Guerrero AF, Pineda-Rodríguez IG, Palacio AM
… +6 more, Obando CE, Chalela T, Camacho J, Villa C, Umaña JP, Sandoval-Reyes NF
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35640540
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OBJECTIVES: Given the anatomical variations of tetralogy of Fallot (TOF), different surgical techniques can be used to achieve correction. Transannular patches (TAPs) are the most commonly used technique; they are associ...OBJECTIVES: Given the anatomical variations of tetralogy of Fallot (TOF), different surgical techniques can be used to achieve correction. Transannular patches (TAPs) are the most commonly used technique; they are associated with right ventricular dysfunction, the incidence of which can be reduced through pulmonary valve preservation. METHODS: Between January 2010 and July 2019, we performed 274 surgical corrections of tetralogy of Fallot at Fundación Cardioinfantil; 63 patients (23%) underwent repair with a TAP in addition to a pulmonary neovalve (Group I), 66 patients (24.1%) received a TAP without a pulmonary valve (Group II) and 145 patients (52.9%) had a repair with valve preservation (Group III). We analysed patient's characteristics before, during and after surgery at a 30-day follow-up. RESULTS: We found that patients in Group III were older (P = 0.04). Group II had the lowest level of O2 saturation before surgery (82%, P = 0.001). Cardiopulmonary bypass and aortic cross-clamp times were longer in Group I (P < 0.001). Right ventricular dysfunction was less frequent in Group III (15.9%, P = 0.011). Severe residual pulmonary regurgitation was more common in Group II (21.9%, P = 0.001). CONCLUSIONS: Preservation of the pulmonary valve is an important factor for immediate postoperative management of tetralogy of Fallot. Patients who were repaired with a TAP with or without a pulmonary neovalve had a higher incidence of right ventricular dysfunction than those with pulmonary valve preservation.
Szpytma MM, Gimpel D, Crouch G
… +1 more, Bennetts JS
Interact Cardiovasc Thorac Surg
· 2022 Jun · PMID 35640536
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Ruxolitinib, a Janus kinase inhibitor, is associated with severe withdrawal phenomena. Adequate tapering is often underemphasized in surgical emergencies and can complicate the postoperative course. We present a case of...Ruxolitinib, a Janus kinase inhibitor, is associated with severe withdrawal phenomena. Adequate tapering is often underemphasized in surgical emergencies and can complicate the postoperative course. We present a case of acute ruxolitinib withdrawal in a gentleman undergoing emergency cardiac surgery.
Nagoya A, Kanzaki R, Kimura K
… +7 more, Fukui E, Kanou T, Ose N, Funaki S, Minami M, Fujii M, Shintani Y
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35640534
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OBJECTIVES: The surgical Apgar score (SAS) is a simple score that predicts postoperative complications based on 3 intraoperative valuables. The present study evaluated the association between the SAS and postoperative ou...OBJECTIVES: The surgical Apgar score (SAS) is a simple score that predicts postoperative complications based on 3 intraoperative valuables. The present study evaluated the association between the SAS and postoperative outcomes in non-small-cell lung cancer patients who underwent surgery. METHODS: A total of 585 patients who underwent lung resection were enrolled in the present study. We calculated the SAS of each patient and investigated its influence on the short- and long-term outcomes. RESULTS: Postoperative complications of any grade were detected in 164 cases (28%). The morbidity rate increased with decreasing SAS. When all the patients were divided into 2 groups (SAS <7 vs ≥7), postoperative complications were observed more frequently in the SAS <7 group than in the SAS ≥7 group (41% vs 25%, P < 0.001). In the multivariate analysis, the SAS was an independent risk factor for postoperative complications (odds ratio: 1.64 [1.03-2.61], P = 0.036). In terms of long-term outcomes, the 5-year disease-free survival (54.1% vs 73.2%, P < 0.001) and overall survival (73.8% vs 83.0%, P = 0.031) were significantly worse in the SAS <7 group than in the SAS ≥7 group. In a multivariate analysis, however, the SAS was not found to be an independent prognostic factor for either disease-free survival (hazard ratio: 1.39 [0.97-2.00], P = 0.075) or overall survival (hazard ratio: 0.90 [0.57-1.42], P = 0.642). CONCLUSIONS: The SAS reflected preoperative and intraoperative characteristics and was able to stratify the morbidity rate, suggesting it to be a useful predictor of short-term outcomes in non-small-cell lung cancer patients who undergo surgery.
