Pulmonary metastases are a sign of advanced malignancy and an omen of poor prognosis. Once primary tumors metastasize, they become notoriously difficult to treat and interdisciplinary management often involves a combination of chemotherapy, radiotherapy, and surgery. Over the last 25 years, the emerging body of evidence has recognized the curative potential of pulmonary metastasectomy. Surgical resection of pulmonary metastases is now commonly considered for patients with controlled primary disease, absence of widely disseminated extrapulmonary disease, completely resectable lung metastases, sufficient cardiopulmonary reserve, and lack of a better alternative systemic therapy. Since the development of these selection criteria, other prognostic factors have been proposed to better predict survival and optimize the selection of surgical candidates. Disease-free interval (DFI), completeness of resection, surgical approach, number and laterality of lung metastases, and lymph node metastases all play a dynamic role in determining patient outcomes. There is a definite need to continue reviewing these prognosticators to identify patients who will benefit most from pulmonary metastasectomy and those who should avoid unnecessary loss of lung parenchyma. This literature review aims to explore and synthesize the last 25 years of evidence on the long-term survival, prognostic factors, and patient selection process for pulmonary metastasectomy.
Purpose: Platelets are crucial components of the coagulation processes, and low admission platelet count (PLC) is associated with adverse clinical outcomes in patients with Stanford type A acute aortic dissection (AAD).
Methods: A total of 130 consecutive patients undergoing Stanford type A AAD surgery in Beijing Anzhen Hospital were enrolled between January 2013 and July 2014. Preoperative clinical and laboratory data from patients were collected. Multiple regression analyses were used to determine the independent factors of low admission platelets.
Results: Adjusted multiple regression analysis showed that age (β: −1.069, 95% confidence interval [CI]: −2.109, −0.029), sex (β: −29.973, 95% CI: −56.512, −3.433), tissue factor pathway inhibitor (TFPI; β: 0.197, 95% CI: 0.039, 0.354), fibrinogen degradation product (FDP) (β: −0.476, 95% CI: −0.879, −0.074), and attack time (β: 11.125, 95% CI: 7.963, 14.287) were significantly associated with admission PLC. Admission PLC increased with attack time up to the 3 days (β: 16.2, 95% CI: 12.1, 20.2).
Conclusions: We found that increasing age, male patients, patients with lower serum levels of TFPI and higher serum levels of FDP, and patients with a shorter attack time were significantly associated with lower PLC at admission. Moreover, the turning point of attack time is 3 days after the onset of dissection.
Purpose: Epicardial adipose tissue (EAT) is associated with atrial fibrillation. We investigated the effect of EAT on postoperative atrial fibrillation (POAF) after cardiac surgery.
Methods: In all, 77 patients underwent scheduled cardiac surgery. Before the operation, we measured total epicardial adipose tissue (Total EAT) and left atrial (LA) EAT by three-dimensional computed tomography (CT). During surgery, we obtained samples of the right atrial appendage, aortic fat, and epicardial fat. The primary endpoint was occurrence of POAF within 1 week after surgery.
Results: POAF occurred in 21 patients (27%). Assessment of preoperative characteristics revealed significant differences of age and the use of aldosterone blockers and loop diuretics between the patients with and without POAF. In univariate analysis, the LA EAT/Total EAT ratio, age, use of aldosterone blockers and loop diuretics, P wave duration, cardioplegia volume, and central venous pressure (CVP) were all higher in POAF group. However, logistic regression analysis with propensity score matching found no significant differences of these factors although the LA EAT/Total EAT ratio was higher in POAF group.
Conclusion: The use of loop diuretics showed the strongest association with POAF. Logistic regression analysis suggested that a high LA EAT/Total EAT ratio had the second strongest association with POAF.
Purpose: In the treatment of the postsurgical pericardial effusions via pericardiocentesis, determination of the puncture site might be difficult. Contrast echocardiography may not be efficient due to surgical artefacts and pulmonary problems and therefore may lead to inaccurate evaluation. Alternative imaging methods might be helpful to perform the pericardiocentesis with decreased complications.
Methods: We retrospectively analyzed the patients who had undergone pericardiocentesis in our department from January 2008 through April 2018. The procedure was performed in slightly semi-seated position with the guidance of the echocardiography and fluoroscopy. Following the catheterization, percutaneous drainage was performed.
Results: There were 63 patients needed intervention due to pericardial effusion. 67% of the patients were using warfarin and the next patients were using acetyl salicylic acid and/or clopidogrel. All effusions were in the posterolateral localization. The mean volume of aspirated pericardial fluid was 404 ± 173 mL (150–980 mL). Control echocardiograms showed that almost all fluid was drained in all patients and there were no procedural or follow-up complications.
Conclusion: In the treatment of postoperative pericardial effusion, fluoroscopy is an alternative method to locate the catheter accurately in challenging situations following cardiac surgery. Thus, procedural risk minimizes and drainage of pericardial fluid is performed safely.
We devised a simple modification of the Florida Sleeve procedure to perform aortic valve-sparing surgery. This technique is simple, quick, effective, and safe. We used this technique in operations performed on two young patients with Marfan syndrome. The initial and short-term results were satisfactory.
A 70-year-old man underwent emergent primary central repair for acute type A aortic dissection (AAAD) with right upper extremity ischemia. Ascending aorta and hemi-arch replacement concomitant with additional right upper peripheral bypass was performed for persistent right upper arm ischemia. The early reperfusion injury (RI) of the right upper extremity was defined the next day, and managed by continuous hemodialysis (CHD) and infusion therapy, resulting in the arm being salvaged. This is an extremely rare adverse phenomenon, and we herein described its successful treatment with perioperative intensive management following central repair of AAAD.
Background: Repair of doubly committed subarterial ventricular septal defects (DCVSD) via a minimal mid-partial sternotomy has not been reported. We aimed to evaluate the feasibility and safety of this procedure.
Methods: We retrospectively reviewed all patients with a clinical diagnosis of DCVSD and underwent repair via minimal mid-partial sternotomy at our institution. Patient characteristics, perioperative, and follow-up data were collected.
Results: A total of 13 patients who underwent minimal mid-partial sternotomy DCVSD repair were analyzed. Postoperative echocardiogram revealed that no patient had the residual shunt. No patient reported adverse event during postoperative course. There was no perioperative or late death during follow-ups. All patients were satisfied with the inconspicuous scar.
Conclusions: Minimal mid-partial sternotomy is a safe and effective approach for DCVSD repair with satisfied treatment outcomes and cosmetic benefits.