Compared with the conventionally harvested saphenous vein graft, the no-touch saphenous vein graft, in which manipulation and tension are minimized and intraluminal dilatation is avoided during vein harvest, has shown better-preserved luminal endothelium and improved patency rates after coronary artery bypass grafting. This review article will detail and summarize the relevant literature on the no-touch saphenous vein in coronary artery bypass grafting.

Purpose: Uniportal video-assisted thoracoscopic surgery (UVATS) has been increasingly adopted for lung cancer management. This study aims to compare the perioperative and oncological outcomes of UVATS versus multiportal VATS (MVATS).

Methods: A comprehensive search was conducted on electronic databases. Perioperative outcomes evaluated were postoperative complications, conversion to open thoracotomy, and visual analog scale (VAS) scores on postoperative days 1 (POD1) and 3 (POD3). The oncological outcomes assessed were total lymph nodes retrieved. Individual patient time-to-event data were estimated from published Kaplan–Meier curves.

Results: The analysis demonstrated that UVATS was associated with significantly lower postoperative complications (relative risk [RR]: 0.76; 95% confidence interval [CI]: 1.64–0.91; p = 0.002), lower VAS scores on POD1(MD: –0.44; 95% CI: –0.70, –0.17; p = 0.001) and POD3 (MD: 0.76; 95% CI: –1.17, –0.36; p <0.001) compared to MVATS. Although UVATS had a lower conversion rate, this difference was not statistically significant (RR: 0.63; 95% CI: 0.33–1.18; p = 0.15). MVATS retrieved a higher number of lymph nodes, but this difference was also not statistically significant (MD: 0.6; 95% CI: –1.39, 0.12, p = 0.1). The overall survival probability at 96 months was slightly higher in the MVATS group (82.49%) compared to the UVATS group (75.89%), with a p-value of 0.5. Disease-free survival was comparable between the groups (75.43% UVATS and 74.74% MVATS, p = 0.59).

Conclusion: UVATS demonstrated favorable perioperative outcomes and comparable oncological efficacy to MVATS in the management of lobectomy and segmentectomy for lung cancer.

Purpose: This study aims to determine the outcomes of maintaining antegrade pulmonary blood flow (APBF) during the bidirectional cavopulmonary shunt (BCPS) procedure in patients with single ventricle physiology undergoing staged palliative surgeries.

Methods: A systematic search of electronic databases was conducted and focused on studies comparing pulsatile BCPS (with APBF) with non-pulsatile BCPS (without APBF). Outcomes were categorized into early (post-BCPS) and late (pre-Fontan). Data were analyzed using Mantel-Haenszel random effects model with odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). The study protocol was registered in the PROSPERO (CRD42024586369).

Results: A total of 17 studies with 2504 patients were included. There was no significant difference in 30-day mortality (OR 1.11, 95% CI: 0.61–2.04, p = 0.73), but pulsatile BCPS led to a higher rate of prolonged chest drainage (OR 2.45, 95% CI: 1.43–4.20, p <0.001). Pulsatile BCPS resulted in significantly higher SaO₂ in both post-BCPS (MD 3.33%, 95% CI: 2.70–3.97, p <0.001) and pre-Fontan (MD 2.91%, 95% CI: 2.51–3.31, p <0.001). The Nakata index was also higher in the pulsatile group (MD 30.67, 95% CI: 16.68–44.65, p <0.001).

Conclusions: Pulsatile BCPS can optimize pre-Fontan hemodynamics by improving oxygenation and pulmonary artery development. However, the increased risk of prolonged chest drainage requires careful patient selection and monitoring.

Purpose: Robotic-assisted thoracoscopic surgery (RATS) has emerged as an alternative to video-assisted thoracoscopic surgery (VATS) for lobectomy in early-stage non-small cell lung cancer (NSCLC). While perioperative and oncologic outcomes have been studied, limited data exist on long-term postoperative pulmonary function. This study compared pulmonary function one year after RATS versus VATS lobectomy.

Methods: We retrospectively analyzed 298 patients who underwent lobectomy for early-stage NSCLC between September 2020 and August 2023. After applying exclusion criteria, 186 patients remained: 128 in the VATS group and 58 in the RATS group. Propensity score matching (1:1) yielded 55 matched pairs. Pulmonary function parameters—%predicted forced vital capacity (%FVC), %predicted forced expiratory volume in one second (%FEV1), %predicted peak expiratory flow (%PEF), and %predicted diffusing capacity for carbon monoxide (%DLco)—were evaluated one year postoperatively.

Results: No significant differences were observed between groups in any pulmonary function parameters at one year, both before and after matching. Lung function was similarly preserved.

Conclusions: Despite the use of more ports, RATS lobectomy did not result in inferior pulmonary function compared to VATS. Given its higher cost, VATS may remain the more cost-effective standard, although RATS offers a promising platform for future innovation.

Purpose: Cryoprecipitate has been covered by Japanese national health insurance since 2020 for cardiopulmonary bypass (CPB)-induced hypofibrinogenemia. This study evaluated the clinical efficacy of in-house cryoprecipitate use in patients undergoing CPB.

Methods: A total of 1357 patients were divided into 2 groups before and after cryoprecipitate introduction in February 2020 (Group A, n = 685; Group B, n = 672). Propensity score matching also compared 205 pairs between transfused patients in Group A (Group A’, n = 597) and those receiving cryoprecipitate in Group B (Group B’, n = 222).

Results: Cryoprecipitate was used in 222 patients (37%) in Group B. While overall transfusion rates did not differ significantly, postoperative red blood cell (20% vs 13%, p <0.01) and platelet concentrate (PC) (35% vs 12%, p <0.01) use were significantly lower in Group B. In the matched cohorts, including ~70% undergoing aortic surgery, postoperative PC use was significantly reduced in Group B’ (26% vs 18%, p = 0.04).

Conclusions: In-house cryoprecipitate use was associated with reduced postoperative PC transfusion, particularly in aortic surgery involving prolonged CPB and deep hypothermic circulatory arrest. A cryoprecipitate-centered hemostatic strategy, supplementing multiple coagulation factors beyond fibrinogen, may be effective in complex CPB procedures.

Purpose: This study aimed to clarify the importance of C-reactive protein (CRP)–albumin–lymphocyte (CALLY) index scores in predicting coronary artery bypass grafting (CABG) outcomes.

Methods: Patients were divided into quartiles (Q1–Q4) based on their preoperative CALLY index values. Preoperative demographic data, laboratory parameters, operative, and postoperative outcomes were recorded.

Results: The CALLY index, a composite marker incorporating CRP, albumin, and lymphocyte levels, increased progressively from Q1 to Q4, showing a statistically significant upward trend (p = 0.001). Operative and postoperative data revealed that intensive care unit (ICU) stay and hospital stay were significantly shorter in Q3 and Q4 compared to Q1 and Q2 groups (p = 0.001 for both). Furthermore, major adverse cardiac and cerebrovascular events (MACCE) rates were significantly reduced in Q3 and Q4 groups (p = 0.001), reinforcing the prognostic utility of the CALLY index. Two-year mortality also demonstrated a statistically significant reduction in the higher quartiles (p = 0.039), while in-hospital mortality did not differ significantly (p = 0.330). Operation time, cross-clamp time, and requirements for inotropic support were similar across all groups (p >0.05). The receiver-operating characteristic curve analysis demonstrated the discriminative ability of the CALLY index in predicting 2-year mortality. Area under the curve was 0.675 (95% confidence interval: 0.607–0.743), indicating moderate predictive performance.