Patukale A, Shikata F, Marathe SS
… +6 more, Patel P, Marathe SP, Colen T, Venugopal P, QPCR Group, Alphonso N
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35640134
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OBJECTIVES: The aim of this study was to evaluate the mid-term outcomes after the repair of aortic arch using a standard patch augmentation technique. METHODS: The study included all patients who underwent repair of a hy...OBJECTIVES: The aim of this study was to evaluate the mid-term outcomes after the repair of aortic arch using a standard patch augmentation technique. METHODS: The study included all patients who underwent repair of a hypoplastic/interrupted aortic arch (IAA) in a single institute from June 2012 to December 2019 by a standardized patch augmentation (irrespective of concomitant intra-cardiac lesions). End points evaluated were reintervention for arch obstruction and persistent/new-onset hypertension. RESULTS: The study included 149 patients [hypoplastic aortic arch, n = 92 (62%), IAA, n = 9 (6%), Norwood procedure, n = 48 (32%)]. The patch material used for augmentation of the aortic arch included pulmonary homograft (n = 120, 81%), homograft pericardium (n = 18, 12%), CardioCel® (n = 9, 6%) and glutaraldehyde-treated autologous pericardium (n = 2, 1%). The median age and weight at surgery were 7 days [interquartile range (IQR) 5-17 days] and 3.5 kg (IQR 3-3.9 kg), respectively. The median follow-up was 3.27 years (IQR 1.28, 5.08), range (0.02, 8.76). Freedom from reintervention at 1, 3 and 5 years was 95% [95% confidence interval (CI) = 89%, 98%], 93% (95% CI = 86%, 96%) and 93% (95% CI = 86%, 96%) respectively. One patient (0.6%) had persistent hypertension 8 years after correction for interrupted arch with truncus arteriosus. CONCLUSIONS: Repair of hypoplastic/IAA by transection and excision of all ductal tissue and standardized patch augmentation provide good mid-term durability. The freedom from reintervention at 5 years is >90%. The incidence of persistent systemic hypertension following arch reconstruction is low. The technique is reproducible and applicable irrespective of underlying arch anatomy.
Wang Y, Cao Y, Wu M
… +4 more, Lu Y, He B, Zhou L, Hu W
Interact Cardiovasc Thorac Surg
· 2022 Jun · PMID 35639970
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OBJECTIVES: The aim of this study was to investigate the effect of preoperative radiotherapy (PrORT) on the overall survival (OS) of patients with stage ipsilateral mediastinal lymph node metastasis (N2) non-small-cell l...OBJECTIVES: The aim of this study was to investigate the effect of preoperative radiotherapy (PrORT) on the overall survival (OS) of patients with stage ipsilateral mediastinal lymph node metastasis (N2) non-small-cell lung cancer. METHODS: A total of 1390 patients with stage N2 non-small-cell lung cancer between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results database. The efficacy of PrORT combined with surgery was compared with that of surgery alone on OS. Propensity score matching (PSM) was performed to balance the baseline characteristics of patients who received (n = 239) and did not receive (n = 1151) PrORT. We compared the OS of the 2 groups using the Kaplan-Meier method and log-rank were used to compare the OS between the 2 groups test before and after PSM and to analyse subgroups of patients with squamous cell carcinoma (SCC) and adenocarcinoma. RESULTS: In whole group analysis before PSM, the median OS was superior in the PrORT group than in the surgery alone group (44.0 [34.4-56.6] vs 39.0 [34.5-43.5] months). There was a significant difference in OS [hazard ratio (HR): 0.819; 95% confidence interval (CI): 0.677-0.991; P = 0.029]. Nevertheless, no statistically significant difference was found in OS between the 2 groups after PSM (HR: 0.856; 95% CI: 0.654-1.122; P = 0.260). Among subgroup analysis of the SCC group before PSM revealed that patients who received PrORT had significantly higher median OS than those who did not receive PrORT (52.0 [40.0-NA] vs 27.0 [22.0-32.0] months; HR: 0.591, 95% CI: 0.442-0.792, P = 0.000) and the differences in OS existed after PSM (P = 0.043). However, no significant difference was found in OS before and after matching in the adenocarcinoma group (P = 0.827 and P = 0.801, respectively). CONCLUSIONS: PrORT demonstrated an OS benefit for patients with stage N2 lung SCC; however, further prospective randomized clinical trials are warranted to confirm this finding.
