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

Purpose: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery and is associated with increased hospital stay, morbidity, and mortality. One of the major factors predisposing patients to the development of POAF is inflammation related to pericardial effusions, which may occur after cardiac surgery. We hypothesized that by creating a pleuro-pericardial window before closing the chest during cardiac surgery, draining the pericardial space into the right pleural space may lead to fewer pericardial effusions and less postoperative atrial fibrillation.

Methods: We conducted a study that included 172 consecutive patients (67 ± 12 years, 48.3% female) who underwent cardiac surgery (73.8% aortic valve replacement [AVR], 5.8% mitral valve replacement, 19% AVR + coronary artery bypass grafting). The first 95 patients included in this study (67 ± 12 years, 48% female) did not have any pleuro-pericardial window created, whereas the remaining 77 patients (67 ± 12 years, 48% female) did. Baseline clinical and procedural characteristics were compared between the 2 groups. Postoperative events and complications were collected until hospital discharge.

Results: A total of 50 patients developed POAF (29%). The incidence of POAF among patients who underwent a pleuro-pericardial window was 18.2% (95% confidence interval [CI]: 9.4%-27.0%). The incidence of POAF among those who underwent the standard technique was 37.7% (95% CI: 28.0%-47.8%). The patients who underwent a pleuro-pericardial window had a higher incidence of dyslipidemia (p = 0.037), right bundle branch block (p = 0.018), 1st-degree atrioventricular block (p = 0.046), and previous myocardial infarction (p = 0.006). Multivariate analysis showed that the risk of POAF was significantly lower in patients who underwent a pleuro-pericardial window compared to those who did not (odds ratio: 0.46, 95% CI: 0.24-0.87, p = 0.019).

Conclusion: Creating a right pleuro-pericardial window before closing the chest after cardiac surgery was independently associated with a lower incidence of POAF.

Purpose: Rapid risk stratification is crucial in patients with acute type A aortic dissection (ATAAD), particularly those presenting with circulatory collapse or malperfusion. This study investigated whether preoperative blood lactate levels could predict surgical outcomes.

Methods: A retrospective analysis was conducted on 166 patients who underwent emergency surgery for ATAAD between 2014 and 2022. Preoperative arterial lactate levels were measured at admission. Multivariate logistic regression identified risk factors for in-hospital mortality. The optimal lactate cutoff value was determined using receiver-operating characteristic curve analysis. Correlation with the Penn classification was also assessed.

Results: In-hospital mortality was 4.2%. A lactate level ≥3.7 mmol/L was independently associated with in-hospital mortality (hazard ratio, 1.41, p = 0.026) and was strongly correlated with Penn classes Ac and Abc. Patients with elevated lactate levels had more severe clinical presentations, prolonged intensive care unit stays, and more postoperative complications. Long-term mortality was also significantly higher in the high-lactate group (p = 0.013).

Conclusions: A preoperative lactate level ≥3.7 mmol/L is a practical and effective point-of-care predictor of surgical outcomes in ATAAD. It reflects circulatory collapse and severe malperfusion, and may assist nonspecialist clinicians in early triage and decision-making.

Purpose: This study aimed to determine whether the 1-minute sit-to-stand test (1-min STST) can be a predictor of postoperative complications following video-assisted thoracic surgery (VATS) lung lobectomy.

Methods: This retrospective cohort study included 152 patients who underwent VATS lobectomy. Preoperative evaluations included pulmonary function tests, the bendopnea test, and the 1-min STST. The predictive value of these assessments for postoperative complications, graded by the Clavien-Dindo (C-D) classification, was analyzed using logistic regression and receiver-operating characteristic curves.

Results: For predicting C-D grade II or III complications, a 1-min STST repetition count of ≤20 had an area under the curve (AUC) of 0.70, with 90% sensitivity and 46% specificity. For predicting C-D grade III complications, a repetition count of ≤15 showed an AUC of 0.72 (95% confidence interval [CI], 0.39-1.00), with 97% sensitivity and 60% specificity. In multivariate analysis for C-D grade III complications, a lower 1-min STST repetition count was a significant predictor (p <0.01).

