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

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.

Purpose: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach widely used for lung resections. However, reliance on staplers increases costs, limiting its adoption in resource-constrained settings. This study evaluates the feasibility, safety, and cost-effectiveness of uniportal stapler-less VATS lobectomies and segmentectomies.

Methods: A retrospective analysis of 7 stapler-less uniportal VATS surgeries performed between March 2021 and February 2022 was conducted. Data on operative time, blood loss, postoperative outcomes, and complications were collected from patient records.

Results: Seven procedures were completed with an average operative time of 80 min (range: 48-118 min). Estimated blood loss was minimal (10-100 mL) in 6 cases. One patient required conversion to open thoracotomy due to vessel injury. Postoperatively, all patients were stable with no major complications.

Conclusion: Stapler-less VATS is a viable, cost-effective alternative to conventional techniques, offering comparable safety and outcomes. This approach supports broader adoption of minimally invasive surgery, particularly in low-income settings, where reducing procedural costs is critical.

The malignancy risk has increased following improvements in the long-term survival rates after liver transplantation. Reports show a 23.4-fold increase in the risk of de novo esophageal cancer after liver transplantation compared to the general population. We report the case of a 47-year-old female diagnosed with early esophageal cancer after liver transplantation. Endoscopic submucosal dissection was performed; however, due to it being a noncurative resection, additional treatment was required. Total robot-assisted minimally invasive esophagectomy (RAMIE) was performed using a robot for thoracic and abdominal procedures. Although extensive adhesions were observed after liver transplantation, precise surgery using the robot did not damage any vital organs, such as the graft blood vessels. The patient was discharged without postoperative complications. Total RAMIE for esophageal cancer after liver transplantation is a feasible and safe option following careful evaluation of the patient's condition, and expands the possibilities of successful complex posttransplant surgeries through robotic precision.

Purpose: There are limited data on outcomes of combined Maze and mitral valve procedures beyond 10 years. This study analyzed the efficacy of this operation.

Methods: Between June 2004 and December 2022, 406 patients underwent mitral surgery concomitant with Maze procedure were evaluated. Rhythm outcomes, predictors of recurrence, and survival were assessed.

Results: The median follow-up period was 100 months. Rheumatic disease was present in 58%. Mitral valve repair was performed in 57.1%. Freedom from atrial fibrillation (AF) at 5, 10, and 15 years was 82.5%, 70.8%, and 52.7%, respectively. Overall survival rates were not different between patients in sinus rhythm (SR) and those who remained in AF (p = 0.172). However, patients in SR experienced fewer neurological complication (p = 0.001). Predictors of AF recurrence included preoperative AF duration (p = 0.005), left atrial diameter (LAD) >50 mm (p <0.001), concomitant tricuspid valve surgery (p = 0.049), and the presence of AF on postoperative day 7 (p <0.001). Factors influencing survival were age >60 years (p <0.001) and a postoperative left ventricular ejection fraction <40% (p <0.001).

Conclusions: The combined Maze and mitral valve surgery provides significant benefits in managing AF with mitral disease. Predictors of recurrence included AF duration, LAD size >50 mm, associated tricuspid valve disease, and AF on day 7. SR patients had fewer neurological complications.

Purpose: The underlying mechanism why segmentectomy has demonstrated the non-inferiority to lobectomy in several randomized trials remains unclear. Computed tomography (CT)-measured pulmonary artery (PA) enlargement reflects PA pressure and predicts the prognosis of certain respiratory diseases. We compared the preoperative and postoperative PA diameter to the ascending aorta diameter (PA/A) ratio, investigating its impact on right ventricular function in lung resection.

Methods: This retrospective study was conducted in patients with lower-lobe lung tumors who underwent anatomical lung resection between 2017 and 2022. The PA diameter at the bifurcation and the ascending aorta diameter at the same CT image slice were measured preoperatively and postoperatively. We calculated the enlargement of PA/A ratio (PA/A change) and compared lobectomy and segmentectomy.

Results: This analysis included 279 patients (235 with lobectomy and 44 with segmentectomy). The PA/A change was significantly greater in patients with lobectomy than segmentectomy (104% vs. 102%, P = 0.02). In the multivariable analysis, airflow obstruction (yes, P = 0.04) and the type of surgery (segmentectomy, P = 0.04) were independent prognostic factors for PA/A change.

Conclusions: The PA/A change was greater in lobectomy than in segmentectomy. This change could reflect a burden on right ventricular function after lobectomy.

Introduction: Kartagener syndrome (KS), a distinct subtype of primary ciliary dyskinesia, is linked to progressive lung disease; concurrent pulmonary mucinous adenocarcinoma mimicking pneumonia is rarely reported and easily misdiagnosed.

Case presentation: A 64-year-old female presented with years of recurrent cough and sputum. Chest computed tomography (CT) revealed bilateral chronic inflammation, interstitial changes, a left lower lobe mass-like shadow, partial bronchiectasis, and dextrocardia. Bronchoscopy showed chronic mucosal inflammation in the left lower lobe base segment; sputum culture was negative. Symptoms improved with antibiotics/expectorants. Two months later, worsening symptoms prompted re-evaluation. Extensive diagnostic tests (tumor markers, bacteriological/mycological, immunological, viral) were largely negative. CT-guided percutaneous lung biopsy confirmed invasive mucinous adenocarcinoma. Preoperative evaluation revealed situs inversus totalis, chronic sinusitis, and bronchiectasis, confirming concurrent KS. Following multidisciplinary discussion, she underwent thoracoscopic left middle and lower lobectomy with uncomplicated recovery; pathology confirmed R0 resection. She completed 5 cycles of adjuvant pemetrexed/platinum chemotherapy and remains recurrence-free on follow-up.