Li Q, Hussein N, Zhang Y
… +5 more, Fang Y, Wang Y, An Q, Honjo O, Luo S
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35604086
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OBJECTIVES: To demonstrate that improvement in technical performance of congenital heart surgical trainees during ventricular septum defect (VSD) closure simulation translates to better patient outcomes. METHODS: Seven t...OBJECTIVES: To demonstrate that improvement in technical performance of congenital heart surgical trainees during ventricular septum defect (VSD) closure simulation translates to better patient outcomes. METHODS: Seven trainees were divided into 2 groups. Experienced-fellows group included 4 senior trainees who had performed >5 VSD closures. Residents group consisted of 3 residents who had never performed a VSD closure. Experienced-fellows completed 3 VSD closures on real patients as a pretest. Both groups participated in a 4-week simulation requiring each participant to complete 2 VSD closures on three-dimensional printed models per week. One month later, all trainees returned for a post-test operation in real patients. All performances were recorded, blinded and scored independently by 2 cardiac surgeons using the validated Hands-On Surgical Training-Congenital Heart Surgery (HOST-CHS). Predefined surgical outcomes were analysed. RESULTS: The median HOST-CHS score increased significantly from week 1 to 4 [50 (39, 58) vs 73 (65, 74), P < 0.001] during simulation. The improvement in the simulation of experienced-fellows successfully transferred to skill acquisition [HOST-CHS score 72.5 (71, 74) vs 54 (51, 60), P < 0.001], with better patients outcomes including shorter total cross-clamp time [pretest: 86 (70, 99) vs post-test: 60 (53, 64) min, P = 0.006] and reduced incidence of major patch leak requiring multiple pump runs [pretest: 4/11 vs post-test: 0/9, P = 0.043]. After simulation, the technical performance and surgical outcomes of Residents were comparable to Experienced-fellows in real patients, except for significantly longer cross-clamp time [Residents: 76.5 (71.7, 86.8) vs Experienced-fellows: 60 (53, 64) min, P = 0.002]. CONCLUSIONS: Deliberate practice using simulation translates to better performance and surgical outcomes in real patients. Residents who had never completed a VSD closure could perform the procedures just as safely and effectively as their senior colleagues following simulation.
Chen Z, Jiang L, Zheng H
… +3 more, Zhang W, Lv X, Abdellateef A
Interact Cardiovasc Thorac Surg
· 2022 Jun · PMID 35579360
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OBJECTIVES: Preoperative selection bias led to the inability to generalize the proposed benefit of subxiphoid uniportal video-assisted thoracoscopic surgery (SVATS) as having less postoperative pain than uniportal interc...OBJECTIVES: Preoperative selection bias led to the inability to generalize the proposed benefit of subxiphoid uniportal video-assisted thoracoscopic surgery (SVATS) as having less postoperative pain than uniportal intercostal VATS. So, we conducted this prospective, single-blinded, randomized controlled trial to investigate the hypothesis that SVATS may have less early postoperative pain than UVATS in patients who undergo major lung resection for early-stage lung cancer. METHODSA TOTAL OF: 262 patients were randomly allocated between 2 groups (each with 131 patients), the first being the UVATS group and the second being the SVATS group. The values indicated on the numerical rating scale (NRS) of pain were collected at 24 h and 48 h during rest and during coughing. In addition, different perioperative variables were analysed and compared between the 2 groups. RESULTS: Multiple linear regression analysis showed that the type of surgical approach was a significant predictor of the postoperative NRS values. The postoperative NRS pain values were significantly lower in the SVATS group after 24 h during rest and coughing and after 48 h during coughing. Postoperatively, patients in the SVATS group got out of bed significantly earlier [16.37 (2.54) vs 18.05 (3.29) h, p < 0.001]. The SVATS group showed a significantly higher rate of intraoperative arrhythmia [20 (15.3%) vs 3 (2.3%) patients, p = 0.03]. CONCLUSIONS: SVATS major pulmonary resection in early-stage lung cancer is associated with less early postoperative pain than the UVATS approach. Operating on patients with cardiac problems using the SVATS approach is still a limiting factor for randomization due to the potential compression on the heart with resulting arrhythmia. CLINICAL TRIAL REGISTRATION: The trial was registered under clinical trials.gov Identifier: NCT03331588. https://clinicaltrials.gov/ct2/show/NCT03331588.
