Annals of Thoracic and Cardiovascular Surgery
Online ISSN : 2186-1005
Print ISSN : 1341-1098
ISSN-L : 1341-1098
Volume 27, Issue 4
Displaying 1-10 of 10 articles from this issue
Original Articles
  • Satoshi Yajima, Takashi Suzuki, Tatsuki Nanami, Yoko Oshima, Yoshinori ...
    2021 Volume 27 Issue 4 Pages 219-224
    Published: 2021
    Released on J-STAGE: August 20, 2021
    Advance online publication: January 06, 2021
    Supplementary material

    Purpose: To compare efficacy and safety of dual docetaxel/nedaplatin treatment versus docetaxel alone as second-line chemotherapy for advanced esophageal cancer.

    Methods: In all, 36 patients with metastatic and/or recurrent esophagus squamous cell carcinoma resistant to first-line chemotherapy (fluorouracil/cisplatin) were recruited from 2011 to 2018 and randomized into two groups. Treatment response and survival were compared between the docetaxel/nedaplatin (60/80 mg/m2/day) group and docetaxel (70 mg/m2/day) group. Treatment was repeated every 3 weeks until tumor progression. Patients were followed up until March 2019 or death.

    Results: The frequency of Grade 3 or higher adverse events in the docetaxel/nedaplatin group (58.8%) was higher compared with the docetaxel group (26.3%) (P = 0.090). We found a treatment response rate of 52.9% and 36.8% and a median survival of 8.9 and 7.0 months in the docetaxel/nedaplatin-treated and docetaxel-treated group, respectively (P = 0.544).

    Conclusion: No significant survival advantage was found for docetaxel/nedaplatin-treated patients, although there was an increased frequency of high-grade adverse events compared to docetaxel-treated patients. Because of the limited cohort size, a Phase III study based on our findings is not warranted to assess the clinical impact of docetaxel/nedaplatin treatment. This trial is registered with the University Hospital Medical Information Network (UMIN 000005877).

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  • Cemal Aker, Celal Bugra Sezen, Mustafa Vedat Dogru, Selin Onay Mahmuti ...
    2021 Volume 27 Issue 4 Pages 225-229
    Published: 2021
    Released on J-STAGE: August 20, 2021
    Advance online publication: November 19, 2020

    Background: Our aim in this study was to compare the results of video-assisted thoracoscopic surgery with those of open surgery regarding efficacy, morbidity, and long-term recurrence of bronchogenic cysts in light of the literature.

    Methods: This study comprises the data of 51 patients whose pathological diagnosis revealed bronchogenic cyst after surgical excision between January 2010 and December 2016. There were two groups according to the type of resection: video-assisted thoracoscopic surgery (VATS) and thoracotomy.

    Results: Of the patients included in the study, 25 (49%) were male and 26 (51%) were female. Their average age was 41.7 ± 14.1 years. While 14 patients (27.5%) were asymptomatic in the preoperative period, 37 patients (72.5%) had symptoms. The Charlson Comorbidity Index was 0 in 35 patients (68.6%) and 1 and above in 16 patients (31.4%). While 22 (43.1%) patients underwent cyst excision via VATS, 29 (56.9%) patients underwent thoracotomy. The average length of hospital stay was 1.77 ± 0.68 days for patients who had VATS, whereas it was 3.82 ± 3.3 days for patients who had thoracotomy (p <0.001).

    Conclusion: VATS procedure is a safe method in the surgical treatment of bronchogenic cysts, with less hospitalization and similar recurrence rates.

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  • Yasuyuki Kanamoto, Yukinori Sakao, Hiroaki Kuroda, Noriaki Sakakura, M ...
    2021 Volume 27 Issue 4 Pages 230-236
    Published: 2021
    Released on J-STAGE: August 20, 2021
    Advance online publication: December 18, 2020

    Objectives: We would like to clarify the imaging findings of the main tumor that may omit the requirement for lymph node dissection in clinical IA (cIA) lung adenocarcinoma.

    Methods: A total of 336 patients with cIA lung adenocarcinomas with normal preoperative carcinoembryonic antigen (CEA) who underwent surgical resection were analyzed. We investigated the association between various computed tomography (CT) imaging findings or the maximum standardized uptake value (SUVmax) of fluorodeoxyglucose-position emission tomography (FDG-PET) and lymph node metastasis. The maximum tumor diameter was calculated from the CT images using both the lung window setting (LD) and mediastinal window setting (MD). The diameter of the solid component (CD) was defined as consolidation diameter in lung window setting. The solid component ratio (C/T) was defined as CD/LD.

    Results: SUVmax, MD, and C/T were independent factors related to lymph node metastasis, but CD was not (p = 0.38). The conditions required for the positive predictive value (PPV) to reach 100% were 10.6 mm for MD, 12.5 mm for CD, and 0.55 for C/T. SUVmax did not reach 100%.

