换，将中心线划分为3个代表性特征（横向、前后和纵向位移），并在每个方向上分析整体和局部位移。以中心线到最小二乘平面的距离表示的横向位移曲线拟合到阻尼振荡波形。然后比较各组的阻尼振荡参数。结果：曲率κ呈双峰分布，在升主动脉和主动脉弓处出现峰值，而扭转τ在主动脉弓处呈现由正向负的转变。各组间各方向平均移位量差异有统计学意义（横向P = 0.0083，正向P = 0.010，纵向P = 1.32 × 10-6）。此外，区间积分分析显示，多个区间在各方向上表现出组间显著差异。二尖瓣主动脉瓣组的阻尼振荡参数幅值明显大于对照组和B型主动脉夹层组。结论：新的分析方法可以定量评估对照组、B型主动脉夹层组和二尖瓣主动脉瓣组之间的三维形态学差异。

{"title":"Three-dimensional morphometry of the human thoracic aorta using centerline analysis based on least-squares plane fitting","authors":"Hiroshi Nagamine MD, Kenji Kishita MD, Yuta Tsukada MD, Hiroshi Nagano MD, Mitsuru Asano MD","doi":"10.1016/j.xjon.2024.09.016","DOIUrl":"10.1016/j.xjon.2024.09.016","url":null,"abstract":"<div><h3>Objective</h3><div>A novel approach to 3-dimensional morphometry of the thoracic aorta was developed by applying centerline analysis based on least-squares plane fitting, and a preliminary study was conducted using computed tomography imaging data.</div></div><div><h3>Methods</h3><div>We retrospectively compared 3 groups of patients (16 controls without aortic disease, and 16 cases each with acute type B aortic dissection and congenital bicuspid aortic valve). In addition to the standard assessment indices for curvature κ and torsion τ, we conducted coordinate transformation based on the least-squares plane, divided the centerline into 3 representative features (transverse, anterior-posterior, and longitudinal displacements), and analyzed the overall and local displacement in each direction. The transverse displacement, represented by the distance of the centerline from the least-squares plane, was curve-fitted to the damped oscillation waveform. Thereafter, damped oscillation parameters were compared for each group.</div></div><div><h3>Results</h3><div>Curvature κ exhibited a bimodal distribution, with peaks observed in the ascending aorta and aortic arch, and torsion τ exhibited a transition from positive to negative values in the arch. There were significant differences in the mean displacement between the groups for each direction (transverse <em>P</em> = .0083, anteroposterior <em>P</em> = .010, longitudinal <em>P</em> = 1.32 × 10<sup>−6</sup>). Furthermore, interval integral analysis revealed that several intervals exhibited significant differences between groups in each direction. The amplitude of damped oscillation parameters was significantly larger in the bicuspid aortic valve group than in the control and type B aortic dissection groups.</div></div><div><h3>Conclusions</h3><div>The novel analytical approach permitted a quantitative assessment of the 3-dimensional morphological differences between the control, type B aortic dissection, and bicuspid aortic valve groups.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 144-155"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intraoperative cardiac arrest in patients undergoing congenital cardiac surgery 先天性心脏手术患者的术中心脏骤停。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.09.015

Morgan L. Brown MD, PhD , Steven J. Staffa MS , Phillip S. Adams DO , Lisa A. Caplan MD , Stephen J. Gleich MD , Jennifer L. Hernandez MD , Martina Richtsfeld MD , Lori Q. Riegger MD , David F. Vener MD , Quality and Safety Committee of the Congenital Cardiac Anesthesia Society

Objective

To describe intraoperative cardiac arrest in patients undergoing congenital heart surgery.

Methods

The Society of Thoracic Surgeons Congenital Heart Surgery Database was queried. Predictors of intraoperative cardiac arrest were assessed using univariate and multivariable analyses. The univariate relationship between intraoperative cardiac arrest was also compared with available outcomes in the database.

