Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Lung Transplantation for COVID-19 Acute Respiratory Distress Syndrome: The British Columbian Experience With New Disease Pathology","authors":"Roy Avraham Hilzenrat MD, MHSc ,&nbsp;John C. English MD ,&nbsp;Anna McGuire MD, MSc ,&nbsp;Gordon Finlayson MD ,&nbsp;James Choi MD, MPH ,&nbsp;John Yee MD","doi":"10.1053/j.semtcvs.2022.12.004","DOIUrl":"10.1053/j.semtcvs.2022.12.004","url":null,"abstract":"<div><div>Lung transplantation is a life-saving treatment for patients with end-stage lung disease. COVID-19 has been associated with a severe and rapid decline in pulmonary function, in which case lung transplantation has been described to be effective. We herein describe 9 patients who underwent lung transplantation for COVID-19 acute respiratory distress syndrome, of whom 6 were bridged with extracorporeal membrane oxygenation (ECMO). The median time of pre-operative observation periods was 54 days to ensure no lung function recovery and the time to wean off extracorporeal membrane oxygenation was 3 days. Patients had comparable short-term survival outcomes to non-COVID-19 lung transplant recipients at our institution during the same time period. Lung transplantation for COVID-19-associated lung disease is feasible with comparable short-term outcomes and may liberate patients from extracorporeal supports.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 445-449"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10530112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Entity of the Anterior Chest Cage Rib Chondrosarcoma: A Case Report and Review of Literature.","authors":"Majed Al-Mourgi, Anwar Shams","doi":"10.1053/j.semtcvs.2024.09.005","DOIUrl":"10.1053/j.semtcvs.2024.09.005","url":null,"abstract":"<p><p>Primary bone cancers, also called bone sarcomas, can arise anywhere in the body. Less than 1% of cancers are identified as primary bone cancers annually, and they are correlated with high rates of morbidity and death. Twenty to twenty-seven percent of primary malignant osseous neoplasms are chondrosarcomas, the rarest subtype of bone sarcomas. The incidence of chondrosarcomas in Saudi Arabia was less common than globally discovered chondrosarcomas, and only a few cases have been recorded. The most common presentation of the primary chondrosarcoma (CS) is to encompass the bony skeleton of the long bones of the lower extremities and the axial skeleton. Detecting primary CS in the anterior chest wall and the rib cage is rare. To our knowledge, chondrosarcomas of the ribs encroaching on the anterior chest are rare and have never been documented in Saudi Arabian or Middle East medical or surgical literature. We describe a case of a 32-year-old female with chondrosarcoma of the left anterior seventh rib, with no other medical or surgical histories. Further work-up at the tertiary care center, including computed tomography-scan, magnetic resonance imaging, and detailed triple bone scan (nuclear scan) imaging and histological biopsy, revealed features of chondrosarcoma arising from the ribs and involving the surrounding soft tissue. The patient underwent en masse surgical resection with a 4 cm margin, including the sixth rib and partial resection of the left hemidiaphragm and a small piece of the diaphragm. The patient was discharged without any inauspicious consequences. In the current work, we comprehensively discussed a scarce case of the anterior chest wall chondrosarcoma affecting the rib. This case highlights the importance of early detection of a rare tumor using a toolkit diagnostic approach to provide successful management and caring of the patient. Consequently, this will guarantee encouraging outcomes and thus stress the fruitful role of the surgery as the best curative modality in chondrosarcoma patients.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications for the Composite Allocation Score System for Organ Distribution in the United States: Implementing the System.","authors":"Justin Cy Chan, Travis C Geraci, Stephanie H Chang","doi":"10.1053/j.semtcvs.2024.09.004","DOIUrl":"10.1053/j.semtcvs.2024.09.004","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of the Composite Allocation Score System for Lung Transplantation in the United States: Review of the New System.","authors":"Isaac S Alderete, Cathlyn K Medina, Samantha E Halpern, Arya Pontula, Matthew G Hartwig","doi":"10.1053/j.semtcvs.2024.09.001","DOIUrl":"10.1053/j.semtcvs.2024.09.001","url":null,"abstract":"<p><p>Due to criticism regarding undue adherence to fixed geographic boundaries, the Lung Allocation Score system was recently replaced by the more holistic allocation via continuous distribution. This review highlights the historical evolution of US lung allocation paradigms, outlines rationale for continuous distribution under the Composite Allocation Score system and discusses expected implications of this new system.