Thoracoscopic right upper lobectomy is a demanding procedure especially in case of hilar adhesions. Herein, we reported a simple technique of simultaneous ligation of hilar structures to facilitate thoracoscopic right up...Thoracoscopic right upper lobectomy is a demanding procedure especially in case of hilar adhesions. Herein, we reported a simple technique of simultaneous ligation of hilar structures to facilitate thoracoscopic right upper lobectomy. After resections of fissures and of hilar lymph nodes, the following structures were sequentially isolated and simultaneously resected in their natural position: V2 + A2 vessels; right upper bronchus; and V1 + V3 + A1 + A3 vessels. This technique was successfully applied in nine patients. The mean hospitalization was 5.2 ± 3.3 days. No intraoperative and major postoperative complications were observed. All patients were alive without recurrence (median follow: 34 months).
The survival advantages of bilateral internal thoracic artery (BITA) grafts in coronary artery bypass grafting (CABG) surgery remain unclear. Therefore, this study aims to systematically evaluate the time-dependent influ...The survival advantages of bilateral internal thoracic artery (BITA) grafts in coronary artery bypass grafting (CABG) surgery remain unclear. Therefore, this study aims to systematically evaluate the time-dependent influence of BITA on long-term survival in elective CABG patients presenting with stable multivessel coronary artery disease.Data from 3,693 patients undergoing isolated CABG with single internal thoracic artery (SITA) or BITA, with or without additional vein grafts, between 2002 and 2012 were retrospectively analyzed. The entire cohort was divided into BITA and SITA groups (830 vs. 2,863 patients). A 1:3 propensity score matching was performed. Subsequent analysis of a subgroup meeting Randomized comparison of the clinical Outcome of single versus Multiple Arterial grafts (ROMA) trial criteria ( = 1,339) followed a 1:1 matching. Differences in restricted mean survival time (RMST) estimates were used to assess the time-varying association of BITA with long-term survival.In-hospital mortality (SITA 1.8% vs. BITA 1.1%, = 0.2) and major postoperative complications were similar between the matched groups. However, long-term survival was significantly higher in BITA patients for the matched whole cohort (15-year survival: 64 vs. 51%, respectively; < 0.001) and the ROMA-like population (76 vs. 60%, respectively; < 0.001). RMST demonstrated an incremental survival advantage of BITA over SITA grafting over time for both the whole and ROMA-like populations (0.1, 0.5, and 1.1 years, and 0.1, 0.4, and 1.0 years at 5-, 10-, and 15-year follow-up, respectively)BITA grafting is safe and associated with superior long-term survival compared with SITA and vein grafts, with benefits extending beyond 5 years for the entire cohort and beyond 10 years for ROMA criteria patients.
Lenos A, Strauch JT, Schlömicher M
… +12 more, Fleissner F, Valencia-Nunez DM, Garbade J, Gottardi R, Massoudy P, Kamler M, Malik R, Wimmer-Greinecker G, Walther T, Gummert J, Bramlage P, Diegeler A
Thorac Cardiovasc Surg
· 2026 Apr · PMID 39870087
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The long-term outcomes of combined rapid-deployment aortic valve replacement (RDAVR) with coronary artery bypass graft surgery (CABG) are not well explored. We report 3-year results from the INCA registry on combined RDA...The long-term outcomes of combined rapid-deployment aortic valve replacement (RDAVR) with coronary artery bypass graft surgery (CABG) are not well explored. We report 3-year results from the INCA registry on combined RDAVR with CABG.INCA is a prospective, multicenter registry that enrolled 224 patients undergoing RDAVR with CABG at 10 cardiac institutions in Germany. Prosthetic valve hemodynamics, clinical outcomes, and quality of life (QoL) up to 3 years were assessed.The mean age of patients was 73.6 ± 6.1 years, and the mean logistic EuroSCORE was 7.8 ± 6.0%. The mean number of distal arterial and venous anastomoses was 3.13 ± 1.56, aortic cross-clamp time was 79.4 ± 24.1 minutes, cardiopulmonary bypass time was 109.6 ± 34.5 minutes, and operation time was 224.2 ± 62.7 minutes. The majority of implanted valve size was 25 mm. At baseline, 11 patients (4.9.%) had a permanent pacemaker. Postoperatively, 17 patients (7.6%) required a new pacemaker implantation (5.4% valve-related). All-cause mortality at 30 days was 2.2%, and 11.2% at 3 years. Patient QoL (SF-12v2) was significantly restored and maintained for up to 3 years ( < 0.001). Five patients (0.9%) underwent reoperation related to endocarditis. The postimplant mean gradient was 9.2 ± 3.7 at discharge and 8.9 ± 4.6 mm Hg at 3 years.Combined RDAVR with CABG procedure is safe and effective over time. It offers stable and low transvalvular gradients with satisfactory clinical outcomes at 3 years. The pacemaker rate appears to be slightly increased, with no significant clinical effect at 3 years.
