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

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.

Purpose: Owing to the time-sensitive nature of myocardial ischemia, challenging clinical scenarios should be considered in patients with type A acute aortic dissection (AAAD) complicated by coronary malperfusion. In clinical settings, the diagnosis and reperfusion strategies for coronary malperfusion often depend on institutional resources. This study evaluated early surgical outcomes in such patients, focusing on transportation type and clinical management.

Methods: We retrospectively reviewed 70 patients who underwent emergency surgery for AAAD with coronary malperfusion, excluding those with cardiac tamponade on arrival, between 1997 and February 2024. Patients were divided into 2 groups based on transportation: direct transfer and referral.

Results: Overall, in-hospital mortality was 27%, with only 1 of 9 patients surviving with preoperative peripheral extracorporeal membrane oxygenation (ECMO). Mortality and morbidity did not significantly differ between groups. Univariate analysis identified left coronary artery involvement and preoperative hemodynamic instability as significant risk factors. Additionally, preoperative diagnostic-only coronary angiography (CAG) with unsuccessful reperfusion was a potential risk factor (P = 0.06).

Conclusions: Regardless of transportation type, preoperative peripheral ECMO itself could not be a definitive solution in AAAD patients with coronary malperfusion. Also, patients who underwent preoperative CAG with unsuccessful reperfusion might be fatal, especially with suspected left coronary artery involvement.

Purpose: Lung torsion is a rare postoperative complication of pulmonary resection caused by lobe displacement. This condition leads to bronchial or pulmonary vascular kinking, which results in airway obstruction or blood flow impairment. In particular, middle lobe torsion is commonly observed after right upper lobectomy. However, the conditions under which it occurs remain unclear. This study aimed to identify the risk factors for middle lobe torsion following right upper lobectomy.

Methods: From November 2012 to December 2024, 127 patients underwent thoracoscopic right upper lobectomy at our institution. Four patients diagnosed with postoperative middle lobe torsion were classified into the torsion group. These patients were retrospectively compared with those without torsion.

Results: Simultaneous partial middle lobe resection and the number of staples used for interlobar fissure formation between the upper and middle lobes were significantly associated with lung torsion. The cutoff value for the number of staples used in the upper-middle fissure formation was 4, demonstrating fair accuracy.

Conclusions: The risk factors for middle lobe torsion after thoracoscopic right upper lobectomy were simultaneous partial resection of the middle lobe and the number of staples used for interlobar fissure formation between the upper and middle lobes.

Purpose: To report our experience with robotic-assisted redo coronary artery bypass grafting (CABG).

Methods: This single-center retrospective study included patients undergoing robotic-assisted redo CABG between 2016 and 2023. Patient demographics and operative outcomes were compared with those of initial robotic-assisted CABG procedures performed during the same period.

Results: There were 12 patients undergoing robotic-assisted redo CABG, with a median age of 73 years. Compared to initial CABG patients (n = 1415), the Society of Thoracic Surgeons scores were significantly higher (median: 0.90 vs. 7.05, p <0.001) in the redo group. Six patients had de novo internal mammary artery (IMA) to left anterior descending (LAD) bypass, 4 had redo LAD bypass, and 2 had non-LAD bypass. Among the 10 patients with LAD bypass, 4 also underwent hybrid percutaneous coronary intervention. While operating room time (5.4 vs. 7.4 hours, p <0.001), postoperative lengths of stay (4.0 vs. 5.5 days, p = 0.02) and the need for blood transfusion (15% vs. 42%, p = 0.02) were significantly greater in the redo group compared to the initial group, there were no conversions to sternotomy, unplanned revascularization, or in-hospital mortality in the redo patients.

Conclusion: Robotic-assisted redo CABG demonstrated promising operative outcomes in appropriately selected patients despite the higher-risk cohort.

Purpose: This study aimed to compare the efficacy and safety of liposomal bupivacaine (Lip-BPVC) versus standard bupivacaine (BPVC) for superficial parasternal intercostal plane block in patients undergoing elective coronary artery bypass grafting (CABG) via median sternotomy.

Methods: A total of 82 adult patients were randomly assigned to the BPVC group (n = 41) or the Lip-BPVC group (n = 41).

Results: The Lip-BPVC group demonstrated significantly lower pain scores at all postinjection time points compared to the BPVC group with fewer opioid analgesics. Lip-BPVC demonstrated an initial heightened inflammatory response postoperatively compared to standard BPVC, indicated by significantly lower levels of pro-inflammatory markers at 24 and 48 hours postinjection with BPVC. However, by 72 hours, inflammatory markers did not differ significantly between Lip-BPVC and BPVC groups. No significant differences were observed between the groups in terms of surgery duration, extubation time, intensive care unit and hospital length of stay, or incidence of postoperative nausea and vomiting.

