Shao GY, Wang CD, Wang D
… +4 more, Sun SY, Wang BK, Peng XN, Yu WQ
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41161734
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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 eas...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.
Duman S, Erdoğdu E, Sarıgül A
… +4 more, Çuhatutar Ş, Özkan B, Demir A, Kara M
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41139484
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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...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.
Nakazawa J, Iba Y, Nakajima T
… +7 more, Shibata T, Arihara A, Kato K, Mukawa K, Yonemori M, Komatsu S, Kawaharada N
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41125362
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PURPOSE: The aim of this study was to evaluate the impact of intercostal nerve cryoablation on postoperative pain, opioid usage, and lung expansion after open aortic repair via left thoracotomy. METHODS: This retrospecti...PURPOSE: The aim of this study was to evaluate the impact of intercostal nerve cryoablation on postoperative pain, opioid usage, and lung expansion after open aortic repair via left thoracotomy. METHODS: This retrospective study included 62 patients who underwent aortic repair via left thoracotomy between 2017 and 2023. Patients were divided into cryoablation (n = 32) and non-cryoablation (n = 30) groups. Pain was assessed using the Numerical Rating Scale (NRS), and lung volume was measured using computed tomography 1 week postoperatively. RESULTS: The cryoablation group showed significantly lower mean NRS scores (1.7 vs. 2.4, p <0.01) and lower opioid consumption (6.2% vs. 56.6%, p <0.01). The left lung volume ratio was significantly higher in the cryoablation group (72.3% vs. 62.4%, p = 0.05). CONCLUSIONS: Intercostal nerve cryoablation effectively reduces postoperative pain and opioid consumption and enhances pulmonary expansion after left thoracotomy. This technique may offer a favorable analgesic option in thoracic aortic surgery.
Brady JR, Walker B, Zajac JC
… +4 more, McCarthy DP, Maloney JD, DeCamp MM, Axtell AL
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41083334
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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...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.
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40930833
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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...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.
Imamura Y, Kato T, Shimada S
… +4 more, Ueno H, Nakamura S, Mizuno T, Chen-Yoshikawa TF
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40903247
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Primary pulmonary sarcoma is a rare disease and is much less common than lung cancer among tumors arising from pulmonary cysts. We report the case of a female patient who showed multifocal cysts in the left S9-10. Follow...Primary pulmonary sarcoma is a rare disease and is much less common than lung cancer among tumors arising from pulmonary cysts. We report the case of a female patient who showed multifocal cysts in the left S9-10. Follow-up computed tomography (CT) revealed that the cyst tended to regress, but the solid component of the cyst wall continued to thicken, growing to a 10-cm-diameter tumor. Thoracoscopic left lower lobectomy was performed to diagnose and treat the cystic lung lesions. For the pathology of the pulmonary cystic lesion, it was marked by solid tumors composed of proliferative atypical spindle cells, with some trapped bronchial tissue. Based on the imaging and pathological findings, the diagnosis was primary pulmonary sarcoma arising from the pulmonary cyst. The present case highlights that, even when a pulmonary cyst appears to shrink, careful follow-up and timely surgical consideration are warranted if cyst wall thickening is observed.
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40887214
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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...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.
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40819899
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Compared with the conventionally harvested saphenous vein graft, the no-touch saphenous vein graft, in which manipulation and tension are minimized and intraluminal dilatation is avoided during vein harvest, has shown be...Compared with the conventionally harvested saphenous vein graft, the no-touch saphenous vein graft, in which manipulation and tension are minimized and intraluminal dilatation is avoided during vein harvest, has shown better-preserved luminal endothelium and improved patency rates after coronary artery bypass grafting. This review article will detail and summarize the relevant literature on the no-touch saphenous vein in coronary artery bypass grafting.
Kawkabani N, Farah R, Akar J
… +4 more, Daajeh W, Mokdad M, Abi Ghanem M, Abi Khalil B
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40819898
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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 patient...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.
Yamazaki M, Matsumoto Y, Takahashi T
… +4 more, Haida H, Kimura N, Hashizume K, Shimizu H
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40803839
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PURPOSE: The superior septal approach offers improved mitral valve exposure compared to the right-sided left atriotomy or transseptal approach. However, the risk of postoperative sinus node dysfunction remains controvers...PURPOSE: The superior septal approach offers improved mitral valve exposure compared to the right-sided left atriotomy or transseptal approach. However, the risk of postoperative sinus node dysfunction remains controversial, with limited data in the context of right mini-thoracotomy. METHODS: This retrospective study included 155 patients (64 women; mean age, 60.8 ± 13.4 years) who underwent mitral valve surgery via right mini-thoracotomy between November 2016 and August 2023. Indications included degenerative mitral regurgitation (94.8%) and mitral stenosis (5.2%). Patients were divided into 2 groups: the conventional minimally invasive mitral valve surgery (CM) group (n = 47), using the right-sided left atriotomy, and the drawer-case technique (DCT) group (n = 108), using the superior septal approach. Demographic, intraoperative, and outcome data were analyzed. RESULTS: Baseline characteristics were similar between groups. There were no significant differences in valve repair techniques or postoperative echocardiographic findings. Postoperative junctional rhythm occurred in 6 patients (CM group) and 21 patients (DCT group); all patients with preoperative sinus rhythm returned to sinus rhythm postoperatively. CONCLUSION: The superior septal approach does not increase the risk of persistent junctional rhythm in right mini-thoracotomy and is a safe and effective option for mitral valve surgery.
