Kazuma Handa, Koichi Maeda, Kyongsun Pak, Kazuo Shimamura, Kizuku Yamashita, Ai Kawamura, Shigeru Miyagawa
{"title":"Midterm Clinical Outcomes after Isolated Surgical and Transcatheter Aortic Valve Replacement in Low-Risk Patients with Aortic Stenosis.","authors":"Kazuma Handa, Koichi Maeda, Kyongsun Pak, Kazuo Shimamura, Kizuku Yamashita, Ai Kawamura, Shigeru Miyagawa","doi":"10.5761/atcs.oa.24-00123","DOIUrl":"10.5761/atcs.oa.24-00123","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the clinical outcomes of isolated surgical aortic valve replacement (SAVR) and transfemoral (TF)-transcatheter aortic valve replacement (TAVR) in low-risk aortic stenosis (AS) patients.</p><p><strong>Methods: </strong>A total of 696 low-risk (Society of Thoracic Surgeons score <4%) AS patients underwent isolated SAVR or TF-TAVR at five centers. After 1:1 propensity score matching, 159 pairs were identified. Early and follow-up events, including cardiac mortality and major adverse cardiac and cerebrovascular events (MACCE: all-cause mortality, heart failure admission, reoperation, prosthetic valve endocarditis, and stroke), were compared.</p><p><strong>Results: </strong>Baseline characteristics are similar between the matched groups. There were no 30-day cardiac mortalities in either group. All-cause mortality and MACCE at 30 days did not differ. During 5-year follow-up (median 3.1 [range 0-7.2] years), the incidence of cardiac mortality (1.3% vs. 18.9%; adjusted hazard ratio [aHR], 8.89; 95% confidence interval [CI], 2.68-29.53; P <0.001), all-cause mortality (4.2% vs. 33.9%; aHR, 8.56; 95% CI, 3.41-21.45; P <0.001), and MACCE (25.1% vs. 47.0%; aHR, 2.36; 95% CI, 1.54-3.63; P <0.001) were lower in the SAVR group than in the TAVR group.</p><p><strong>Conclusions: </strong>Isolated SAVR demonstrated better outcomes in low-risk AS patients. TAVR in this subset should be chosen carefully.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11439598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334222","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}
Toshiyuki Nagata, Masaya Aoki, Koki Maeda, Go Kamimura, Aya Takeda, Masami Sato, Kazuhiro Ueda
{"title":"En Bloc Resection of a Primary Tumor and Lymph Nodes in Non-Small-Cell Lung Cancer.","authors":"Toshiyuki Nagata, Masaya Aoki, Koki Maeda, Go Kamimura, Aya Takeda, Masami Sato, Kazuhiro Ueda","doi":"10.5761/atcs.oa.24-00108","DOIUrl":"10.5761/atcs.oa.24-00108","url":null,"abstract":"<p><strong>Purpose: </strong>We established a novel surgical procedure for resectable non-small-cell lung cancer (NSCLC), which involves resection of the affected lobe and regional lymph nodes without separation, namely en bloc surgery. We introduced the technical details and early and late outcomes by comparing them with those of conventional surgery.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent lobectomy with hilar and mediastinal lymph node dissection for stages I-III NSCLC. A propensity score-matched analysis was performed based on demographic variables.</p><p><strong>Results: </strong>Propensity score-matching yielded 317 pairs. En bloc surgery was not associated with a longer operation time, a higher amount of intraoperative bleeding, or a higher frequency of postoperative complications. The number of resected lymph nodes (P = 0.277) and frequency of N upstaging (P = 0.587) did not differ between the groups. However, en bloc surgery was associated with higher overall survival in comparison to conventional surgery (P = 0.012). According to a stratification analysis, the survival advantage of en bloc surgery over conventional surgery was remarkable in pathological N-positive disease (P = 0.005), whereas it disappeared in pathological N-negative disease (P = 0.147).</p><p><strong>Conclusion: </strong>En bloc surgery is feasible and can be performed in patients with possible N-positive NSCLC.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11381205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134731","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":"Prognostic Significance of CONUT Score in Elderly NSCLC.","authors":"Masaya Tamura, Takashi Sakai, Naoki Furukawa, Marino Yamamoto, Ryohei Miyazaki, Hironobu Okada","doi":"10.5761/atcs.oa.24-00009","DOIUrl":"10.5761/atcs.oa.24-00009","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the Controlling Nutritional Status (CONUT) score as a prognostic predictor in elderly non-small cell lung cancer (NSCLC) patients with surgical resection.</p><p><strong>Methods: </strong>Overall, 114 patients over 80 years old undergoing curative resection for NSCLC were retrospectively analyzed. Receiver operating characteristic (ROC) analysis was conducted to evaluate the capacity of immune-inflammatory markers to predict overall survival (OS). Cox-proportional hazards regression analysis was implemented to investigate prognostic markers for OS.