Thoracic and Cardiovascular Surgeon最新文献

{"title":"The Solid Volume Ratio is Better Than the Consolidation Tumor Ratio in Predicting the Malignant Pathological Features of cT1 Lung Adenocarcinoma.","authors":"Yu Liu, Ning Jiang, Zhiqiang Zou, Hongxiu Liu, Chuanhang Zang, Jia Gu, Ning Xin","doi":"10.1055/a-2380-6799","DOIUrl":"10.1055/a-2380-6799","url":null,"abstract":"<p><strong>Background: </strong> More effective methods are urgently needed for predicting the pathological grade and lymph node metastasis of cT1-stage lung adenocarcinoma.</p><p><strong>Methods: </strong> We analyzed the relationships between CT quantitative parameters (including three-dimensional parameters) and pathological grade and lymph node metastasis in cT1-stage lung adenocarcinoma patients of our center between January 2015 and December 2023.</p><p><strong>Results: </strong> A total of 343 patients were included, of which there were 233 males and 110 females, aged 61.8 ± 9.4 (30-82) years. The area under the receiver operating characteristic (ROC) curve for predicting the pathological grade of lung adenocarcinoma using the consolidation-tumor ratio (CTR) and the solid volume ratio (SVR) were 0.761 and 0.777, respectively. The areas under the ROC curves (AUCs) for predicting lymph node metastasis were 0.804 and 0.873, respectively. Multivariate logistic regression analysis suggested that the SVR was an independent predictor of highly malignant lung adenocarcinoma pathology, while the SVR and pathological grade were independent predictors of lymph node metastasis. The sensitivity of predicting the pathological grading of lung adenocarcinoma based on SVR >5% was 97.2%, with a negative predictive value of 96%. The sensitivity of predicting lymph node metastasis based on SVR >47.1% was 97.3%, and the negative predictive value was 99.5%.</p><p><strong>Conclusion: </strong> The SVR has greater diagnostic value than the CTR in the preoperative prediction of pathologic grade and lymph node metastasis in stage cT1-stage lung adenocarcinoma patients, and the SVR may replace the diameter and CTR as better criteria for guiding surgical implementation.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"308-316"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Outcomes of Surgical Redo Aortic Valve Replacement in Prosthetic Valve Failure.","authors":"Yoonjin Kang, Nazla Amanda Soehartono, Jae Woong Choi, Kyung Hwan Kim, Ho Young Hwang, Joon Bum Kim, Hong Rae Kim, Seung Hyun Lee, Yang Hyun Cho","doi":"10.1055/a-2281-1897","DOIUrl":"10.1055/a-2281-1897","url":null,"abstract":"<p><strong>Background: </strong> As redo surgical aortic valve replacement (AVR) is relatively high risk, valve-in-valve transcatheter AVR has emerged as an alternative for failed prostheses. However, the majority of studies are outdated. This study assessed the current clinical outcomes of redo AVR.</p><p><strong>Methods and results: </strong> This study enrolled 324 patients who underwent redo AVR due to prosthetic valve failure from 2010 to 2021 in four tertiary centers. The primary outcome was operative mortality. The secondary outcomes were overall survival, cardiac death, and aortic valve-related events. Logistic regression analysis, clustered Cox proportional hazards models, and competing risk analysis were used to evaluate the independent risk factors. Redo AVR was performed in 242 patients without endocarditis and 82 patients with endocarditis. Overall operative mortality was 4.6% (15 deaths). Excluding patients with endocarditis, the operative mortality of redo AVR decreased to 2.5%. Multivariate analyses demonstrated that endocarditis (hazard ratio [HR]: 3.990, <i>p</i> = 0.014), longer cardiopulmonary bypass time (HR: 1.006, <i>p</i> = 0.037), and lower left ventricular ejection fraction (LVEF) (HR: 0.956, <i>p</i> = 0.034) were risk factors of operative mortality. Endocarditis and lower LVEF were independent predictors of overall survival.</p><p><strong>Conclusion: </strong> The relatively high risk of redo AVR was due to reoperation for prosthetic valve endocarditis. The outcomes of redo AVR for nonendocarditis are excellent. Our findings suggest that patients without endocarditis, especially with acceptable LVEF, can be treated safely with redo AVR.