Results

A total of 92,764 cases had anesthesia adverse event data, and 357 patients (0.38%) had an intraoperative cardiac arrest. Multivariable predictors of an intraoperative cardiac arrest included age (odds ratio [OR], 0.98 per year; 95% confidence interval [CI], 0.97-0.99; P = .036), preoperative cardiac arrest (<48 hours) (OR, 9.6; 95% CI 6.3-14.6, P < .001), preoperative neurologic deficit (OR, 2.0; 95% CI, 1.3-3.1, P = .002), noninsulin-dependent diabetes mellitus (OR, 6.4; 95% CI, 1.9-21.9, P = .003), increasing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category (OR, 2.3 for STAT 5 vs STAT 1; 95% CI, 1.3-3.9, P = .003), urgent (OR, 2.0; 95% CI, 1.6-2.6, P < .001) or emergent surgery (OR, 3.1; 95% CI, 1.9-5.0, P < .001), and increasing length of total operating room time (OR, 1.2 per hour; 95% CI, 1.2-1.3, P < .001). Intraoperative cardiac arrest was associated with a greater 30-day mortality (14.6% vs 1.8%, P < .001). There were more morbidities in the intraoperative cardiac arrest group including postoperative neurologic deficits (12% vs 1.0%, P < .001), multisystem organ failure (5.9% vs 0.7%, P < .001), and greater rates of unplanned reoperation (19.3% vs 5.0%, P < .001) or interventional cardiac catheterization (7% vs 3.2%, P < .001).

Conclusions

The incidence of intraoperative cardiac arrest is low; however, it is an important indicator of significant patient perioperative morbidity and mortality.

目的：描述先天性心脏手术患者术中心脏骤停的情况。方法：查询美国胸外科学会先天性心脏外科数据库。采用单变量和多变量分析评估术中心脏骤停的预测因素。术中心脏骤停的单变量关系也与数据库中可用的结果进行了比较。结果：共有92764例患者出现麻醉不良事件，357例（0.38%）患者出现术中心脏骤停。术中心脏骤停的多变量预测因素包括年龄(优势比[OR]， 0.98 /年；95%置信区间[CI]， 0.97-0.99；P = 0.036)，术前心脏骤停（P = 0.002），非胰岛素依赖型糖尿病(OR, 6.4；95% CI, 1.9-21.9, P = 0.003)，增加胸外科学会-欧洲心胸外科协会（STAT）分类(OR, STAT 5 vs STAT 1；95% CI, 1.3-3.9, P = 0.003)，紧急(OR, 2.0；95% CI, 1.6-2.6， P P P P P P P P P结论：术中心脏骤停发生率低；然而，它是患者围手术期发病率和死亡率的重要指标。

{"title":"Intraoperative cardiac arrest in patients undergoing congenital cardiac surgery","authors":"Morgan L. Brown MD, PhD , Steven J. Staffa MS , Phillip S. Adams DO , Lisa A. Caplan MD , Stephen J. Gleich MD , Jennifer L. Hernandez MD , Martina Richtsfeld MD , Lori Q. Riegger MD , David F. Vener MD , Quality and Safety Committee of the Congenital Cardiac Anesthesia Society","doi":"10.1016/j.xjon.2024.09.015","DOIUrl":"10.1016/j.xjon.2024.09.015","url":null,"abstract":"<div><h3>Objective</h3><div>To describe intraoperative cardiac arrest in patients undergoing congenital heart surgery.</div></div><div><h3>Methods</h3><div>The Society of Thoracic Surgeons Congenital Heart Surgery Database was queried. Predictors of intraoperative cardiac arrest were assessed using univariate and multivariable analyses. The univariate relationship between intraoperative cardiac arrest was also compared with available outcomes in the database.</div></div><div><h3>Results</h3><div>A total of 92,764 cases had anesthesia adverse event data, and 357 patients (0.38%) had an intraoperative cardiac arrest. Multivariable predictors of an intraoperative cardiac arrest included age (odds ratio [OR], 0.98 per year; 95% confidence interval [CI], 0.97-0.99; <em>P</em> = .036), preoperative cardiac arrest (<48 hours) (OR, 9.6; 95% CI 6.3-14.6, <em>P</em> < .001), preoperative neurologic deficit (OR, 2.0; 95% CI, 1.3-3.1, <em>P</em> = .002), noninsulin-dependent diabetes mellitus (OR, 6.4; 95% CI, 1.9-21.9, <em>P</em> = .003), increasing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category (OR, 2.3 for STAT 5 vs STAT 1; 95% CI, 1.3-3.9, <em>P</em> = .003), urgent (OR, 2.0; 95% CI, 1.6-2.6, <em>P</em> < .001) or emergent surgery (OR, 3.1; 95% CI, 1.9-5.0, <em>P</em> < .001), and increasing length of total operating room time (OR, 1.2 per hour; 95% CI, 1.2-1.3, <em>P</em> < .001). Intraoperative cardiac arrest was associated with a greater 30-day mortality (14.6% vs 1.8%, <em>P</em> < .001). There were more morbidities in the intraoperative cardiac arrest group including postoperative neurologic deficits (12% vs 1.0%, <em>P</em> < .001), multisystem organ failure (5.9% vs 0.7%, <em>P</em> < .001), and greater rates of unplanned reoperation (19.3% vs 5.0%, <em>P</em> < .001) or interventional cardiac catheterization (7% vs 3.2%, <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>The incidence of intraoperative cardiac arrest is low; however, it is an important indicator of significant patient perioperative morbidity and mortality.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"22 ","pages":"Pages 427-437"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intracavitary cisplatin-fibrin followed by irradiation improved tumor control compared to the single treatments in a mesothelioma rat model 在间皮瘤大鼠模型中，与单一治疗相比，腔内顺铂-纤维蛋白后照射改善了肿瘤控制。

