Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia最新文献

Purpose: Pulmonary vein stump thrombus (PVST) is a relatively common complication after left upper lobectomy that can cause vital organ embolism. We previously found that patients with PVST on postoperative day 7 show risky hemodynamic features around the pulmonary vein stump on 4-dimensional (4D) flow magnetic resonance imaging (MRI), which may contribute to thrombus development. However, it remains unclear whether such hemodynamics persist later.

Methods: Eleven patients who underwent left upper lobectomy for lung cancer received 4D flow MRI on postoperative day 7 and again after over 3 months. Hemodynamic parameters were used to classify each case as risky or non-risky for PVST.

Results: According to a total of 24 examinations in 11 patients, 7 were classified as risky and 17 as non-risky. PVST developed in 6 patients during various postoperative phases, and all PVST cases developed under the risky conditions. Furthermore, PVST did not develop under non-risky conditions, suggesting that our risk assessment is valid as a predictive marker for PVST.

Conclusion: Our results suggest that late postoperative hemodynamic assessments, as well as early postoperative assessments, are useful for identifying patients at high risk of PVST. A late postoperative hemodynamic assessment may contribute to determining when to discontinue anticoagulants.

Purpose: The internal thoracic artery (ITA) has shown increased production of nitric oxide, which has beneficial effects on ventricular remodeling, among conduits of coronary artery bypass grafting (CABG). However, little is known about the impact of bilateral ITA strategy on postoperative left ventricle (LV) reverse remodeling as compared with single ITA, especially in patients with severely impaired LV function.

Methods: We retrospectively reviewed 126 propensity-matched patients with advanced ischemic cardiomyopathy (ICM) (left ventricular ejection fraction <40%) who underwent isolated multiple CABG utilizing bilateral (BITA group; n = 65) or single (SITA group; n = 61) ITA. The primary endpoint was postoperative reduction in the indexed left ventricular end-systolic volume index (LVESVI). Baseline covariates were adjusted with propensity score-matching.

Results: At baseline, there were no intergroup differences in LVESVI (78 vs. 78 ml/m², P = 0.93) and EuroSCORE II score (3.0% vs. 2.8%, P = 0.70). At 6 months post-surgery, the BITA group reduced LVESVI to a greater degree than the SITA group (-33% vs. -17%, P <0.01), resulting in significantly smaller postoperative LVESVI (49 vs. 63 ml/m², P = 0.03). Multivariable analysis showed that CABG with BITA (P = 0.011) was associated with postoperative LV reverse remodeling.

Conclusion: In patients with ICM undergoing CABG, the in situ BITA strategy was associated with greater reductions in postoperative LV volume.

Purpose: Surgery for Jehovah's Witness patients with Stanford type A aortic dissection (TAAD) carries a high surgical risk, and few reports have examined outcomes in this patient population. This study evaluated perioperative outcomes of surgery for TAAD in Jehovah's Witness patients.

Methods: Eight Jehovah's Witness patients who underwent surgery for TAAD at our institution between February 2016 and January 2025 were retrospectively reviewed. No patients were receiving antiplatelet or anticoagulant therapy at the time of surgery. Preoperative characteristics, operative data, and postoperative outcomes were assessed.

Results: Emergency ascending aortic replacement was performed in 6 patients, while the 2 patients who underwent elective surgery due to a chronic course or thrombosed false lumen received total or partial arch replacement. Both elective cases received preoperative iron supplementation. The median postoperative nadir hemoglobin was 9.2 (interquartile range, 6.8-9.6) g/dL. One patient died, one was transferred to rehabilitation, and 6 patients (75.0%) were discharged home without major complications.

Conclusions: Perioperative outcomes of surgery for TAAD in Jehovah's Witness patients were favorable. Proper surgical timing and preoperative management are essential to achieving satisfactory results. Further investigation with a larger cohort and longer follow-up is warranted.

Purpose: The superior segment (S6) may differ from the basal segments (BSs) in lymphatic spread, affecting surgical strategy and mediastinal lymph node dissection (LND). We aimed to define lymphatic spread patterns and to guide surgical strategy in S6 non-small cell lung cancer (NSCLC).