Antifibrinolytics, such as tranexamic acid (TXA), are widely used in cardiac surgery to reduce bleeding risks; however, the optimal dosage for TXA infusion remains a subject of debate. Hence, this study aims to evaluate...Antifibrinolytics, such as tranexamic acid (TXA), are widely used in cardiac surgery to reduce bleeding risks; however, the optimal dosage for TXA infusion remains a subject of debate. Hence, this study aims to evaluate the safety and efficacy of high-dose compared with low-dose TXA infusion in cardiac surgery patients.PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched until June 10, 2023, for studies assessing efficacy outcomes (e.g., blood loss, transfusions) and safety outcomes (e.g., mortality, complications).Results were analyzed via random-effects model, using Mantel-Haenszel risk ratio (RR) and standard mean difference (SMD). -value < 0.05 was considered significant. We analyzed 17 studies involving 93,206 participants (mean age 59.3 years, study duration 3 months to 10 years). Our analysis found significant reductions in total blood loss (SMD, -0.17 g; CI, -0.34 to -0.01; = 0.04), 24-hour blood loss (SMD, -0.23 g; = 0.005), and the need for fresh frozen plasma (FFP) transfusions (RR: 0.94; CI, 0.89 to 1.00; = 0.05) with high-dose TXA. Chest tube output was also lower (SMD, -0.12 g; = 0.0006), but postoperative seizures increased (RR: 2.23; CI, 1.70 to 2.93; < 0.00001) with high-dose TXA. For other outcomes like blood transfusions, hospital/ICU stay, mortality, stroke, myocardial infarction, pulmonary embolism, renal dysfunction, and reoperation, no significant differences were found between high-dose and low-dose TXA regimens.Our study showed that high TXA dose effectively reduce postoperative bleeding, chest tube drainage, and the need for FFP transfusion, but it increases the risk of seizures. Increasing TXA dose did not affect thromboembolic events or mortality. This emphasizes the importance of weighing the benefits and risks when selecting the appropriate TXA regimen for each patient.
The factors affecting the prolonged air leak (PAL) and expansion failure in the lung in patients undergoing resection for lung malignancy were analyzed. In this context, the value of the percentage of low attenuation are...The factors affecting the prolonged air leak (PAL) and expansion failure in the lung in patients undergoing resection for lung malignancy were analyzed. In this context, the value of the percentage of low attenuation area (LAA%) measured on preoperative quantitative chest computed tomography (Q-: CT) in predicting the development of postoperative PAL and the expansion time of the remaining lung (ET) in patients undergoing resection for lung malignancy was investigated.The data of 202 cases who underwent lung resection between July 2020 and December 2022 were analyzed. The factors affecting the development of PAL and ET were investigated using univariate and multivariate analyses. The cut-off value for LAA% was determined and its relationship with postoperative results was examined.In univariate analyses, for PAL, age ( = 0.022), presence of chronic obstructive pulmonary disease (COPD; < 0.001), body mass index (BMI; = 0.006), FEV ( = 0.020), FEV/FVC ( < 0.001), LAA% ( = 0.008), diagnosis ( = 0.007), and surgical procedure ( < 0.001); for ET, diagnosis ( < 0.001) and surgical procedure ( = 0.001) were significant factors. A negative correlation between ET and BMI and FEV/FVC ( < 0.01) and a positive correlation ( < 0.05) was detected with LAA%. The cut-off value for LAA% was calculated as 1.065. Multivariate analyses showed that the probability of developing PAL, increased 3.17-, 7.68-, and 3.08-fold in patients with COPD, lobectomy, and those above the cut-off value for LAA%, respectively ( = 0.045, < 0.001, and = 0.011). In addition, FEV/FVC ( = 0.027), BMI ( = 0.016), and surgical procedure ( = 0.001) were shown to be independent factors affecting ET.Our study revealed the factors affecting PAL and expansion failure in the lung. Within this scope, it was concluded that preoperative Q-CT may have an important role in predicting the development of PAL and ET in the postoperative period and that LAA% measurement is an effective, objective, and practical method for taking precautions against possible complications.