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Masthead (copyright and information page)","authors":"","doi":"10.1053/S1043-0679(24)00058-3","DOIUrl":"10.1053/S1043-0679(24)00058-3","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Page I"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skilled Nursing Facility Quality Rating and Surgical Outcomes Following Coronary Artery Bypass Grafting","authors":"","doi":"10.1053/j.semtcvs.2022.11.007","DOIUrl":"10.1053/j.semtcvs.2022.11.007","url":null,"abstract":"<div><p><span>Centers for Medicare and Medicaid Services created a 5-star quality rating system to evaluate skilled nursing facilities (SNFs). Patient discharge to lower-star quality SNFs has been shown to adversely impact surgical outcomes. Recent data has shown that over 20% of patients are discharged to an SNF after CABG, but the link between SNF quality and CABG outcomes has not been established. The purpose of this study is to evaluate the impact of SNF quality ratings on postoperative outcomes after CABG. Retrospective cohort review of Medicare patients undergoing CABG and discharged to an SNF between the years 2016-2017. Patients were categorized into 3 groups according to the star rating of the SNF with receipt of care after discharge (ie, below average, average, above average). Risk-adjusted 30-day to 1-year outcomes of mortality, readmission, and SNF length of stay were calculated and compared using multivariable logistic regression and Poisson models across SNF quality categories. Of the 73,164 Medicare patients in our sample, 15,522 (21.2%) were discharged to an SNF. Patients in below average SNFs were more likely to be younger, Black, Medicare/Medicaid dual eligible, and have more comorbidities. Compared to above average SNFs, patients discharged to below average SNFs experienced higher risk-adjusted 30-day mortality (2.1% vs 1.6%, </span><em>P</em>&lt;0.02), readmission (21.6% vs 19.3%, <em>P</em>&lt;0.01) and SNF length of stay (17.3d vs 16.5d, <em>P</em>&lt;0.0001). Within 90-days, below average SNFs experienced higher risk-adjusted readmission rates (31.7% vs 30.0%, <em>P</em>&lt;0.004). Outcomes at 1-year were not statistically significant. Medicare beneficiaries discharged to lower quality SNFs experienced worse postoperative outcomes after CABG. Identifying best practices at high performing SNFs, to potentially implement at low performing facilities, may improve equitable care for patients.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Pages 313-320"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10336182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Homelessness and Race are Mortality Predictors in US Veterans Undergoing CABG","authors":"","doi":"10.1053/j.semtcvs.2022.10.001","DOIUrl":"10.1053/j.semtcvs.2022.10.001","url":null,"abstract":"<div><p><span><span>Coronary artery disease<span> requiring surgical revascularization is prevalent in United States Veterans. We aimed to investigate preoperative predictors of 30-day mortality following </span></span>coronary artery bypass grafting<span><span> (CABG) in the Veteran population. The Veterans Affairs Surgical Quality Improvement (VASQIP) national database was queried for isolated CABG cases between 2008 and 2018. The primary outcome was 30-day mortality. A multivariable </span>logistic regression was performed to assess for independent predictors of the primary outcome. A </span></span><em>P</em><span><span><span>-value of &lt;0.05 was considered statistically significant. A total of 32,711 patients were included. The 30-day mortality rate<span> was 1.37%. Multivariable analysis identified the following predictors of 30-day mortality: African-American race (OR 1.46, 95% CI 1.09-1.96); homelessness (OR 6.49, 95% CI 3.39-12.45); female sex (OR 2.15, 95% CI 1.08-4.30); preoperative myocardial infarction within 7 days (OR 1.49, 95% CI 1.06-2.10) or more than 7 days before CABG (OR 1.34, 95% CI 1.04-1.72); partially/fully dependent functional status (OR 1.44, 95% CI 1.07-1.93); </span></span>chronic obstructive pulmonary disease<span><span> (OR 1.54, 95% CI 1.24-1.92); mild (OR 1.48, 95% CI 1.04-2.11) and severe aortic stenosis (OR 2.06, 95% CI 1.37-3.09); moderate (OR 1.88, 95% CI 1.31-2.72), or severe (OR 2.99, 95% CI 1.71-5.22) </span>mitral regurgitation<span>; cardiomegaly (OR 1.73, 95% CI 1.35-2.22); </span></span></span>NYHA Class III/IV heart failure (OR 2.05, 95% CI 1.10-3.83); and urgent/emergent operation (OR 1.42, 95% CI 1.08-1.87). The 30-day mortality rate in US Veterans undergoing isolated CABG between 2008 and 2018 was 1.37%. In addition to established clinical factors, African-American race and homelessness were independent demographic predictors of 30-day mortality.