Conclusion: This study revealed that patients with higher CALLY index scores who underwent CABG had significantly shorter hospital and ICU stays. Moreover, MACCE ratio and mortality rate in the first 2 years after CABG were significantly lower in patients with higher CALLY scores.

Purpose: Cardiovascular surgery entails considerable risk because of its complexity and the frequency of perioperative complications. The right ventricular Tei index (RV-TI) provides an integrated measure of ventricular performance, encompassing systolic and diastolic function. Although not widely applied in this setting, its role as a predictor of outcomes is promising. This study evaluated the utility of RV-TI in predicting postoperative complications in patients undergoing diverse cardiovascular surgeries, emphasizing its value for surgical risk stratification and patient management.

Methods: A single-center, cross-sectional study was conducted at the National Institute of Cardiology Ignacio Chávez, Mexico City, including 195 adults who underwent cardiac surgery between June 2022 and April 2023. RV-TI was obtained by transthoracic tissue Doppler, using 0.53 as the abnormal cutoff. One hundred and forty-nine patients had normal RV-TI values, while 46 were classified as abnormal.

Results: Abnormal RV-TI correlated with diabetes mellitus, advanced age, and vasoplegic syndrome. These patients experienced higher in-hospital mortality and more severe complications, including the need for renal replacement therapy, pneumonia, delirium, and greater transfusion requirements.

Conclusion: RV-TI appears to be a valuable adjunct in preoperative risk assessment for cardiac surgery. Its incorporation into clinical practice could improve patient selection and decision-making, contributing to better surgical outcomes.

Purpose: The study investigated the importance of left ventricular volume assessment before primary repair in asymptomatic tetralogy of Fallot (TOF) patients.

Methods: Forty-two asymptomatic TOF patients who underwent preoperative cardiac catheterization at a median age of 4.7 months interquartile range [IQR], 4.0–5.3) between 2013 and 2023 were enrolled. Asymptomatic TOF was defined as room air oxygen saturation ≥85% without duct-dependent circulation. Left ventricular end-diastolic volume (LVEDV) as a percentage of predicted normal (LVEDV%N) was measured using the single-plane area–length method. Correlation with echocardiographic parameters was assessed.

Results: The median LVEDV%N was 107% (IQR, 87.5–139.5). Five patients (11.6%) had LVEDV%N ≤80%. One patient with the lowest LVEDV%N (62%) underwent a modified Blalock–Taussig shunt instead of primary repair. The remaining four patients had a small pulmonary valve annulus (PVA) (Z-score −4.2 to −6.6) and underwent transannular patch repair. Seven additional patients underwent transannular patch repair due to total conal ventricular septal defect (n = 5) or patent ductus arteriosus with small PVA (n = 2). LVEDV%N showed a weak correlation with 1-month echocardiographic parameters (R² = 0.27–0.347).

Conclusions: Left ventricular volume assessment prior to primary repair is essential in asymptomatic TOF patients. There were cases with small LV for whom primary repair was deferred, or whose PVA was also small; therefore, transannular patch repair was selected.

Purpose: The objective of this study was to examine the correlation between normalized lactate load (NLL) and the 30-day mortality rate in patients with acute type A aortic dissection (AAAD) patients, as well as its predictive value for prognosis.

Methods: Data were obtained from the Medical Information Mart for Intensive Care-IV database. The Cox model and restricted cubic spline (RCS) were used to assess the relationship between NLL and 30-day mortality in AAAD patients. Receiver-operating characteristic curves were plotted to evaluate the predictive value of NLL for 7-, 14-, and 30-day mortality. Kaplan–Meier (K–M) curves were used to compare 30-day survival across different risk levels.

Results: Among 150 AAAD patients, NLL was recognized as a risk factor for 30-day mortality (hazard ratio = 1.83, 95% confidence interval: 1.29–2.58; P <0.001). The RCS analysis showed a linear relationship. NLL showed areas under the curve of 0.781, 0.781, and 0.730 for predicting 7-, 14-, and 30-day mortality, respectively. K–M curves revealed a significant difference in 30-day survival between the high- and low-risk groups (log-rank P = 0.042).

Conclusion: NLL is a risk factor for 30-day mortality in AAAD patients and shows good predictive value. This study supports NLL as an early-warning biomarker for identifying high-risk AAAD patients.

Purpose: We aimed to compare the midterm outcomes of the no-touch saphenous vein graft (NT-SVG) as a second conduit with those of other graft types.

Methods: We retrospectively reviewed 549 consecutive patients who underwent multivessel isolated coronary artery bypass grafting (CABG) with ≥2 distal anastomoses between 2002 and 2024. Five conduit groups for non-LAD grafting were analyzed: in situ internal thoracic artery (ITA), free ITA, conventional saphenous vein graft (cSVG), NT-SVG, and right gastroepiploic artery (rGEA). We analyzed conduit-specific patency and propensity score–matched patency between cSVG and NT-SVG.

Results: The mean age was 68.6 ± 9.5 years, and 74% were men. Off-pump CABG was performed in 60.5% of cases, with a mean of 3.3 ± 0.9 distal anastomoses. Hospital mortality was 1.5%. Notably, the 5- and 10-year survival rates were 85.9% and 74.1%, respectively. Among 794 non-LAD grafts, the NT-SVG demonstrated a 5-year patency of 96.4%, which was significantly higher than that of cSVG (89.5%, p = 0.05) and rGEA (87.2%, p = 0.04), and equivalent to in situ ITA (94.4%) and free ITA (95.0%). The propensity score–matched analysis further demonstrated superior graft patency with the NT-SVG.

Conclusions: The NT-SVG achieves a 5-year patency comparable to that of ITA grafts and superior to that of cSVG and rGEA, suggesting its potential as a promising option for non-LAD revascularization, pending further validation.

Purpose: We evaluated patients with acute type A aortic dissection (ATAAD) who were suffering from a collapsed true lumen in the descending aorta.

Methods: Among 146 patients with ATAAD who underwent surgery, 6 (4.1%) with a collapsed true lumen of <10% of the total area at the level of the diaphragmatic transition in the descending aorta were detected. Preoperative and postoperative computed tomography images, preoperative characteristics, surgical techniques, and major adverse aortic events were assessed.

Results: Patients with a collapsed true lumen tended to have spinal cord or peripheral malperfusion preoperatively. In two patients, because intraoperative transesophageal echocardiography showed no improvement in the collapsed true lumen after femoral artery cannulation, ascending aortic cannulation was added. Entry resection was achieved in five patients; however, three of them needed thoracic endovascular aortic repair (TEVAR). All six patients survived for one year, and after staged TEVAR, aortic remodeling was achieved.

Conclusion: Patients with a collapsed true lumen in the descending aorta tended to develop lower body malperfusion, and usual cardiopulmonary bypass may be ineffective. Even if entry resection was achieved, aortic remodeling could not be obtained in some cases; therefore, staged repair with TEVAR can solve this issue.

