Annals of thoracic surgery short reports最新文献

{"title":"Bone Plug in the Bronchoscopic Management of Postoperative Bronchopleural Fistulas","authors":"","doi":"10.1016/j.atssr.2024.03.004","DOIUrl":"10.1016/j.atssr.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><p>Bronchopleural fistula (BPF) is a rare and often difficult postoperative complication to manage. This case series describes a bronchoscopic technique using a bone plug for closure of BPFs.</p></div><div><h3>Methods</h3><p>Six patients at Henry Ford Hospital from 2014 to 2021, who had a postoperative BPF after lung resection with curative intent for non-small cell lung cancer, underwent bronchoscopic placement of a customized bone plug.</p></div><div><h3>Results</h3><p>All 6 patients experienced initial resolution of the BPF after bone plug placement. Four of the 6 (66.7%) patients were inpatients, with severe pleural space infections requiring chest tube drainage; all patients clinically improved with resolution of persistent air leaks resulting in chest tube removal. Two of the 6 (33.3%) patients had BPF recurrence within 2 months, and 2 of the /6 (33.3%) patients also eventually required additional surgical repair.</p></div><div><h3>Conclusions</h3><p>Endobronchial placement of a customized bone plug is an option for the management of postoperative BPF.</p></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277299312400127X/pdfft?md5=57971ec83e9581724c16d698262b7a35&pid=1-s2.0-S277299312400127X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140759519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Tamponade After Video-Assisted Thoracoscopy Surgical Diaphragmatic Plication","authors":"","doi":"10.1016/j.atssr.2024.02.010","DOIUrl":"10.1016/j.atssr.2024.02.010","url":null,"abstract":"<div><p>Video-assisted thoracoscopy surgical diaphragmatic plication is the standard of care for diaphragmatic eventration. However, it is associated with complications like injuries to the bowel, liver, spleen, and lung parenchyma. We report life-threatening cardiac tamponade after Video-assisted thoracoscopy surgical diaphragmatic plication. The mechanisms contributing to the injury are described as well.</p></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277299312400113X/pdfft?md5=6963197288a96b8a5090f87d07873fb0&pid=1-s2.0-S277299312400113X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140272600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inadequate Anti–Factor Xa Levels With Daily 40-mg Enoxaparin After Cardiac Surgery","authors":"","doi":"10.1016/j.atssr.2023.12.024","DOIUrl":"10.1016/j.atssr.2023.12.024","url":null,"abstract":"<div><h3>Background</h3><p>Cardiac surgery patients are at increased risk for venous thromboembolism (VTE). Prevention is the most critical strategy to reduce VTE-associated morbidity and death. However, there is a lack of data on the optimal approach to VTE prophylaxis in this population of high-risk patients. This study aimed to assess whether the standard dose of enoxaparin, the subcutaneous injection of 40 mg of enoxaparin daily, achieves adequate anti–factor Xa (aFXa) levels for VTE prophylaxis in patients after open heart surgery.</p></div><div><h3>Methods</h3><p>All patients with open heart surgery with cardiopulmonary bypass from August to December 2022 who received at least 3 consecutive doses of subcutaneously administered enoxaparin were included in the study. Patients receiving therapeutic anticoagulation, patients who underwent cardiac transplantation or placement of ventricular assist device, and patients with renal insufficiency were excluded. Serum aFXa was measured 0.5 to 1 hour before the fourth dose to attain the steady-state trough levels.</p></div><div><h3>Results</h3><p>Data were completed for 44 patients. The target aFXa level was between 0.10 and 0.20 IU/mL for the avoidance of both underanticoagulation (≤0.10 IU/mL) and overanticoagulation (&gt;0.20 IU/mL). The mean was 0.049 IU/mL with SD of 0.026 IU/mL, which was statistically significantly lower than the lower end of the target aFXa values (0.10 IU/mL; <em>t</em>₄₃ = −13; <em>P</em> &lt; .001; <em>d</em> = −1.9; 99% CI, −0.059 to −0.043).</p></div><div><h3>Conclusions</h3><p>The daily subcutaneous administration of 40 mg of enoxaparin leads to subprophylactic aFXa levels for most patients who undergo cardiac surgery. Further studies on the clinical relevance are warranted.