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"279-287"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acquired Thrombocytopenia in Contemporary Transcatheter Aortic Valve Prosthesis.","authors":"Asen Petrov, Ali Taghizadeh-Waghefi, Abdel-Hannan Diab, Linda Breuer, Sebastian Arzt, Klaus Ehrhard Matschke, Konstantin Alexiou","doi":"10.1055/a-2198-1235","DOIUrl":"10.1055/a-2198-1235","url":null,"abstract":"<p><strong>Background: </strong> Postprocedural thrombocytopenia is a known phenomenon following transcatheter aortic valve implantation (TAVI). The aim of this study is to evaluate whether postinterventional platelet kinetics differ when comparing the current generation of balloon-expandable valve (BEV) and self-expanding valve (SEV) prostheses.</p><p><strong>Methods: </strong> We performed a retrospective analysis of patients undergoing TAVI at our facility between 2017 and 2019. Patients were stratified according to the type of prosthesis used: BEV or SEV. Hematocrit-corrected platelet counts were calculated to account for dilution. Nadir platelet counts (lowest recorded platelet count), drop platelet counts (DPC; highest relative platelet drop from baseline), and severity of thrombocytopenia during the discourse and at discharge were assessed.</p><p><strong>Results: </strong> Of the 277 included patients, 212 received SEV and 65 BEV. BEV patients were younger (81.8 ± 4.4 years vs 79.7 ± 6.8 years, <i>p</i> = 0.03). Further demographic characteristics were similar between groups. Implanted SEV were larger (<i>p</i> < 0.001) and had shorter procedural times (<i>p</i> < 0.01). There were no significant differences in postprocedural discourse. Postinterventional platelet drop was more pronounced in BEV patients in several evaluated metrics: mean DPC (24.3 ± 10.9% vs 18.8 ± 14.8%, <i>p</i> < 0.01), patients with DPC > 30% (<i>n</i> = 19, 29.2%, vs <i>n</i> = 33, 15.6%, <i>p</i> = 0.02), and also when comparing platelet kinetics.</p><p><strong>Conclusion: </strong> Despite improvements in outcome, the current generation of balloon-expandable TAVI prostheses carries a predisposition for postprocedural thrombocytopenia even when the effects of dilution are accounted for.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"264-271"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50163025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamics and Diastolic Function after Native Aortic Valve Preserving vs. Replacing Surgery.","authors":"Theresa Holst, Xiaoqin Hua, Christoph Sinning, Benjamin Waschki, Hermann Reichenspurner, Evaldas Girdauskas, Johannes Petersen","doi":"10.1055/a-2178-0395","DOIUrl":"10.1055/a-2178-0395","url":null,"abstract":"<p><strong>Background: </strong> Alterations in left ventricular (LV) diastolic function following native tissue-preserving aortic valve (AV) procedures have not been systematically investigated. Furthermore, no comparisons have been made between these changes and those observed after prosthetic AV replacement.</p><p><strong>Methods: </strong> From October 2017 to August 2020, 74 patients aged <65 years were referred to our institution for elective AV surgery. Preoperative and postoperative (i.e., discharge, 3-month and 1-year follow-up) transthoracic echocardiography was analyzed.</p><p><strong>Results: </strong> Native tissue-preserving surgery was performed in 55 patients (AV repair: <i>n</i> = 42, Ross procedure: <i>n</i> = 13). The remaining 19 patients underwent prosthetic AV replacement. Preoperatively and at discharge, transvalvular hemodynamics and LV diastolic function were comparable in both groups. At 1-year follow-up, native valve (NV) patients showed significantly lower mean transvalvular gradient (7 ± 5 vs. 9 ± 3 mmHg, <i>p</i> = 0.046) and peak velocity (1.74 ± 0.51 vs. 2.26 ± 0.96 m/s, <i>p</i> = 0.004), and significantly better septal e' (9.1 ± 2.7 vs. 7.7 ± 2.5 cm/s, <i>p</i> = 0.043) and lateral e' (14.7 ± 3.1 vs. 11.7 ± 3.7 cm/s, <i>p</i> = 0.001). From preoperatively to 1-year postoperatively, septal and lateral e' and E/e' improved markedly after NV preservation (septal e': +0.7 cm/s, <i>p</i> = 0.075; lateral e': +2.3 cm/s, <i>p</i> < 0.001; E/e': -1.5, <i>p</i> = 0.001) but not after AV replacement (septal e': +0.2 cm/s, <i>p</i> = 0.809; lateral e': +0.8 cm/s, <i>p</i> = 0.574; E/e': -1.2, <i>p</i> = 0.347). Significant negative linear correlations between postoperative transvalvular gradients and absolute changes in lateral e' and E/e' were detected during follow-up.