Wang S, Ao Y, Jiang J
… +8 more, Lin M, Chen G, Liu J, Zhao S, Gao J, Zhang Y, Ding J, Tan L
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35579357
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OBJECTIVES: The aim of this study was to determine the prevalence of nontherapeutic thymectomy and define a clinical standard to reduce it. METHODS: From 2016 to 2020, consecutive patients who underwent thymectomy were r...OBJECTIVES: The aim of this study was to determine the prevalence of nontherapeutic thymectomy and define a clinical standard to reduce it. METHODS: From 2016 to 2020, consecutive patients who underwent thymectomy were retrospectively reviewed. Univariable and multivariable analyses were used to identify the correlation factors of nontherapeutic thymectomy. A receiver operating characteristic curve was analysed to assess the cut-off threshold of factors correlated with nontherapeutic thymectomy. RESULTS: A total of 1039 patients were included in this study. Overall, 78.4% (n = 814) of thymectomies were therapeutic and 21.6% (n = 225) were nontherapeutic. Thymoma (57.9%, n = 602) was the most common diagnosis in therapeutic thymectomy. Among those of nontherapeutic thymectomy, thymic cysts (11.9%, n = 124) were the most common lesion. Compared with therapeutic thymectomy, patients with nontherapeutic thymectomy were more likely to be younger (median age 50.1 vs 55.6 years, P < 0.001) with a smaller precontrast and postcontrast computed tomography (CT) value (P < 0.001, P < 0.001), as well as ΔCT value [10.7 vs 23.5 Hounsfield units (HU), P < 0.001]. Multivariable analysis indicated that only age and ΔCT value were significantly different between therapeutic and nontherapeutic thymectomy groups. Receiver operating characteristic curve analysis showed that cut-off values of age and ΔCT value were 44 years and 6 HU, respectively. Patients with age ≤44 years and a ΔCT value ≤6 HU had a 95% probability of nontherapeutic thymectomy. CONCLUSIONS: Surgeons should be cautious to perform thymectomy for patients with age ≤44 years and ΔCT value ≤6 HU. This simple clinical standard is helpful to reduce the rate of nontherapeutic thymectomy.
