Portuguese journal of cardiac thoracic and vascular surgery最新文献

{"title":"Professor Doutor António Braga The Founder of the Service, School and Attitude.","authors":"José F Teixeira","doi":"10.48729/pjctvs.493","DOIUrl":"https://doi.org/10.48729/pjctvs.493","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"15-19"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017971","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":"President's Message.","authors":"Miguel Sousa Uva","doi":"10.48729/pjctvs.494","DOIUrl":"https://doi.org/10.48729/pjctvs.494","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017968","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":"Pancoast Tumors: 11-Year Single-Centre Experience.","authors":"Catarina Pereira Moita, Catarina Figueiredo, Zenito Cruz, Ana Rita Costa, João Maciel, João Santos Silva, João Eurico Reis, Paulo Calvinho","doi":"10.48729/pjctvs.438","DOIUrl":"10.48729/pjctvs.438","url":null,"abstract":"<p><strong>Introduction: </strong>Pancoast tumors encompass any tumor located on the lung apex, extending into structures in the thoracic inlet and, often, leading to the characteristic clinical syndrome. The main goal of this study is to analyze the response to multimodal treatment and outcome of patients with Pancoast tumors.</p><p><strong>Materials and methods: </strong>We performed a retrospective cohort single center study of patients with superior sulcus nonsmall cell lung carcinomas who underwent surgery between January of 2011 and February of 2022.</p><p><strong>Results: </strong>A total of ten patients were considered, 80,0% were male with a mean age of 53,6 (±6,6) years. At diagnosis, two tumors were stage II and eight were stage III. Histopathology revealed eight were adenocarcinomas and two were sarcomatoid carcinomas. All patients underwent neoadjuvant treatment before surgery. Nine patients received lung lobectomy, with en bloc resection comprising, predominantly, the chest wall (80,0%) and brachial plexus (30,0%). In one patient, surgery was aborted. Surgical histopathology showed free surgical margins were achieved in eight patients (80,0%). Two patients achieved full tumoral remission (ypT0N0, 22,2%), two tumors were stage I (22,2%), two were stage II (22,2%), two were stage III (22,2%) and one tumor was stage IV (11,1%). Mean disease-free survival was 83,9 (CI95% 42,1-125,8) months. 3-month disease-free survival rate was 88,9% and 1-year and 5-year disease-free survival rates were 63,5%. After the first-year follow-up, there was no evidence of disease progression. Mean overall survival was 115,7 (CI95% 89,3-142,1) months. At 3-month, 1-year and 5-years, overall survival was 88,9%.</p><p><strong>Conclusion: </strong>Although considering the small sample of patients, the survival of Pancoast tumors in our institution exhibits a positive outcome, when compared to current literature, Significant improvements have been reported recently, in understanding the nature of Pancoast tumors, emphasizing the importance of a multidisciplinary approach but still, further research is required.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"39-46"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017966","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":"Tailored Perioperative Medicine For Frail Patients Undergoing Vascular Surgery: A Narrative Review.","authors":"Bernardo Miguel, Sarah Oliveira, João Valente Jorge, Patrícia Conde, Ângela Alves","doi":"10.48729/pjctvs.442","DOIUrl":"10.48729/pjctvs.442","url":null,"abstract":"<p><p>Frailty is a concept that is emerging as an important tool in the preoperative assessment of patients. The incidence of frailty in vascular surgery patients is high and is expected to increase concomitantly with the aging of the population. The identification of these patients and their optimization in the perioperative period can lead to an improvement in their outcomes with a reduction in morbidity and mortality. In this narrative review we address the concept of frailty applied to vascular surgery patients as well as assessment tools for its evaluation. This review focus not only on the most utilized evaluation tools but also on the most recent and specific frailty evaluation instruments that are suitable for vascular surgery patients. Furthermore, we review patient optimization strategies to improve perioperative outcomes.