</p><p><strong>Conclusion: </strong> Preservation of native tissue in AV surgery results in superior transvalvular hemodynamics compared with prosthetic AV replacement. This may induce faster LV reverse remodeling and may explain more pronounced improvement in LV diastolic function.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"254-263"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41141057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Different Valve-in-Valve Positions on Functional Results of the New Generation of Balloon-Expandable Transcatheter Heart Valve.","authors":"Najla Sadat, Michael Scharfschwerdt, Stefan Reichert, Buntaro Fujita, Stephan Ensminger","doi":"10.1055/s-0044-1787701","DOIUrl":"10.1055/s-0044-1787701","url":null,"abstract":"<p><strong>Objectives: </strong> Very precise positioning of the transcatheter heart valve (THV) inside the degenerated SAV is a crucial factor for valve-in-valve (ViV) procedure to achieve optimal hemodynamic results. Therefore, our study aimed to investigate the impact of implantation depth on functional results after ViV procedures in a standardized in vitro setting.</p><p><strong>Methods: </strong> THV (SAPIEN 3 Ultra 23-mm size) and three SAV models (Magna Ease, Trifecta, and Hancock II-all 21-mm size) were tested at different circulatory conditions in five different positions of the THV (2-6 mm) inside the SAV. Mean pressure gradient (MPG), effective orifice area (EOA), geometric orifice area (GOA_max), and pinwheeling index (PWI_mean) were analyzed.</p><p><strong>Results: </strong> EOA and MPG of the THV did not differ significantly regarding the position inside the Magna Ease and the Hancock II (<i>p</i> > 0.05). However, EOA differed significantly, depending on the position of the THV inside Trifecta (2 vs. 5 mm; <i>p</i> = 0.021 and 2 vs. 6 mm; <i>p</i> < 0.001). The THV presented the highest EOA (2.047 cm²) and the lowest MPG (5.387 mm Hg) inside the Magna Ease, whereas the lowest EOA (1.335 cm²) and the highest MPG (11.876 mm Hg) were shown inside the Hancock II. Additionally, the highest GOA_max and the lowest PWI_mean of the THV were noticed inside the Magna Ease. The THV showed lower GOA_max and higher PWI_mean inside the Trifecta when placed in a deeper position.</p><p><strong>Conclusion: </strong> Deep implantation of the SAPIEN 3 Ultra inside the Trifecta correlates with impaired functional results. In contrast, the implantation position of the SAPIEN 3 Ultra inside the Magna Ease and the Hancock II did not have a significant effect on functional results.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"288-295"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are YouTube Videos Useful in Robot-assisted Segmentectomy Education?","authors":"Tuğba Coşgun, Talha Doğruyol, Çağatay Tezel","doi":"10.1055/a-2513-9522","DOIUrl":"10.1055/a-2513-9522","url":null,"abstract":"<p><strong>Background: </strong> 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.</p><p><strong>Methods: </strong> 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).</p><p><strong>Results: </strong> Eighty-one videos were included. Almost half of the videos (<i>n</i> = 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.</p><p><strong>Conclusion: </strong> 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.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"325-330"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal Learning Curve for Minimally Invasive Aortic Valve Replacement.","authors":"Dror B Leviner, Tom Ronai, Dana Abraham, Hadar Eliad, Naama Schwartz, Erez Sharoni","doi":"10.1055/a-2337-1978","DOIUrl":"10.1055/a-2337-1978","url":null,"abstract":"<p><strong>Background: </strong> Minimally invasive aortic valve replacement (MiAVR) is an established technique for surgical aortic valve replacement (AVR). Although MiAVR was first described in 1993 and has shown good results compared with full sternotomy AVR (FSAVR) only a minority of patients undergo MiAVR. We recently started using MiAVR via an upper hemisternotomy. We aimed to examine the early results of our initial experience with this technique.