</p><p><strong>Results: </strong>Based on ROC curves, the CONUT score was found to be the most valuable prognostic marker (area under the curve = 0.716). The high CONUT (≥2) group included 54 patients, and the low CONUT (0 or 1) group included 60 patients. The high CONUT group had poorer prognosis rates compared to the low CONUT group with regard to OS (5-year OS: 46.3% vs. 86.0%, p = 0.0006). In the multivariate data analysis, histology, lymphatic invasion, and CONUT score (hazard ratio: 4.23, p = 0.0003) were found to be exclusive and independent prognostic markers for OS.</p><p><strong>Conclusion: </strong>Preoperatively, the CONUT score can be used as a novel prognostic marker in elderly NSCLC patients. CONUT evaluations can also be used to design nutritional interventions to improve patient outcomes.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11082491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874363","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":"Beyond the Deus Ex Machina of Goal-Directed Perfusion: A Holistic Approach to Oxygen Delivery in Cardiac Surgery.","authors":"Ignazio Condello","doi":"10.5761/atcs.lte.24-00124","DOIUrl":"10.5761/atcs.lte.24-00124","url":null,"abstract":"","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115882","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":"Strategies to Minimize Sternal and Leg Wound Complications after Coronary Artery Bypass Grafting Using No-Touch Saphenous Vein Grafts.","authors":"Min-Seok Kim, Seong Wook Hwang, Ki-Bong Kim","doi":"10.5761/atcs.oa.23-00154","DOIUrl":"10.5761/atcs.oa.23-00154","url":null,"abstract":"<p><strong>Purpose: </strong>The aims of the present study were to examine sternal and saphenous vein (SV) harvest site wound complication rates, and to assess the strategies to minimize the sternal and leg wound complications after coronary artery bypass grafting using a no-touch (NT) SV.</p><p><strong>Methods: </strong>Patients who underwent coronary artery bypass grafting (CABG) using internal thoracic artery (ITA) and/or NT SV grafts from March 2021 to June 2023 (N = 166) at a newly opened cardiac surgical program were included. We obeyed the current guidelines for the prevention of sternal wound infection. In addition, unilateral ITA was used in most of the patients and the sternal wound was meticulously closed using multiple sternal wires (≥7) and ZipFix. For the NT SV harvesting, the LigaSure device was used to minimize thermal injury, and the wound was meticulously closed.</p><p><strong>Results: </strong>Sternal wound infections developed in 3/166 (1.8%) patients; all three patients showed superficial sternal wound infections. Leg wound complications were present in 2/153 (1.3%) patients, who recovered after secondary intention healing.</p><p><strong>Conclusion: </strong>Sternal wound complications after CABG could be minimized by the unilateral ITA usage, meticulous closure of the sternal wound in addition to compliance with the current guidelines. Wound complications after NT SV harvest may also be minimized by preoperative evaluation, careful harvesting, and meticulous wound closure.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10902855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699070","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":"Videothoracoscopic First Rib Resection for Neurogenic Thoracic Outlet Syndrome: Results of 13 Patients.","authors":"Onur Derdiyok, Ugˇur Temel","doi":"10.5761/atcs.oa.23-00110","DOIUrl":"10.5761/atcs.oa.23-00110","url":null,"abstract":"<p><strong>Purpose: </strong>To present the clinical experience in video-assisted thoracic surgery (VATS) of first rib resection for patients with neurogenic thoracic outlet syndrome (NTOS).</p><p><strong>Methods: </strong>The files of 13 patients (10 males, 3 females) having unilateral NTOS undergoing first rib resection via VATS were retrospectively investigated. The symptoms, operative times, durations of chest tube and hospital stay, complications, and postoperative courses were analyzed. All patients underwent VATS using a camera port and 3-5 cm utility incision.</p><p><strong>Results: </strong>There was no morbidity. The average operation time was 81 ± 11 min (range 65-100 min). Chest tubes were removed in the first or second postoperative day (mean 1.23 ± 0.43 days). The mean postoperative length of hospital stay was 2.1 ± 0.9 days (range 1-3 days). The average duration of follow-up was 19 ± 13 months (range 2-38 months). Ten patients completed a follow-up during 6 months. One patient (10%) had minor residual symptoms, and the remaining patients (90%) were fully asymptomatic.</p><p><strong>Conclusion: </strong>The VATS approach in the resection of the first rib for thoracic outlet syndrome is a safe method. It should be performed with acceptable risks under experienced hands. The magnified view and optimal visualization from the scope are beneficial. Avoiding neurovascular bundle retraction may seem to decrease the postoperative pain.