Purpose: Despite the knowledge that right-sided colon tumors are associated with worse overall survival (OS) and disease-free survival (DFS) compared to left-sided and rectal tumors, there are conflicting results on the impact of the primary location of colorectal tumors after lung metastasectomy. In this study, we aimed to investigate this contradiction.

Methods: We conducted a retrospective analysis of 131 patients who underwent lung metastasectomy for colorectal cancer. DFS and OS were evaluated in relation to primary tumor location, liver metastasis, lymph node dissection, nodal status, and carcinoembryonic antigen (CEA) levels.

Results: Among patients with no nodal metastasis (N0), significantly better DFS (p = 0.024) and OS (p = 0.030) were observed. Elevated CEA levels were not associated with DFS but were linked to improved OS (p = 0.004). Right-sided colon tumors were associated with worse DFS and OS compared to left-sided and rectal tumors (p <0.002 and p <0.001, respectively).

Conclusion: Right-sided colon tumors were associated with the poorest DFS and OS, underscoring the prognostic significance of primary tumor location. Additionally, the absence of nodal metastasis was associated with significantly improved survival outcomes. Liver metastasis was not significantly associated with DFS or OS.

Purpose: The aim of this study was to evaluate the impact of intercostal nerve cryoablation on postoperative pain, opioid usage, and lung expansion after open aortic repair via left thoracotomy.

Methods: This retrospective study included 62 patients who underwent aortic repair via left thoracotomy between 2017 and 2023. Patients were divided into cryoablation (n = 32) and non-cryoablation (n = 30) groups. Pain was assessed using the Numerical Rating Scale (NRS), and lung volume was measured using computed tomography 1 week postoperatively.

Results: The cryoablation group showed significantly lower mean NRS scores (1.7 vs. 2.4, p <0.01) and lower opioid consumption (6.2% vs. 56.6%, p <0.01). The left lung volume ratio was significantly higher in the cryoablation group (72.3% vs. 62.4%, p = 0.05).

Conclusions: Intercostal nerve cryoablation effectively reduces postoperative pain and opioid consumption and enhances pulmonary expansion after left thoracotomy. This technique may offer a favorable analgesic option in thoracic aortic surgery.

Purpose: Tumor spread through air spaces (STAS) and visceral pleural invasion (VPI) are negative prognostic factors in lung cancer. However, it is unknown whether they have a compounding prognostic effect. Therefore, we analyzed the association between STAS and VPI with overall survival and recurrence.

Methods: A retrospective cohort analysis was conducted on 421 adult patients who underwent pulmonary resection for non-small cell lung cancer at an academic institution between 2018 and 2022. Baseline characteristics were compared between patients who had STAS only, VPI only, or both STAS and VPI. Overall survival and cumulative recurrence were compared using the Kaplan–Meier method.

Results: Of the 421 patients who underwent a pulmonary resection, 34 (8%) had both STAS and VPI. Their combined presence was associated with increased smoking pack-years, increased tumor size, and an increased presence of lymphovascular invasion. There was no overall survival difference (p = 0.190) between patients with both STAS and VPI and those with only one feature or neither. However, cumulative incidence of recurrence was increased (p = 0.001) for patients with both.

Conclusion: The presence of STAS and VPI was not associated with decreased overall survival; however, their combined presence may have a compounding effect on recurrence risk.

Purpose: This study aimed to determine whether the 1-minute sit-to-stand test (1-min STST) can be a predictor of postoperative complications following video-assisted thoracic surgery (VATS) lung lobectomy.

Methods: This retrospective cohort study included 152 patients who underwent VATS lobectomy. Preoperative evaluations included pulmonary function tests, the bendopnea test, and the 1-min STST. The predictive value of these assessments for postoperative complications, graded by the Clavien–Dindo (C–D) classification, was analyzed using logistic regression and receiver-operating characteristic curves.

Results: For predicting C–D grade II or III complications, a 1-min STST repetition count of ≤20 had an area under the curve (AUC) of 0.70, with 90% sensitivity and 46% specificity. For predicting C–D grade III complications, a repetition count of ≤15 showed an AUC of 0.72 (95% confidence interval [CI], 0.39–1.00), with 97% sensitivity and 60% specificity. In multivariate analysis for C–D grade III complications, a lower 1-min STST repetition count was a significant predictor (p <0.01).

Conclusion: The 1-min STST shows potential as a simple tool for preoperative risk stratification in patients undergoing VATS lobectomy.

Purpose: Rapid risk stratification is crucial in patients with acute type A aortic dissection (ATAAD), particularly those presenting with circulatory collapse or malperfusion. This study investigated whether preoperative blood lactate levels could predict surgical outcomes.

Methods: A retrospective analysis was conducted on 166 patients who underwent emergency surgery for ATAAD between 2014 and 2022. Preoperative arterial lactate levels were measured at admission. Multivariate logistic regression identified risk factors for in-hospital mortality. The optimal lactate cutoff value was determined using receiver-operating characteristic curve analysis. Correlation with the Penn classification was also assessed.

Results: In-hospital mortality was 4.2%. A lactate level ≥3.7 mmol/L was independently associated with in-hospital mortality (hazard ratio, 1.41, p = 0.026) and was strongly correlated with Penn classes Ac and Abc. Patients with elevated lactate levels had more severe clinical presentations, prolonged intensive care unit stays, and more postoperative complications. Long-term mortality was also significantly higher in the high-lactate group (p = 0.013).

Conclusions: A preoperative lactate level ≥3.7 mmol/L is a practical and effective point-of-care predictor of surgical outcomes in ATAAD. It reflects circulatory collapse and severe malperfusion, and may assist nonspecialist clinicians in early triage and decision-making.

Purpose: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery and is associated with increased hospital stay, morbidity, and mortality. One of the major factors predisposing patients to the development of POAF is inflammation related to pericardial effusions, which may occur after cardiac surgery. We hypothesized that by creating a pleuro-pericardial window before closing the chest during cardiac surgery, draining the pericardial space into the right pleural space may lead to fewer pericardial effusions and less postoperative atrial fibrillation.

Methods: We conducted a study that included 172 consecutive patients (67 ± 12 years, 48.3% female) who underwent cardiac surgery (73.8% aortic valve replacement [AVR], 5.8% mitral valve replacement, 19% AVR + coronary artery bypass grafting). The first 95 patients included in this study (67 ± 12 years, 48% female) did not have any pleuro-pericardial window created, whereas the remaining 77 patients (67 ± 12 years, 48% female) did. Baseline clinical and procedural characteristics were compared between the 2 groups. Postoperative events and complications were collected until hospital discharge.

Results: A total of 50 patients developed POAF (29%). The incidence of POAF among patients who underwent a pleuro-pericardial window was 18.2% (95% confidence interval [CI]: 9.4%–27.0%). The incidence of POAF among those who underwent the standard technique was 37.7% (95% CI: 28.0%–47.8%). The patients who underwent a pleuro-pericardial window had a higher incidence of dyslipidemia (p = 0.037), right bundle branch block (p = 0.018), 1st-degree atrioventricular block (p = 0.046), and previous myocardial infarction (p = 0.006). Multivariate analysis showed that the risk of POAF was significantly lower in patients who underwent a pleuro-pericardial window compared to those who did not (odds ratio: 0.46, 95% CI: 0.24–0.87, p = 0.019).

