Asian Cardiovascular and Thoracic Annals

The Cox maze procedure is the gold-standard concomitant surgical procedure to restore sinus rhythm in rheumatic mitral valve disease with atrial fibrillation. Left atrial reduction surgery was found to be beneficial for rhythm conversion, but no study has investigated its efficacy compared to the Cox maze procedure for atrial contractility restoration. We aimed to compare the early success rate of left atrial contractility restoration with the Cox maze procedure and left atrial reduction in rheumatic subjects.

Preoperative and within one-month postoperative electrocardiograms and echocardiograms of patients who underwent a Cox maze IV procedure or left atrial reduction with mitral valve surgery were compared. Effective atrial contraction was defined as A wave peak velocity ≥10 cm·s⁻¹ or atrial filling fraction ≥20%.

Ninety patients (mean age 40.6 ± 10.2 years, 66.7% female) were divided equally into group A (Cox maze IV) and group B (left atrial reduction). The early sinus rhythm conversion rate was 64.4% versus 24.4% (p < 0.001) in groups A and B, respectively. In patients with restored sinus rhythm, contractility was restored in 41.4% and 36.4% (p = 1.000). Postoperative left atrial volume index ≤76 mL·m⁻² was an independent variable associated with early atrial contractility restoration in both groups (prevalence rate 0.97, p = 0.007).

In rheumatic subjects, the early sinus rhythm conversion rate was significantly higher after Cox maze IV compared to left atrial reduction, but for restoring left atrial contractility, left atrial reduction was not inferior to Cox maze IV.

We aimed to investigate the association between body phenotype markers and coronary atherosclerosis markers.

Eighty-nine patients (mean age 57 ± 9 years, 50.5% male) who were assessed for coronary artery disease by 64-slice multidetector computed tomography angiography were enrolled in the study.

A significant positive association was observed between coronary artery calcification and the second to fourth digit ratio (r = 0.2, p = 0.00); more notably in males compared to females (p = 0.03 vs. p = 0.08). There was a significant association between coronary artery calcification and pure white hair (p = 0.00). There was no significant association between pericardial fat volume and second to fourth digit ratio (p = 0.8). Pericardial fat volume was significantly associated with pure white hair (p = 0.02). A significant association was observed between coronary plaque and a higher second to fourth digit ratio (p = 0.01) and this was more notable in males (p = 0.04). A significant association was observed between pure white hair and coronary plaque (p = 0.00). After adjustment for conventional cardiac risk factors, the association of coronary artery calcification and coronary plaque with the second to fourth digit ratio did not persist, whereas the association of pericardial fat volume and coronary artery calcification with pure white hair remained significant (p = 0.01 and p = 0.00, respectively).

These results suggest a possible predictive value of hair color, rather than digit ratio, in assessing increased risk of coronary atherosclerosis and cardiac fat deposition.

Prolonged air leak is one of the most annoying complications after pulmonary surgery. Studies have shown that patients with more intraoperative air leaks are at higher risk of developing prolonged postoperative air leak. Various types of sealants have been used effectively for decreasing intraoperative alveolar air leak. We decided to compare 3 sealants to determine which was best.

This was a prospective nonrandomized study that included 120 patients undergoing pulmonary surgical procedures associated with intraoperative air leak. They were divided into 4 equal groups. In the first group, no sealant was used. Glubran 2 sealant was used in the second group, BioGlue in the third, and TachoSil in the fourth.

Preoperative and intraoperative data showed no significant differences among groups, except age which was significantly older in the BioGlue group. Air leak duration and tube duration were significantly shorter in the sealant groups, separately and collectively. No significant difference was found among groups regarding total tube drainage. Also, no significant difference was found between the no-sealant and sealant groups collectively regarding the incidence of postoperative complications, but the BioGlue group had a significantly lower incidence of postoperative complications compared to the no-sealant group. Postoperative hospital stay was significantly shorter in the sealant groups, separately and collectively.

Our results support the use of sealants for decreasing alveolar air leak. They were easily used in a short time with no significant superiority of one sealant over the others, except for a lower incidence of postoperative complications with BioGlue.

The stability of the pectus bar is an important determinant of the success of pectus excavatum repair surgery. In practice, several different types of fixation method are in use for stabilizing pectus bars. The aim of this study was to compare the performance of the bridge fixation system with previous fixation systems for stabilizing pectus bars.

