Asian Cardiovascular and Thoracic Annals

Blood cardioplegia, the gold-standard cardioprotective strategy, requires frequent dosing, resulting in hyperkalemia-induced myocardial edema. The aim of our study was to compare the efficacy and safety of a long-acting blood-based cardioplegia with physiological potassium levels versus the well-established cold blood St. Thomas’ Hospital no. 1 cardioplegia solution in multivalve surgeries.

One hundred patients undergoing simultaneous elective aortic and mitral valve replacement ± tricuspid valve repair were randomized in two groups. In group 1, adenosine 12 mg was given via the aortic root after crossclamping, followed by a single dose of long-acting solution at 14℃ (30 mLċkg⁻¹); in group 2, an initial 30 mLċkg⁻¹ of St. Thomas’ cardioplegia at 14℃ was administered, followed by 15 mLċkg⁻¹ every 20 min. Duration of cardiopulmonary bypass, inotropic score, arrhythmias, ventilation time, and the levels of interleukin-6, creatinine kinase-MB, and troponin I were compared.

Mean cardiopulmonary bypass and crossclamp times were 134.04 ± 36.12 vs. 154.34 ± 34.26 (p = 0.004) and 110.37 ± 24.80 vs. 132.48 ± 31.68 min (p = 0.002), respectively, in the long-acting and St. Thomas’ groups. Cardiac index, creatinine kinase-MB and troponin I levels were comparable. Interleukin-6 levels post-bypass were 61.72 ± 15.33 and 75.44 ± 31.78 pgċmL⁻¹ (p = 0.007) in the long-acting and St. Thomas’ cardioplegia groups, respectively.

Single-dose long-acting cardioplegia gives a cardioprotective effect comparable to repeated doses of the well-established St. Thomas’ Hospital no. 1 cold blood cardioplegia.

Axillary artery cannulation is still regarded with distrust by surgeons because the artery is supposed to be fragile, difficult to access, and its cannulation is often considered time-consuming. This study was carried out to assess our results in a series of patients, using a simplified surgical approach to axillary artery cannulation.

Data were collected retrospectively from our prospective database. All patients operated on in our department between January 2004 and October 2016 and scheduled for various cardiac procedures with direct axillary artery cannulation were included in this study. In this twelve-year period, 246 patients had direct axillary artery cannulation during a cardiac surgical procedure. The mean age was 67.3 ± 14.7 years. The artery was approached at the level of the deltopectoral groove and cannulated by the direct Seldinger technique.

The main indications for axillary artery cannulation were: right minithoracotomy aortic valve replacement (n = 93), aortic dissection (n = 57), extracorporeal life support (n = 36), transarterial valve replacement (n = 27), ascending aortic aneurysm (n = 16), and others (n = 17). The cannulation was right-sided in 90.6% of patients. Axillary cannulation-related morbidity was 6.1%. Axillary cannulation-related mortality was 0.8% (2 patients).

The axillary artery is a reliable site for rapid cannulation, carrying a low risk of morbidity and mortality. Our findings show that this artery is solid and can be very useful in everyday cardiac surgical practice.

Renal dysfunction is a well-recognized major complication after coronary artery bypass grafting. Off-pump coronary artery bypass theoretically appears to have less impact on renal function. We estimated preoperative and postoperative creatinine clearance as a marker of renal dysfunction in patients undergoing off-pump and on-pump coronary artery bypass.

Thirty patients undergoing coronary artery bypass were randomly allocated to undergo either on-pump (n = 15) or off-pump surgery (n = 15). The two groups had similar preoperative demographic characteristics. Serum creatinine and creatinine clearance were measured for 4 days postoperatively and the results were compared with preoperative levels.

The rise in serum creatinine on postoperative day 1 was 0.28 mgċdL⁻¹ in the on-pump group and 0.22 mgċdL⁻¹ in the off-pump group (p = 0.27); on postoperative day 4 it was 0.15 mgċdL⁻¹ and 0.10 mgċdL⁻¹, respectively, (p = 0.28). Similarly, the fall in creatinine clearance was 17.34 mLċmin⁻¹ in the on-pump group and 19.62 mLċmin⁻¹ in the off-pump group on postoperative day 1 (p = 0.42), and 10.9 and 10.94 mLċmin⁻¹, respectively, on postoperative day 4 (p = 0.64).