Conclusion: Creating a right pleuro-pericardial window before closing the chest after cardiac surgery was independently associated with a lower incidence of POAF.

Purpose: The superior septal approach offers improved mitral valve exposure compared to the right-sided left atriotomy or transseptal approach. However, the risk of postoperative sinus node dysfunction remains controversial, with limited data in the context of right mini-thoracotomy.

Methods: This retrospective study included 155 patients (64 women; mean age, 60.8 ± 13.4 years) who underwent mitral valve surgery via right mini-thoracotomy between November 2016 and August 2023. Indications included degenerative mitral regurgitation (94.8%) and mitral stenosis (5.2%). Patients were divided into 2 groups: the conventional minimally invasive mitral valve surgery (CM) group (n = 47), using the right-sided left atriotomy, and the drawer-case technique (DCT) group (n = 108), using the superior septal approach. Demographic, intraoperative, and outcome data were analyzed.

Results: Baseline characteristics were similar between groups. There were no significant differences in valve repair techniques or postoperative echocardiographic findings. Postoperative junctional rhythm occurred in 6 patients (CM group) and 21 patients (DCT group); all patients with preoperative sinus rhythm returned to sinus rhythm postoperatively.

Conclusion: The superior septal approach does not increase the risk of persistent junctional rhythm in right mini-thoracotomy and is a safe and effective option for mitral valve surgery.

Purpose: This study evaluated the midterm outcomes, including adverse aortic events (AAEs), of the “graft insertion technique” (GIT) for left ventricular outflow tract (LVOT) and aortic root reconstruction.

Methods: From August 2014 to March 2024, 14 consecutive patients underwent GIT for LVOT and aortic root reconstruction. The indications for surgery were prosthetic valve endocarditis in 9 cases and noninfectious pseudoaneurysm in 5 cases. Among these patients, seven (50.0%) underwent aortic root surgery, while the other seven (50.0%) underwent aortic valve replacement alone or in combination with other procedures without aortic root surgery. Their mean EuroSCORE II was 28.8 ± 17.6.

Results: The mean total operation time was 504 ± 87 min. The mean cardiopulmonary bypass and aortic cross-clamp times were 311 ± 41 and 240 ± 45 min, respectively. Operative mortality occurred in one case (7.1%), and five patients (35.7%) died during the first year of follow-up. No surviving patients experienced recurrent endocarditis. No patients died from cardiovascular events or infections after the second year of follow-up. Furthermore, no AAEs were observed on computed tomography during the follow-up period after hospital discharge.

Conclusion: GIT is a feasible alternative for high-risk cases of redo aortic root surgery.

Purpose: This study aims to evaluate the treatment outcomes for patients who developed post-pneumonectomy bronchopleural fistula (BPF) and to identify factors that may influence the success of these treatment methods.

Methods: A cohort of 60 patients diagnosed with resistant BPF following pneumonectomy for non-small cell lung cancer was included in the study. Patients were categorized into 2 groups based on the efficacy of the BPF closure methods: successful closure and failed closure. Data on demographic, clinical, and pathological characteristics, surgical procedures, oncologic treatment status, laboratory parameters at the time of BPF diagnosis, fistula diameter, and bronchial stump length were collected. The effectiveness of bronchoscopic treatments and advanced surgical procedures was analyzed.

Results: Of the 60 patients included in the study, 55 (95%) were male, with a mean age of 61.6 ± 9.4 years. Multivariate analysis identified fistula diameter and the type of previous suture as significant predictors of BPF closure success ( p = 0.024 and 0.008, respectively).

Conclusion: Fistula diameter and previous suture type are critical determinants of the success of post-pneumonectomy BPF closure.

Purpose: Pericardial effusion (PE), tamponade, and atrial fibrillation are challenging complications after cardiac surgeries. This prospective randomized study was conducted to evaluate the impact of posterior pericardiotomy (PP) in the prevention of PE and cardiac tamponed after adult cardiac surgery.

Methods: This single-center, prospective, randomized controlled trial included 330 patients undergoing open-heart surgery. They were randomly assigned to either a PP group or a control group.

Results: Of 703 screened patients, 330 were enrolled from January 2022 to June 2024 (mean age: 50.2 ± 14.7 years, 64.2% males). Compared to controls, the PP group had significantly lower early and late PE (19.4% vs. 44.8%, and 4.2% vs. 17%, respectively), tamponade (2.4% vs. 11.5%), and postoperative atrial fibrillation (10.3% vs. 19.4%). PP also significantly reduced the need for surgical re-exploration, duration of mechanical ventilation, and both intensive care unit and overall hospital stays (all P <0.05). Adjusted multivariate analysis confirmed the benefits of PP after correcting for baseline imbalances in left ventricular ejection fraction and operative time. No adverse events directly attributable to PP were noted.

Conclusions: PP is a simple, safe, and effective technique for reducing postoperative PE, and cardiac tamponade after cardiac surgery.

Purpose: Motorized automatic staplers are used for bronchial closure following pulmonary resection. This study aimed to compare the completeness of staple formation in bronchial closure using 2 commonly adopted staple cartridges with motorized automatic staplers as follows: graduated-height staples (GHS) and equal-height staples (EHS).

Methods: This prospective observational study included 103 patients (105 bronchial stumps) undergoing pulmonary resections for lung cancer. Resected bronchi were embedded in paraffin, X-rays were taken, and staple formations were scored on a 0–4 scale, with a score of 4 indicating complete staple formation. Stump scores represented the average score of all staples per bronchial stump.

Results: The GHS exhibited a higher incidence of staple scores above the median (3.91) than that of the EHS (37/59 [62.7%] vs. 19/46 [41.3%], respectively; p = 0.033). Additionally, the GHS had a higher rate of complete staple formation than that in the EHS (84.7% vs. 75.1%; p <0.0001). This difference was more evident in calcified bronchi (84.2% vs. 57.6%, respectively; p <0.0001). No bronchopleural fistula was observed in any patients during the year.

Conclusion: Staple formations were generally more complete in the GHS than in the EHS. This difference was particularly notable in calcified bronchi.

Purpose: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach widely used for lung resections. However, reliance on staplers increases costs, limiting its adoption in resource-constrained settings. This study evaluates the feasibility, safety, and cost-effectiveness of uniportal stapler-less VATS lobectomies and segmentectomies.

Methods: A retrospective analysis of 7 stapler-less uniportal VATS surgeries performed between March 2021 and February 2022 was conducted. Data on operative time, blood loss, postoperative outcomes, and complications were collected from patient records.

Results: Seven procedures were completed with an average operative time of 80 min (range: 48–118 min). Estimated blood loss was minimal (10–100 mL) in 6 cases. One patient required conversion to open thoracotomy due to vessel injury. Postoperatively, all patients were stable with no major complications.

Conclusion: Stapler-less VATS is a viable, cost-effective alternative to conventional techniques, offering comparable safety and outcomes. This approach supports broader adoption of minimally invasive surgery, particularly in low-income settings, where reducing procedural costs is critical.

Purpose: Cardioplegia directly affects patient outcomes after cardiac surgery with prolonged aortic cross-clamping. Our hospital revised its myocardial protection protocol in April 2021 and compared the clinical outcomes of patients with prolonged aortic cross-clamping before versus after the revision.

