Journal of thoracic disease最新文献

{"title":"High-velocity nasal insufflation with oxygen assist module versus conventional high-velocity nasal insufflation after extubation: an open-label randomized crossover study.","authors":"Suharit Visuthisakchai, Patharapan Lersritwimanmaen, Nuttapol Rittayamai","doi":"10.21037/jtd-24-1345","DOIUrl":"10.21037/jtd-24-1345","url":null,"abstract":"<p><strong>Background: </strong>The current technology of high-velocity nasal insufflation (HVNI) can be equipped with an oxygen assist module (OAM) that continuously monitors and automatically adjusts the inspired oxygen fraction (FiO₂) to maintain oxygen saturation by pulse oximetry (SpO₂) within the target range. This study aimed to evaluate the use of HVNI with OAM compared to conventional HVNI in patients after endotracheal extubation.</p><p><strong>Methods: </strong>This randomized crossover study enrolled 16 mechanically ventilated subjects who were ready to wean. The subjects were randomized to protocol A (HVNI with OAM for 60 min, followed by conventional HVNI for another 60 min) or protocol B (conventional HVNI for 60 min, followed by HVNI with OAM for another 60 min) after extubation. In HVNI with OAM, the target SpO₂ was set at 94% with a range of 92-98%, temperature of 37 °C and flow rate of 40 L/min. In the conventional HVNI group, the attending physician adjusted the FiO₂ to maintain an SpO₂ of at least 94%. The primary outcome was the time in the SpO₂ range between the two groups. The secondary outcomes included FiO₂, transcutaneous carbon dioxide pressure (PtcCO₂), respiratory rate oxygenation (ROX) index, and hemodynamic variables.</p><p><strong>Results: </strong>HVNI with OAM significantly maintained SpO₂ within the target range compared to conventional HVNI [99.4% (97.4-99.8%) <i>vs.</i> 5.3% (1.5-68.1%); P=0.001]. The use of FiO₂ was significantly lower and the ROX index was significantly higher at the end of the study in the HVNI with OAM group than in the conventional HVNI group [0.22 (0.21-0.25) <i>vs.</i> 0.40 (0.40-0.40); P=0.001 and 22.26 (15.94-26.46) <i>vs.</i> 13.01 (10.72-14.66); P=0.001, respectively]. No differences in breathing frequency, PtcCO₂ or hemodynamic variables were observed between the two groups.</p><p><strong>Conclusions: </strong>HVNI with OAM can maintain SpO₂ within the target range while using a lower FiO₂ and providing a higher ROX index than conventional HVNI in patients after extubation.</p><p><strong>Trial registration: </strong>This study was registered in the Thai Clinical Trial Registry (TCTR20220801007) before the inclusion of the first patient.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"333-343"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sublobectomy versus lobectomy for peripheral small-sized pulmonary mucinous adenocarcinoma.","authors":"Zhen Yang, Fujun Yang, Zhaoxun Li, Hiran C Fernando, Xiang Li, Gening Jiang, Xiao Song","doi":"10.21037/jtd-2024-2096","DOIUrl":"10.21037/jtd-2024-2096","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary mucinous adenocarcinoma (PMA), a rare type of adenocarcinoma, remains controversial in terms of its associated prognosis. We conducted this study to compare the oncological outcomes of lobectomy and sublobectomy for peripheral small-sized PMA.</p><p><strong>Methods: </strong>This retrospective observational study included all patients with peripheral small-sized (≤2 cm) clinical stage IA1-A2 PMA who underwent lobectomy or sublobectomy (with margin distances ≥2 cm or greater than tumor diameter) between January 2015 and December 2018. Recurrence-free survival (RFS) and overall survival (OS) were compared between the lobectomy and sublobectomy groups with Kaplan-Meier curves and log-rank tests.</p><p><strong>Results: </strong>This study examined 279 patients, with 176 cases in the lobectomy group and 103 cases in the sublobectomy group. Recurrence occurred in 8 patients, and 6 patients died. Before and after propensity score matching (PSM), log-rank tests showed no statistical differences between the lobectomy and sublobectomy groups in terms of 5-year RFS (before PSM: 97.0% <i>vs.</i> 98.9%; after PSM: 94.6% <i>vs.</i> 98.9%) or 5-year OS (before PSM: 96.9% <i>vs.</i> 98.8%; after PSM: 94.8% <i>vs.</i> 98.8%), and the recurrence patterns were also similar between the two groups. The incidence of postoperative complications, such as bronchopleural fistula, hydrothorax requiring redrainage, chylothorax, respiratory failure, and pulmonary embolism, also did not differ between the two groups.</p><p><strong>Conclusions: </strong>For peripheral small-sized PMA, sublobectomy yielded an RFS and OS comparable to those of lobectomy.