</p></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772993124000913/pdfft?md5=ac3d9c7715260a3e2a1ec5f8bf365b38&pid=1-s2.0-S2772993124000913-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139823413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histology and Lung Nodule Fluorescence in Intraoperative Molecular Imaging With Pafolacianine","authors":"","doi":"10.1016/j.atssr.2024.02.003","DOIUrl":"10.1016/j.atssr.2024.02.003","url":null,"abstract":"<div><h3>Background</h3><p>Intraoperative molecular imaging (IMI) uses a cancer-targeted fluorescent agent injected into patients to localize tumor nodules. Pafolacianine is a folate receptor (FR)–targeted near-infrared fluorescent probe. Almost 10% of patients have false negative fluorescence findings intraoperatively. We hypothesized that tumor histology explains why lung cancer may not fluoresce.</p></div><div><h3>Methods</h3><p>Adenocarcinoma (AC) (A549, LKR) and squamous cell carcinoma (SCC) (H127, H1264) cell lines were stained with pafolacianine. Near-infrared fluorescent microscopy was used to quantify mean fluorescence intensity. Tissue microarray slides of patients with AC and SCC were evaluated by immunohistochemistry for FR alpha (FRα) and beta (FRβ) expression. Finally, we retrospectively analyzed IMI data from clinical trials of patients with AC and SCC receiving pafolacianine.</p></div><div><h3>Results</h3><p>AC (intensity 30.31) cell lines have a higher fluorescence intensity than SCC cell lines (intensity 5.4) (<em>P</em> &lt; .001). On slide analysis, 93.8% of ACs expressed FRα compared with 44.4% of SCCs (<em>P</em> = .002). Finally, there were 326 patients enrolled in clinical trials: 211 had lesions localized in vivo, and 134 of these patients had pure AC or SCC. All 9 patients with SCC have a positive smoking history and a mean pack-year of 60.2 (SD 3,6), whereas 76% of patients with AC have a history of smoking and a mean pack-year of 29.3 (<em>P</em> = .02). The odds ratio for fluorescence of (AC/SCC) was 2.05 (<em>P</em> = .004) and 2.01 (<em>P</em> = .02) on univariate and multivariate logistic regression, respectively.</p></div><div><h3>Conclusions</h3><p>During IMI with pafolacianine, a nonfluorescent nodule is more likely to be SCC than AC. AC has a high probability of fluorescing because of higher expression of FRα or FRβ, or both.</p></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772993124001062/pdfft?md5=e889a5a50867500e8f9617795575a2e0&pid=1-s2.0-S2772993124001062-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140275452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significance of Pulmonary Artery Dilatation in Lung Cancer Patients With Chronic Obstructive Pulmonary Disease Who Underwent Pulmonary Resection","authors":"","doi":"10.1016/j.atssr.2024.03.001","DOIUrl":"10.1016/j.atssr.2024.03.001","url":null,"abstract":"<div><h3>Background</h3><p>The significance of pulmonary artery (PA) diameter in patients with non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD) who undergo pulmonary resection has not been elucidated.</p></div><div><h3>Methods</h3><p>Data of 357 patients with NSCLC and COPD who underwent pulmonary resection were retrospectively reviewed. The main PA diameter, determined by preoperative computed tomography, relative to the body surface area (PBR), was used as an index of PA dilatation, and patients were divided into 2 groups using median values. The relationship between the PBR and short- and long-term outcomes was also analyzed.</p></div><div><h3>Results</h3><p>The mean age was 70.8 years, and 82% of the patients were men. The median main PA diameter was 24 mm (range, 17-43 mm), and the median PBR was 14.5 (range, 10.4-28.6). Lobectomy or more was performed in 276 patients (78%) and sublobar resection in 81 patients (22%). The postoperative complication rates did not differ between the low- and high-PBR groups (33% vs 32%, <em>P</em> = .91). The relapse-free survival (RFS) and overall survival (OS) rates of the low-PBR group were significantly better than those of the high-PBR group (5-year RFS: 76% vs 59%, <em>P</em> = .0003; 5-year OS: 88% vs 72%, <em>P</em> = .0010). A multivariable analysis identified high PBR as a poor prognostic factor for both RFS and OS.</p></div><div><h3>Conclusions</h3><p>PA dilatation was associated with poor long-term outcomes and was an independent poor prognostic factor for both RFS and OS in NSCLC patients with COPD who underwent pulmonary resection.