Pimentel MD, Lobo Filho JG, Lobo Filho HG
… +5 more, de Castro Miguel E, Pinheiro Paiva SK, Silva Matos JI, Mesquita Fernandes MA, Fechine Jamacaru FV
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35575424
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OBJECTIVES: Approaches to improve saphenous vein (SV) patency in coronary artery bypass graft (CABG) surgery remain relevant. This study aimed to evaluate the effects of different preservation solutions and different pre...OBJECTIVES: Approaches to improve saphenous vein (SV) patency in coronary artery bypass graft (CABG) surgery remain relevant. This study aimed to evaluate the effects of different preservation solutions and different pressures of intraluminal distention on the endothelium of SV segments in CABG. METHODS: Forty-two SV segments obtained from 12 patients undergoing CABG were divided into 7 groups. Group 1 (control) was prepared without preservation or intraluminal distension, while the other 6 groups were preserved in autologous heparinized autologous arterial blood or normal saline (NS), with distention pressures 30, 100 and 300 mmHg. To assess the effects of using these solutions and pressures on the endothelium, the grafts were analysed by scanning electron microscopy, with the measurement of endothelial damage degree. RESULTS: Segments in group 1 showed minimal endothelial damage. SV grafts preserved with NS had significantly greater endothelial damage both compared to the control group and compared to groups preserved with autologous arterial blood (P < 0.001). Segments distended with pressures up to 100 mmHg showed less damage when compared to those distended at 300 mmHg, with the ones subjected to higher pressures presenting a maximum degree of damage, with considerable loss and separation of endothelial cells, extensive foci of exposure of the basement membrane and numerous fractures of the intimate layer, without differences regarding the solution used. CONCLUSIONS: Preparation of SV using NS and with intraluminal distension pressures above 100 mmHg is factors related to increased damage to the venous endothelium.
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35575403
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Ectopic adrenocorticotrophic hormone (ACTH) syndrome has historically been a therapeutic challenge because of the difficulty localizing occult ACTH-secreting tumours. Here, we report a case of a 67-year-old woman with ec...Ectopic adrenocorticotrophic hormone (ACTH) syndrome has historically been a therapeutic challenge because of the difficulty localizing occult ACTH-secreting tumours. Here, we report a case of a 67-year-old woman with ectopic ACTH syndrome and had an ACTH-secreting tumour hidden within a congenitally hypoplastic left lung. A satisfactory therapeutic outcome was obtained after left pneumonectomy was performed on patient in this case.
Medina Estrada ML, Silaschi MC, Charitos EI
… +1 more, Treede H
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35575384
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A 46-year-old male patient presented with cardiac decompensation due to a giant left ventricular aneurysm combined with a severely reduced left ventricular function after a silent myocardial infarction. Left ventricular...A 46-year-old male patient presented with cardiac decompensation due to a giant left ventricular aneurysm combined with a severely reduced left ventricular function after a silent myocardial infarction. Left ventricular unloading was performed with a microaxial pump as a bridge to surgery. Myocardial function in the basal segments was preserved and surgical ventricular reconstruction was performed successfully.
Li S, Liu M, Liu X
… +3 more, Yang D, Dong N, Li F
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35575352
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OBJECTIVES: Acute kidney injury (AKI) is common following cardiac surgery. The aim was to investigate the characteristics of AKI that occurred within 48 h and during 48 h to 7 days after cardiac surgery. METHODS: Patient...OBJECTIVES: Acute kidney injury (AKI) is common following cardiac surgery. The aim was to investigate the characteristics of AKI that occurred within 48 h and during 48 h to 7 days after cardiac surgery. METHODS: Patient data were extracted from Medical Information Mart for Intensive Care III database. AKI was defined according to the Kidney Disease Improving Global Outcomes guideline and divided into early (within 48 h) and late (during 48 h to 7 days) AKI. Multivariable logistic regression models were established to investigate risk factors for AKI. Cox proportional hazards model was used to analyse 90-day survival. RESULTS: AKI occurred in 51.2% (2741/5356) patients within the first 7 days following cardiac surgery, with the peak occurrence at 36-48 h. The incidence of early and late AKI was 41.9% and 9.2%, respectively. Patients with late AKI were older and had more comorbidities compared to early AKI patients. Risk factors associated with early AKI included age, body mass index, congestive heart failure and diabetes. While late AKI was related to atrial fibrillation, estimated glomerular filtration rate, sepsis, norepinephrine, mechanical ventilation and packed red blood cell transfusion. In Cox proportional model, both late and early AKIs were independently associated with 90-day mortality, and patients with early AKI had better survival than those with late AKI. CONCLUSIONS: AKI that occurred earlier was distinguishable from AKI that occurred later after cardiac surgery. Time frame should be taken into consideration.