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"390-399"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the gap: expanding access to minimally invasive thoracic surgery to reduce health disparities.","authors":"Emily June Zolfaghari, Safraz A Hamid, Mara B Antonoff","doi":"10.21037/jtd-2024-1986","DOIUrl":"10.21037/jtd-2024-1986","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"516-517"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal relationship between type II diabetes mellitus, metformin, insulin, gliclazide, and esophageal cancer-insights from two-sample Mendelian randomization study and meta-analysis.","authors":"Ye Lin, Junhuang Lin, Hui Xu, Zhinuan Hong, Mingqiang Kang","doi":"10.21037/jtd-24-1152","DOIUrl":"10.21037/jtd-24-1152","url":null,"abstract":"<p><strong>Background: </strong>Over recent decades, findings on the potential correlation between type II diabetes mellitus (T2DM) and the risk of esophageal cancer (EC) have displayed considerable heterogeneity. Furthermore, metformin has emerged as a potentially protective agent against certain site-specific malignancies. This study aims to explore the causal relationship between T2DM, medication treatments (metformin, insulin, gliclazide), and EC risk while addressing the notable variability in previous research findings.</p><p><strong>Methods: </strong>To elucidate the causal associations between T2DM, medication treatments, and EC, we employed a synergistic methodology that integrates the two-sample Mendelian randomization (MR) approach with meta-analysis. The genome-wide association studies (GWAS) pertaining to each exposure and EC were acquired from a publicly accessible database.</p><p><strong>Results: </strong>For MR analyses, three out of seven GWAS datasets within the T2DM cohort exhibited statistical significance. Conversely, all MR analyses yielded non-significant results in the medication cohort. Meta-analyses suggested that a genetic predisposition to T2DM correlated with a reduced risk of EC [odds ratio (OR), 0.999612; 95% confidence interval (CI): 0.999468-0.999756; P=0.01; I²=0%]. Moreover, metformin intake was causally linked to a decreased prevalence of EC (OR, 0.988954; 95% CI: 0.979044-0.998963; P=0.03; I²=0%), whereas neither insulin nor gliclazide manifests statistical significance.</p><p><strong>Conclusions: </strong>Our findings indicate T2DM and metformin are causally associated with diminished risk of EC, while no causal associations exist between insulin, gliclazide, and EC.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"243-253"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the duration of corticosteroid treatment for postoperative acute lung injury following lung cancer surgery.","authors":"Sungmin Zo, Junghee Lee, Yeong Jeong Jeon, Hong Kwan Kim, Kyeongman Jeon","doi":"10.21037/jtd-24-1295","DOIUrl":"10.21037/jtd-24-1295","url":null,"abstract":"<p><strong>Background: </strong>Acute lung injury (ALI) is one of the most serious pulmonary complications following lung resection. Despite the known beneficial effects of corticosteroid treatment for postoperative ALI, limited data are available regarding corticosteroid treatment duration. This study aimed to evaluate the beneficial effects of a short-course corticosteroid in patients with postoperative ALI following lung resection surgery for lung cancer.</p><p><strong>Methods: </strong>This retrospective observational study included 91 patients who were treated with corticosteroids for postoperative ALI among 7,317 patients who underwent lung resection surgery for lung cancer between January 2017 and March 2021. Patients were divided into two groups, short (≤14 days, n=31) and long (≥15 days, n=60) courses, on the basis of corticosteroid treatment duration.</p><p><strong>Results: </strong>While similar baseline characteristics were observed between the two groups, the short-course group had a higher corticosteroid loading dose than the long-course group; however, the cumulative dose in the first 7 days was not different between the two groups. Overall, in-hospital mortality rates were 3.2% and 26.7% in the short- and long-course groups, respectively (P=0.01). Moreover, the long-course group had higher additional intensive care unit (ICU) admission (32.3% <i>vs.</i> 60.0%, P=0.02) and persistent air leakage (0% <i>vs.</i> 13.3%, P=0.09). In the logistic regression analysis, corticosteroid treatment duration was marginally associated with in-hospital mortality [adjusted odds ratio (OR), 9.03; 95% confidence interval (CI): 0.96-84.9, P=0.054].