The Cardiothoracic Surgeon最新文献

{"title":"Exploring long-term outcomes in COPD patients: a comprehensive narrative review of bilateral and single lung transplantation","authors":"Andia Taghdiri","doi":"10.1186/s43057-023-00117-7","DOIUrl":"https://doi.org/10.1186/s43057-023-00117-7","url":null,"abstract":"Millions of people throughout the world suffer from the common and fatal respiratory disorder known as chronic obstructive pulmonary disease (COPD). Lung transplantation gives hope to individuals with end-stage COPD, with both bilateral lung transplantation and single lung transplantation being effective procedures. The complexity of chronic obstructive pulmonary disease is underscored by various factors influencing transplant outcomes, including patient characteristics, donor features, and complications post-transplantation. This narrative review explores recent studies on bilateral and single lung transplantation in chronic obstructive pulmonary disease patients, focusing on research published after 2020. Databases like PubMed and Google Scholar were used with keywords such as “COPD,” “lung transplantation,” “bilateral lung transplantation,” and “single lung transplantation” guided the research, emphasizing survival rates, quality of life, and post-transplant complications. Five selected articles encompassing 63,426 patients were examined, evaluating methodological variations among the studies. The selected studies showed no unanimous agreement on whether bilateral or single lung transplantation is superior for chronic obstructive pulmonary disease patients. Bilateral lung transplantation exhibited higher mid- and long-term survival rates, influenced significantly by age, comorbidities, and disease profiles. Improved quality of life was observed with bilateral transplantation, but this outcome depended on external circumstances. Post-transplant complications emphasized the need for rigorous post-transplant care. Individualized assessments are crucial when choosing between bilateral and single lung transplantation for chronic obstructive pulmonary disease patients. Despite varying research results, bilateral transplantation generally offers better survival and quality of life. Informed decisions require personalized post-transplant care, standardized reporting, and consistent research methods. Emphasizing donor management, preventing chronic lung allograft dysfunction, and prioritizing patient-centered care is vital. Collaborative efforts and patient-focused strategies are essential for improving long-term outcomes in these patients undergoing lung transplantation.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138535727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to “Postoperative atrial fibrillation after thoracic surgery: addressing risk factors and outcomes”—a letter to the Editor","authors":"Kanakath Sanvi, Ravneet Kaur","doi":"10.1186/s43057-023-00116-8","DOIUrl":"https://doi.org/10.1186/s43057-023-00116-8","url":null,"abstract":"<p>To the Editor, </p><p>We are writing in response to the article “Postoperative atrial fibrillation after thoracic surgery (PoAF): risk factors and outcome” by Valentina et al., published on September 21, 2023. Firstly, I would like to commend the authors for their insightful research on assessing the risk factors for and the consequences of PoAF in patients undergoing thoracic surgery for lung cancer antecedent to the COVID-19 pandemic, also allowing at least 12 months of follow-up.</p><p>PoAF, in fact, due to its close temporal correlation with the surgical intervention, is an event triggered by surgery-induced stress, usually self-limiting and transitory [1]. PoAF is relatively frequent after thoracic surgery, although its incidence is lower on average (10–20%) compared to cardiac surgery due to the better cardiac status of non-cardiac surgical patients [2].</p><p>The article published by Valentina et al. [3] provides a well-organized and systematic approach that advanced age and open surgery are independently associated with an increased risk of PoAF in lung cancer surgery and left atrial enlargement association. The study mentions previous research, showing other risk factors, such as male gender, history of heart disease, more advanced cancer stages, postoperative serum potassium, and transfusions.</p><p>While the study by Valentina et al. provides significant data through analysis, showcasing the multifactorial dependence, it could have included diverse populations and lifestyles. This would have helped to assess and treat people according to their specific requirements. Additionally, the paper could have discussed post-discharge risk in patients and any complications that might occur beyond the mean follow-up period. Rena et al. demonstrated that the vast majority of PoAF resolved after hospital release, while in a study by Amar et al., 50% of episodes of PoAF spontaneously converted to sinus rhythm in less than 24 h [4].