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10902856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139992008","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":"Review of the Japanese Classification of Esophageal Cancer 12th Edition, and Proposals for the 13th Edition.","authors":"Shinji Mine","doi":"10.5761/atcs.ra.24-00061","DOIUrl":"10.5761/atcs.ra.24-00061","url":null,"abstract":"<p><p>In this review, we summarize the modifications made in the Japanese Classification of Esophageal Cancer 12th edition, identify several issues, and discuss the prospects for the next 13th edition.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11219218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141473356","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":"Thoracoscopic Sublobectomy for Lung Cancer in a Patient with Unilateral Absence of Pulmonary Artery: Case Report and Narrative Review.","authors":"Jiangshan Ai, Lianzheng Zhao, Huijiang Gao","doi":"10.5761/atcs.cr.24-00115","DOIUrl":"10.5761/atcs.cr.24-00115","url":null,"abstract":"<p><p>Unilateral absence of a pulmonary artery (UAPA) is an uncommon congenital anomaly. Among the rarer conditions, UAPA with lung cancer has been previously reported in 13 cases; however, there remains controversy regarding the surgical approach and precautions. Herein, we present a case study of a 56-year-old female patient who was incidentally diagnosed with a nodule in the right lower lobe of the lung during a routine physical examination and subsequently found to have an absent right pulmonary artery upon preoperative evaluation. A wedge resection of the right lower lobe was performed as treatment. Postoperative pathology confirmed invasive adenocarcinoma (pT1N0M0). We provide a narrative review of existing literature on these patients and discuss optimal surgical management strategies.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482823","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":"Temporary Stenting for Anastomotic Stenosis after Tracheal Resection of Adenoid Cystic Carcinoma: A Case Report.","authors":"Ryosuke Amemiya, Ikki Takada, Taisuke Matsubara, Shotaro Ono, Yukio Morishita, Norihiko Ikeda, Kinya Furukawa","doi":"10.5761/atcs.cr.22-00009","DOIUrl":"10.5761/atcs.cr.22-00009","url":null,"abstract":"<p><p>A 51-year-old man who noticed discomfort in the pharynx was found to have a tracheal tumor on physical examination. He was diagnosed as having adenoid cystic carcinoma by a transbronchial biopsy and underwent tracheal segmental resection via a collar incision. He was additionally treated with radiation therapy owing to a positive surgical margin, and he subsequently developed anastomotic tracheal stenosis. Silicon stent placement to open the airway was performed for the tracheal stenosis. One year after stent placement, the trachea was dilated, so the stent was removed, and he is still under follow-up without recurrence free 1.5 years after stent replacement.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":" ","pages":"256-260"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/20/atcs-29-256.PMC10587473.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686208","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":"Two Cases of Surgical Correction of Recurrent Mitral Regurgitation due to Failed Catheter- Delivered Mitral Clip (MitraClip).","authors":"Masahide Komagamine, Kan Nawata, Shota Kita, Kiyoshi Chiba, Shingo Kuwata, Yoshihiro Akashi, Takeshi Miyairi","doi":"10.5761/atcs.cr.22-00002","DOIUrl":"10.5761/atcs.cr.22-00002","url":null,"abstract":"<p><p>From April 2018 to February 2021, 150 patients underwent MitraClip implantation for severe functional mitral regurgitation (MR) at our hospital. Two of our patients, an 85-year-old man and an 84-year-old woman, developed a single leaflet device attachment in the acute phase after the implantation and had severe residual MR requiring surgical correction. The recurrent MR was first pointed out on day 5 and day 4, and the duration between MitraClip implantation and surgery was 13 and 55 days, respectively. Due to strong adhesions with the clips and severe valve damage after MitraClip implantation, both cases underwent mitral valve replacement with a good postoperative course. In patients with a high-risk baseline profile, surgical mitral valve replacement after failed MitraClip implantation should be considered at an optimal timing, and a detailed echocardiographic follow-up is required.</p>","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":" ","pages":"266-269"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/19/2b/atcs-29-266.PMC10587475.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686209","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}