</p><p><strong>Methods: </strong> We compared 55 MiAVR patients with a historical cohort of 142 isolated FSAVR patients (December 2016-December 2022). The primary outcome was in-hospital mortality. Secondary outcomes included cardiopulmonary bypass (CPB) and cross-clamp times, blood product intake, in-hospital morbidity, and length of intensive care unit and hospital stay.</p><p><strong>Results: </strong> There was no significant difference in preoperative characteristics, including age, laboratory values, and comorbidities. There was no significant difference between the groups regarding in-hospital mortality (FSAVR 3.52 vs. MiAVR 1.82%). There was no significant difference in CPB time (FSAVR 103.5 [interquartile range: 82-119.5] vs. MiAVR 107 min [92.5-120]), aortic cross-clamp time (FSAVR 81 [66-92] vs. MiAVR 90 min [73-99]), and valve size (FSAVR 23 [21-25] vs. MiAVR 23 [21-25]). The incidence of intraoperative blood products transfusion was significantly lower in the MiAVR group (10.91%) compared with the FSAVR group (25.35%, <i>p</i> = 0.03).</p><p><strong>Conclusion: </strong> Our findings further establish the possibility of reducing invasiveness of AVR without compromising patient safety and clinical outcomes. This is true even in the learning curve period and without requiring any significant change in the operative technique and dedicated equipment.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"296-303"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Valve Replacement with Single-Strip Autologous Pericardium.","authors":"Ismail Dilawar, Jusuf Rachmat, Ito Puruhito, Idrus Alwi, Sudigdo Sastroasmoro, Suhendro Suhendro, Isabella Kurnia Liem, Minarma Siagian, Ahmad Aulia Jusuf, William Makdinata, Imamurahman Taslim, Stefanie Melisa","doi":"10.1055/a-2111-1217","DOIUrl":"10.1055/a-2111-1217","url":null,"abstract":"<p><strong>Background: </strong> Aortic valve replacement with mechanical valves is the standard treatment for aortic valve disease in Indonesia. Its usage is associated with high cost, risk of endocarditis and thromboembolic event, and lifetime consumption of anticoagulants. We performed a novel replacement technique of the aortic valve using an autologous pericardium and evaluated the short-term outcomes.</p><p><strong>Methods: </strong> From April 2017 to April 2020, 16 patients underwent aortic valve replacement with a single-strip autologous pericardium. Outcomes of the left ventricular reverse remodeling (LVRR), 6-minute walk test (6MWT), and soluble suppression of tumorigenicity-2 (sST-2) were measured at 6 months postoperation.</p><p><strong>Results: </strong> A total of 16 surgeries were performed using aortic valve replacement with single-strip pericardium without conversion to mechanical valve replacement. The patients included eight males and eight females, and the mean age was 49.63 ± 12.54 years. The most common diagnosis was mixed aortic valve stenosis and regurgitation (9 cases). Five patients underwent a concomitant coronary artery bypass graft (CABG) procedure and 12 patients underwent either mitral or tricuspid valve repair. The mean aortic cross-clamp time was 139.88 ± 23.21 minutes and cardiopulmonary bypass time was 174.37 ± 33.53 minutes. At 6 months postoperation, there was an increase in the distance walked at the 6MWT (<i>p</i> = 0.006) and a decrease of the sST-2 level (<i>p</i> = 0.098). Echocardiogram showed two patients had LVRR. Survival and freedom from reoperation are 100% at 1 year of follow-up.</p><p><strong>Conclusion: </strong> Aortic valve replacement with a single strip of pericardium is a good alternative to aortic valve replacement with a mechanical valve. Short-term evaluation at 6 months postoperation showed improvement in clinical status and echocardiographic parameters compared to baseline.