Purpose: Knowledge regarding programmed death-ligand 1 (PD-L1) expression in lung cancer is limited. We aim to clarify PD-L1-positive expression in non-small-cell lung cancer (NSCLC), including adenocarcinoma subtypes.

Methods: In all, 90 NSCLC specimens containing various adenocarcinoma subtypes, in addition to squamous cell carcinoma and large-cell carcinoma were selected. PD-L1 was immunohistochemically stained by murine monoclonal antibody clone 22C3.

Results: When PD-L1-positive expression was defined by tumor proportion score (TPS) ≥1%, the positive cases were 0/11 in adenocarcinoma in situ, 0/12 in minimally invasive adenocarcinoma, 1/10 in lepidic predominant adenocarcinoma, 1/13 in papillary predominant adenocarcinoma, 8/14 in acinar predominant adenocarcinoma, 6/11 in solid predominant adenocarcinoma, 0/3 in micropapillary predominant adenocarcinoma, 0/4 in invasive mucinous adenocarcinoma, 4/9 in squamous cell carcinoma, and 2/3 in large-cell carcinoma. PD-L1 positivity was higher in males, smokers, advanced pathologic stages, positive vessel invasion, and positive lymphatic invasion. Postoperative survival analysis revealed that PD-L1-positive expression was a significantly worse prognostic factor in univariate analysis for recurrence-free survival (RFS).

Conclusion: PD-L1-positive tumors were frequent in acinar predominant adenocarcinoma and solid predominant adenocarcinoma than other adenocarcinoma subtypes. PD-L1 expression seemed to increase according to pathologic tumor progression, suggesting a worse postoperative prognosis in NSCLC patients.

Purpose: The purpose of this study was to evaluate the effect of different cardioplegic solutions on endothelial integrity and oxidative stress in cardiovascular surgery.

Methods: In this randomized prospective study, after ethics approval and informed consent, 60 surgical patients were included. Patients undergoing coronary bypass surgery were randomized into two groups as warm blood cardioplegia (n = 30) and cold crystalloid cardioplegia (n = 30) following the cross-clamping. Measurements were performed at three time points: before induction of anesthesia (T1), at admission to intensive care unit (ICU) (T2) and at the 24th postoperative hour (T3). Besides biochemical routine hemodynamic monitoring, patients were assessed for the sialic acid (SA), ischemic-modified albumin (IMA), advanced oxide protein products (AOPPs), total thiol (SH), and free hemoglobin (fHb) level.

Results: Neither crystalloid nor blood cardioplegia led to significant changes in the AOPPs, T-SH, and SA level (p >0.05). Crystalloid cardioplegia, however, increased IMA level compared to both baseline (p <0.01) and blood cardioplegia group (p <0.05). fHb levels were transiently increased in both groups at the second-time point (p <0.001). fHb level was lower in the crystalloid group compared to that in the other group (p <0.05) at T2.

Conclusion: Cardioplegia type creates similar effects on glycocalyx integrity. However, myocardial protection could be provided with warm blood cardioplegia.

Background: To report single-institution experience with minimally invasive mitral valve operations through the right minithoracotomy over a 5-year period.

Methods: Patients who underwent minimally invasive mitral valve surgery (MIMVS) between January 2012 and December 2016 were included. Clinical follow-up data were collected in a prospective database and analyzed retrospectively.

Results: Data from 151 patients were assessed (mean age, 63.4 ± 9.7 years; 55% were females). Overall 30-day mortality was 0.7% (n = 1). Mean operating time, cardiopulmonary bypass, and aortic cross-clamp times were 254.9 ± 48.7, 140.5 ± 36.1, and 94.8 ± 27.0 minutes, respectively. Associated procedures were tricuspid valve annuloplasty (37.1%, n = 56) and closure of atrial septal defect (6.0%, n = 9). Cryoablation was performed in 43.7% of patients (n = 66). One patient (0.7%) required conversion to median sternotomy and six patients (4.0%) underwent re-explorations due to bleeding. Median postoperative hospital stay was 12 days. Overall survival at 5 years was 94.1% ± 2.0%. Freedom from reoperation was 94.6% ± 2.9% at 5 years.

Conclusions: MIMVS is a feasible, safe, and reproducible approach with low mortality and morbidity. Mitral valve surgery through a small thoracotomy is a good alternative to conventional surgical access.

Objective: Suvorexant is an orexin receptor antagonist and is effective in inducing sleep. We hypothesized that Suvorexant would reduce the incidence of postoperative delirium (POD) after coronary artery bypass grafting (CABG).

Methods: We reviewed 88 patients (12 women, mean age: 69.3 ± 2.5 years) who were undergone CABG alone. Patients were divided into two groups; patients received Suvorexant (S group, n = 36), patients not received Suvorexant (N group, n = 52), and the following data were analyzed and compared between two groups.