Methods: This study included 36 patients who underwent cardiac surgery via a median sternotomy and prolonged aortic cross-clamping for >4 h at our hospital from 2018 to 2024. Patients treated between 2018 and March 2021 (before the protocol revision) were designated as Group 1, while those treated from April 2021 to 2024 (after the revision) were designated as Group 2.

Results: Groups 1 and 2 comprised 17 and 19 patients, respectively. The mean creatine kinase level immediately postoperative was significantly lower in Group 2 versus Group 1 (P = 0.018). The mean hospital stay was also significantly shorter in Group 2 versus Group 1 (P = 0.017). Regarding new postoperative right-ventricular dysfunction, there were 3 cases (15.8%) in Group 2 versus 5 cases (29.4%) in Group 1, but the difference was not statistically significant.

Conclusion: These findings suggest that our hospital’s revised myocardial protection protocol, which requires no alteration of the solution itself, achieves safe and favorable surgical results, even in cardiac surgeries requiring prolonged aortic cross-clamping.

Purpose: This study evaluated the prognostic significance of the controlling nutritional status/creatine kinase score (CNKS), a composite index derived from the controlling nutritional status (CONUT) score and creatine kinase (CK) level, in patients with interstitial pneumonia awaiting lung transplantation (LT).

Methods: We retrospectively analyzed 202 patients with interstitial pneumonia who were registered for LT between January 2014 and July 2023. CNKS was calculated using CK levels and the CONUT (derived from albumin level, lymphocyte count, and cholesterol level).

Results: Among the 202 patients, 130 (64.4%) were alive, while 72 (35.6%) had died at the time of analysis. Among the surviving patients, 79 (39.1%) underwent cadaveric LT, and 51 (25.2%) remained on the waiting list. A high CNKS (n = 72 [35.6%]) was significantly associated with a lower body mass index (P <0.001), a shorter 6-minute walk distance (P <0.001), and lower forced vital capacity (P = 0.006) compared with a low CNKS (n = 130 [64.4%]). The results of the multivariate analysis showed that CNKS was a significant independent prognostic factor for survival during the waiting period (P = 0.031).

Conclusion: CNKS represents a promising prognostic marker, potentially useful in selecting lung transplant candidates and guiding nutritional and rehabilitative interventions during the pretransplant period.

Purpose: This study compared the short-term outcomes after conventional minimally invasive esophagectomy (MIE) vs. robot-assisted minimally invasive esophagectomy (RAMIE)s by analyzing national data.

Methods: Data were collected from adults aged ≥20 years who underwent MIE from 2017 to 2020, from the US Nationwide Inpatient Sample database. The outcomes included in-hospital mortality, unfavorable discharges, prolonged length of stays (LOS), total hospital charge, and various complications. Propensity score matching (PSM) was employed to balance the baseline characteristics between RAMIE and conventional MIE.

Results: After PSM, 628 patients (representing 3140 patients in the US after weighting) were analyzed. After adjustment, multivariable analysis revealed no significant differences between RAMIE and traditional MIE in terms of in-hospital mortality (adjusted odd ratio [aOR] =1.45, 95% confidence interval [CI]: 0.46–4.61), unfavorable discharge (aOR = 0.76, 95%CI: 0.41–1.41), prolonged LOS (aOR = 0.87, 95%CI: 0.60–1.26), total hospital charge (aBeta = 12.23, 95%CI: −19.24 to 43.69), or complications (aOR = 1.05, 95%CI: 0.78–1.41). Stratified analysis indicated that, among obese patients, RAMIE was associated significantly with a higher risk of overall complications compared with MIE (aOR = 1.90, 95%CI: 1.11–3.25).

Conclusions: The study found no significant differences in unfavorable discharge and prolonged LOS between RAMIE and traditional MIE. Nevertheless, obese patients undergoing RAMIE experienced higher complications.

Purpose: Endovascular aneurysm repair (EVAR) is widely used to treat abdominal aortic aneurysms (AAAs), but mid-term survival remains a concern. This study aims to develop a machine learning-based random forest model to predict 3-year survival after EVAR.

Methods: A random forest model was trained using data from 176 EVAR patients, of whom 169 patients were retained for analysis, incorporating 23 preoperative and perioperative variables. Model performance was evaluated using 5-fold cross-validation.

Results: The model achieved an area under the receiver-operating characteristic curve (AUC) of 0.91, with an accuracy of 81.1%, a sensitivity of 81.6%, a specificity of 80.9%, and an F1 score of 0.66. Feature importance analysis identified poor nutritional status (geriatric nutritional risk index <101.4), compromised immunity (neutrophil-to-lymphocyte ratio >3.19), chronic kidney disease (CKD), octogenarian status, chronic obstructive pulmonary disease (COPD), small aneurysm size, and statin use as the top predictors of 3-year mortality. The average values of the AUC, accuracy, sensitivity, specificity, and F1 score across the 5-folds were 0.76 ± 0.10, 73.9 ± 5.8%, 60.4 ± 1.9%, 77.8 ± 0.7%, and 0.59 ± 0.17, indicating consistent performance across different data subsets.

Conclusions: The random forest model effectively predicts 3-year survival after EVAR, indicating key factors such as poor nutritional status, compromised immunity, CKD, octogenarian status, COPD, small aneurysm size, and statin use.

Purpose: This study aimed to summarize 8-year clinical outcomes for patients who underwent transcatheter aortic valve replacement (TAVR) with the J-Valve system and evaluate the long-term durability and hemodynamic performance of the valve.

Methods: Between July 2014 and June 2015, 21 patients underwent transapical TAVR with the J-Valve system. Systematic clinical and echocardiographic follow-up was conducted on 18 patients for up to 8 years.

Results: Eight years post-TAVR with the J-Valve system, the all-cause mortality rate was 16.7%, with no prosthesis failures or thrombosis. Moderate to severe valve deterioration was observed in 50% of patients with aortic stenosis (AS), whereas no such deterioration was noted in patients with pure aortic regurgitation (PAR). At 8 years following TAVR, the effective orifice area measured 2.27 ± 0.50 cm² in patients with PAR and 1.35 ± 0.38 cm² in those with AS. Additionally, patients with AS exhibited a mean pressure gradient of 17.90 ± 10.61 mmHg. Over 8 years, PAR patients experienced a significant reduction in left ventricular end-diastolic diameter from 61.50 ± 2.08 mm to 48.67 ± 7.23 mm (p < 0.001), whereas AS patients showed no significant change.

Conclusion: The J-Valve system demonstrates favorable long-term outcomes in TAVR, with excellent durability and hemodynamic performance in PAR patients.

Purpose: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are both well-established treatments for carotid artery stenosis. We analyzed real-world data from the Korean National Health Insurance Service (NHIS) database to compare the clinical outcomes.

Methods: This retrospective cohort study included patients with carotid artery stenosis registered in the NHIS from 2008 to 2018. Patients who underwent either treatment were divided into CEA or CAS groups and subjected to 1:4 propensity score matching.

