Purpose: Whether the lobe-specific lymph node dissection is an alternative to systematic lymph node dissection for early-stage non-small-cell lung cancer remains controversial. An elaborate meta-analysis was conducted to evaluate the effects of lobe-specific lymph node dissection in early-stage patients.
Methods: A systematic literature search was conducted up to February 19, 2020 in PubMed, Ovid, Web of Science, and China National Knowledge Infrastructure databases. The outcomes including overall survival (OS), complications, and recurrence rate were extracted and analyzed.
Results: Nine studies including one randomized controlled trial (RCT) and eight retrospective cohort studies with 8499 non-small-cell lung cancer patients were included. The results indicated that lobe-specific lymph node had a lower rate of postoperative complication (relative risk [RR]: 0.83, 95% confidence interval [CI]: 0.72–0.95, P = 0.006). No significant difference was observed between lobe-specific lymph node and systematic lymph node dissection in OS (hazard rate = 1.12, 95% CI: 0.81–1.54, P = 0.501) with high heterogeneity (I2 = 71.9%).
Conclusion: Lobe-specific lymph node can reach a comparable long-term prognosis in some highly selected patients. However, these results should be viewed cautiously with the existence of high heterogeneity. Due to the high heterogeneity, a strict patient selection process by experienced thoracic surgeons was recommended before validating lobe-specific lymph node.
Background: We report this propensity score matching (PSM) analysis to assess prognostic roles of preoperative gamma-glutamyl transpeptidase to platelet ratio (GPR) in video-assisted thoracoscopic (VATS) lobectomy for stage I-II non-small-cell lung cancer (NSCLC).
Methods: The PSM-based study conducted on our single-center prospectively collected database from January 2014 to August 2015 provided Kaplan–Meier survival analyses using the log-rank test to discriminate differences in overall survival (OS) and disease-free survival (DFS) between patients stratified by preoperative GPR.
Results: Our study includes 379 patients diagnosed with operable primary stage I-II NSCLC. A GPR value at 0.16 was recognized as the optimal cutoff point for prognostic prediction. Both OS and DFS of patients with GPR ≥0.16 were significantly shortened when compared to those of patients with GPR <0.16. Patients with GPR ≥0.16 had significantly lower 5-year rates of OS and DFS than those of patients with GPR <0.16 (P <0.001). Significant associations between GPR and unfavorable survival still are validated in the PSM analysis. Multivariable Cox regression models on both the entire cohort and the PSM cohort consistently demonstrated that an elevated preoperative GPR could be an independent prognostic marker for both OS and DFS of resectable NSCLC.
Conclusions: GPR may be an effective and noninvasive prognostic biomarker in VATS lobectomy for surgically resectable NSCLC.
Objective: The aim of this study was to evaluate the prognostic factors affecting morbidity and mortality among patients who underwent surgery for giant pulmonary hydatid cysts in our center.
Methods: Data from 283 patients who underwent surgery in our center for pulmonary hydatid cyst between 2008 and 2018 were retrospectively analyzed. Cysts 10 cm in diameter or larger were considered giant hydatid cysts.
Results: There were 145 women (51.2%) and 138 men (48.8%). Giant cyst (≥10 cm) was present in 57 patients (20.1%), while the other 226 patients (79.9%) had cysts smaller than 10 cm. Operations were performed using videothoracoscopic approach in 68 patients (24%) and with thoracotomy in 215 patients (76%). Hydatid cysts were on the left side in 129 patients (45.6%), on the right side in 143 patients (50.5%), and bilateral in 11 patients (3.9%). Postoperative morbidity occurred in 29 patients (10.2%). Use of videothoracoscopic surgical approach did not affect morbidity. The mortality rate within the first 90 days was 0.35% (n = 1).
Conclusion: Giant cysts are more common in the young age group than in older adults. Regardless of cyst size, surgery should be performed as soon as possible after diagnosis to avoid potential complications.
Purpose: Autologous pericardium is an ideal material for cardiovascular reconstruction including pulmonary artery plasty. Despite the fact that dehydration by ethanol has been used to improve its surgical handling, the effects of the ethanol on mechanical properties of the pericardium have not been previously investigated. The effects of short-duration ethanol dehydration on the mechanical properties of porcine pericardium were evaluated.
Methods: Porcine pericardia (n = 3) were separated into three groups: the raw group with no treatments (RAW), the group immersed in 70% ethanol for 10 min (ET group), and the group immersed in 0.6% glutaraldehyde for 10 min (GA). We measured five parameters of mechanical properties as specified in ISO 7198.
Results: ET treatment improved surgical handling as well as GA treatment. There were no significant differences in burst pressure (P = 0.639), suture retention strength (P = 0.529), ultimate tensile strength (UTS; P = 0.486), or Young’s modulus (P = 0.408). Only the ultimate strain of the GA group was significantly higher among the three groups (RAW: 33.34% ± 2.02%, ET: 37.48% ± 1.84%, GA: 44.74% ± 2.87%; P = 0.046).
Conclusions: Short-duration ethanol dehydration did not compromise its mechanical properties while maintaining its surgical handling improvements.
Purpose: Graft evaluation after coronary artery bypass grafting (CABG) is still not sufficient. This study analyzed the flow waveform of coronary arteries and grafts during intra-aortic balloon pumping (IABP) assist.
Methods: Subjects were eight pigs that underwent off-pump CABG. Using transit-time flow measurement (TTFM) and occluder, blood flow waveforms were recorded while changing the degree of stenosis of Seg.6 and the left internal thoracic artery (LITA) and analyzed by percentage of reverse flow component to the total blood flow (R/T) and the ratio of diastolic blood flow of IABP operative and IABP inoperative (D1/D0).
