Thoracic and Cardiovascular Surgeon最新文献

{"title":"Concomitant Surgical Ablation for Treatment of Atrial Fibrillation in Patients Undergoing Minimally Invasive Mitral Valve Surgery: A Single-Center Experience in Vietnam.","authors":"Pham Tran Viet Chuong, Phan Quang Thuan, Vu Tri Thanh, Nguyen Hoang Dinh","doi":"10.1055/s-0044-1779622","DOIUrl":"10.1055/s-0044-1779622","url":null,"abstract":"<p><p>This study presents the early and midterm outcomes of combining atrial fibrillation (AF) treatment with minimally invasive mitral valve surgery (MIMVS) at our center.From January 2017 to June 2022, our center treated a total of 86 patients with both MIMVS and surgical AF ablation. The patient cohort included 62 women (72.1%) and 24 men (27.9%). The average EuroScore II was 2.64 ± 1.49%, and the patients were followed up for an average period of 46.31 ± 9.84 months.Postoperatively, 95.3% of patients experienced a change in sinus rhythm, and 86.2% were discharged in sinus rhythm. The hospital's mortality rate was 2.3%, with a late mortality rate of 3.5%. Survival analysis revealed an atrial fibrillation-free 5-year follow-up rate of 59.1 ± 9.1%. The 5-year survival rate was 92.7 ± 3.3%.Our 5-year experience demonstrates that the combination of MIMVS and surgical AF ablation can be routinely performed with favorable peri- and postoperative outcomes. This reflects our hospital's culture and guidance on patient selection, particularly when adopting minimally invasive approaches for multiple procedures.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"368-372"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139713137","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":"Surgical Ablation of Atrial Fibrillation in High-Risk Patients: Success versus Risk.","authors":"Bernd Niemann, Nicolas Doll, Herko Grubitzsch, Thorsten Hanke, Michael Knaut, Jochen Senges, Taoufik Ouarrak, Maximilian Vondran, Andreas Böning","doi":"10.1055/a-2334-9039","DOIUrl":"10.1055/a-2334-9039","url":null,"abstract":"<p><p>Surgical atrial ablation is evaluated by surgeons in relation to the estimated surgical risk. We analyze whether high-risk patients (HRPs) experience risk escalation by ablation procedures.The CASE-Atrial Fibrillation (AF) registry is a prospective, multicenter, all-comers registry of atrial ablation in cardiac surgery. We analyzed the 1-year outcome regarding survival and rhythm endpoints of 1,000 consecutive patients according to the operative risk classification (EuroSCORE II ≤ 2 vs. >2).Higher NYHA (New York Heart Association) score, ischemic heart failure, status poststroke, renal insufficiency, chronic obstructive pulmonary disease, and diabetes mellitus were strongly represented in HRPs. HRPs exhibit more left ventricular ejection fraction < 40% (19.2 vs. 8.8%; <i>p</i> < 0.001) but identical left atrial diameter and left ventricular end-diastolic diameter compared with low-risk patients (LRPs). CHA2DS-Vasc-score (2.4 ± 1 vs. 3.6 ± 1.5; <i>p</i> < 0.001), sternotomies, combination surgeries, coronary artery bypass graft, and mitral valve procedures were increased in HRPs. LRPs underwent stand-alone ablations as well. Ablation energy did not differ. Left atrial appendage closure was performed in up to 86.1% (mainly cut-and-sew procedures). Mortality corresponded to the original risk class without an escalation that may be related to ablation, stroke rate, or myocardial infarction. A total of 60.6% of HRPs versus 75.1% of LRPs were discharged in sinus rhythm. Long-term EHRA (European Heart Rhythm Association) score symptoms were lower in HRPs. Repeated rhythm therapies were rare. Additional antiarrhythmics received a minority without group dependency. A total of 1.6 versus 4.1% of HRPs (<i>p</i> = 0.042) underwent long-term stroke; excess mortality was not observed. Anticoagulation remained common in HRPs.Surgical risk and long-term mortality are determined by the underlying disease. In HRPs, freedom from AF and symptom relief can be achieved. Preoperative risk scores should not lead to withholding an ablation procedure.