</p></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772993124001244/pdfft?md5=bc453a5ca3d467f4ac0ca60aec947fef&pid=1-s2.0-S2772993124001244-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients With Hypoplastic Left Heart Syndrome Have a Shorter Superior Vena Cava","authors":"","doi":"10.1016/j.atssr.2024.01.016","DOIUrl":"10.1016/j.atssr.2024.01.016","url":null,"abstract":"<div><h3>Background</h3><p>The primary treatment for hypoplastic left heart syndrome (HLHS) is the Fontan pathway, which entails performing the Glenn procedure. We hypothesized that the superior vena cava in patients with HLHS was short. As the length of the superior vena cava influences the Glenn procedure, we compared its length between patients with HLHS and those with other congenital heart diseases.</p></div><div><h3>Methods</h3><p>Patients with HLHS or its variant, patients with ventricular septal defects (VSD), and patients with pulmonary atresia with intact ventricular septum (PA/IVS)—including critical pulmonary stenosis—were enrolled in this study. The effective superior vena cava ratio (ESCVR), which is defined as the inferior border of the left brachiocephalic vein to the superior surface of the right pulmonary artery/height, was measured.</p></div><div><h3>Results</h3><p>The median ESVCR of the HLHS, VSD, and PA/IVS patients was 12.54 mm/m, 17.96 mm/m, and 18.46 mm/m, respectively. ESVCR of the HLHS group was significantly smaller than that of the other groups (<em>P</em> = .0013 vs VSD group, <em>P</em> = .0002 vs PA/IVS group).</p></div><div><h3>Conclusions</h3><p>Patients with HLHS have a relatively short superior vena cava, which may complicate the Glenn procedure.</p></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772993124001013/pdfft?md5=fe0694061e2015687af370f84876cc67&pid=1-s2.0-S2772993124001013-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140463817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complication Rate of the Nuss Procedure in Adults and Pediatric Patients: National Database Analysis","authors":"","doi":"10.1016/j.atssr.2024.04.013","DOIUrl":"10.1016/j.atssr.2024.04.013","url":null,"abstract":"<div><h3>Background</h3><p>Pectus excavatum (PE) is the most common congenital chest wall defect and is characterized by the inward displacement of the sternum and costal cartilages. To date, there are limited data on adult patients undergoing the Nuss procedure for PE. This study aimed to assess the complication rate between the pediatric and adult populations and assess the trends in demographics.</p></div><div><h3>Methods</h3><p>Retrospective analysis was conducted using a global health care database, TriNetX. Current Procedural Terminology codes (21742, 21743) were used to identify all patients who underwent Nuss procedures in the years 2004 to 2023. The cohort was then subdivided on the basis of age and sex. These patients were assessed for 30-day and 90-day major and minor postoperative complications, as well as acute pain and chronic postoperative pain.</p></div><div><h3>Results</h3><p>A total of 2843 patients who underwent Nuss repair were identified. Patients aged &gt;18 years had increased hemorrhagic complications (3% vs 0.86% in patients aged &lt;18 years; <em>P</em> &lt; .001) and acute pain (55% in patients aged &gt;18 years vs 39.1% in patients aged &lt;18 years; <em>P</em> &lt; .001). Overall complication rates were 28.48% in female patients and 21.7% in male patients (<em>P</em> = .0014). Female patients had higher rates of respiratory complications (6% vs 2.7% in male patients; <em>P</em> = .001), chronic pain (5.2% in female patients vs 2% in male patients; <em>P</em> &lt; .001), and hemorrhagic complications (6% in female patients vs 0.97% in male patients; <em>P</em> = .0042).</p></div><div><h3>Conclusions</h3><p>This study suggests that adults with PE experience significantly increased postoperative pain and hemorrhagic complications after the Nuss procedure when compared with the pediatric population. Female patients experience significantly higher complication rates when compared with male patients in all age groups.</p></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772993124001943/pdfft?md5=9824bf48ff929568a99d8fdf564cca72&pid=1-s2.0-S2772993124001943-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142129354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant Tricuspid Valve Surgery With Mitral Valve Surgery for Moderate Tricuspid Regurgitation","authors":"","doi":"10.1016/j.atssr.2023.12.005","DOIUrl":"10.1016/j.atssr.2023.12.005","url":null,"abstract":"<div><h3>Background</h3><p>Tricuspid valve surgical procedures (TVS) concomitant with mitral valve (MV) surgical procedures for less than severe tricuspid regurgitation (TR) remains controversial. This study examined the long-term outcomes of patients with moderate or mild to moderate TR undergoing MV surgical procedures with or without TVS.