Renal function is not affected by the technique of coronary artery bypass surgery, whether with or without cardiopulmonary bypass, in spite of the theoretical advantage of off-pump surgery. Our study suggests that off-pump coronary artery bypass surgery does not confer significant protection from postoperative renal dysfunction in low-risk patients, when compared with on-pump surgery.

Minute pulmonary meningothelial-like nodules are incidentally discovered in lung specimens. We analyzed the clinicopathologic features of 14 cases identified in surgically resected lungs.

Among patients who underwent lung resection in our hospital from October 2007 to March 2016, 14 were found to have minute pulmonary meningothelial-like nodules. The clinical parameters, radiologic findings, and pathologic features of these patients were retrospectively reviewed using the medical records.

The patients included 4 men and 10 women, with a mean age of 69 years (range 53–82 years). The coexisting main disease was adenocarcinoma in 8 patients, squamous cell carcinoma in 1, atypical adenomatous hyperplasia in 1, and metastatic pulmonary tumor in 3. In one patient, the minute pulmonary meningothelial-like nodules presented as multiple lung nodules on chest computed tomography. The median size of the nodules was 1.4 mm (range 0.3–6.0 mm). Similar to meningioma, one case had immunoreactivity to progesterone receptor and epithelial membrane antigen, although the minute pulmonary meningothelial-like nodules were not associated with a meningioma.

The relationship between minute pulmonary meningothelial-like nodules and meningioma should be investigated. If minute pulmonary meningothelial-like nodules are found on preoperative computed tomography, thoracoscopic lung biopsy is helpful for differential diagnosis.

A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery.

The data of 83 consecutive patients who underwent a McKeown’s esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach.

Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy (p = 0.02), but these patients reported less postoperative pain (p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy (p = 0.01), but there were no significant differences in inpatient care and total hospital costs.

Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.

This study was undertaken to determine the relationship between preoperative and postoperative psychiatric status and postoperative complications in patients operated on due to lung cancer.

We prospectively enrolled 25 patients undergoing surgery with a diagnosis of lung cancer. There were 17 (68%) males, 8 (32%) females, and the mean age was 61 ± 8.9 years (range 38–81 years). Their psychiatric status was assessed using the Experiences in Close Relationships Scale II, European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30, Perceived Family Support Scale, the combined Stress Thermometer and Hospital Anxiety Depression Scale, in the preoperative period, and the Perceived Family Support, Stress Thermometer, and European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 at 1 month postoperatively.

We found that 44% of patients had depression and 28% had anxiety. There was no difference between sexes in terms of anxiety (p = 0.088), but more women had depression (p = 0.03). Postoperative complications occurred in 5 of 18 patients with negligible anxiety scores (27.8%) and 3 (42.9%) of 7 patients with high scores, as well as 3 (21.4%) patients with negligible depression scores and 5 (45.5%) of 11 patients with high scores.

Patients selected for lung cancer surgery should be assessed preoperatively using the Hospital Anxiety-Depression Scale and Stress Thermometer. Psychosocial support is recommended to improve their quality of life and reduce postoperative complications.

Recurrent pneumothorax is one of the most common complications after thoracostomy tube removal. The purpose of this study was to assess the optimal method of thoracostomy tube removal by comparing party balloon-assisted Valsalva and classic Valsalva techniques.

Trauma patients with indications for tube thoracostomy from 2014 to 2015 were recruited. Exclusion criteria were age < 15- or > 64-years-old, history of chronic lung disease, Glasgow Coma Scale < 13, latex allergy, or tracheostomy. Participants were randomly allocated by randomized block design into 4 groups using different Valsalva maneuvers: group A: classic inspired, group B: classic expired, group C: balloon-inspired; and group D: balloon-expired. The primary and secondary outcomes were recurrent pneumothorax and respiratory complications.

Forty-eight tube thoracostomies were randomized for analysis; 4 patients had bilateral tube thoracostomies. The mean patient age was 38.1 ± 19.9 years. The incidence of recurrent pneumothorax confirmed by chest radiography was 15.4% in group A, 16.8% in group B, and none in groups C and D (p = 0.31). When group A combined with group B was compared with groups C and D, the incidence was 16% vs. 0%, respectively (p = 0.11). The thoracostomy tube reinsertion rate in all 4 groups was 0%, 8.33%, 0%, and 0%, respectively, which was not significant (p = 0.38).

Performing the Valsalva maneuver correctly during full inspiration may be the method of choice for removing thoracostomy tubes. Using a party balloon forces the patient perform the Valsalva maneuver adequately and is simpler to explain.