Result: Reverse flow of the LITA was reduced when stenosis of Seg.6 increased and R/T decreased. The average diastolic blood flow of Seg.8 and the LITA increased with IABP on showing a D1/D0 of 1 or more. R/T of the LITA increased when stenosis of Seg.6 was fixed and increasing the degree of LITA stenosis. D1/D0 increased up to a 75% LITA stenosis and is decreased in more severe stenosis.
Conclusion: R/T is significantly higher in the antagonist or stenosis during IABP assist and was able to confirm the effectiveness of the graft as a functional assessment of graft. D1/D0 is useful as an indicator of the effectiveness of IABP on coronary blood flow.
Objective: The present study aimed to evaluate short- and middle-term results and postoperative anticoagulation of left atrial appendage (LAA) exclusion with an epicardial clip device.
Materials and Methods: From September 2017 to August 2019, 102 patients at our institution underwent epicardial LAA exclusion using the AtriClip device. Anticoagulation therapy was resumed in the very early postoperative period and continued for at least three months after surgery. The patients’ data were obtained by reviewing their medical records retrospectively.
Results: The mean and median durations of follow-up was 510 ± 184 days and 482 days (range, 216–938 days), respectively. Successful LAA exclusion was confirmed in all but one patient. No device-related complications occurred during surgery. Postoperative computed tomography (CT) findings revealed no migration or displacement of the clips in any patient; however, small clots were observed at the LAA stump in seven patients. Stroke-free rate during the follow-up period was 98.9%.
Conclusion: LAA exclusion using the AtriClip device was a feasible treatment method in terms of its early and middle-term safety and efficacy. In addition, our postoperative anticoagulation strategy could be optimal for maximizing the procedure’s merits, although further studies, involving a larger number of patients and longer duration of follow-up, are needed.
Purpose: Recently, guidelines recommended the use of direct oral anticoagulants (DOACs) for the management of non-valvular atrial fibrillation (NVAF). Postoperative atrial fibrillation (POAF) is the most common post-surgical complication of cardiac surgery, but the efficacy and safety of DOAC for POAF have rarely been investigated. We conducted a prospective observational study to investigate the efficacy and safety of DOAC administered immediately after POAF.
Materials and Methods: In all, 135 patients that experienced POAF after cardiac surgery were treated with a DOAC. Primary endpoints were either bleeding or thromboembolic events. Secondary endpoints included changes in hemoglobin (Hb), prothrombin time (PT), activated partial thromboplastin time (APTT), serum creatinine (sCr), estimated glomerular filtration rate (eGFR), and pleural/pericardial effusion.
Results: Patients were treated with apixaban (n = 31), edoxaban (n = 87), and rivaroxaban (n = 17). Major bleeding (p = 0.011) and gastrointestinal (GI) bleeding (p = 0.047) were significantly more frequent in the rivaroxaban group. Stroke was observed in one rivaroxaban group patient and none in the other two groups.
Conclusion: DOAC as anticoagulation therapy for the early intervention of POAF following cardiac surgery is associated with a low incidence of major bleeding; a favorable safety profile and excellent efficacy were demonstrated for DOAC. Furthermore, our results indicate that the safety and efficacy of apixaban and edoxaban are better than rivaroxaban.
Purpose: To evaluate the safety and efficacy of a novel vascular-friendly thoracic stent graft for patients with acute complicated type B aortic dissection (ac-TBAD).
Methods: A multicenter retrospective study was undertaken in which we prospectively collected data in consecutive ac-TBAD patients treated by thoracic endovascular aortic repair (TEVAR) with the Ankura Thoracic Stent. Complications, true lumen rate (TLR), and mortality were recorded. Follow-up computed tomography angiography (CTA) was performed at 1, 6, and 12 months postoperatively and yearly thereafter.
Results: Altogether, 63 patients with ac-TBAD in four medical centers were included. No deaths or serious complications occurred during the perioperative period. The mean follow-up time was 30.1 ± 18.9 months. All-cause mortality rate was 3.1% (n = 2). TEVAR-related mortality rate was 1.6% (n = 1) because of retrograde type A dissection (RTAD) at 6 months. The other death was caused by acute myocardial infarction (AMI) during the third postoperative month. A distal endoleak detected at 3 months in one patient (1.6%) was treated by reintervention. The use of this novel vascular-friendly thoracic stent graft in ac-TBAD postoperative patients significantly improved their TLR.
Conclusion: The novel vascular-friendly thoracic stent graft showed satisfactory results, with favorable stability of the aortic diameter during follow-up.
We present a case of left ventricular outflow tract (LVOT) obstruction after double valve re-replacement with bioprostheses. A 72-year-old man, who had undergone double valve replacement (DVR) with bioprosthetic valves 9 years previously, underwent re-replacement of valves because of structural valve deterioration. However, owing to LVOT obstruction related to the bioprosthesis in the mitral position, acute pulmonary edema occurred immediately after surgery. LVOT obstruction was diagnosed by emergent cardiac catheterization. So prompt re-replacement surgery using a mechanical prosthesis was performed.
Mechanical circulatory support may result in sufficient myocardial recovery to allow for explantation of the left ventricular assist device (LVAD). The duration of support associated with left ventricular recovery has generally been 6–12 months. In this report, we present a patient in whom the left ventricle recovered after 5 years of support with a LVAD. Our report demonstrates that long-term monitoring for left ventricular recovery is prudent and may allow for late device explantation.