This study evaluated the midterm outcomes of rapid deployment aortic valve replacement (RDAVR) performed regardless of pathology for various aortic valve diseases at a single center.Of the 344 patients who underwent RDAV...This study evaluated the midterm outcomes of rapid deployment aortic valve replacement (RDAVR) performed regardless of pathology for various aortic valve diseases at a single center.Of the 344 patients who underwent RDAVR using Edwards INTUITY during the study period at our institution, 176 had bicuspid valve diseases (51.2%), 20 had pure aortic regurgitation (5.8%), and 4 had infective endocarditis (1.2%). Median follow-up duration was 28.6 months (maximum: 86.4 months). Midterm clinical outcomes were evaluated, and the changes of valve hemodynamics from early postoperative period to 5 years after surgery were also investigated.Mean age was 68.9 ± 9.8 years, and 46.2% of the patients were female. Isolated RDAVR was performed in 90 patients (26.2%), and concomitant procedures, including aortic surgery (48.8%), mitral valve surgery (20.3%), arrhythmia surgery (9.0%), tricuspid valve surgery (7.0%), and coronary artery bypass grafting (5.5%), were performed in 254 patients (73.8%). Operative mortality occurred in 11 patients (3.2%), and permanent pacemaker implantation was required in 5 patients (1.5%) in early postoperative period. Overall survival rate was 86.9% at 5 years, and cumulative incidence of cardiac death was 6.3% at 5 years. No deterioration of valve hemodynamics was observed at midterm echocardiographic evaluation in either the overall population or for each size of valve.Isolated or concomitant aortic valve replacement using rapid-deployment valves was performed for various aortic valve diseases regardless of the underlying pathology at our institution, and the clinical and hemodynamic outcomes were excellent for up to 5 years.
Tengler A, Michel J, Arenz C
… +6 more, Bauer U, Beudt J, Horke A, Kerst G, Beckmann A, Hofbeck M
Thorac Cardiovasc Surg
· 2025 Jan · PMID 39805310
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BACKGROUND: Interventional cardiac catheterizations have gained major importance in the treatment of congenital heart defects (CHDs). Since patients with CHDs frequently require lifelong medical care and sometimes subseq...BACKGROUND: Interventional cardiac catheterizations have gained major importance in the treatment of congenital heart defects (CHDs). Since patients with CHDs frequently require lifelong medical care and sometimes subsequent invasive treatment, repeated radiation exposure during interventional procedures is a relevant issue concerning potential radiation-related risks. Therefore, a 9-year subanalysis on radiation data during interventional cardiac catheterizations from the German Registry for Cardiac Operations and Interventions in patients with CHDs was performed. METHODS: The German Registry for Cardiac Operations and Interventions in Patients with CHDs is a real-world, prospective all-comers database collecting clinical and procedural data on invasive treatment of CHDs. From January 2012 until December 2020, a total of 28,374 cardiac catheter interventions were recorded. For a homogeneous case mix and for obtaining comparable data, eight specified interventions were selected for detailed evaluation. The selected procedures were: atrial septal defect (ASD)/patent foramen ovale (PFO) occlusion, patent ductus arteriosus (PDA) occlusion, ventricular septal defect (VSD) occlusion, coarctation of the aorta (CoA) balloon dilatation and stent implantation, aortic valvuloplasty, pulmonary valvuloplasty, and transcatheter pulmonary valve implantation (TPVI). Data on radiation exposure included total fluoroscopy time (TFT), dose area product (DAP), and DAP per body weight (DAP/BW). RESULTS: The cohort accounted for 9,350 procedures, including 3,426 ASD/PFO occlusions, 2,039 PDA occlusions, 599 aortic and 1,536 pulmonary valvuloplasties, 383 balloon dilatations and 496 stent implantations for CoA, 168 VSD occlusions, and 703 TPVI. Six hundred and ten ASD/PFO procedures (17.8%) were performed without radiation. During the 9-year period, median annual TFT, DAP, and DAP/BW showed a continuous decrease while radiation burden correlated with intervention complexity: For ASD/PFO and PDA occlusion, aortic and pulmonary valvuloplasty as well as balloon dilatation of CoA the median DAP/BW was <20.0 μGy*m/kg, while median values of 26.3 μGy*m/kg and 31.6 μGy*m/kg were noted for stent treatment of CoA and VSD closure, respectively. Radiation burden was highest in TPVI with a median TFT of 23.6 minutes, median DAP of 4,491 μGy*m, and median DAP/BW of 79.4 μGy*m/kg. CONCLUSION: A decrease in radiation exposure was found in eight cardiac interventions from January 2012 to December 2020. Comparison with international registries revealed a good quality of radiation protection. The data underline the requirement of surveillance of radiation burden, especially in this patient group.