Conclusion: The 1-min STST shows potential as a simple tool for preoperative risk stratification in patients undergoing VATS lobectomy.

Purpose: Our primary concern was the risk of overtreating elderly patients with endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. We investigated the association between age at the time of EVAR and all-cause mortality in Japan's aging population by stratifying patients into age groups.

Methods: Data from 175 patients who underwent elective EVAR from 2012 to 2016 were analyzed. Patients were categorized into 3 age groups: <75 years, 75-84 years, and ≥85 years, based on Japan's healthy life expectancy and average life expectancy. Survival rates and risk factors for mortality were assessed across these patient groups.

Results: Among 175 patients, 3- and 5-year survival rates were significantly lower in elderly patients, with rates of 74.6% and 64.2% for those aged 75-84 years and 51.9% and 39.7% for those aged ≥85 years. Multivariate analysis identified age ≥85 years, chronic kidney disease, chronic obstructive pulmonary disease, and active cancer as independent adverse predictors of all-cause mortality, whereas obesity was identified as an independent protective predictor.

Conclusions: Adjusting guidelines to incorporate not only comorbidities but also age could optimize outcomes and healthcare resource allocation by prioritizing EVAR for patients most likely to benefit in Japan's super-aging society.

Purpose: Motorized automatic staplers are used for bronchial closure following pulmonary resection. This study aimed to compare the completeness of staple formation in bronchial closure using 2 commonly adopted staple cartridges with motorized automatic staplers as follows: graduated-height staples (GHS) and equal-height staples (EHS).

Methods: This prospective observational study included 103 patients (105 bronchial stumps) undergoing pulmonary resections for lung cancer. Resected bronchi were embedded in paraffin, X-rays were taken, and staple formations were scored on a 0-4 scale, with a score of 4 indicating complete staple formation. Stump scores represented the average score of all staples per bronchial stump.

Results: The GHS exhibited a higher incidence of staple scores above the median (3.91) than that of the EHS (37/59 [62.7%] vs. 19/46 [41.3%], respectively; p = 0.033). Additionally, the GHS had a higher rate of complete staple formation than that in the EHS (84.7% vs. 75.1%; p <0.0001). This difference was more evident in calcified bronchi (84.2% vs. 57.6%, respectively; p <0.0001). No bronchopleural fistula was observed in any patients during the year.

Conclusion: Staple formations were generally more complete in the GHS than in the EHS. This difference was particularly notable in calcified bronchi.

Purpose: This study evaluated the midterm outcomes, including adverse aortic events (AAEs), of the "graft insertion technique" (GIT) for left ventricular outflow tract (LVOT) and aortic root reconstruction.

Methods: From August 2014 to March 2024, 14 consecutive patients underwent GIT for LVOT and aortic root reconstruction. The indications for surgery were prosthetic valve endocarditis in 9 cases and noninfectious pseudoaneurysm in 5 cases. Among these patients, seven (50.0%) underwent aortic root surgery, while the other seven (50.0%) underwent aortic valve replacement alone or in combination with other procedures without aortic root surgery. Their mean EuroSCORE II was 28.8 ± 17.6.

Results: The mean total operation time was 504 ± 87 min. The mean cardiopulmonary bypass and aortic cross-clamp times were 311 ± 41 and 240 ± 45 min, respectively. Operative mortality occurred in one case (7.1%), and five patients (35.7%) died during the first year of follow-up. No surviving patients experienced recurrent endocarditis. No patients died from cardiovascular events or infections after the second year of follow-up. Furthermore, no AAEs were observed on computed tomography during the follow-up period after hospital discharge.

Conclusion: GIT is a feasible alternative for high-risk cases of redo aortic root surgery.

Purpose: This study aims to evaluate the treatment outcomes for patients who developed post-pneumonectomy bronchopleural fistula (BPF) and to identify factors that may influence the success of these treatment methods.

Methods: A cohort of 60 patients diagnosed with resistant BPF following pneumonectomy for non-small cell lung cancer was included in the study. Patients were categorized into 2 groups based on the efficacy of the BPF closure methods: successful closure and failed closure. Data on demographic, clinical, and pathological characteristics, surgical procedures, oncologic treatment status, laboratory parameters at the time of BPF diagnosis, fistula diameter, and bronchial stump length were collected. The effectiveness of bronchoscopic treatments and advanced surgical procedures was analyzed.