    Conclusions: In cIA lung adenocarcinoma with CEA in the normal range, we found that it may be possible for lymph node dissection to be omitted by MD, CD, and C/T.

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  • Ying-Yuan Chen, Wei-Li Huang, Chao-Chun Chang, Yi-Ting Yen, Yau-Lin Ts ...
    2021 Volume 27 Issue 4 Pages 237-243
    Published: 2021
    Released on J-STAGE: August 20, 2021
    Advance online publication: November 25, 2020

    Purpose: Uniportal video-assisted thoracoscopic surgery (VATS) complex segmentectomy has been challenging for thoracic surgeons. This study was designed to compare the perioperative outcomes between uniportal and multiportal VATS complex segmentectomy.

    Methods: Data on a total of 122 uniportal and 57 multiportal VATS complex segmentectomies were assessed. Propensity score (PS) matching yielded 56 patients in each group. A crude comparison and PS matching analyses, incorporating preoperative variables, were conducted to elucidate the short-term outcomes between uniportal and multiportal VATS complex segmentectomies.

    Results: The uniportal group had a significantly shorter operation time (173 min vs. 195 min, p = 0.004), pleural drainage duration (2.5 d vs. 3.5 d, p <0.001), and postoperative hospital stay (4.2 d vs. 5.3 d, p <0.001) before matching, and a significant difference was also observed after matching for pleural drainage duration (2.5 d vs. 3.6 d, p <0.001) and postoperative hospital stay (4.5 d vs. 5.2 d, p = 0.001). The numbers of dissected lymph nodes in N1 and N2 stations, the intraoperative and postoperative complication rates were not significantly different between these two groups.

    Conclusions: The uniportal VATS complex segmentectomy was not inferior to multiportal VATS in terms of perioperative outcomes and therefore should be considered as a viable surgical approach for treatment.

    Editor's pick

    September 2022 Editors' Pick

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  • Ilhan Inci, Mace M. Schuurmans, Claudio Caviezel, Sven Hillinger, Isab ...
    2021 Volume 27 Issue 4 Pages 244-250
    Published: 2021
    Released on J-STAGE: August 20, 2021
    Advance online publication: January 20, 2021

    Background: Cadaveric lobar lung transplantation (L-LTx) is developed to overcome donor–recipient size mismatch. Controversial short- and long-term outcomes following L-LTx have been reported compared to full-sized lung transplantation (F-LTx). This study reports long-term outcomes after L-LTx.

    Methods: We reviewed patients undergoing lung transplantation (LTx) between 2000 and 2016. The decision to perform L-LTx was made based mainly on donor–recipient height discrepancy and visual assessment of donor lungs. Predicted donor–recipient total lung capacity (TLC) ratio was calculated more recently. Primary outcome was overall survival.

    Results: In all, 370 bilateral LTx were performed during the study period, among those 250 (67%) underwent F-LTx and 120 (32%) underwent L-LTx, respectively. One- and 5-year survival rates were 85% vs. 90% and 53% vs. 63% for L-LTx and F-LTx, respectively (p = 0.16). Chronic lung allograft dysfunction (CLAD)-free survival at 5 years was 48% in L-LTx vs. 51% in F-LTx recipients (p = 0.89), respectively. Age, intraoperative extracorporeal membrane oxygenation (ECMO) use, intensive care unit (ICU) stay, and postoperative renal replacement therapy (RRT) were significant prognostic factors for survival using multivariate analysis.

    Conclusions: Overall survival and CLAD-free survival following L-LTx were comparable to F-LTx. Given the ongoing donor organ shortage, cadaveric L-LTx remains as an important resource in LTx.

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  • Changcun Fang, Chen Wang, Kai Liu, Xinyan Pang
    2021 Volume 27 Issue 4 Pages 251-259
    Published: 2021
    Released on J-STAGE: August 20, 2021
    Advance online publication: December 18, 2020

    Background: More evidence was required to guide the management of left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR). The present study aimed to compare the outcomes of LSA coverage with LSA revascularization. Another purpose of this study was to share our experience of LSA revascularization with castor single-branched stent-graft.

    Methods: From January 2016 to December 2019, 134 patients with type B aortic dissection (TBAD) or intramural hematoma (IMH) were enrolled and divided into two groups, the LSA-covered group (n = 61) and the LSA-revascularized group (with castor single-branched stent-graft, n = 73). The results, such as in-hospital and 30-day mortality, stroke, paraplegia, left arm ischemia, operation time, endoleak, were compared between the two groups.

    Results: The incidence of 30-day stroke in the LSA-covered group (8.2%) was significantly higher compared with the LSA-revascularized group (0%, P = 0.018). 30-day ischemia of left arm occurred in more patients in the LSA-covered group (11.5%, P = 0.003). No statistical difference was found in the incidences of paraplegia, endoleak, in-hospital mortality, and 30-day mortality.