BACKGROUND: Segmentectomy operation became a preferable operation for small lesions due to the importance of saving lung parenchyma. Using robotic technology has too many advantages for segmentectomy operations. Web site...BACKGROUND: Segmentectomy operation became a preferable operation for small lesions due to the importance of saving lung parenchyma. Using robotic technology has too many advantages for segmentectomy operations. Web sites such as YouTube have become educational tools for surgical trainees. The aim of our study is to analyze YouTube videos for accurate and up-to-date information about robotic segmentectomy operations. METHODS: The videos on www.youtube.com, which were reached on July 11, 2024, by using the keywords "robot segmentectomy" and "robotic segmentectomy lung," were evaluated in this research. The videos were evaluated by using the Journal of the American Medical Association (JAMA) scoring system, Critical View of safety (CVS), and LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS). RESULTS: Eighty-one videos were included. Almost half of the videos ( = 42) were affiliated with university hospitals. Preoperative imaging was seen in 49% of all videos; however, the rates were 32% and 20.9% for patients' demographics and preoperative assessment information, respectively. Only 29.6% of the videos presented the placement of trocars during the presentation. CONCLUSION: It has become possible to record high-quality videos easily with developing technology. However, our results showed that many of the videos do not include the parameters especially related to education. Our findings suggest that those videos are inadequate for trainees.
Cardiac troponin levels might rise significantly after cardiac surgeries as a surgical outcome rather than ischemic myocardial damage alone, making the diagnosis of postoperative (type 5) myocardial infarction challengin...Cardiac troponin levels might rise significantly after cardiac surgeries as a surgical outcome rather than ischemic myocardial damage alone, making the diagnosis of postoperative (type 5) myocardial infarction challenging. Previous studies have demonstrated that cardiac troponin is related to left ventricular mass, but this correlation was not investigated after cardiac surgery. We aimed to study a possible correlation between postoperative cardiac troponin levels and left ventricular mass index in patients who underwent cardiac surgery to refine the diagnosis of type 5 myocardial infarction, but observed no such correlation regardless of preoperative troponin levels or surgery type.
The long-term comparative results between porcine and pericardial bioprostheses for surgical aortic valve replacement (SAVR) are debated. Scarce information exists concerning direct comparative evaluation among contempor...The long-term comparative results between porcine and pericardial bioprostheses for surgical aortic valve replacement (SAVR) are debated. Scarce information exists concerning direct comparative evaluation among contemporary devices. We compared late and very late results in a single center series ( = 3,983 cases).From a prospectively collected database we included 3,983 recipients of two current porcine bioprostheses (porcine group) or one current pericardial bioprosthesis (pericardial group). We evaluated the long-term freedom from structural valve deterioration (SVD) with both Kaplan-Meier and competing risk methods (primary endpoint). We distinguished between SVD and patient-prosthesis mismatch (PPM). Secondary endpoints were late survival, freedom from valve-related mortality, freedom from reoperation for SVD, freedom from nonstructural valve dysfunction (NSVD) and freedom from endocarditis.Median follow-up was 10.4 years (99.7% complete, 32,219 patients/years). Overall survival was significantly lower in the porcine group ( = 0.002), related to baseline intergroup differences. At 10 years, Kaplan-Meier freedom from SVD was significantly better in the porcine group (98.0% ± 0.3 vs. 96.3% ± 0.8; = 0.003). Competing risk freedom from SVD at 10 years was 98.6% ± 0.2 and 97.2% ± 0.6 (porcine and pericardial group, respectively; = 0.001). The porcine group displayed a higher rate of PPM.Despite the augmented risk of PPM compared with pericardial valves, in this series porcine bioprostheses seem to perform better concerning protection from late (>10 years) SVD. Smaller valve sizes (19-21 mm) may negatively impact the SVD risk among porcine valves but not among pericardial valves. These elements need to be considered for valve choice and surgical strategy in SAVR candidates according to their life expectancy, clinical context, and annulus size.