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35575347
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A subaortic left ventricular diverticulum (SLVD) represents an extremely rare congenital anomaly. It can be asymptomatic but sometimes develops fatal complications. Treatment has been debated due to limited experience. W...A subaortic left ventricular diverticulum (SLVD) represents an extremely rare congenital anomaly. It can be asymptomatic but sometimes develops fatal complications. Treatment has been debated due to limited experience. We present the successful treatment of a giant SLVD with aortic regurgitation and stenosis and ascending aorta dilatation. Our goal is to improve understanding of this rare entity.
Spanjersberg A, Hoek L, Ottervanger JP
… +4 more, Nguyen TY, Kaplan E, Laurens R, Singh S
Interact Cardiovasc Thorac Surg
· 2022 Jun · PMID 35554537
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OBJECTIVES: Robot-assisted coronary artery bypass grafting (CABG) has been developed as a less invasive alternative for conventional CABG to enhance postoperative recovery, patient satisfaction and early discharge to hom...OBJECTIVES: Robot-assisted coronary artery bypass grafting (CABG) has been developed as a less invasive alternative for conventional CABG to enhance postoperative recovery, patient satisfaction and early discharge to home. Furthermore, it may provide a basis for hybrid coronary revascularization. To determine the feasibility of this procedure, we compared robot-assisted with conventional off-pump CABG. METHODS: All consecutive patients undergoing a robot-assisted left internal mammary artery-to-left anterior descending coronary artery procedure were compared to consecutive patients undergoing conventional off-pump CABG for single-vessel disease from October 2016 to July 2019. The primary outcome was discharge to home within 5 days after the operation. Secondary outcomes were total hospital stay, reoperations within 48 h, transfusions, atrial fibrillation, 30-day mortality and quality of life 1 month postoperatively. A propensity matched cohort was assembled to correct for possible confounders. RESULTS: A total of 107 patients who had robot-assisted CABG were compared to 194 patients who had conventional off-pump CABG. The primary outcome was reached in 51% of the robot-assisted group versus 19% of the conventional off-pump group (P < 0.01). The median postoperative hospital stay was 5 days for the robot-assisted group versus 7 days in the conventional off-pump group (P < 0.01). Other secondary outcomes did not differ significantly between the groups, and the quality of life 1 month after the operation was equal. The results after propensity matching were similar. CONCLUSIONS: Early discharge to home is more frequent for patients who have robot-assisted CABG than in those who have conventional off-pump CABG, with no difference in health-related quality of life. Therefore, this approach may reduce healthcare resources and provide a solid basis for hybrid coronary revascularization.
Kimura N, Nakamura M, Takagi R
… +6 more, Mieno MN, Yamaguchi A, Czerny M, Beyersdorf F, Kari FA, Rylski B
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35552699
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OBJECTIVES: We aimed to determine whether non-A non-B aortic dissection (AD) differs in morphologic and haemodynamic properties from type B AD. METHODS: We simulated and compared haemodynamics of patients with acute type...OBJECTIVES: We aimed to determine whether non-A non-B aortic dissection (AD) differs in morphologic and haemodynamic properties from type B AD. METHODS: We simulated and compared haemodynamics of patients with acute type B or acute non-A non-B AD by means of computational fluid dynamics. Wall pressure and wall shear stress (WSS) in both the true lumen (TL) and false lumen (FL) at early, mid- and late systole were evaluated. Morphology, WSS and the FL/TL wall pressure ratio were compared between groups. RESULTS: Nineteen patients (type B, n = 7; non-A non-B, n = 12) were included. The median age (51 [46, 67] vs 53 [50, 63] years; P = 0.71) and a complicated course (14% vs 33%; P = 0.6) did not differ between the type B group and the non-A non-B group. However, the median entry tear width was increased in the non-A non-B group (9.7 [7.3, 12.7] vs 16.3 [11.9, 24.9] mm; P = 0.010). Streamlines showed, in patients with non-A non-B AD, blood from the TL flowed into the FL via the entry tear. Prevalence of a FL/TL wall pressure ratio >1.0 (type B versus non-A non-B) at early, mid- and late systole was 57% vs 83% (P = 0.31), 43% vs 83% (P = 0.13) and 57% vs 75% (P = 0.62), respectively. WSS did not differ between the groups. CONCLUSIONS: The increased FL/TL wall pressure ratio observed during systole in non-A non-B AD may beget a complicated presentation.