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Pages 323-332"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33501308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developments in Postoperative Analgesia in Open and Minimally Invasive Thoracic Surgery Over the Past Decade","authors":"","doi":"10.1053/j.semtcvs.2023.07.002","DOIUrl":"10.1053/j.semtcvs.2023.07.002","url":null,"abstract":"<div><p><span><span><span><span>Whether through minimally invasive or conventional open techniques, thoracic surgery is often reported to be one of the most painful surgical procedures due to the </span>incision<span> of intercostal and respiratory muscles, rib injury or resection, and placement of surgical drains. Some of the more severe complications related to poor analgesia include prolonged </span></span>intensive care unit<span> stay, mechanical ventilation, pneumonia, and the development of chronic </span></span>postoperative pain<span> syndromes. Over the past few decades, much progress has been made in recognizing the importance of multimodal analgesic techniques<span><span>. These may include a variety of regional anesthetic<span> techniques such as epidural anesthesia, fascial plane blocks, and intrapleural catheters, as well as the utilization of opioid and opioid-sparing oral regimens. This article provides an up-to-date review of pain management following thoracic surgery, emphasizing multimodal techniques and enhanced recovery pathways. In our review, we included articles published between 2010 and 2022. PubMed and Google Scholar were researched using the keywords thoracic, cardiac, pain control, thoracic </span></span>epidural analgesia, fascial plane blocks, multimodal analgesia, and </span></span></span>Enhanced Recovery after Surgery<span><span><span><span><span> in thoracic surgery. Over 100 articles were then reviewed. We excluded articles not in English and articles that were not pertinent to cardiac or thoracic surgery. Eventually, 53 articles were included in the review, composed of clinical trials, case series, and </span>retrospective cohort studies. A variety of pain control methods employed in thoracic and cardiac surgery range from opioids and opioid-sparing medications, such as </span>acetaminophen<span> and gabapentin, to regional techniques, such as fascial plane blocks to epidural anesthesia. Multimodal anesthesia combining regional and opioid-sparing </span></span>analgesics and their combination in enhanced recovery protocols were shown to provide adequate pain control, decrease opioid consumption and lead to shorter lengths of stay. Postoperative pain control remains one of the biggest challenges in the care of thoracic surgery patients. Analgesic plans must be individualized for each patient. Multimodal analgesia remains the gold standard; however, more studies are still warranted. Finding the optimal combination of opioid and non-opioid pain medication and </span>local anesthetic delivered via suitable regional technique will improve the outcomes and lead to successful patient recovery.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Pages 378-385"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41173063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twenty-Five Years of Lung Transplantation in Medellín: Overcoming the Challenges of an Emerging Country","authors":"","doi":"10.1053/j.semtcvs.2023.03.001","DOIUrl":"10.1053/j.semtcvs.2023.03.001","url":null,"abstract":"<div><p><span>The first successful lung transplant in Colombia was performed on October 28, 1997 in Medellín by </span><em>Alberto Villegas Hernández</em><span><span> at the “Clínica Cardiovascular Santa María” today called the Cardio VID Clinic. Here we present both survival outcomes and characteristics of the oldest and most experienced lung transplant program in Colombia. We conducted a retrospective study of all patients taken to lung transplantation at the Cardio VID Clinic in Medellín, Colombia from October 1997 to October 2022. Patient information from our institutional database and transplant archives were retrieved and reviewed. From October 1997 to October 2022, a total of 153 patients underwent orthotopic lung transplantation at our institution in Medellín, Colombia. Mean recipient age was 48 ± 13 years, the youngest patient was 15 years old and the oldest patient was 73 years old at the time of transplant. Seventy-four (48.4%) patients were men and seventy-nine (51.6%) were women. Uncensored lung transplant survival<span> in Medellin at 1 month, 1 year, 5 years, and 10 years were 68%, 50%, 31%, and 12%, respectively. Although health care coverage in Colombia reaches nearly 100%, socioeconomic hurdles during post-transplant care, nonreturning patients, infections, and traumatic donor deaths lead to high </span></span>mortality rates. Due to these factors, establishing successful and sustainable lung transplant programs in these settings is challenging.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Pages 369-375"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9444809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Imaging Surveillance of Pulmonary Regurgitation: Is Echo Good Enough?","authors":"","doi":"10.1053/j.semtcvs.2023.03.002","DOIUrl":"10.1053/j.semtcvs.2023.03.002","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Pages 356-357"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9683208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}