We performed a retrospective review of 1760 pectus excavatum repair cases conducted in the Thoracic Department of Choray Hospital and its satellite hospitals, between 2007 and 2017. We compared the results of 560 patients who had the bridge fixation system with the previous 1200 patients who had other fixation techniques.

The bridge fixation system with 2 bars in 560 patients gave better results in terms of bar stabilization, operative time, and postoperative complications, compared to the previous 1200 patients who had other stabilization techniques. The average skin-to-skin surgery time using the bridge fixation system was 55 min. Of the 560 cases, only one patient showed trivial one bar dislocation, and one had a postoperative complication (pneumothorax).

We found the bridge fixation system to be superior not only in terms of stabilizing the bars but also for minimizing the time of surgery and postoperative complications, compared to other fixation systems. The bridge fixation system with 2 bars showed excellent results. Use of 3 bars is not necessary. One bar was used in the other fixation techniques and the results were found to be inferior compared to those using 2 bars.

Video-assisted thoracoscopic surgery has been widely adopted. However, conversion to open thoracotomy is still necessary when intraoperative complications are encountered.

Between January 2009 and December 2014, 1566 patients underwent anatomical lung resection for lung cancer using video-assisted thoracoscopic surgery at our institution. Among these patients, 39 required conversion to open thoracotomy. We retrospectively examined the current status of conversion to thoracotomy during video-assisted thoracoscopic surgery in a single city hospital. Data were compared with those of 89 patients undergoing a scheduled thoracotomy.

The main reason for conversion was the need for angioplasty for pulmonary artery invasion by silicotic lymph nodes (12 cases), and metastatic lymph nodes or tumors (9 cases). Univariate analysis demonstrated that the risk factors for conversion were male sex, smoking habit, induction therapy, large tumor size, and advanced stage. Multivariate analysis showed that advanced clinical stage was the only significant predictor of intraoperative conversion. Compared to the video-assisted thoracoscopic surgery group, mortality and morbidity in the conversion group were significantly higher, but there was no significant difference in mortality or morbidity between the conversion and scheduled thoracotomy groups. The conversion group showed a significantly higher rate of lethal acute exacerbation of interstitial pneumonitis than the video-assisted thoracoscopic surgery group.

The main reason for conversion was angioplasty, and advanced clinical stage was a significant predictor of intraoperative conversion. Conversion was safely performed but postoperative complications, although similar in frequency to scheduled thoracotomy cases, were more frequent than those in thoracoscopic surgery cases.

The crural diaphragm is responsible for pulmonary ventilation in the early period after lobectomy. However, the role of its thickness in pulmonary ventilation remains unclear. We investigated the impact of crural diaphragm thickness on pulmonary oxygenation and gas exchange early after lobectomy.

We enrolled 32 patients with non-small-cell lung cancer who underwent video-assisted thoracoscopic lobectomy. Crural diaphragm thickness was defined as the average of the maximum thicknesses of the right and left crural diaphragm at the level of the median arcuate ligament on computed tomography. Pulmonary oxygenation and gas exchange were evaluated by the ratio of arterial oxygen tension/fraction of inspiratory oxygen and alveolar-arterial oxygen difference on the second postoperative day.

Crural diaphragm thickness of 7.0 ± 1.7 mm was associated with vital capacity. After lobectomy, arterial oxygen tension/fraction of inspiratory oxygen decreased significantly and alveolar-arterial oxygen difference increased significantly. Five patients with oxygen saturation via pulse oximetry ≤92% had a lower arterial oxygen tension/fraction of inspiratory oxygen and higher alveolar-arterial oxygen difference than the others. Crural diaphragm thickness in these patients was less than in the others (5.5 ± 1.9 vs. 7.3 ± 1.5 mm, p = 0.033). In multivariate analysis, crural diaphragm thickness remained an independent factor affecting arterial oxygen tension/fraction of inspiratory oxygen and alveolar-arterial oxygen difference (p = 0.044, p = 0.049). Crural diaphragm thickness was positively associated with arterial oxygen tension/fraction of inspiratory oxygen and negatively associated with alveolar-arterial oxygen difference.

Crural diaphragm thickness affects pulmonary ventilation early after lobectomy.