Bottet B, Rivera C, Dahan M
… +10 more, Falcoz PE, Jaillard S, Baste JM, Seguin-Givelet A, de la Tour RB, Bellenot F, Rind A, Gossot D, Thomas PA, D'Journo XB
Interact Cardiovasc Thorac Surg
· 2022 Aug · PMID 35543477
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OBJECTIVES: The reporting of patient safety incidents (PSIs) occurring in minimally invasive thoracic surgery (MITS) is crucial. However, previous reports focused mainly on catastrophic events whereas minor events are of...OBJECTIVES: The reporting of patient safety incidents (PSIs) occurring in minimally invasive thoracic surgery (MITS) is crucial. However, previous reports focused mainly on catastrophic events whereas minor events are often underreported. METHODS: All voluntary reports of MITS-related PSIs were retrospectively extracted from the French REX database for 'in-depth analysis'. From 2008 to 2019, we retrospectively analysed and graded events according to the WHO classification of PSIs: near miss events, no harm incidents and harmful incidents. Causes and corrective measures were analysed according to the human-technology-organization triad. RESULTS: Of the 5145 cardiothoracic surgery PSIs declared, 407 were related to MITS. Among them, MITS was performed for primary lung cancer in 317 (78%) and consisted in a lobectomy in 249 (61%) patients. PSIs were: near miss events in 42 (10%) patients, no harm incidents in 81 (20%) patients and harmful incidents in 284 (70%) patients (mild: n = 163, 40%; moderate: n = 78, 19%; severe: n = 36, 9%; and deaths: n = 7, 2%). Human factors represented the most important cause of PSIs with 267/407 (65.6%) cases, including mainly vascular injuries (n = 90; 22%) and non-vascular injuries (n = 43; 11%). Pulmonary arteries were the most affected site with 57/91 cases (62%). In all, there were 7 deaths (2%), 53 patients required second surgery (13%) and 30 required additional lung resection (7%). CONCLUSIONS: The majority of reported MITS -related PSIs were non-catastrophic. Human factors were the main cause of PSIs. Systematic reporting and analysis of these PSIs will allow surgeon and his team to avoid a large proportion of them.
Tanahashi M, Suzuki E, Yoshii N
… +6 more, Watanabe T, Tsuchida H, Yobita S, Iguchi K, Uchiyama S, Nakamura M
Interact Cardiovasc Thorac Surg
· 2022 Jul · PMID 35543472
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OBJECTIVES: The present study compared the utility of fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) for predicting the pathological response and prognosis following neoadjuvant th...OBJECTIVES: The present study compared the utility of fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) for predicting the pathological response and prognosis following neoadjuvant therapy for locally advanced non-small-cell lung cancer (NSCLC). METHODS: This retrospective analysis included 72 patients in whom adjacent structures showed involvement and/or cN2 NSCLC who received induction chemoradiotherapy (ICRT) and subsequent surgery at our hospital from 2008 to 2019. FDG-PET and CT were performed in all patients before and after ICRT using the same scanner with similar techniques. We calculated the reduction in the maximum standardized uptake value in FDG-PET (ΔSUVmax) and tumour size on CT (ΔCT-size) before and after ICRT and investigated the relationship between the pathological response and prognosis. RESULTS: The disease response was classified as a major pathological response in 43 patients, and a minor response in 29 patients. ΔSUVmax 60% and ΔCT-size 30% were identified as the optimal cut-off values for predicting a major pathological response. ΔSUVmax was superior to ΔCT-size in terms of sensitivity, specificity, positive predictive value and negative predictive value. Furthermore, ΔSUVmax was superior to ΔCT-size for predicting the prognosis. CONCLUSIONS: Based on the results of the present study, FDG-PET appeared to have greater utility than CT in predicting the pathological response following ICRT and the postoperative prognosis in patients with locally advanced NSCLC.