We retrospectively analyzed patients who underwent prone positioning (PP) for acute respiratory failure after pulmonary endarterectomy (PEA).A total of 125 patients underwent PEA and the outcome related to patients who u...We retrospectively analyzed patients who underwent prone positioning (PP) for acute respiratory failure after pulmonary endarterectomy (PEA).A total of 125 patients underwent PEA and the outcome related to patients who underwent PP for acute respiratory failure after surgery was analyzed.In all 13 patients (10%) underwent PP at the mean duration of 28.2 ± 10.6 hours after surgery and the mean prone time was 29.4 ± 9.8 hours. Compared with the pre-prone values, there was a significant improvement in the mean arterial oxygen to fraction of inspired oxygen ratio at the end of PP (119.4 ± 12.4 versus 202 ± 58.3) ( = 0.0002). Eight patients (61%) revealed a significant improvement in oxygenation with PP. Five patients who remained unresponsive underwent extracorporeal membrane oxygenation and four of them were weaned off successfully. In multivariate logistic stepwise analysis, the need for a moderate inotropy (odds ratio [OR]: 3.1) and low preoperative cardiac index (OR: 0.2) were independent predictors of PP. Under PP, the most common complication was ventilator-associated pneumonia ( = 9, 70%) and PP was found to be an independent predictor of ventilator-associated pneumonia (OR: 10.3). Early mortality was seen in three patients (23%, sepsis in two and adult respiratory distress syndrome in one).In the early care of acute respiratory failure following PTE, PP may be a feasible option, despite an increased risk of ventilator-associated pneumonia. More research involving a larger sample size is necessary.
In obese patients, minimally invasive surgical aortic valve replacement (MIS-AVR) presents challenges, and the risk of patient-prosthesis mismatch (PPM) is elevated. This retrospective single-center study evaluates the i...In obese patients, minimally invasive surgical aortic valve replacement (MIS-AVR) presents challenges, and the risk of patient-prosthesis mismatch (PPM) is elevated. This retrospective single-center study evaluates the impact of body mass index (BMI) on the outcome of an initial MIS-AVR program.A total of 307 patients underwent MIS-AVR between January 2013 and December 2015, the initial phase of our MIS-AVR program. They were divided into normal/overweight (BMI <30 kg/m) versus obese patients (BMI ≥30 kg/m). Primary endpoints included 30-day and 2-year mortality and stroke. Secondary endpoints comprised type 3 bleeding, PPM, paravalvular leakage, wound healing disorders (WHDs), and pacemaker rates.In all 191 patients exhibited a BMI <30 kg/m, while 116 patients had a BMI ≥30 kg/m. The BMI groups did not differ in baseline characteristics, excepting a higher peripheral arterial disease incidence among obese patients (15.7% vs. 26.7%; = 0.01). Aortic clamp time (75 ± 29 min vs. 87 ± 37 min; = 0.001), cardiopulmonary bypass (104 ± 36 min vs. 124 ± 56 min; = 0.0002), and ventilation times (26 ± 6 h vs. 44 ± 8 h; = 0.03) were longer in obese patients. They demonstrated a higher risk for bleeding (2.6% vs. 9.5%; = 0.008) but lower pacemaker rates (9% vs. 3%; = 0.02). PPM, paravalvular leakage, and WHD exhibited no group differences. No BMI-related differences revealed in 30-day mortality (4.7% vs. 3.4%) and stroke rates (2% vs. 2.6%), as well as 2-year mortality (12.6% vs. 11.2%) and stroke rates (2.1% vs. 2.6%).In the initial phase of an MIS-AVR program, the 30-day mortality may be elevated. Despite longer operative times and an increased risk for bleeding in obese patients, no influence of BMI on postoperative morbidity, mortality, or stroke rates was observed.