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"65-72"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017980","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":"Sequential Double-Lung Transplantation In Kartagener Syndrome: A Case Report.","authors":"Catarina Nunes Figueiredo, João Santos Silva, João Maciel, Luísa Semedo, Paulo Calvinho","doi":"10.48729/pjctvs.465","DOIUrl":"10.48729/pjctvs.465","url":null,"abstract":"<p><p>Kartagener syndrome (KS) is a rare congenital disorder, characterized by sinusitis, bronchiectasis and situs inversus. Lung transplantation is an effective treatment for end-stage lung failure, but dextrocardia and differences between hilar structures and pulmonary lobes require adjustments to conventional surgical technique. We present a case of a double-lung transplant without extracorporeal oxygenation in a 48-year-old male patient with KS. Through a Clamshell incision, right-left rotation was identified. To provide an end-to-end arterial and bronchial anastomosis, longer donor PA's and right main bronchus were preserved. Wedge resection of right inferior lobe was unnecessary and there was no left residual cardiac chamber. Patient was discharged 32 days after surgery without complications. Despite being anatomically challenging, lung transplant was done successfully without the need for plastic maneuvers or extracorporeal circulation. This reinforces the idea that it should be an option in end-stage lung disease.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"83-86"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017976","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":"Advancing Vascular Surgery: The Role Of Artificial Intelligence And Machine Learning In Managing Carotid Stenosis.","authors":"Ana Daniela Pias, Juliana Pereira-Macedo, Ana Marreiros, Nuno António, João Rocha-Neves","doi":"10.48729/pjctvs.411","DOIUrl":"10.48729/pjctvs.411","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular diseases affect 17.7 million people annually, worldwide. Carotid degenerative disease, commonly described as atherosclerotic plaque accumulation, significantly contributes to this, posing a risk for cerebrovascular events and ischemic strokes. With carotid stenosis (CS) being a primary concern, accurate diagnosis, clinical staging, and timely surgical interventions, such as carotid endarterectomy (CEA), are crucial. This review explores the impact of Artificial Intelligence (AI) and Machine Learning (ML) in improving diagnosis, risk stratification, and management of CS.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted using PubMed and SCOPUS, focusing on AI and ML applications in diagnosing and managing extracranial CS. English language publications from the past two decades were reviewed, including cross-referenced scientific articles.</p><p><strong>Results: </strong>Recent advancements in AI-enhanced imaging techniques, particularly in deep learning, have significantly improved diagnostic accuracy in identifying carotid plaque vulnerability and symptomatic plaques. Integration of clinical risk factors with AI systems has further enhanced precision. Additionally, ML models have shown promising results in identifying culprit arteries in patients with previous cerebrovascular events. These advancements hold immense potential for improving CS diagnosis and classification, leading to better patient management.</p><p><strong>Conclusion: </strong>Integrating AI and ML into vascular surgery, particularly in managing CS, marks a transformative advancement. These technologies have significantly improved diagnostic accuracy and risk assessment, paving the way for more personalized and safer patient care. Despite clinical validation and data privacy challenges, AI and ML have immense potential for enhancing clinical decision-making in vascular surgery, marking a pivotal phase in the field's evolution.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"55-64"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017958","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":"Surviving By A Thread Of Life For 20 Years.","authors":"Vidur Bansal, Vinay Upadhyay, Ruchit Patel, Chirag Doshi","doi":"10.48729/pjctvs.476","DOIUrl":"https://doi.org/10.48729/pjctvs.476","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"89"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017978","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":"High And Intermediate-High Risk Pulmonary Embolism Management: A 5-Year Intensive Care Unit Casuistic Review.","authors":"Inês Mendonça, Sara Teixeira, Ana Rita Ferreira, José Artur Paiva","doi":"10.48729/pjctvs.415","DOIUrl":"10.48729/pjctvs.415","url":null,"abstract":"<p><strong>Background and objectives: </strong>The optimal management of high-risk and intermediate-high-risk Pulmonary Embolism (PE) is a matter of ongoing debate. This paper aims to assess the short and long-term clinical outcomes associated with different treatment approaches for high-risk and intermediate-high-risk PE within an Intensive Care Unit (ICU) and identify potential areas for improvement.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients admitted to an ICU with high and intermediate-high-risk PE between January 2018 and December 2023. The therapeutic approach and clinical outcomes were evaluated: ICU and 28-days survival, ICU and hospital length of stay, major hemorrhagic complications and direct and indirect signs of pulmonary hypertension (PHT). Demographic, comorbid state and severity at admission data were also collected (sex, age, Charlson Comorbidity and APACHE II scores).