Conclusions: This represents the first documented case of KS coexisting with pulmonary invasive mucinous adenocarcinoma, to some extent expanding the clinical spectrum of ciliopathy-associated lung malignancies. It suggests that clinicians and radiologists should consider the possibility of concurrent mucinous adenocarcinoma in KS patients.

Purpose: Endovascular aneurysm repair (EVAR) is widely used to treat abdominal aortic aneurysms (AAAs), but mid-term survival remains a concern. This study aims to develop a machine learning-based random forest model to predict 3-year survival after EVAR.

Methods: A random forest model was trained using data from 176 EVAR patients, of whom 169 patients were retained for analysis, incorporating 23 preoperative and perioperative variables. Model performance was evaluated using 5-fold cross-validation.

Results: The model achieved an area under the receiver-operating characteristic curve (AUC) of 0.91, with an accuracy of 81.1%, a sensitivity of 81.6%, a specificity of 80.9%, and an F1 score of 0.66. Feature importance analysis identified poor nutritional status (geriatric nutritional risk index <101.4), compromised immunity (neutrophil-to-lymphocyte ratio >3.19), chronic kidney disease (CKD), octogenarian status, chronic obstructive pulmonary disease (COPD), small aneurysm size, and statin use as the top predictors of 3-year mortality. The average values of the AUC, accuracy, sensitivity, specificity, and F1 score across the 5-folds were 0.76 ± 0.10, 73.9 ± 5.8%, 60.4 ± 1.9%, 77.8 ± 0.7%, and 0.59 ± 0.17, indicating consistent performance across different data subsets.

Conclusions: The random forest model effectively predicts 3-year survival after EVAR, indicating key factors such as poor nutritional status, compromised immunity, CKD, octogenarian status, COPD, small aneurysm size, and statin use.

Cowden syndrome (CS) is a rare hereditary disorder caused by a germline variant of the phosphatase and tensin homolog, associated with multiple hamartomatous lesions occurring in various organs. Additionally, although rare, arteriovenous malformations (AVMs) with CS are found in the skin, brain, and spinal cord; however, peribronchial AVMs have not been previously reported. Herein, we report a rare case of a peribronchial AVM in a 30-year-old man with CS who presented with hemoptysis. Computed tomography (CT) revealed an AVM around the left upper bronchus, which was mainly fed by the left bronchial artery and drained into the left inferior pulmonary vein. Under video-assisted thoracic surgery, ligation of the feeding and draining vessels was performed. The AVM remarkably decreased in size one month after the surgery. This case highlights the need for whole-body contrast-enhanced CT to screen for AVMs and the importance of identifying feeding and draining vessels for optimal treatment methods.

Purpose: Cardioplegia directly affects patient outcomes after cardiac surgery with prolonged aortic cross-clamping. Our hospital revised its myocardial protection protocol in April 2021 and compared the clinical outcomes of patients with prolonged aortic cross-clamping before versus after the revision.

Methods: This study included 36 patients who underwent cardiac surgery via a median sternotomy and prolonged aortic cross-clamping for >4 h at our hospital from 2018 to 2024. Patients treated between 2018 and March 2021 (before the protocol revision) were designated as Group 1, while those treated from April 2021 to 2024 (after the revision) were designated as Group 2.

Results: Groups 1 and 2 comprised 17 and 19 patients, respectively. The mean creatine kinase level immediately postoperative was significantly lower in Group 2 versus Group 1 (P = 0.018). The mean hospital stay was also significantly shorter in Group 2 versus Group 1 (P = 0.017). Regarding new postoperative right-ventricular dysfunction, there were 3 cases (15.8%) in Group 2 versus 5 cases (29.4%) in Group 1, but the difference was not statistically significant.

Conclusion: These findings suggest that our hospital's revised myocardial protection protocol, which requires no alteration of the solution itself, achieves safe and favorable surgical results, even in cardiac surgeries requiring prolonged aortic cross-clamping.

Thymomas are commonly associated with autoimmune diseases such as myasthenia gravis (MG), pure red cell aplasia, and hypogammaglobulinemia, while those associated solely with alopecia areata (AA) are extremely rare. A 55-year-old woman with AA underwent chest computed tomography, which revealed a 33-mm anterior mediastinal cystic mass with fluctuating size. She was referred to our department for evaluation of a suspected cystic thymoma. The patient underwent thoracoscopic tumor resection under general anesthesia with isolated lung ventilation in the left lateral decubitus position. The operation lasted 81 minutes with minimal blood loss, and her postoperative course was uneventful. Histopathology confirmed a type B2-dominant thymoma. Notably, the patient's AA improved rapidly after surgery and did not recur for at least 3 years. This case strongly suggests a potential immunological relationship between AA and thymoma, though further research is needed to confirm this relationship.