There have been few recent innovations since the introduction of cardioplegia more than 50 years ago. Surprisingly, cardioplegia as one of the most essential steps in terms of heart muscle protection during a surgical pr...There have been few recent innovations since the introduction of cardioplegia more than 50 years ago. Surprisingly, cardioplegia as one of the most essential steps in terms of heart muscle protection during a surgical procedure requiring cardiac arrest has never been really standardized. As a consequence, a considerable variety of cardioplegic solutions and applications have developed: cold versus warm, crystalloid versus blood cardioplegia, antegrade versus retrograde or both, as well as different time schedules for repeated administration. A new cardioplegia solution, called Cardioplexol™, has recently received CE marking approval as a drug following two phase III studies. Cardioplexol™ shows several advantages: the administration follows a very simple protocol, minimizing the risk of errors in manipulation, and diastolic arrest occurs immediately, thus allowing immediate start of the cardiac work once the aorta has been cross clamped. The very low volume of crystalloid solution (e.g., 100 mL as induction and a second application of 100 mL following 45-60 minutes of ischemia) avoids hemodilution and therefore the need for filtration during surgery. In addition, the injection through the aortic root canula eliminates the need for an additional cardioplegia pump and its disposable tubing system. This simplified cardioplegia that is not inferior to Buckberg solution has the potential for standardization of myocardial protection protocols.
A single-center retrospective study was initialized to investigate the occurrence of acute kidney injury (AKI) and its impact on short- and long-term outcomes after aortic valve replacement in patients with aortic stenos...A single-center retrospective study was initialized to investigate the occurrence of acute kidney injury (AKI) and its impact on short- and long-term outcomes after aortic valve replacement in patients with aortic stenosis (AS) and complex coronary artery disease (CAD).Between January 2010 and December 2020, 1,232 patients with severe AS and CAD were treated. Propensity score matching generated 40 patient pairs with intermediate Society of Thoracic Surgeons (STS) risk scores (3.2 ± 0.3) and EuroSCORE II (4.1 ± 0.3) undergoing percutaneous (transcatheter aortic valve replacement [TAVR] + percutaneous coronary intervention [PCI]) or surgical (surgical aortic valve replacement [SAVR] + coronary artery bypass grafting [CABG]) combined procedures. The renal function-corrected ratio of contrast medium to body weight was calculated to determine the risk of postprocedural contrast medium-associated AKI. Renal retention values were recorded daily until the 7th day after the procedure.The overall incidence of postprocedural AKI was similar between the groups. There was no correlation between the contrast medium volume to serum creatinine to body weight ratio and AKI occurrence. During the first 7 postprocedural days, creatinine clearance values were comparable: 68.97 ± 4.92 mL/min (SAVR + CABG) vs. 64.95 ± 9.78 mL/min (TAVR + PCI), mean difference 4.02, 95% CI (-24.5 to 16.4), = 0.691. On the 7th day after the procedure, 35% (8/23) of patients with renal impairment had improved renal function. No correlation between impaired renal function and short- or long-term mortality was found in multivariable models.Contrast agents may temporarily impair renal function during a minimally invasive percutaneous approach; however, occurrence of AKI was not related to the amount of contrast medium, and AKI was not associated with short- and long-term mortality.
Rapid and accurate diagnosis of infective endocarditis (IE) allows timely management of this life-threatening disease and improves outcome. The Duke criteria have traditionally been the clinical method for diagnosing IE....Rapid and accurate diagnosis of infective endocarditis (IE) allows timely management of this life-threatening disease and improves outcome. The Duke criteria have traditionally been the clinical method for diagnosing IE. These criteria were reformulated at different timepoints. We aimed to evaluate the real accuracy of the modified Duke criteria based on several studies that concluded the diagnosis of IE.Three databases were assessed. Studies were considered for inclusion if they reported the use of modified Duke criteria as the initial approach and the confirmation of the diagnosis with the gold standard methods. The meta-analysis of diagnostic test accuracy was performed after fitting the hierarchical summary receiver operating characteristic model (HSROC) with bivariate model and displaying the summarized measures of sensitivity and specificity, and positive and negative likelihood ratios.A total of 11 studies were included. Accuracy in the included studies ranged from 62.3 to 92.2%, sensitivity ranged from 58.3 to 84.0%, and specificity ranged from 50.0 to 100%. The combined overall sensitivity and specificity were 85% (95% CI: 0.77-0.90) and 98% (95% CI: 0.89-0.99), respectively. The positive likelihood ratio was 40.2 (95% CI: 7.26-220.74) and the negative likelihood ratio was 0.15 (95% CI: 0.01-0.23).The analysis reveals that the modified Duke criteria have a high positive likelihood ratio, suggesting a robust correlation between a positive test result and the existence of IE, and a very good overall specificity at 98%. The latter aspect holds significant importance in order to prevent unnecessary overtreatment, given the intricacies involved in managing IE.