Results: Of the 60 patients included in the study, 55 (95%) were male, with a mean age of 61.6 ± 9.4 years. Multivariate analysis identified fistula diameter and the type of previous suture as significant predictors of BPF closure success ( p = 0.024 and 0.008, respectively).

Conclusion: Fistula diameter and previous suture type are critical determinants of the success of post-pneumonectomy BPF closure.

Purpose: Pericardial effusion (PE), tamponade, and atrial fibrillation are challenging complications after cardiac surgeries. This prospective randomized study was conducted to evaluate the impact of posterior pericardiotomy (PP) in the prevention of PE and cardiac tamponed after adult cardiac surgery.

Methods: This single-center, prospective, randomized controlled trial included 330 patients undergoing open-heart surgery. They were randomly assigned to either a PP group or a control group.

Results: Of 703 screened patients, 330 were enrolled from January 2022 to June 2024 (mean age: 50.2 ± 14.7 years, 64.2% males). Compared to controls, the PP group had significantly lower early and late PE (19.4% vs. 44.8%, and 4.2% vs. 17%, respectively), tamponade (2.4% vs. 11.5%), and postoperative atrial fibrillation (10.3% vs. 19.4%). PP also significantly reduced the need for surgical re-exploration, duration of mechanical ventilation, and both intensive care unit and overall hospital stays (all P <0.05). Adjusted multivariate analysis confirmed the benefits of PP after correcting for baseline imbalances in left ventricular ejection fraction and operative time. No adverse events directly attributable to PP were noted.

Conclusions: PP is a simple, safe, and effective technique for reducing postoperative PE, and cardiac tamponade after cardiac surgery.

Purpose: Cardiovascular surgery entails considerable risk because of its complexity and the frequency of perioperative complications. The right ventricular Tei index (RV-TI) provides an integrated measure of ventricular performance, encompassing systolic and diastolic function. Although not widely applied in this setting, its role as a predictor of outcomes is promising. This study evaluated the utility of RV-TI in predicting postoperative complications in patients undergoing diverse cardiovascular surgeries, emphasizing its value for surgical risk stratification and patient management.

Methods: A single-center, cross-sectional study was conducted at the National Institute of Cardiology Ignacio Chávez, Mexico City, including 195 adults who underwent cardiac surgery between June 2022 and April 2023. RV-TI was obtained by transthoracic tissue Doppler, using 0.53 as the abnormal cutoff. One hundred and forty-nine patients had normal RV-TI values, while 46 were classified as abnormal.

Results: Abnormal RV-TI correlated with diabetes mellitus, advanced age, and vasoplegic syndrome. These patients experienced higher in-hospital mortality and more severe complications, including the need for renal replacement therapy, pneumonia, delirium, and greater transfusion requirements.

Conclusion: RV-TI appears to be a valuable adjunct in preoperative risk assessment for cardiac surgery. Its incorporation into clinical practice could improve patient selection and decision-making, contributing to better surgical outcomes.

A 68-year-old woman was diagnosed with clinical T3N1M0 middle thoracic esophageal cancer. Preoperative three-dimensional computed tomography indicated a right superior posterior pulmonary vein (RSPPV) anomaly, which ran behind the right intermediate bronchus. The patient underwent thoracoscopic esophagectomy with mediastinal lymph node (LN) dissection. Before we began the dissection of the right subcarinal LN, we administered indocyanine green intravenously to confirm the running position of the anomalous RSPPV, and we were able to ascertain its placement accurately with correct recognition of the difference between the blood vessels and surrounding tissue. Although the patient had LN metastasis adjacent to this anomalous vessel and the dissection procedure was tough due to tightly adhesion, intraoperative fluorescent imaging enabled us to perform the dissection without any superfluous vascular injury. Intraoperative fluorescent imaging is very useful in such cases, providing accurate intraoperative information on the location of the anomaly and facilitating safer surgery.