Results: Intensive Care Unit Delirium Screening Checklist Score was significantly lower in S group compared with N group (N:S = 2.0 ± 1.7:0.8 ± 1.0, p = 0.0003). Although POD was present in 11 of 52 patients (21.2%) in N group, one patient (2.8%) developed in S group (p = 0.008). In S group, both intensive care unit stay (N:S = median 6:5 days, p = 0.001) and hospital stay (N:S = median 23:20 days, p = 0.035) were significantly shorter than in N group.

Conclusions: Suvorexant might reduce incidence of POD in patients undergone CABG.

Objective: The aim of this retrospective study was to investigate the early operative results and detect the factors influencing the fate of radial artery grafts (RAGs) by evaluating the mid-term patency.

Methods: We retrospectively reviewed 410 patients who underwent isolated coronary artery bypass grafting using RAG. RAGs were anastomosed to 526 coronary arteries. Mid-term angiography was performed in 214 patients at an average 4.9 years after the operation.

Results: The early patency of RAGs was 97.6%. Cumulative 5-year patency was 86.5% for RAG, 94.1% for LITA graft, and 81.0% for saphenous vein graft (SVG). RAG was significantly superior to SVG in mid-term patency. Individual grafting (not sequential grafting) (hazard ratio [HR]: 2.535; 95% confidence interval [CI]: 1.293–5.281; p = 0.006) and grafting to the target coronary artery with ≤75% proximal stenosis (HR: 1.947; 95% CI: 1.090–3.484; p = 0.025) were found to be independent risk factors influencing late RAG patency.

Conclusions: The patency of RAGs was superior to that of SVGs in the studied population. When using RAGs, grafting to the target vessel with severe proximal stenosis is favorable. The RAG is suitable for sequential grafting.

Purpose: In this study, we aim to investigate the efficacy and clinical results of using Del Nido solution (DNS) in coronary artery bypass grafting (CABG) surgery by comparing with intermittent warm blood cardioplegia (IWBC).

Methods: Between March 2017 and February 2018, 297 adult patients who underwent primary isolated CABG surgery with cardiopulmonary bypass (CPB) were included in the study. We used DNS in 112 patients and IWBC was used in 185 patients. We compared both the clinical and the laboratory results.

Results: Aortic cross-clamp time, CPB time, and peak glucose level are lower with DNS. But we did not observe any meaningful difference of clinical results between two methods including postoperative myocardial enzyme release.

Conclusion: Del Nido cardioplegia was developed for immature heart and pediatric surgery. But in our opinion, it is a good and useful alternative to CABG surgery with similar results to IWBC.

Purpose: This study analyzed the different levels of aortic remodeling in patients with DeBakey IIIb aortic dissection (AD) after thoracic endovascular aortic repair (TEVAR) at a single center.

Methods: In all, 66 patients with DeBakey IIIb AD who underwent TEVAR in the acute (Group A) or subacute phase (Group SA) from January 2012 to October 2016 were included in the study. The change in aortic lumen (A), true lumen (TL), false lumen (FL), and true lumen index (TLi) at different levels were analyzed.

Results: There was no statistically significant difference in the clinical information and morphologic imaging findings in Groups A and SA. At proximal levels (levels A–C), there was no difference in aortic remodeling parameters, that is, increased TL, decreased FL, and increased TLi at levels B and C and stable A at levels A–C, in both groups. Moreover, the above parameters were illustrated using a box-and-whisker plot, which revealed the unstable acute phase by the larger distribution interval and the median and abnormal values of the right skew distribution in Group A.

Conclusion: Postoperative surveillance is important for patients of both acute and subacute AD.

Background: Because left upper division resection is similar to right upper lobectomy, this procedure is frequently employed. Few studies have used the anatomic courses of veins evaluated on preoperative computed tomography (CT) imaging to determine what types of patients are at the highest risk for hemorrhagic pulmonary infarction.

Case: We describe our experience with a patient in whom hemorrhagic pulmonary infarction occurred at 6 days after transecting two superior branches (V¹ and V³) of the three branches of the left superior pulmonary vein. We preoperatively confirmed that small-caliber lingular veins were perfused by V³. However, the patient had a poor pulmonary function, and the tumor was located distal to V³. Left upper division resection was therefore performed.

Conclusion: The division of V³ could be the cause of hemorrhagic infarction in the lingular segment after upper division segmentectomy.

Cardiac tumors are relatively rare, with primary hemangiomas being a particularly rare benign neoplasm. Herein, we report a case of a symptomatic cardiac tumor detected via echocardiography in an 82-year-old woman. Although we performed advanced imaging examinations for her heart, we could not diagnose the tumor before surgery. Eventually, a tumor involving the left atrial roof was detected, and it was completely resected to relieve her symptoms and establish a precise diagnosis. Histopathological examination indicated a cardiac cavernous hemangioma. The patient exhibited an uneventful recovery without any complications.