Results: The study cohort included 1521 CEA and 6768 CAS patients. In symptomatic patients, the stroke rate within 1 month was lower in the CAS group (hazard ratio [HR], 0.61). However, the incidence of cardiovascular disease (CVD) death was higher in the CAS group at 1 month, 1 year, and during the total follow-up (HRs, 4.18, 2.43, and 1.50). There were no significant differences in outcomes between asymptomatic patients in the 2 groups.

Conclusion: The periprocedural stroke risk was higher in symptomatic carotid stenosis patients who underwent CEA, but mortality was higher in those who received CAS, both in the short and long term. In asymptomatic patients, however, the incidence of major adverse cardiovascular events and mortality was similar between the 2 groups.

Purpose: Lung torsion is a rare postoperative complication of pulmonary resection caused by lobe displacement. This condition leads to bronchial or pulmonary vascular kinking, which results in airway obstruction or blood flow impairment. In particular, middle lobe torsion is commonly observed after right upper lobectomy. However, the conditions under which it occurs remain unclear. This study aimed to identify the risk factors for middle lobe torsion following right upper lobectomy.

Methods: From November 2012 to December 2024, 127 patients underwent thoracoscopic right upper lobectomy at our institution. Four patients diagnosed with postoperative middle lobe torsion were classified into the torsion group. These patients were retrospectively compared with those without torsion.

Results: Simultaneous partial middle lobe resection and the number of staples used for interlobar fissure formation between the upper and middle lobes were significantly associated with lung torsion. The cutoff value for the number of staples used in the upper-middle fissure formation was 4, demonstrating fair accuracy.

Conclusions: The risk factors for middle lobe torsion after thoracoscopic right upper lobectomy were simultaneous partial resection of the middle lobe and the number of staples used for interlobar fissure formation between the upper and middle lobes.

Purpose: To report our experience with robotic-assisted redo coronary artery bypass grafting (CABG).

Methods: This single-center retrospective study included patients undergoing robotic-assisted redo CABG between 2016 and 2023. Patient demographics and operative outcomes were compared with those of initial robotic-assisted CABG procedures performed during the same period.

Results: There were 12 patients undergoing robotic-assisted redo CABG, with a median age of 73 years. Compared to initial CABG patients (n = 1415), the Society of Thoracic Surgeons scores were significantly higher (median: 0.90 vs. 7.05, p <0.001) in the redo group. Six patients had de novo internal mammary artery (IMA) to left anterior descending (LAD) bypass, 4 had redo LAD bypass, and 2 had non-LAD bypass. Among the 10 patients with LAD bypass, 4 also underwent hybrid percutaneous coronary intervention. While operating room time (5.4 vs. 7.4 hours, p <0.001), postoperative lengths of stay (4.0 vs. 5.5 days, p = 0.02) and the need for blood transfusion (15% vs. 42%, p = 0.02) were significantly greater in the redo group compared to the initial group, there were no conversions to sternotomy, unplanned revascularization, or in-hospital mortality in the redo patients.

Conclusion: Robotic-assisted redo CABG demonstrated promising operative outcomes in appropriately selected patients despite the higher-risk cohort.

Purpose: The objective of this study was to evaluate the safety and efficacy of catheter-directed thrombolysis (CDT) and mechanical aspiration (MA) for acute pulmonary embolism (PE).

Methods: From February 2022 to October 2024, the clinical data of patients with high- and intermediate-risk PE who received endovascular therapy were retrospectively reviewed. Patients were categorized based on the treatment strategy.

Results: Fifty-eight consecutive patients were identified. CDT was initiated in 29 patients, while the remaining 29 received MA treatment. The time of thrombolysis and the dosage of urokinase were both lower in the MA group (P <0.05). No differences were found in cardiac biomarkers after 48 hours, perioperative bleeding events, heart/valve injury, and mortality. The total cost of the MA group was much higher compared to CDT alone. The MA group showed better improvement in right ventricular (RV) function with a higher reduction in the right ventricular-to-left ventricular ratio (0.55 ± 0.46 vs. 0.13 ± 0.53, P = 0.017). No differences were found in the reduction of the CT obstruction index.

Conclusion: CDT and MA seem to have similar outcomes for patients with acute high- and intermediate-risk PE. MA is more effective in improving RV function with less thrombolysis time and fewer thrombolytics.

Purpose: This study aimed to compare the efficacy and safety of liposomal bupivacaine (Lip-BPVC) versus standard bupivacaine (BPVC) for superficial parasternal intercostal plane block in patients undergoing elective coronary artery bypass grafting (CABG) via median sternotomy.

Methods: A total of 82 adult patients were randomly assigned to the BPVC group (n = 41) or the Lip-BPVC group (n = 41).

Results: The Lip-BPVC group demonstrated significantly lower pain scores at all postinjection time points compared to the BPVC group with fewer opioid analgesics. Lip-BPVC demonstrated an initial heightened inflammatory response postoperatively compared to standard BPVC, indicated by significantly lower levels of pro-inflammatory markers at 24 and 48 hours postinjection with BPVC. However, by 72 hours, inflammatory markers did not differ significantly between Lip-BPVC and BPVC groups. No significant differences were observed between the groups in terms of surgery duration, extubation time, intensive care unit and hospital length of stay, or incidence of postoperative nausea and vomiting.

Conclusions: Lip-BPVC initially increased inflammatory markers postoperatively, but levels were comparable to BPVC by 72 hours. It provided superior pain control and reduced opioid use compared to standard BPVC in CABG patients, with similar safety and recovery outcomes.

Purpose: The application of wedge resection in thoracoscopic surgery is becoming more and more widely prevalent. However, achieving precise intraoperative positioning of the pulmonary nodules still poses challenges. This study proposed a method for surface positioning using a computed tomography (CT) simulation positioning system in the radiation physics room.

Methods: After screening patients, the level of nodules was located under the CT simulation positioning system, and the pleural projection point of the nodule and the closest surface puncture point from this point to the body surface were determined by the laser positioning system. During the operation, a needle was inserted at a predetermined angle at the puncture point, leaving a pinhole in the visceral pleura. Finally, the distance between the true pleural projection point of the nodule and the pinhole was measured on the specimen.

Results: The success rate of our positioning method was 97.2%. The average distance between the puncture pinhole location and the actual pleural projection point of the nodule was 8.1 mm. No related complications occurred during the perioperative period.

Conclusion: The new method of preoperative surface positioning and intraoperative lung positioning through puncture has a high success rate, good positioning accuracy, and good safety, which is worthy of clinical application.

Purpose: There are limited data on outcomes of combined Maze and mitral valve procedures beyond 10 years. This study analyzed the efficacy of this operation.

Methods: Between June 2004 and December 2022, 406 patients underwent mitral surgery concomitant with Maze procedure were evaluated. Rhythm outcomes, predictors of recurrence, and survival were assessed.

Results: The median follow-up period was 100 months. Rheumatic disease was present in 58%. Mitral valve repair was performed in 57.1%. Freedom from atrial fibrillation (AF) at 5, 10, and 15 years was 82.5%, 70.8%, and 52.7%, respectively. Overall survival rates were not different between patients in sinus rhythm (SR) and those who remained in AF (p = 0.172). However, patients in SR experienced fewer neurological complication (p = 0.001). Predictors of AF recurrence included preoperative AF duration (p = 0.005), left atrial diameter (LAD) >50 mm (p <0.001), concomitant tricuspid valve surgery (p = 0.049), and the presence of AF on postoperative day 7 (p <0.001). Factors influencing survival were age >60 years (p <0.001) and a postoperative left ventricular ejection fraction <40% (p <0.001).