</p><p><strong>Conclusions: </strong>Short-course corticosteroid treatment was associated with a lower rate of surgical site complications, additional ICU admission, and in-hospital mortality, which suggests the necessity of efforts for reducing the total duration by weighing the benefits and adverse effects of corticosteroid treatment for postoperative ALI.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"220-230"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lobectomy <i>vs.</i> bisegmentectomy for lung cancer in the left upper lobe: a retrospective comparative cohort study.","authors":"Hao Liu, Jinjie Yu, Yunfeng Yuan, Klara Schwarzova, Lijie Tan, Hao Zhang, Miao Lin","doi":"10.21037/jtd-2024-2199","DOIUrl":"10.21037/jtd-2024-2199","url":null,"abstract":"<p><strong>Background: </strong>Lobectomy has been established as the standard treatment for resectable non-small cell lung cancer (NSCLC) since the publication of a randomized prospective clinical trial conducted by the Lung Cancer Study Group (LCSG) in the 1990s. However, this study possesses certain drawbacks from a contemporary standpoint. Over the past decades, further studies have been conducted to comprehensively outline appropriate surgical procedures for NSCLC. Segmentectomy is considered a potential alternative for predominant ground-glass opacities (GGOs) or tumors smaller than 2 cm. However, there is limited research regarding their relative benefits. We compared oncological outcomes of patients undergoing left upper lobectomy and a \"multi-segmentectomy\" [trisegmentectomy (S₁₊₂ + S₃) or lingulectomy (S₄ + S₅)] for NSCLC of the left upper lobe, only patients with a pathological stage I-IIIA [according to the 8^th edition of the International Association for the Study of Lung Cancer tumor-node-metastasis (TNM) classification system] were then included in our study. Oncological outcomes, including overall survival (OS) and disease-free survival (DFS), were compared between patients who underwent lobectomy and those who underwent bisegmentectomy.</p><p><strong>Methods: </strong>A retrospective study was performed in the Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, that included patients who underwent lobectomy and bisegmentectomy for NSCLC in the left upper lobe from January 2009 to December 2016. Oncological outcomes, including OS and DFS, were compared between patients who underwent lobectomy and those who underwent bisegmentectomy. Subgroup analyses were completed based on the type of operation and tumor size.</p><p><strong>Results: </strong>A total of 997 patients were included, with 888 undergoing left upper lobectomy, 33 undergoing lingulectomy, and 76 undergoing inherent segmentectomy. After a retrospective comparative cohort study, no significant differences were observed in OS (P=0.49) or DFS (P=0.62) between the lobectomy and bisegmentectomy groups. Subgroup analyses were performed for each type of bisegmentectomy and different tumor sizes. Despite a noted inferior OS in the lingulectomy group (P=0.049), no significant difference in OS or DFS was identified in the other subgroup comparisons (P>0.05).</p><p><strong>Conclusions: </strong>Left upper bisegmentectomy demonstrated comparable oncological outcomes to those of left upper lobectomy, even in cases of larger tumor size (≥2 cm). However, the lingulectomy group exhibited a concerning inferiority in OS, necessitating further evaluation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"400-412"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of concomitant Cox-Maze III procedure in patients with aortic valve diseases and preoperative atrial fibrillation.","authors":"Chan Hyeong Kim, Yoonjin Kang, Ji Seong Kim, Yeiwon Lee, Sue Hyun Kim, Suk Ho Sohn, Ho Young Hwang, Kyung Hwan Kim, Jae Woong Choi","doi":"10.21037/jtd-24-1223","DOIUrl":"10.21037/jtd-24-1223","url":null,"abstract":"<p><strong>Background: </strong>There was limited evidence on the clinical benefits of the concomitant Cox-Maze procedure with aortic valve replacement (AVR) in patients with atrial fibrillation. This study aimed to evaluate the early and long-term results of the concomitant Cox-Maze procedure in patients undergoing AVR for aortic valve disease.</p><p><strong>Methods: </strong>We enrolled 101 patients who underwent AVR and had preoperative atrial fibrillation between January 1994 and December 2020. The early- and long-term clinical outcomes were compared between patients who underwent the concomitant Cox-Maze III procedures and those who did not undergo surgical ablation. Inverse probability of treatment weighting (IPTW) was used to adjust for differences in preoperative characteristics.