Takehara H, Kodama K, Momozane T
… +1 more, Kido K
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40803838
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We report a rare case of the independent coexistence of lung cancer and organizing pneumonia (OP) in different lobes of the right lung in a 67-year-old man with a history of left upper lobectomy. Computed tomography reve...We report a rare case of the independent coexistence of lung cancer and organizing pneumonia (OP) in different lobes of the right lung in a 67-year-old man with a history of left upper lobectomy. Computed tomography revealed a lesion consistent with OP in the right upper lobe and a suspicious shadow in the right lower lobe, which was diagnosed as squamous cell carcinoma via bronchoscopic biopsy. The patient underwent right lower lobectomy and partial resection of the right upper lobe under left one-lung ventilation. Empirical corticosteroids were administered preoperatively, followed by a brief postoperative course for 3 days after pathological confirmation of OP to reduce complications such as bronchial fistula, then transitioned to macrolide therapy for 3 months. Fourteen months postoperatively, OP had not recurred, although bone metastases developed and responded well to chemoradiotherapy. This case highlights the need for individualized perioperative management in patients with complex pulmonary pathology.
Fujimoto K, Kenzaki K, Kubo T
… +4 more, Sawada T, Norimura S, Miura K, Yamamoto A
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40670126
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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...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.
Narita T, Ishizawa A, Inoue N
… +2 more, Uchida T, Nakamura Y
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40634068
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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...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.
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40634067
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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. ME...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.
Al-Shameri I, Al-Ganadi AA, Noman T
… +4 more, Kadry MA, Elsharkawy IM, Al-Wsabi N, Mohammed AA
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40603058
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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 pericardio...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.
Tomizawa K, Oiki H, Fukuda S
… +3 more, Nishino M, Sato K, Mitsudomi T
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40545373
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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 ca...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.
Ayyad RF, Ayyad A, Sweity R
… +2 more, Idkedek M, Abu Akar F
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40533227
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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...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.
Komagamine M, Fukunishi T, Yamasaki Y
… +4 more, Tomita M, Kinebuchi S, Tomimoto D, Nawata K
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40500176
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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...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.
Toyokawa G, Yamaguchi M, Yamaya T
… +4 more, Kawashima M, Konoeda C, Shimokawa M, Sato M
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40467471
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PURPOSE: This study evaluated the prognostic significance of the controlling nutritional status/creatine kinase score (CNKS), a composite index derived from the controlling nutritional status (CONUT) score and creatine k...PURPOSE: This study evaluated the prognostic significance of the controlling nutritional status/creatine kinase score (CNKS), a composite index derived from the controlling nutritional status (CONUT) score and creatine kinase (CK) level, in patients with interstitial pneumonia awaiting lung transplantation (LT). METHODS: We retrospectively analyzed 202 patients with interstitial pneumonia who were registered for LT between January 2014 and July 2023. CNKS was calculated using CK levels and the CONUT (derived from albumin level, lymphocyte count, and cholesterol level). RESULTS: Among the 202 patients, 130 (64.4%) were alive, while 72 (35.6%) had died at the time of analysis. Among the surviving patients, 79 (39.1%) underwent cadaveric LT, and 51 (25.2%) remained on the waiting list. A high CNKS (n = 72 [35.6%]) was significantly associated with a lower body mass index (P <0.001), a shorter 6-minute walk distance (P <0.001), and lower forced vital capacity (P = 0.006) compared with a low CNKS (n = 130 [64.4%]). The results of the multivariate analysis showed that CNKS was a significant independent prognostic factor for survival during the waiting period (P = 0.031). CONCLUSION: CNKS represents a promising prognostic marker, potentially useful in selecting lung transplant candidates and guiding nutritional and rehabilitative interventions during the pretransplant period.
Kamata T, Yoshida S, Hirai Y
… +4 more, Karita R, Onozato Y, Wada H, Anayama T
Ann Thorac Cardiovasc Surg
· 2025 · PMID 40436767
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Severe subcutaneous emphysema that is refractory to chest tube drainage can result in significant patient discomfort, airway compromise, and hemodynamic instability. Various interventional approaches, including subcutane...Severe subcutaneous emphysema that is refractory to chest tube drainage can result in significant patient discomfort, airway compromise, and hemodynamic instability. Various interventional approaches, including subcutaneous drain insertion and the blowhole technique, with or without negative pressure wound therapy (NPWT), have been proposed to manage this condition. In this case series, we describe 10 patients who developed severe subcutaneous emphysema following surgery or pneumothorax and were treated using the blowhole technique, with or without NPWT. A Wound Protector/Retractor XXS or LapProtector was used to maintain the patency of the blowhole, facilitating continuous decompression. In cases with more extensive emphysema, the application of NPWT led to rapid respiratory improvement, thereby enabling additional invasive interventions to address the underlying pulmonary air leak. These findings highlight the potential utility of a structured approach incorporating NPWT for the management of severe subcutaneous emphysema, particularly in cases refractory to conventional chest tube drainage.