Methods: We reviewed 375 patients with cT1a-cT1c N0 lower-lobe NSCLC (S6, 168; BS, 207) who underwent segmentectomy or lobectomy (2012-2024). We analyzed nodal metastasis and recurrence by station.

Results: Segmentectomy was more frequent in S6 than in BS. pN1 and pN2 incidence was 8.3% and 2.4% in S6 and 4.3% and 6.8% in BS, respectively. In S6, pN2 metastases were single-station with N1, with no inferior mediastinal involvement. S6 nodal recurrences were confined to #4L/#4R and occurred outside the LND field. In BS, skip pN2 was more frequent and nodal recurrences occurred at #7 within the field.

Conclusion: In clinical stage IA S6 NSCLC, nodal events occurred in the superior mediastinal stations. All pN2 were single-station with N1, and all nodal recurrences occurred after lobe-specific mediastinal LND. Management should follow intraoperative N1 assessment: if negative, S6 segmentectomy without mediastinal LND; if positive, lobectomy with superior mediastinal and subcarinal LND, omitting inferior mediastinal nodes unless specifically suspected.

Purpose: This study aimed to evaluate sex-based differences in the clinical characteristics, aortic anatomy, surgical strategies, and outcomes of patients undergoing emergency surgery for acute Stanford type A aortic dissection (AAAD).

Methods: We retrospectively analyzed 148 consecutive patients (82 males and 66 females) who underwent surgery for AAAD at a single center. We compared their backgrounds, entry tear locations, operative procedures, and postoperative outcomes. Kaplan-Meier analysis assessed long-term survival and freedom from re-intervention.

Results: Female patients were significantly older than male patients, more likely to have ascending aortic entry tears, and more often treated by hemiarch replacement. Male patients underwent total arch replacement more frequently because of arch or distal entry tears and had a higher incidence of iliac artery involvement, indicating more extensive distal dissection. In-hospital mortality, major postoperative complications, long-term survival, and freedom from re-intervention showed no significant sex-based differences.

Conclusion: In female patients, the predominance of ascending entry tears allows less extensive surgery without compromising outcomes. Therefore, when dissection patterns are suitable, emergent surgery is appropriate even in elderly female patients.

Giant cell tumor of bone (GCTB) rarely metastasizes, but pulmonary lesions pose therapeutic challenges. We report a woman in her 30s who developed multiple bilateral lung nodules 3.5 years after distal ulna GCTB resection and local recurrences. Denosumab 120 mg every 4 weeks was given for 2.5 years, producing shrinkage, calcification, and stability. Staged, palpation-guided thoracoscopic wedge resections (8 left, 5 right) achieved complete macroscopic clearance with negative margins. Histology showed spindle-cell proliferation with woven bone and depletion of giant cells; H3.3 G34W immunostaining confirmed metastatic GCTB. She remains recurrence-free 7 years and 5 months after metastasectomy. Denosumab displayed site-specific surgical implications-unfavorable at the primary bone site due to peritumoral sclerosis, yet advantageous in the lung where it clarifies margins and enables parenchyma-sparing R0 resection. A surgery-forward strategy that uses time-limited denosumab as a bridge to meticulous thoracoscopic metastasectomy may secure durable control in multifocal pulmonary GCTB.

Purpose: This study aimed to assess perioperative features, early postoperative outcomes, and mid-term cardiac function in children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) undergoing surgical repair.

Methods: A retrospective review of 23 patients treated surgically between 2007 and 2023 was conducted. Patients were categorized into infants (<1 year) and older patients (>1 year). Clinical, operative, and echocardiographic data were analyzed, including left ventricular ejection fraction (LVEF) and mitral regurgitation (MR). Follow-up evaluations were performed at 1 and 6 months postoperatively.

Results: The median age at surgery was 9 months. Early mortality occurred in 17.4%, with no late deaths during follow-up. Preoperative LVEF was significantly lower in infants than in older patients (p = 0.013). Among 19 survivors, LVEF improved markedly by 1 month and normalized in all patients by 6 months. MR was present in 89.5% preoperatively, with 47.3% showing moderate to severe grades. At 6 months, MR improved in most cases, with only 2 patients exhibiting residual moderate regurgitation and no severe cases.