</p></div><div><h3>Methods</h3><p>Patients with moderate or mild to moderate TR undergoing MV replacement or repair between January 2002 and June 2021 were included. Primary outcomes of reoperation and long-term survival were compared for patients undergoing MV replacement or repair with or without TVS before and after stratifying by mitral disease cause.</p></div><div><h3>Results</h3><p>The study included 505 patients. Mean age was 69 ± 12.7 years. The Society of Thoracic Surgeons Predicted Risk of Mortality for MV replacement (3.71 vs 4.39; <em>P</em> = .34) and repair (1.73 vs 1.67; <em>P</em> = .84) was similar for patients who did and did not undergo TVS. Operative mortality was similar for replacement (4.2% vs 6.1%; <em>P</em> = .77) or repair (0% vs 0%) with or without TVS. Patients undergoing MV replacement or repair with or without TVS had similar 10-year survival (67.1% vs 73.2% [<em>P</em> = .37]; 68.7% vs 78.8% [<em>P</em> = .052]) and rates of reoperation (2.1% vs 0.8% [<em>P</em> = .69]; 4.9% vs 4.6% [<em>P</em> = .99]). Cox proportional hazards modeling confirmed that TVS did not decrease the risk of death after MV replacement (hazard ratio, 0.839 [0.479-1.467]) or repair (hazard ratio, 0.852 [0.516-1.408]). The findings were unchanged after stratifying by MV disease cause or restricting the analysis to patients with moderate TR only, with no differences in survival or reoperation (all <em>P</em> &gt; .05).</p></div><div><h3>Conclusions</h3><p>Concomitant TVS for moderate or mild to moderate TR did not improve survival or decrease reoperation. Parameters beyond the degree of TR may aid in surgical decision-making.</p></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772993123003923/pdfft?md5=4d5f89435aea6c23af15104a6914b434&pid=1-s2.0-S2772993123003923-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142129352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Surgical Treatment for Thymoma-Related Stiff Person Syndrome","authors":"","doi":"10.1016/j.atssr.2024.01.004","DOIUrl":"10.1016/j.atssr.2024.01.004","url":null,"abstract":"<div><p>Stiff person syndrome (SPS) is a neurologic disorder, some cases of which are associated with malignant disease. Here, we report a case of thymoma-associated SPS that was successfully treated with surgical resection. A 57-year-old man with progressive muscle stiffness and weakness was diagnosed with thymoma-related SPS. After administration of medication and intravenous immunoglobulin, the patient underwent extended thymectomy, partial pericardial resection, and pericardial reconstruction. After tumor resection, the symptoms gradually diminished, and performance status and respiratory function improved significantly. This report indicates that tumor resection may improve respiratory function, eliminate dyspnea, and improve performance status in tumor-related SPS.</p></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772993124000858/pdfft?md5=8186cd39047aedc39f899f4c1df011f6&pid=1-s2.0-S2772993124000858-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142129504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impella 5.5 Use in the Setting of Severe Aortic Insufficiency: A Relative Contraindication","authors":"","doi":"10.1016/j.atssr.2024.04.012","DOIUrl":"10.1016/j.atssr.2024.04.012","url":null,"abstract":"<div><p>Moderate or severe aortic insufficiency is a contraindication to transvalvular Impella left ventricular assist device (Abiomed) use out of concern for worsening valvular insufficiency and recirculation. This report describes the case of a 75-year-old man with severe eccentric aortic insufficiency and systemic hypoperfusion who was supported with a transvalvular Impella 5.5 device for 6 days as preoperative rehabilitation before aortic valve replacement. The Impella device provided adequate systemic tissue perfusion, and left ventricular function remained without signs of volume overload and recirculation. Moderate or severe aortic insufficiency may not be an absolute contraindication to transvalvular Impella use, although this is case dependent.</p></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772993124001931/pdfft?md5=9e292501f338692b7c2e562015e9999a&pid=1-s2.0-S2772993124001931-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142129468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}