</p><p>While the study claims an absence of echocardiogram details of the patient to be used for studies, there is significance of such findings to understand outcomes. Hence, despite the prevalence of a strong correlation between echocardiogram findings, the size and function of the left atrium have been studied but without ECG data. A positive correlation was found between PoAF and LA maximal volume, atrial pre-contraction volume, active stroke volume, expansion index, and volume index. Studies also showed a negative correlation between the LA total emptying fraction and the LA passive ejection fraction. Hu et al. analyzed changes with transesophageal echocardiography and found that Global Longitudinal Strain (GLS;T2) and Atrial Global Longitudinal Strain (AGLS%) were independent predictors of PoAF [1].</p><p>I highly appreciate that the authors provided substantial data and subsequent discussions, including univariable (<i>p</i> = 0.08) and multivariable analysis of age (OR 1.089 per year, 95% CI 1.039–1.141, <i>p</i","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138535724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of anatomy of the aorta in patients with a coarctation of aorta","authors":"B. B. Turaev, Kh. K. Abralov, B. Kh. Kobiljonov, N. Sh. Ibragimov","doi":"10.1186/s43057-023-00114-w","DOIUrl":"https://doi.org/10.1186/s43057-023-00114-w","url":null,"abstract":"Coarctation of the aorta (CoA) is a congenital heart disease characterized by the narrowing of the aorta, resulting in reduced blood flow to the body and increased pressure in the left ventricle. The pathophysiology of CoA is complex and involves several changes in the structure and function of the aorta. Recent studies have suggested that patients with CoA may have changes in the aortic wall beyond the site of the narrowing. Understanding these changes in the aorta is essential for optimizing the management of patients with CoA. Eighty-five patients who were diagnosed with an isolated coarctation of aorta (CoA) and underwent elective surgical repair—during the last 10 years were included in the study. Eighty-five patients (62 males, 72.9%) with a median age of 7 years old (range from 1 month to 48 years old) underwent surgical repair of CoA during the last 10 years using 4 different methods of operation. The study showed that more than a half (51.7%) of our patients with coarctation of the aorta had an enlargement of an ascending aorta, and z-score of ascending aortic size positively correlated with age, height, and weight, which means in patients with non-corrected CoA, ascending aorta tends to enlarge by time. In the present study, 31.8% of patients had an aortic arch hypoplasia, and aortic arch sizes z-score negatively correlated with ICU and hospital stay, which indicates that, patients with smaller aortic arch have poorer outcomes. Therefore, evaluating AAH before planning surgical repair is important for achieving better results. CT examination showed advantages in assessing aortic anatomy. It is suggested that an MSCT examination should be performed to take into consideration of current aortic anatomy, before planning the surgical correction of the aortic coarctation to achieve better results.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138535725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-right ventricle to pulmonary artery conduit: short- and intermediate-term outcomes: a single-center study","authors":"Yasmin Abdelrazek Ali, Alaa Roushdy, Mohammed Abdullah Hegab, Amr Mansour Mohammed","doi":"10.1186/s43057-023-00115-9","DOIUrl":"https://doi.org/10.1186/s43057-023-00115-9","url":null,"abstract":"Surgery for congenital heart disease has progressed by leaps and bounds in the last few decades, but the right ventricular outflow tract continues to pose a challenge to the congenital heart surgeon. We aim to describe the outcomes of patients with CHD who had surgical placement of right ventricle to pulmonary artery conduits with a focus on the risk factors for redo-surgery. We performed a retrospective single-center clinical data review of patients who had RVOT surgery using RV-to-PA conduits Thirty-three patients (54.5% males) were included. The mean age at first conduit placement was 3.57 ± 3.18 years, mean conduit size conduit was 14.45 ± 3.85 mm. 51.5% of patients received Contegra tubes. On a mean follow-up of 2.07 ± 2.36 years, 45.5% of patients underwent RV-to-PA conduits redo replacement after 5.67 ± 3.25 years from the first surgery, 2 patients underwent re-intervention for the second time, 7 patients had transcatheter interventions on RVOT or branch PAs. The main mode of conduit failure was stenosis. The median survival without the need for surgical reintervention was 2.5 years for the non-contegra subgroup versus 3 years for the contegra subgroup (P = 0.59). we predicted that 100% of the study group would require redo surgery for conduit replacement within the first 11 years post-initial surgery. For every year of age increase at follow-up, the hazard ratio for redo surgery increases by a factor of 1.47. For every year of age increase at the time of first operation, the hazard ratio for redo surgery decreases by a factor of 0.7. The use of conduits to treat the RV to PA discontinuity is a cornerstone in treating congenital heart diseases. Nevertheless, conduit failure and replacement are inevitable. In our experience the higher the age at the first conduit, the longer the re-intervention-free survival period.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138535726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}