Conclusions: The combined Maze and mitral valve surgery provides significant benefits in managing AF with mitral disease. Predictors of recurrence included AF duration, LAD size >50 mm, associated tricuspid valve disease, and AF on day 7. SR patients had fewer neurological complications.

Purpose: Our primary concern was the risk of overtreating elderly patients with endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. We investigated the association between age at the time of EVAR and all-cause mortality in Japan’s aging population by stratifying patients into age groups.

Methods: Data from 175 patients who underwent elective EVAR from 2012 to 2016 were analyzed. Patients were categorized into 3 age groups: <75 years, 75–84 years, and ≥85 years, based on Japan’s healthy life expectancy and average life expectancy. Survival rates and risk factors for mortality were assessed across these patient groups.

Results: Among 175 patients, 3- and 5-year survival rates were significantly lower in elderly patients, with rates of 74.6% and 64.2% for those aged 75–84 years and 51.9% and 39.7% for those aged ≥85 years. Multivariate analysis identified age ≥85 years, chronic kidney disease, chronic obstructive pulmonary disease, and active cancer as independent adverse predictors of all-cause mortality, whereas obesity was identified as an independent protective predictor.

Conclusions: Adjusting guidelines to incorporate not only comorbidities but also age could optimize outcomes and healthcare resource allocation by prioritizing EVAR for patients most likely to benefit in Japan’s super-aging society.

Purpose: Owing to the time-sensitive nature of myocardial ischemia, challenging clinical scenarios should be considered in patients with type A acute aortic dissection (AAAD) complicated by coronary malperfusion. In clinical settings, the diagnosis and reperfusion strategies for coronary malperfusion often depend on institutional resources. This study evaluated early surgical outcomes in such patients, focusing on transportation type and clinical management.

Methods: We retrospectively reviewed 70 patients who underwent emergency surgery for AAAD with coronary malperfusion, excluding those with cardiac tamponade on arrival, between 1997 and February 2024. Patients were divided into 2 groups based on transportation: direct transfer and referral.

Results: Overall, in-hospital mortality was 27%, with only 1 of 9 patients surviving with preoperative peripheral extracorporeal membrane oxygenation (ECMO). Mortality and morbidity did not significantly differ between groups. Univariate analysis identified left coronary artery involvement and preoperative hemodynamic instability as significant risk factors. Additionally, preoperative diagnostic-only coronary angiography (CAG) with unsuccessful reperfusion was a potential risk factor (P = 0.06).

Conclusions: Regardless of transportation type, preoperative peripheral ECMO itself could not be a definitive solution in AAAD patients with coronary malperfusion. Also, patients who underwent preoperative CAG with unsuccessful reperfusion might be fatal, especially with suspected left coronary artery involvement.

Purpose: In totally endoscopic off-pump left atrial appendage (LAA) closure and surgical ablation, securing the operative field is sometimes difficult in some patients because of a narrow working space caused by an elevated diaphragm or ventricles. In this study, we aimed to investigate the effectiveness of a method that facilitates securing the operative field using an artificial pneumothorax.

Methods: We analyzed 71 consecutive patients who underwent totally endoscopic off-pump LAA closure and bilateral pulmonary vein isolation. The factors contributing to the reduction in operative time were examined. The patients were divided into the following 2 groups according to whether or not an artificial pneumothorax was used: Group C comprised 24 patients without an artificial pneumothorax and Group A comprised 47 patients with an artificial pneumothorax.

Results: There were no hospital deaths or major complications. The operative time was significantly shorter in Group A (108 ± 26 minutes) than in Group C (198 ± 77 minutes) (p <0.0001).

Conclusions: In totally endoscopic off-pump LAA closure and surgical ablation, an artificial pneumothorax may be useful in reducing the operative time.

Purpose: The underlying mechanism why segmentectomy has demonstrated the non-inferiority to lobectomy in several randomized trials remains unclear. Computed tomography (CT)-measured pulmonary artery (PA) enlargement reflects PA pressure and predicts the prognosis of certain respiratory diseases. We compared the preoperative and postoperative PA diameter to the ascending aorta diameter (PA/A) ratio, investigating its impact on right ventricular function in lung resection.

Methods: This retrospective study was conducted in patients with lower-lobe lung tumors who underwent anatomical lung resection between 2017 and 2022. The PA diameter at the bifurcation and the ascending aorta diameter at the same CT image slice were measured preoperatively and postoperatively. We calculated the enlargement of PA/A ratio (PA/A change) and compared lobectomy and segmentectomy.

Results: This analysis included 279 patients (235 with lobectomy and 44 with segmentectomy). The PA/A change was significantly greater in patients with lobectomy than segmentectomy (104% vs. 102%, P = 0.02). In the multivariable analysis, airflow obstruction (yes, P = 0.04) and the type of surgery (segmentectomy, P = 0.04) were independent prognostic factors for PA/A change.

Conclusions: The PA/A change was greater in lobectomy than in segmentectomy. This change could reflect a burden on right ventricular function after lobectomy.

Purpose: We aimed to elucidate the efficacy of conventional cisplatin-based adjuvant chemotherapy for patients with lung cancers harboring epidermal growth factor receptor (EGFR) mutation.

Methods: This retrospective cohort study included 110 patients (EGFR mutation group: n = 51; EGFR wild-type group: n = 59) receiving cisplatin-based adjuvant chemotherapy following complete resection of non-small-cell non-squamous-cell lung cancer (2010–2021). Clinicopathological characteristics, recurrence-free survival (RFS), and overall survival (OS) were investigated.

Results: The pStage distribution was not statistically different. The EGFR mutation group was characterized by more advanced pN, papillary predominance, and presence of micropapillary components, whereas the EGFR wild-type group exhibited more advanced pT and solid predominant patterns. The median RFS was significantly worse in the EGFR mutation group (23.0 vs. 76.1 months, p = 0.017). Nevertheless, the median OS was not significantly different (85.6 months vs. not reached, p = 0.151). Multivariable analysis demonstrated that EGFR mutation and lymphatic invasion were significant risk factors in RFS; however, no independent factors were identified in OS.

Conclusions: Cisplatin-based adjuvant chemotherapy might be less effective in patients with EGFR-mutated lung cancer. The style of progression and histological pattern related with EGFR mutation may be associated with the efficacy of adjuvant chemotherapy and poor RFS.

Cowden syndrome (CS) is a rare hereditary disorder caused by a germline variant of the phosphatase and tensin homolog, associated with multiple hamartomatous lesions occurring in various organs. Additionally, although rare, arteriovenous malformations (AVMs) with CS are found in the skin, brain, and spinal cord; however, peribronchial AVMs have not been previously reported. Herein, we report a rare case of a peribronchial AVM in a 30-year-old man with CS who presented with hemoptysis. Computed tomography (CT) revealed an AVM around the left upper bronchus, which was mainly fed by the left bronchial artery and drained into the left inferior pulmonary vein. Under video-assisted thoracic surgery, ligation of the feeding and draining vessels was performed. The AVM remarkably decreased in size one month after the surgery. This case highlights the need for whole-body contrast-enhanced CT to screen for AVMs and the importance of identifying feeding and draining vessels for optimal treatment methods.