</p><p><strong>Results: </strong>Forty-seven patients underwent the concomitant Cox-Maze III procedure (CM group), and 54 patients did not undergo surgical ablation for atrial fibrillation (non-CM group). There were no significant differences in early surgical outcomes between the two groups, except for a higher occurrence of acute kidney injury (AKI) in the CM group (P<0.001). The median follow-up duration was 70.7 months (interquartile range 36.2-118.8 months), and there were no significant differences in overall survival, thromboembolic complications, and anticoagulation-related bleeding between the two groups. Atrial fibrillation occurrence was significantly lower (P<0.001) in the CM group, and a greater number of patients discontinued anticoagulation in the CM group compared to the non-CM group (P=0.001).</p><p><strong>Conclusions: </strong>The concomitant Cox-Maze procedure in patients with atrial fibrillation undergoing AVR did not increase early mortality or morbidity, except for AKI, and showed favorable long-term results in terms of rhythm outcome and anticoagulation discontinuation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"369-378"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of statin use with 28-day mortality in the Medical Information Mart for Intensive Care IV database: a retrospective cohort study.","authors":"Chen Kang, Feifei Li, He Zhao, Patrick M Honore, Carolina Dagli-Hernandez, Tomoya Hoshi, Yiran Jin","doi":"10.21037/jtd-2024-2243","DOIUrl":"10.21037/jtd-2024-2243","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Statins, acknowledged for their ability to reduce cardiovascular risk, demonstrate a variety of pleiotropic effects, including anti-inflammatory, antithrombotic, endothelial stabilizing activity and prevention of acute kidney injury (AKI) post cardiac surgery. Patients in the intensive care unit (ICU) face heightened risks of cardiovascular disease, infections, and thrombotic complications, but the effect of statin therapy on ICU mortality remains controversial. The Medical Information Mart for Intensive Care IV (MIMIC-IV) database is a publicly available intensive care medicine information database that includes data on critically ill patients admitted to the ICU at Beth Israel Deaconess Medical Center from 2008 to 2019, with a large sample size. In this retrospective cohort study, the MIMIC-IV database was used to clarify the association between statin therapy and all-cause mortality in critically ill patients. An additional aim was to compare the effect of different statin types on mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients aged 18 years or older, with first-time admissions and complete data, were categorized based on their use of statins during their ICU stay. The primary outcome was 28-day mortality, analyzed through multivariable Cox regression and expressed as adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). The relationship between statin therapy and 28-day mortality in ICU patients was estimated using propensity score matching (PSM) and multivariable analysis to adjust for covariates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 50,624 enrolled patients, 30.9% were treated with statins. Compared to patients not receiving statin therapy, those on statins were older, had a higher proportion of males (62.0% &lt;i&gt;vs&lt;/i&gt;. 53.1%), a greater percentage with health insurance (50.2% &lt;i&gt;vs&lt;/i&gt;. 39.5%), and a higher rate of concurrent aspirin use (70.8% &lt;i&gt;vs&lt;/i&gt;. 18.2%). In terms of comorbidities, patients in the statin group had higher proportions of congestive heart failure (CHF), AKI, myocardial infarction, and chronic obstructive pulmonary disease (COPD). Statin treatment in patients in the ICU was correlated with reduced 28-day all-cause mortality in the multivariate Cox analysis (statins: HR =0.66, 95% CI: 0.61-0.70; atorvastatin: HR =0.71, 95% CI: 0.66-0.78; rosuvastatin: HR =0.57, 95% CI: 0.45-0.72; simvastatin: HR =0.54, 95% CI: 0.48-0.62; other statins: HR =0.68, 95% CI: 0.56-0.83). PSM confirmed these findings (statins: HR =0.69, 95% CI: 0.63-0.75).