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"304-307"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10306094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staging of Early-Stage Lung Cancer without Routine PET in Candidates for Segmentectomy.","authors":"Alberto Lopez-Pastorini, Zehra Tatli, Antonia von Bargen, Dennis Faltenberg, Hendrik Beling, Aris Koryllos, Thomas Galetin, Erich Stoelben","doi":"10.1055/a-2405-2603","DOIUrl":"10.1055/a-2405-2603","url":null,"abstract":"<p><strong>Introduction: </strong> We aimed to investigate the accuracy of clinical staging without the routine use of positron emission tomography/computed tomography (PET/CT) in patients with cIA1 and cIA2 non-small-cell lung cancer (NSCLC) scheduled for segmentectomy.</p><p><strong>Methods: </strong> A total of 305 consecutive segmentectomies were retrospectively analyzed. Overall survival was calculated using the Kaplan-Meier method. Logistic regression was performed to investigate factors independently associated with pathologic upstaging.</p><p><strong>Results: </strong> The Union for International Cancer Control (UICC) upstaging was found in 86 patients (28%). Upstaged patients had longer operative times (146 ± 46 vs. 131 ± 44 minutes, <i>p</i> = 0.009), a higher number of lymph node resection (17 ± 10 vs. 13 ± 8, <i>p</i> = 0.001), and a higher rate of L1 involvement (34 vs. 16%, <i>p</i> < 0.001) than nonupstaged patients. N1 was found in 10 patients (3%) and N2 in 13 patients (4%). Nodal positive patients had longer operation times (154 ± 50 vs. 133 ± 44 minutes, <i>p</i> = 0.031) and higher rates of R1 (9 vs. 1%, <i>p</i> = 0.006) and L1 (39 vs. 20%, <i>p</i> < 0.026) than patients without nodal involvement. The 3- and 5-year overall survival rates for nonupstaged and upstaged patients were 85 and 67% and 67 and 54%, respectively (<i>p</i> = 0.040). In logistic regression, L1 involvement (odds ratio [OR]: 2.394, <i>p</i> = 0.005) and the number of dissected lymph nodes (OR: 1.037, <i>p</i> = 0.016) were independently associated with upstaging. Patients who received PET as part of clinical staging did not have a significantly lower nodal upstaging.</p><p><strong>Conclusion: </strong> Selective use of PET/CT based on the results of CT may be a viable option for patients with proven or suspected NSCLC up to 2 cm in size.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"317-324"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ebstein repair at high altitude setting ≥ 2,500 m - First experience from Bolivia.","authors":"Sven Weber, Inge von Alvensleben, Valentin Vadiunec, Andre Iben, Felix Berger, Hannes Sallmon, Joachim Photiadis","doi":"10.1055/a-2620-3643","DOIUrl":"https://doi.org/10.1055/a-2620-3643","url":null,"abstract":"<p><strong>Background: </strong>Contemporary surgical approaches for Ebstein anomaly are based on a paradigm shift towards earlier surgery in order to avoid the deleterious effects of chronic right ventricular (RV) volume overload. In addition, RV dysfunction may worsen in the setting of high altitude and, to date, no results on Ebstein anomaly surgery have been reported from a high altitude setting.</p><p><strong>Methods: </strong>We herein present first postoperative results from Ebstein anomaly patients who underwent cone reconstruction (with or without bi-directional Glenn anastomosis) in Cochabamba, Bolivia (> 2,500 m above sea level) using a specific high altitude protocol for prophylactic medical treatment of presumed pulmonary hypertension including sildenafil, iloprost, and higher FiO2.</p><p><strong>Results: </strong>Four patients underwent surgical correction of Ebstein anomaly (median age 9 years, range 4 to 12 years, all female). Ebstein anomaly was classified as Carpentier type C in three and as Carpentier Type B in one patient. All patients showed some degree of atrial shunting while one patient exhibited an additional perimembranous ventricular septal defect. All underwent cone reconstruction of the tricuspid valve. Due to massive intraoperative bleeding, which required re-thoracotomy subsequently causing impaired RV function, one patient underwent concomitant \"one and half ventricle\" repair. All other patients showed an uncomplicated postoperative course and all were alive with a good and/or improved RV function and only minimal-to-mild tricuspid regurgitation after 1 year.</p><p><strong>Discussion: </strong>Cone reconstruction in children with Ebstein anomaly is feasible in a high altitude setting when using a dedicated protocol to prophylactically manage pulmonary hypertension.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}