</p><p><strong>Results: </strong>64 patients were included: 32 high-risk PE (including 18 in cardiac arrest) [Groups 1-5] and 32 intermediate-high-risk PE [Group 6a-c]. Treatment approaches varied: Group 1 - High-risk PE treated with systemic thrombolysis (ST) (n=18); Group 2 - High-risk PE treated with Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) plus ST (n=6); Group 3 - High-risk PE treated with VA-ECMO alone (n=5); Group 4 - High-risk PE treated with catheter-direct-therapy (n=1); Group 5 - Heparin only (n=2). Group 1 demonstrated an ICU and 28-day survival of 83.0%, while Groups 2 and 3 exhibited survival rates of 66.67% and 60.0%, respectively. There were 10 major bleeding complications in Group 1 and 2. For intermediate-high-risk PE, heparin alone was used in 90%; ICU and 28-day survival rate was 97%. Three patients exhibited signs of PHT during follow-up.</p><p><strong>Conclusion: </strong>This paper provides insights for the decision-making process involved in managing high and intermedi- ate-high-risk PE drawing from a 5-year retrospective cohort study conducted at an ECMO center and literature review. Fur- ther research is needed to identify the specific subgroup within the intermediate-high-risk PE that would benefit from more advanced treatment modalities for both short and long-term outcomes.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"21-31"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017961","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":"Segmentectomies: 5-Year Experience Of A Center.","authors":"Catarina Nunes Figueiredo, Catarina Moita, Zenito Cruz, Ana Rita Costa, João Santos Silva, João Eurico Reis, João Maciel, Paulo Calvinho","doi":"10.48729/pjctvs.419","DOIUrl":"10.48729/pjctvs.419","url":null,"abstract":"<p><strong>Introduction: </strong>Segmental anatomical resections have been a subject of debate in recent years. There is increasing evidence that these procedures may offer some advantages in the treatment of early-stage lung cancer, with overall survival (OS) and disease-free survival (DFS) similar to those seen in lobar anatomical resections.</p><p><strong>Materials and methods: </strong>We conducted a retrospective analysis of patients who underwent segmentectomy at Santa Marta Hospital (HSM) between January 2018 and September 2022. Patients undergoing trauma-related segmentectomy or as a secondary procedure were excluded.</p><p><strong>Results: </strong>37 segmentectomies were performed, of which 34 were included in this analysis. 29 (85.3%) were performed for malignancies, 5 (14.7%) for benign conditions. Of the malignancies, 24 (82.8%) were primary lung cancer (PLC): 18 (75%) adenocarcinomas (ADC), 2 (8.3%) squamous cell carcinomas (SCC), 4 (16.7%) typical carcinoids (TC); 5 (17.2%) were colorectal-origin metastases. Among the benign cases: 3 (60%) were aspergillomas. Mean age of PLC patients was 71 years (min=56;max=88), with 9 (37.5%) females and 15 (62.5%) males. In 11 (45.8%), FEV1 or DLCO was <60%. 18 (75%) were smokers. Lesions were mostly solid nodules (N=12;50%). Others included subsolid lesions (N=11;45%) and 1 (4.2%) cystic formation. At surgery, only 3 (12.5%) patients had a pre-operative histological diagnosis (ADC=2; SCC=1). 21 (87.5%) were stage IA, 2 (8.33%) patients were stage IB and 1 (8.33%) patient was stage IIA. Procedures were performed via VATS (N=17;70.8%), via thoracotomy (N=5;20.8%) and via RATS (N=2;8.3%). 23 (95.8%) were R0 resections. Postoperatively: 19 (79.2%) were stage IA; 3 (12.5%) IB; ,1 (4.2%) IIB, and 1 (4.2%) IIIA. 3 (12.5%) had upstaging. 2 (8.3%) patients underwent adjuvant chemotherapy, 1 (4.2%) had completion lobectomy. 2 (8.3%) experienced recurrence. DFS was 100% at 3, 6, and 12 months, and at 3 and 5 years, was 88.9% and 66.7% respectively. OS was 100% at 3, 6, and 12 months and 95% at 3 and 5 years. Median follow up time was 29 months (IQR: 18 - 44).</p><p><strong>Conclusion: </strong>This study reinforces the idea that segmental resections should be considered a viable option for patients with early-stage lung cancer. Although this analysis has some limitations, such as a limited number of preoperative histological diagnoses and postoperative upstaging, our results demonstrate promising OS and DFS, in accordance with recent literature.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"33-38"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017974","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":"The Future of Aortic Surgery.","authors":"Florian S Schoenhoff","doi":"10.48729/pjctvs.495","DOIUrl":"https://doi.org/10.48729/pjctvs.495","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"11-14"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017982","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}