    Conclusions: LSA should be revascularized during TEVAR to reduce the incidences of stroke and left arm ischemia. Castor single-branched stent-graft was feasible and safe for treating TBAD or IMH.

    Editor's pick

    September 2022 Editor's Pick 

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Case Reports
  • Haruhiko Shiiya, Yasuhiro Suzuki, Shigeo Yamazaki, Kichizo Kaga
    2021 Volume 27 Issue 4 Pages 260-263
    Published: 2021
    Released on J-STAGE: August 20, 2021
    Advance online publication: March 11, 2019

    We describe a 36-year-old asymptomatic female with multiple bronchial artery aneurysms (BAAs) and a bronchial artery (BA) to pulmonary artery (PA) fistula. She was treated with thoracoscopic BA resection without lobectomy in lieu of catheter embolization as first-line treatment. The configuration of the BA and the location of the BAAs were clearly visualized using three-dimensional computed tomography (3DCT); therefore, the segment of the BA to resect was assessed preoperatively and complete resection of all BAAs was performed. Preoperative BA angiography delineated the BA to PA fistula, and guided surgical decision-making.

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  • Yusuke Misumi, Toru Kuratani, Koichi Maeda, Koichi Toda, Shigeru Miyag ...
    2021 Volume 27 Issue 4 Pages 264-266
    Published: 2021
    Released on J-STAGE: August 20, 2021
    Advance online publication: December 18, 2018

    Transcatheter aortic valve implantation (TAVI) through a peripheral arterial access is often complicated by concomitant arteriopathy. We describe here the first successful case of TAVI through the carotid artery in Japan. The patient was an 83-year-old woman with severe aortic stenosis (AS). Preoperative computed tomography (CT) revealed a shaggy distal aortic arch and left subclavian artery ostium, along with severely calcified bilateral iliofemoral arteries. Trans-apical and direct aortic approaches were abandoned because of frailty. Following the thorough cerebrovascular assessment, the left common carotid artery was selected for arterial access and a CoreValve transcatheter aortic valve was successfully implanted without neurologic complications.

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New Methods
  • Radosław Gocoł, Jarosław Bis, Damian Hudziak, Łukasz Morkisz, Marek A. ...
    2021 Volume 27 Issue 4 Pages 267-272
    Published: 2021
    Released on J-STAGE: August 20, 2021
    Advance online publication: February 09, 2021

    Purpose: We propose a novel technique for reconstruction of the dissected aortic root with the use of TachoSil fibrin sealant patch.

    Methods: Patients with acute type A aortic dissection involving the aortic root were included. Appropriately prepared TachoSil fibrin sealant patch was placed between the dissected layers of the aortic root to achieve their durable fusion. Thus, the false lumen was eliminated, and the anatomical and functional structure of the aortic wall was restored.

    Results: In all, 13 patients mean aged 57 ± 10.3 years underwent surgery for acute type A aortic dissection with the use of TachoSil fibrin sealant patch. All patients survived the surgery. The mean follow-up time was 30.8 ± 16.4 months. Follow-up computed tomography angiography (CTA) scans confirmed no aortic root dissection in all patients.

    Conclusions: This technique ensures durable restoration of the aortic wall structure, eliminates the secondary aortic valve regurgitation, and allows for the preservation of patients’ native aortic valve.

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  • Luca Koechlin, Giuseppe Isu, Vladislav Borisov, Diana Robles Diaz, Fri ...
    2021 Volume 27 Issue 4 Pages 273-277
    Published: 2021
    Released on J-STAGE: August 20, 2021
    Advance online publication: February 03, 2021

    Purpose: The aim of this study was to analyze the effects of 10-minute (standard term) versus 20-minute treatment with glutaraldehyde (GA) on mechanical stability and physical strength of human pericardium in the setting of the OZAKI procedure.

    Methods: Leftover pericardium (6 patients) was bisected directly after the operation, and one-half was further fixed for 10 additional minutes. Uniaxial tensile tests were performed and ultimate tensile strength (UTS), ultimate tensile strain (uts), and collagen elastic modulus were evaluated.

    Results: Both treatments resulted in similar values of uniaxial stretching-generated elongations at rupture (10 minutes 25 ± 7 % vs. 20 minutes: 22 ± 5 %; p = 0.05), UTS (5.16 ± 2 MPa vs. 6.54 ± 3 MPa; p = 0.59), and collagen fiber stiffness (elastic modulus: 31.80 ± 15.05 MPa vs. 37.35 ± 15.78 MPa; p = 0.25).

    Conclusion: Prolongation of the fixation time of autologous pericardium has no significant effect on its mechanical stability; thus, extending the intraoperative treatment cannot be recommended.

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