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Statin use may correlate with a decreased risk of 28-day mortality in patients in the ICU, with simvastatin showing a more pronounced effect. The robustness of these findings remain unaffected in the subgroup analyses, sensitivity analyses, and PSM, indicating potential clinical significance. The high mortality rate among ICU patients means that any method capable of reducing mortality could have signifi","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"429-440"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitude towards a moderate aortic valve dysfunction during rheumatic mitral valve surgery: a retrospective cohort study.","authors":"Chuang Liu, Maozhou Wang, Peiyi Liu, Jing Liu, Qiuju Deng, Wenjian Jiang, Hongjia Zhang","doi":"10.21037/jtd-24-1283","DOIUrl":"10.21037/jtd-24-1283","url":null,"abstract":"<p><strong>Background: </strong>There are insufficient data regarding how to deal with moderate aortic valve (AV) dysfunction during rheumatic mitral valve (MV) surgery. In this study, the clinical outcomes of patients who underwent rheumatic MV surgery with or without concurrent AV procedures were compared.</p><p><strong>Methods: </strong>A total of 343 patients who underwent rheumatic MV surgery with moderate AV dysfunction were enrolled between January 2015 and August 2022, and a median 40-month follow-up was conducted. The more-than-mild AV dysfunction during follow-up was the primary endpoint event, while all-cause mortality and cardiac reoperation both before discharge and during follow-up encompassed the secondary endpoint events.</p><p><strong>Results: </strong>Patients were allocated into two groups, including the no treatment (NT) (n=121) and aortic valvuloplasty (AVP) or aortic valve replacement (AVR) groups (n=222). Most of patients (110/121, 90.9%) in the NT group were combined with predominant aortic regurgitation. In the NT and AVP or AVR groups, 27.9% and 8.0% of patients reached the primary endpoint, and 5.0% and 7.3% of patients experienced the secondary endpoint events, respectively. This study confirmed a significantly higher proportion of patients in the NT group who reached the primary endpoint (relative risk, 2.98; 95% confidence interval: 1.61-5.62; P<0.001), after inverse probability treatment weighting.</p><p><strong>Conclusions: </strong>Concomitant AV surgery significantly improved AV condition during follow-up for patients with moderate AV dysfunction during rheumatic valve surgery. However, it was safe and reasonable to delay surgical treatment of the AV and regular follow-ups for patients with predominant moderate aortic regurgitation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"187-197"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative day 1 discharge for segmentectomy using a minimally invasive approach after drain removal on the day of surgery.","authors":"Hitoshi Igai, Akinobu Ida, Kazuki Numajiri, Kazuhito Nii, Mitsuhiro Kamiyoshihara","doi":"10.21037/jtd-24-1372","DOIUrl":"10.21037/jtd-24-1372","url":null,"abstract":"<p><strong>Background: </strong>Although early removal of postoperative chest drains in segmentectomy may be difficult due to the management of air leakage in intersegmental planes, patients can be discharged earlier if it is successfully achieved. In segmentectomy, we evaluated the feasibility of postoperative day (POD) 1 discharge using a minimally invasive approach (MIA) after drain removal on the day of surgery (DOS).</p><p><strong>Methods: </strong>Ninety patients who underwent segmentectomy via MIA between July 2021 and September 2023 were included in this retrospective study. These patients were divided into those who received drain removal on DOS or after DOS. Clinical characteristics and perioperative outcomes were compared between the two groups. In addition, the factors associated with drain removal on DOS and discharge on POD1 in the patients who received drain removal on DOS were identified.</p><p><strong>Results: </strong>Drains were removed on DOS in 67 patients (74.4%). Therefore, the 90 patients were divided into those who underwent drain removal on DOS (n=67) or after DOS (n=23). Patients who underwent drain removal on DOS had significantly higher forced expiratory volume in 1 second (FEV1.0) % (P=0.03) and shorter postoperative hospital stay (P<0.001). In multivariate analyses, FEV1.0% was significantly associated with drain removal on DOS (odds ratio: 0.934, 95% confidence interval: 0.880-0.993, P=0.03). Of the 67 patients who underwent drain removal on DOS, 31 (46.3%) were discharged on POD1. Among the variables, surgery performed by the chief surgeon was significantly associated with discharge on POD1 (<i>vs</i>. others, odds ratio: 0.117, 95% confidence interval: 0.019-0.730, P=0.02).</p><p><strong>Conclusions: </strong>POD1 discharge for segmentectomy using a MIA after drain removal on DOS is considered feasible. However, we still have room for improvement as 53.7% of patients were discharged on POD2 or later despite drain removal on DOS.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"82-92"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}