JTCVS open

Pub Date : 2024-12-01 DOI: 10.1016/j.xjon.2024.07.024

Michaela B. Kirschner PhD , Mayura Meerang PhD , Vanessa Orlowski , Katarzyna Furrer MD , Fabienne Tschanz PhD , Ivo Grgic PhD , Virginia Cecconi PhD , Maries van den Broek PhD , Matthias Guckenberger MD , Martin Pruschy MD , Olivia Lauk MD , Isabelle Opitz MD

Objective

To test the safety and efficacy of combination treatment for pleural mesothelioma (PM) with intracavitary cisplatin-fibrin (cis-fib) plus hemithoracic irradiation (IR) applied after lung-sparing surgery in an orthotopic immunocompetent rat model.

Methods

We randomized male F344 rats into 5 groups: cis-fib (n = 9), 10 Gy IR (n = 6), 20 Gy IR (n = 9), cis-fib+10 Gy IR (n = 6), and cis-fib+20 Gy IR (n = 9). Subpleural tumor implantation was performed on day 0 with 1 million syngeneic rat mesothelioma cells (IL45-luciferase). Tumors were resected on day 9, followed by treatment with intracavitary cis-fib or vehicle control (NaCl-fib). On day 12, computed tomography–guided local irradiation in a single high dose of the former tumor region was applied.

Results

We observed only short-term side effects related to 20 Gy radiotherapy. Compared to 20 Gy, 10 Gy IR did not show an impact on tumor growth. At 3 days after treatment with 20 Gy IR (day 15 of the experiment), we detected significantly smaller tumors in the cis-fib+IR group compared to IR alone (mean tumor growth, 252% vs 539%; P = .04). On day 21, there was a significant difference in tumor growth between cis-fib–treated and cis-fib+IR– treated tumors (mean tumor growth, 2295% vs 660%; P = .01).

Conclusions

Localized treatment after tumor resection in PM aims to improve local tumor control. Irradiation applied in combination with intracavitary cis-fib in rats is safe up to a dosage of 20 Gy and shows an additive effect on tumor growth delay compared to the single treatments.

目的：探讨保肺术后腔内顺铂-纤维蛋白（cis-fib）联合半胸照射（IR）治疗胸膜间皮瘤（PM）的安全性和有效性。方法：将雄性F344大鼠随机分为顺式fib （n = 9）、10 Gy IR （n = 6）、20 Gy IR （n = 9）、顺式fib+10 Gy IR （n = 6）、顺式fib+20 Gy IR (n = 9) 5组，于第0天用100万个同基因大鼠间皮瘤细胞（il45 -荧光素酶）进行胸膜下肿瘤植入。第9天切除肿瘤，随后采用腔内cis-fib或对照（NaCl-fib）治疗。第12天，在计算机断层扫描引导下，对原肿瘤区域进行单次高剂量局部照射。结果：我们只观察到与20gy放疗相关的短期副作用。与20 Gy相比，10 Gy IR对肿瘤生长没有影响。在20 Gy IR治疗后3天（实验第15天），我们发现cis-fib+IR组的肿瘤明显小于单独IR组(平均肿瘤生长252% vs 539%；p = .04)。第21天，cis-fib治疗组和cis-fib+IR治疗组的肿瘤生长有显著差异(平均肿瘤生长为2295% vs 660%；p = 0.01)。结论：PM肿瘤切除术后的局部治疗旨在改善局部肿瘤控制。在大鼠中，与腔内cis-fib联合照射在20 Gy的剂量下是安全的，并且与单独治疗相比，对肿瘤生长延迟显示出累加效应。

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引用次数: 0