Introduction: Kartagener syndrome (KS), a distinct subtype of primary ciliary dyskinesia, is linked to progressive lung disease; concurrent pulmonary mucinous adenocarcinoma mimicking pneumonia is rarely reported and easily misdiagnosed.

Case Presentation: A 64-year-old female presented with years of recurrent cough and sputum. Chest computed tomography (CT) revealed bilateral chronic inflammation, interstitial changes, a left lower lobe mass-like shadow, partial bronchiectasis, and dextrocardia. Bronchoscopy showed chronic mucosal inflammation in the left lower lobe base segment; sputum culture was negative. Symptoms improved with antibiotics/expectorants. Two months later, worsening symptoms prompted re-evaluation. Extensive diagnostic tests (tumor markers, bacteriological/mycological, immunological, viral) were largely negative. CT-guided percutaneous lung biopsy confirmed invasive mucinous adenocarcinoma. Preoperative evaluation revealed situs inversus totalis, chronic sinusitis, and bronchiectasis, confirming concurrent KS. Following multidisciplinary discussion, she underwent thoracoscopic left middle and lower lobectomy with uncomplicated recovery; pathology confirmed R0 resection. She completed 5 cycles of adjuvant pemetrexed/platinum chemotherapy and remains recurrence-free on follow-up.

Conclusions: This represents the first documented case of KS coexisting with pulmonary invasive mucinous adenocarcinoma, to some extent expanding the clinical spectrum of ciliopathy-associated lung malignancies. It suggests that clinicians and radiologists should consider the possibility of concurrent mucinous adenocarcinoma in KS patients.

Primary pulmonary sarcoma is a rare disease and is much less common than lung cancer among tumors arising from pulmonary cysts. We report the case of a female patient who showed multifocal cysts in the left S9–10. Follow-up computed tomography (CT) revealed that the cyst tended to regress, but the solid component of the cyst wall continued to thicken, growing to a 10-cm-diameter tumor. Thoracoscopic left lower lobectomy was performed to diagnose and treat the cystic lung lesions. For the pathology of the pulmonary cystic lesion, it was marked by solid tumors composed of proliferative atypical spindle cells, with some trapped bronchial tissue. Based on the imaging and pathological findings, the diagnosis was primary pulmonary sarcoma arising from the pulmonary cyst. The present case highlights that, even when a pulmonary cyst appears to shrink, careful follow-up and timely surgical consideration are warranted if cyst wall thickening is observed.

We report a rare case of the independent coexistence of lung cancer and organizing pneumonia (OP) in different lobes of the right lung in a 67-year-old man with a history of left upper lobectomy. Computed tomography revealed a lesion consistent with OP in the right upper lobe and a suspicious shadow in the right lower lobe, which was diagnosed as squamous cell carcinoma via bronchoscopic biopsy. The patient underwent right lower lobectomy and partial resection of the right upper lobe under left one-lung ventilation. Empirical corticosteroids were administered preoperatively, followed by a brief postoperative course for 3 days after pathological confirmation of OP to reduce complications such as bronchial fistula, then transitioned to macrolide therapy for 3 months. Fourteen months postoperatively, OP had not recurred, although bone metastases developed and responded well to chemoradiotherapy. This case highlights the need for individualized perioperative management in patients with complex pulmonary pathology.

Thymomas are commonly associated with autoimmune diseases such as myasthenia gravis (MG), pure red cell aplasia, and hypogammaglobulinemia, while those associated solely with alopecia areata (AA) are extremely rare. A 55-year-old woman with AA underwent chest computed tomography, which revealed a 33-mm anterior mediastinal cystic mass with fluctuating size. She was referred to our department for evaluation of a suspected cystic thymoma. The patient underwent thoracoscopic tumor resection under general anesthesia with isolated lung ventilation in the left lateral decubitus position. The operation lasted 81 minutes with minimal blood loss, and her postoperative course was uneventful. Histopathology confirmed a type B2-dominant thymoma. Notably, the patient’s AA improved rapidly after surgery and did not recur for at least 3 years. This case strongly suggests a potential immunological relationship between AA and thymoma, though further research is needed to confirm this relationship.

Severe subcutaneous emphysema that is refractory to chest tube drainage can result in significant patient discomfort, airway compromise, and hemodynamic instability. Various interventional approaches, including subcutaneous drain insertion and the blowhole technique, with or without negative pressure wound therapy (NPWT), have been proposed to manage this condition. In this case series, we describe 10 patients who developed severe subcutaneous emphysema following surgery or pneumothorax and were treated using the blowhole technique, with or without NPWT. A Wound Protector/Retractor XXS or LapProtector was used to maintain the patency of the blowhole, facilitating continuous decompression. In cases with more extensive emphysema, the application of NPWT led to rapid respiratory improvement, thereby enabling additional invasive interventions to address the underlying pulmonary air leak. These findings highlight the potential utility of a structured approach incorporating NPWT for the management of severe subcutaneous emphysema, particularly in cases refractory to conventional chest tube drainage.

The malignancy risk has increased following improvements in the long-term survival rates after liver transplantation. Reports show a 23.4-fold increase in the risk of de novo esophageal cancer after liver transplantation compared to the general population. We report the case of a 47-year-old female diagnosed with early esophageal cancer after liver transplantation. Endoscopic submucosal dissection was performed; however, due to it being a noncurative resection, additional treatment was required. Total robot-assisted minimally invasive esophagectomy (RAMIE) was performed using a robot for thoracic and abdominal procedures. Although extensive adhesions were observed after liver transplantation, precise surgery using the robot did not damage any vital organs, such as the graft blood vessels. The patient was discharged without postoperative complications. Total RAMIE for esophageal cancer after liver transplantation is a feasible and safe option following careful evaluation of the patient’s condition, and expands the possibilities of successful complex posttransplant surgeries through robotic precision.

Bronchogenic cysts (BCs) are often incidental findings during imaging and can cause compressive symptoms depending on their location and size. Infections of mediastinal BCs are serious complications that can lead to life-threatening mediastinitis. The impact of severe acute respiratory syndrome coronavirus 2 on BCs remains largely undocumented. We present a unique case of a purulent-inflammatory mediastinal BC complicated by sepsis in the context of a Coronavirus Disease 2019 infection. The Coronavirus Disease 2019 infection may result in a bacterial superinfection of the BC. However, the transmission path requires further investigation. For the surgical excision, we opted for a two-step surgical approach: thoracoscopic incision and drainage in the acute setting, followed by elective thoracotomy and resection of the BC. We confirm the safety and favorable outcome of this approach.

Left atrial mitral valve chorda (LAMVC) is a rare congenital cardiac anomaly. The abnormal tissue band, like a mitral valve chorda, is attached to the left atrial wall on one side and mostly to the mitral valve leaflet on the other side and the band sometimes disturbs the mitral leaflet motion, followed by mitral regurgitation (MR). We encountered a case with a LAMVC which originated from a papillary muscle and attached to the posterior mitral annulus over the posterior leaflet and caused MR due to restricted mitral leaflet motion.