Conclusions: Lip-BPVC initially increased inflammatory markers postoperatively, but levels were comparable to BPVC by 72 hours. It provided superior pain control and reduced opioid use compared to standard BPVC in CABG patients, with similar safety and recovery outcomes.

Purpose: Tumor spread through air spaces (STAS) and visceral pleural invasion (VPI) are negative prognostic factors in lung cancer. However, it is unknown whether they have a compounding prognostic effect. Therefore, we analyzed the association between STAS and VPI with overall survival and recurrence.

Methods: A retrospective cohort analysis was conducted on 421 adult patients who underwent pulmonary resection for non-small cell lung cancer at an academic institution between 2018 and 2022. Baseline characteristics were compared between patients who had STAS only, VPI only, or both STAS and VPI. Overall survival and cumulative recurrence were compared using the Kaplan-Meier method.

Results: Of the 421 patients who underwent a pulmonary resection, 34 (8%) had both STAS and VPI. Their combined presence was associated with increased smoking pack-years, increased tumor size, and an increased presence of lymphovascular invasion. There was no overall survival difference (p = 0.190) between patients with both STAS and VPI and those with only one feature or neither. However, cumulative incidence of recurrence was increased (p = 0.001) for patients with both.

Conclusion: The presence of STAS and VPI was not associated with decreased overall survival; however, their combined presence may have a compounding effect on recurrence risk.

Purpose: Despite the knowledge that right-sided colon tumors are associated with worse overall survival (OS) and disease-free survival (DFS) compared to left-sided and rectal tumors, there are conflicting results on the impact of the primary location of colorectal tumors after lung metastasectomy. In this study, we aimed to investigate this contradiction.

Methods: We conducted a retrospective analysis of 131 patients who underwent lung metastasectomy for colorectal cancer. DFS and OS were evaluated in relation to primary tumor location, liver metastasis, lymph node dissection, nodal status, and carcinoembryonic antigen (CEA) levels.

Results: Among patients with no nodal metastasis (N0), significantly better DFS (p = 0.024) and OS (p = 0.030) were observed. Elevated CEA levels were not associated with DFS but were linked to improved OS (p = 0.004). Right-sided colon tumors were associated with worse DFS and OS compared to left-sided and rectal tumors (p <0.002 and p <0.001, respectively).

Conclusion: Right-sided colon tumors were associated with the poorest DFS and OS, underscoring the prognostic significance of primary tumor location. Additionally, the absence of nodal metastasis was associated with significantly improved survival outcomes. Liver metastasis was not significantly associated with DFS or OS.

Purpose: We aimed to elucidate the efficacy of conventional cisplatin-based adjuvant chemotherapy for patients with lung cancers harboring epidermal growth factor receptor (EGFR) mutation.

Methods: This retrospective cohort study included 110 patients (EGFR mutation group: n = 51; EGFR wild-type group: n = 59) receiving cisplatin-based adjuvant chemotherapy following complete resection of non-small-cell non-squamous-cell lung cancer (2010-2021). Clinicopathological characteristics, recurrence-free survival (RFS), and overall survival (OS) were investigated.

Results: The pStage distribution was not statistically different. The EGFR mutation group was characterized by more advanced pN, papillary predominance, and presence of micropapillary components, whereas the EGFR wild-type group exhibited more advanced pT and solid predominant patterns. The median RFS was significantly worse in the EGFR mutation group (23.0 vs. 76.1 months, p = 0.017). Nevertheless, the median OS was not significantly different (85.6 months vs. not reached, p = 0.151). Multivariable analysis demonstrated that EGFR mutation and lymphatic invasion were significant risk factors in RFS; however, no independent factors were identified in OS.

Conclusions: Cisplatin-based adjuvant chemotherapy might be less effective in patients with EGFR-mutated lung cancer. The style of progression and histological pattern related with EGFR mutation may be associated with the efficacy of adjuvant chemotherapy and poor RFS.

This preclinical study in a porcine model of recurrent regurgitation following tricuspid valvuloplasty aims to confirm the feasibility and safety of a novel transjugular tricuspid valve (TV) replacement device and to optimize the implantation procedure prior to first-in-human study. The novel device was implanted via a transjugular approach in a large white pig model (n = 2). No perivalvular leakage (PVL) or central tricuspid regurgitation (TR) was observed on post-operative echocardiography. The mean transvalvular gradient at 3 months follow-up was 1.69 ± 0.7 mmHg with mild central TR but no PVL. There was no right ventricular outflow tract obstruction, III atrioventricular block, device malposition, pericardial effusion, coronary artery compression, or myocardial infarction. This technique may be a promising option for patients after TV valvuloplasty and is ideal for high-risk patients undergoing open-heart surgery.