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"373-386"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162246","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":"Implementation of a Short-term Treatment Protocol in Anemic Patients before Cardiac Surgery.","authors":"Dror B Leviner, Dana Abraham, Maayan Shiner, Naama Schwartz, Ophir Lavon, Erez Sharoni","doi":"10.1055/a-2176-2218","DOIUrl":"10.1055/a-2176-2218","url":null,"abstract":"<p><p>We assessed whether implementation of an immediate preoperative treatment in anemic patients could result in fewer perioperative packed red blood cell (PRBC) transfusions and improved outcomes in a real-world setting.From January 1, 2020, to November 31, 2022, we implemented a perioperative protocol for anemic patients (hemoglobin (Hb) level in women <11.5 g/dL, men <12.5 g/dL), which included subcutaneous erythropoietin α, intravenous Iron, and intramuscular vitamin B12 (all given preoperatively) and per os iron and folic acid given once a day postoperatively. We retrospectively compared all patients receiving the protocol to all eligible patients who were operated upon in the 4 years prior to implementation of the protocol. Primary outcome was amount of PRBC transfusions during surgery and index admission.In the months after protocol implementation, 114 patients who received the treatment protocol were compared with 236 anemic patients in the 4 years prior to who did not receive the protocol. The treatment reduced total PRBC use (control group median 4 [2-7] units vs. treatment 2 [1-3] units, <i>p</i> < 0.0001) and the incidence of postoperative blood products transfusions (treatment group 58 patients, 50.88% vs. control group 177 patients, 75%, <i>p</i> < 0.0001). Hb prior to discharge was higher among the protocol group (treatment median 9 g/dL [8.3-9.5 g/dL] vs. control 8.6 g/dL [8.1-9.1 g/dL], <i>p</i> = 0.0081).Despite some differences compared with previously described protocols, the implementation of a perioperative treatment protocol for anemic patients was associated with a reduction in PRBC transfusion in a real-world setting.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"360-367"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10246102","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":"Every Piece of Knowledge has its Value.","authors":"Christos Voucharas, Angeliki Vouchara","doi":"10.1055/a-2642-3307","DOIUrl":"https://doi.org/10.1055/a-2642-3307","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765560","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":"\"With a Little Help from My Friends\".","authors":"Andreas Boening","doi":"10.1055/a-2639-4896","DOIUrl":"https://doi.org/10.1055/a-2639-4896","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":"73 5","pages":"331"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765562","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":"Role of the Goddard Score in Predicting Prolonged Air Leak in Pulmonary Segmentectomies.","authors":"Thomas Galetin, Lisann Rheinhold, Rachel Klamer, Ahmet Alkhatam, Aris Koryllos","doi":"10.1055/a-2516-4020","DOIUrl":"10.1055/a-2516-4020","url":null,"abstract":"<p><p>Prolonged air leak (PAL) is a major cause of morbidities and increased treatment costs following lung resection. The Goddard score (GS) quantifies pulmonary emphysema on computed tomography, a risk factor for PAL, from 0 to 24.We evaluated the GS as a predictor of PAL in pulmonary segmentectomies by retrospectively analyzing 131 patients with anatomical segmentectomy. We identified predictors of PAL and performed logistic regression.Eighty-three percent of patients had a history of smoking. The mean air leak duration was 4.2 days; 16% had PAL (>7 days). Median GS was 1. The optimal cutoff was GS ≥ 6 (area under the curve AUC = 0.625). GS did not correlate with air leak duration. In combination, body mass index, cumulative pack-years, immunosuppression, adhesiolysis, operation time, and GS ≥ 6 best predicted PAL with AUC = 0.914. Omitting GS still leads to an AUC = 0.864.The GS does not add enough information to be of practical value in anatomic segmentectomies, but it is of academic significance to quantify and compare lung emphysema in the context of clinical studies.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"427-431"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426228","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":"Reply to Every Piece of Knowledge has its Value.","authors":"Tuğba Coşgun, Talha Doğruyol, Çağatay Tezel","doi":"10.1055/a-2642-3637","DOIUrl":"https://doi.org/10.1055/a-2642-3637","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765561","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":"DEX Inhibits H/R-induced Cardiomyocyte Ferroptosis by the miR-141-3p/lncRNA TUG1 Axis.","authors":"Mei Zhu, Zhiguo Yuan, Chuanyun Wen, Xiaojia Wei","doi":"10.1055/s-0044-1787691","DOIUrl":"10.1055/s-0044-1787691","url":null,"abstract":"<p><p>Ferroptosis is emerging as a critical pathway in ischemia/reperfusion (I/R) injury, contributing to compromised cardiac function and predisposing individuals to sepsis and myocardial failure. The study investigates the underlying mechanism of dexmedetomidine (DEX) in hypoxia/reoxygenation (H/R)-induced ferroptosis in cardiomyocytes, aiming to identify novel targets for myocardial I/R injury treatment.H9C2 cells were subjected to H/R and treated with varying concentrations of DEX. Additionally, H9C2 cells were transfected with miR-141-3p inhibitor followed by H/R treatment. Levels of miR-141-3p, long noncoding RNA (lncRNA) taurine upregulated 1 (TUG1), Fe²⁺, glutathione (GSH), and malondialdehyde were assessed. Reactive oxygen species (ROS) generation was measured via fluorescent labeling. Expression of ferroptosis-related proteins glutathione peroxidase 4 (GPX4) and acyl-CoA synthetase long-chain family member 4 (ACSL4) was determined using Western blot. The interaction between miR-141-3p and lncRNA TUG1 was evaluated through RNA pull-down assay and dual-luciferase reporter gene assays. The stability of lncRNA TUG1 was assessed using actinomycin D.DEX ameliorated H/R-induced cardiomyocyte injury and elevated miR-141-3p expression in cardiomyocytes. DEX treatment increased cell viability, Fe²⁺, and ROS levels while decreasing ACSL4 protein expression. Furthermore, DEX upregulated GSH and GPX4 protein levels. miR-141-3p targeted lncRNA TUG1, reducing its stability and overall expression. Inhibition of miR-141-3p or overexpression of lncRNA TUG1 partially reversed the inhibitory effect of DEX on H/R-induced ferroptosis in cardiomyocytes.DEX mitigated H/R-induced ferroptosis in cardiomyocytes by upregulating miR-141-3p expression and downregulating lncRNA TUG1 expression, unveiling a potential therapeutic strategy for myocardial I/R injury.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"410-417"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421102","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":"Analysis of Factors Affecting Prolonged Air Leak and Expansion Failure in the Lung after Resection in Patients with Pulmonary Malignancy and Predictive Value of Preoperative Quantitative Chest Computed Tomography.","authors":"Gizem Kececi Ozgur, Hasan Yavuz, Alpaslan Cakan, Kevser Durgun, Ayse Gul Ergonul, Tevfik Ilker Akcam, Ali Özdil, Selen Bayraktaroglu, Kutsal Turhan, Ufuk Cagirici","doi":"10.1055/a-2508-6067","DOIUrl":"10.1055/a-2508-6067","url":null,"abstract":"<p><p>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 (<i>p</i> = 0.022), presence of chronic obstructive pulmonary disease (COPD; <i>p</i> < 0.001), body mass index (BMI; <i>p</i> = 0.006), FEV₁ (<i>p</i> = 0.020), FEV₁/FVC (<i>p</i> < 0.001), LAA% (<i>p</i> = 0.008), diagnosis (<i>p</i> = 0.007), and surgical procedure (<i>p</i> < 0.001); for ET, diagnosis (<i>p</i> < 0.001) and surgical procedure (<i>p</i> = 0.001) were significant factors. A negative correlation between ET and BMI and FEV₁/FVC (<i>p</i> < 0.01) and a positive correlation (<i>p</i> < 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 (<i>p</i> = 0.045, <i>p</i> < 0.001, and <i>p</i> = 0.011). In addition, FEV₁/FVC (<i>p</i> = 0.027), BMI (<i>p</i> = 0.016), and surgical procedure (<i>p</i> = 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.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"418-426"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012083","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":"Clinical Outcomes with High- versus Low-Dose Tranexamic Acid Infusion in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.","authors":"Hussain Sohail Rangwala, Burhanuddin Sohail Rangwala, Moath Alotaibi, Mohammad Arham Siddiq, Amna Qamber, Syeda Dua E Zehra Zaidi, Tooba Naveed, Hufsa Naveed, Syed Talal Azam, Ishaque Hameed","doi":"10.1055/s-0044-1791233","DOIUrl":"10.1055/s-0044-1791233","url":null,"abstract":"<p><p>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). <i>P</i>-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; <i>p</i> = 0.04), 24-hour blood loss (SMD, -0.23 g; <i>p</i> = 0.005), and the need for fresh frozen plasma (FFP) transfusions (RR: 0.94; CI, 0.89 to 1.00; <i>p</i> = 0.05) with high-dose TXA. Chest tube output was also lower (SMD, -0.12 g; <i>p</i> = 0.0006), but postoperative seizures increased (RR: 2.23; CI, 1.70 to 2.93; <i>p</i> < 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.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"346-359"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024670","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}