Infective endocarditis (IE) is associated with extremely high surgical mortality. During the SARS-CoV-2 pandemic, hospitals restructured their intensive care units and outpatient services to prioritize COVID-19 care, whi...Infective endocarditis (IE) is associated with extremely high surgical mortality. During the SARS-CoV-2 pandemic, hospitals restructured their intensive care units and outpatient services to prioritize COVID-19 care, which may have affected the outcomes of patients requiring urgent procedures. This study aimed to evaluate the impact of the pandemic on surgical outcomes of IE patients in Southern Germany.This observational, community-based study compared two cohorts of surgical candidates: a pandemic cohort from March 2020 to November 2021 ( = 84) and a pre-pandemic cohort from August 2018 to March 2020 (before the lockdown, = 94). Preoperative status and postoperative in-hospital complications were analyzed and compared between the groups.The pandemic cohort experienced longer symptom onset to diagnosis intervals (14.5 versus 8 days, = 0.529). A higher incidence of definite IE was observed after the lockdown according to the modified Duke criteria (82.1% versus 68.1%, = 0.035). Patients presented with more severe symptoms post-lockdown (NYHA Class III: 50% versus 33%; Class IV: 22.6% versus 11.7%, = 0.001). Postoperative complications, such as re-thoracotomy due to bleeding and hemofiltration for acute renal failure, were significantly more frequent after the lockdown ( < 0.05). However, in-hospital survival rates did not differ significantly between the groups.The COVID-19 pandemic and related lockdown measures were associated with delayed diagnoses and worse perioperative outcomes for surgical IE patients, highlighting the need for improved management strategies during public health crises.
Thorac Cardiovasc Surg
· 2025 Mar · PMID 39591993
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BACKGROUND: Lung cancer is the most prevalent and lethal cancer globally, necessitating accurate differentiation between benign and malignant pulmonary nodules to guide treatment decisions. This study aims to develop a p...BACKGROUND: Lung cancer is the most prevalent and lethal cancer globally, necessitating accurate differentiation between benign and malignant pulmonary nodules to guide treatment decisions. This study aims to develop a predictive model that integrates artificial intelligence (AI) analysis with biomarkers to enhance early detection and stratification of lung nodule malignancy. METHODS: The study retrospectively analyzed the patients with pathologically confirmed pulmonary nodules. AI technology was employed to assess CT features, such as nodule size, solidity, and malignancy probability. Additionally, lung cancer blood biomarkers were measured. Statistical analysis involved univariate analysis to identify significant differences among factors, followed by multivariate logistic regression to establish independent risk factors. The model performance was validated using receiver operating characteristic curves and decision curve analysis (DCA) for internal validation. Furthermore, an external dataset comprising 51 cases of lung nodules was utilized for independent validation to assess robustness and generalizability. RESULTS: A total of 176 patients were included, divided into benign/preinvasive ( = 76) and invasive cancer groups ( = 100). Multivariate analysis identified eight independent predictors of malignancy: lobulation sign, bronchial inflation sign, AI-predicted malignancy probability, nodule nature, diameter, solidity proportion, vascular endothelial growth factor, and lung cancer autoantibodies. The combined predictive model demonstrated high accuracy (area under the curve [AUC] = 0.946). DCA showed that the combined model significantly outperformed the traditional model, and also proved superior to models using AI-predicted malignancy probability or the seven lung cancer autoantibodies plus traditional model. External validation confirmed its robustness (AUC = 0.856), achieving a sensitivity of 0.80 and specificity of 0.86, effectively distinguishing between invasive and noninvasive nodules. CONCLUSION: This combined approach of AI-based CT features analysis with lung cancer biomarkers provides a more accurate and clinically useful tool for guiding treatment decisions in pulmonary nodule patients. Further studies with larger cohorts are warranted to validate these findings across diverse patient populations.