Conclusions: ALCAPA is a rare but surgically correctable condition. Early surgical intervention leads to significant recovery of ventricular function and regression of MR within the first 6 postoperative months.

Purpose: The objective of this study was to evaluate the safety and efficacy of catheter-directed thrombolysis (CDT) and mechanical aspiration (MA) for acute pulmonary embolism (PE).

Methods: From February 2022 to October 2024, the clinical data of patients with high- and intermediate-risk PE who received endovascular therapy were retrospectively reviewed. Patients were categorized based on the treatment strategy.

Results: Fifty-eight consecutive patients were identified. CDT was initiated in 29 patients, while the remaining 29 received MA treatment. The time of thrombolysis and the dosage of urokinase were both lower in the MA group (P <0.05). No differences were found in cardiac biomarkers after 48 hours, perioperative bleeding events, heart/valve injury, and mortality. The total cost of the MA group was much higher compared to CDT alone. The MA group showed better improvement in right ventricular (RV) function with a higher reduction in the right ventricular-to-left ventricular ratio (0.55 ± 0.46 vs. 0.13 ± 0.53, P = 0.017). No differences were found in the reduction of the CT obstruction index.

Conclusion: CDT and MA seem to have similar outcomes for patients with acute high- and intermediate-risk PE. MA is more effective in improving RV function with less thrombolysis time and fewer thrombolytics.

Purpose: This study compared the short-term outcomes after conventional minimally invasive esophagectomy (MIE) vs. robot-assisted minimally invasive esophagectomy (RAMIE)s by analyzing national data.

Methods: Data were collected from adults aged ≥20 years who underwent MIE from 2017 to 2020, from the US Nationwide Inpatient Sample database. The outcomes included in-hospital mortality, unfavorable discharges, prolonged length of stays (LOS), total hospital charge, and various complications. Propensity score matching (PSM) was employed to balance the baseline characteristics between RAMIE and conventional MIE.

Results: After PSM, 628 patients (representing 3140 patients in the US after weighting) were analyzed. After adjustment, multivariable analysis revealed no significant differences between RAMIE and traditional MIE in terms of in-hospital mortality (adjusted odd ratio [aOR] =1.45, 95% confidence interval [CI]: 0.46-4.61), unfavorable discharge (aOR = 0.76, 95%CI: 0.41-1.41), prolonged LOS (aOR = 0.87, 95%CI: 0.60-1.26), total hospital charge (aBeta = 12.23, 95%CI: -19.24 to 43.69), or complications (aOR = 1.05, 95%CI: 0.78-1.41). Stratified analysis indicated that, among obese patients, RAMIE was associated significantly with a higher risk of overall complications compared with MIE (aOR = 1.90, 95%CI: 1.11-3.25).

Conclusions: The study found no significant differences in unfavorable discharge and prolonged LOS between RAMIE and traditional MIE. Nevertheless, obese patients undergoing RAMIE experienced higher complications.

Purpose: The objective of this study was to examine the correlation between normalized lactate load (NLL) and the 30-day mortality rate in patients with acute type A aortic dissection (AAAD) patients, as well as its predictive value for prognosis.

Methods: Data were obtained from the Medical Information Mart for Intensive Care-IV database. The Cox model and restricted cubic spline (RCS) were used to assess the relationship between NLL and 30-day mortality in AAAD patients. Receiver-operating characteristic curves were plotted to evaluate the predictive value of NLL for 7-, 14-, and 30-day mortality. Kaplan-Meier (K-M) curves were used to compare 30-day survival across different risk levels.

Results: Among 150 AAAD patients, NLL was recognized as a risk factor for 30-day mortality (hazard ratio = 1.83, 95% confidence interval: 1.29-2.58; P <0.001). The RCS analysis showed a linear relationship. NLL showed areas under the curve of 0.781, 0.781, and 0.730 for predicting 7-, 14-, and 30-day mortality, respectively. K-M curves revealed a significant difference in 30-day survival between the high- and low-risk groups (log-rank P = 0.042).

Conclusion: NLL is a risk factor for 30-day mortality in AAAD patients and shows good predictive value. This study supports NLL as an early-warning biomarker for identifying high-risk AAAD patients.