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

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.

Purpose: We evaluated patients with acute type A aortic dissection (ATAAD) who were suffering from a collapsed true lumen in the descending aorta.

Methods: Among 146 patients with ATAAD who underwent surgery, 6 (4.1%) with a collapsed true lumen of <10% of the total area at the level of the diaphragmatic transition in the descending aorta were detected. Preoperative and postoperative computed tomography images, preoperative characteristics, surgical techniques, and major adverse aortic events were assessed.

Results: Patients with a collapsed true lumen tended to have spinal cord or peripheral malperfusion preoperatively. In two patients, because intraoperative transesophageal echocardiography showed no improvement in the collapsed true lumen after femoral artery cannulation, ascending aortic cannulation was added. Entry resection was achieved in five patients; however, three of them needed thoracic endovascular aortic repair (TEVAR). All six patients survived for one year, and after staged TEVAR, aortic remodeling was achieved.

Conclusion: Patients with a collapsed true lumen in the descending aorta tended to develop lower body malperfusion, and usual cardiopulmonary bypass may be ineffective. Even if entry resection was achieved, aortic remodeling could not be obtained in some cases; therefore, staged repair with TEVAR can solve this issue.

Purpose: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are both well-established treatments for carotid artery stenosis. We analyzed real-world data from the Korean National Health Insurance Service (NHIS) database to compare the clinical outcomes.

Methods: This retrospective cohort study included patients with carotid artery stenosis registered in the NHIS from 2008 to 2018. Patients who underwent either treatment were divided into CEA or CAS groups and subjected to 1:4 propensity score matching.

Results: The study cohort included 1521 CEA and 6768 CAS patients. In symptomatic patients, the stroke rate within 1 month was lower in the CAS group (hazard ratio [HR], 0.61). However, the incidence of cardiovascular disease (CVD) death was higher in the CAS group at 1 month, 1 year, and during the total follow-up (HRs, 4.18, 2.43, and 1.50). There were no significant differences in outcomes between asymptomatic patients in the 2 groups.

Conclusion: The periprocedural stroke risk was higher in symptomatic carotid stenosis patients who underwent CEA, but mortality was higher in those who received CAS, both in the short and long term. In asymptomatic patients, however, the incidence of major adverse cardiovascular events and mortality was similar between the 2 groups.

Bronchogenic cysts (BCs) are often incidental findings during imaging and can cause compressive symptoms depending on their location and size. Infections of mediastinal BCs are serious complications that can lead to life-threatening mediastinitis. The impact of severe acute respiratory syndrome coronavirus 2 on BCs remains largely undocumented. We present a unique case of a purulent-inflammatory mediastinal BC complicated by sepsis in the context of a Coronavirus Disease 2019 infection. The Coronavirus Disease 2019 infection may result in a bacterial superinfection of the BC. However, the transmission path requires further investigation. For the surgical excision, we opted for a two-step surgical approach: thoracoscopic incision and drainage in the acute setting, followed by elective thoracotomy and resection of the BC. We confirm the safety and favorable outcome of this approach.

Purpose: This study aims to determine the outcomes of maintaining antegrade pulmonary blood flow (APBF) during the bidirectional cavopulmonary shunt (BCPS) procedure in patients with single ventricle physiology undergoing staged palliative surgeries.

Methods: A systematic search of electronic databases was conducted and focused on studies comparing pulsatile BCPS (with APBF) with non-pulsatile BCPS (without APBF). Outcomes were categorized into early (post-BCPS) and late (pre-Fontan). Data were analyzed using Mantel-Haenszel random effects model with odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). The study protocol was registered in the PROSPERO (CRD42024586369).

Results: A total of 17 studies with 2504 patients were included. There was no significant difference in 30-day mortality (OR 1.11, 95% CI: 0.61-2.04, p = 0.73), but pulsatile BCPS led to a higher rate of prolonged chest drainage (OR 2.45, 95% CI: 1.43-4.20, p <0.001). Pulsatile BCPS resulted in significantly higher SaO₂ in both post-BCPS (MD 3.33%, 95% CI: 2.70-3.97, p <0.001) and pre-Fontan (MD 2.91%, 95% CI: 2.51-3.31, p <0.001). The Nakata index was also higher in the pulsatile group (MD 30.67, 95% CI: 16.68-44.65, p <0.001).

Conclusions: Pulsatile BCPS can optimize pre-Fontan hemodynamics by improving oxygenation and pulmonary artery development. However, the increased risk of prolonged chest drainage requires careful patient selection and monitoring.

Purpose: Robotic-assisted thoracoscopic surgery (RATS) has emerged as an alternative to video-assisted thoracoscopic surgery (VATS) for lobectomy in early-stage non-small cell lung cancer (NSCLC). While perioperative and oncologic outcomes have been studied, limited data exist on long-term postoperative pulmonary function. This study compared pulmonary function one year after RATS versus VATS lobectomy.

Methods: We retrospectively analyzed 298 patients who underwent lobectomy for early-stage NSCLC between September 2020 and August 2023. After applying exclusion criteria, 186 patients remained: 128 in the VATS group and 58 in the RATS group. Propensity score matching (1:1) yielded 55 matched pairs. Pulmonary function parameters-%predicted forced vital capacity (%FVC), %predicted forced expiratory volume in one second (%FEV1), %predicted peak expiratory flow (%PEF), and %predicted diffusing capacity for carbon monoxide (%DLco)-were evaluated one year postoperatively.

Results: No significant differences were observed between groups in any pulmonary function parameters at one year, both before and after matching. Lung function was similarly preserved.

Conclusions: Despite the use of more ports, RATS lobectomy did not result in inferior pulmonary function compared to VATS. Given its higher cost, VATS may remain the more cost-effective standard, although RATS offers a promising platform for future innovation.