Cardiothorac Surg Research Articles

Invited Commentary

In the Fontan circulation, variation in the negative intrathoracic pressure associated with normal respiration enhances venous return and pulmonary blood flow. This influence is now well known, with further recognition that phrenic nerve palsy leading to diaphragmatic paralysis is poorly tolerated in Fontan patients. It is rare for a Fontan patient with phrenic nerve palsy to be able to go home without surgical diaphragm plication. However, there is an awareness growing that despite fixing the diaphragm to prevent its paradoxical motion, Fontan patients with phrenic nerve palsy will have more restrictive ventilatory physiology and potentially worse hemodynamics, at least in the short term, than those with normal diaphragmatic function.1Ovroutski S. Alexi-Meskishvili V. Stiller B. et al.Paralysis of the phrenic nerve as a risk factor for suboptimal Fontan hemodynamics.Eur J Cardiothoracic Surg. 2005; 27: 561-565Crossref PubMed Scopus (30) Google Scholar Because a significant proportion of children with phrenic nerve palsy following congenital heart surgery will eventually recover diaphragm function, the logical questions are what happens to those paralyzed diaphragms in Fontan patients, and how they are coping later in life. The difficulty with answering these questions, however, is also a blessing: not many Fontan patients had paralyzed diaphragms. Thanks to Komori and colleagues2Komori M. Hoashi T. Shimada M. et al.Impact of phrenic nerve palsy on late Fontan circulation.Ann Thorac Surg. 2020; 109: 1897-1903Abstract Full Text Full Text PDF Scopus (1) Google Scholar from the highly respected group in Osaka, Japan, we are able to gain valuable insights in this issue of The Annals of Thoracic Surgery. In an elegant study that included spirometry, exercise testing, and cardiac catheterization, they delineated some of the long-term effects of phrenic nerve palsy in Fontan patients 10 years after total cavopulmonary connection completion. Despite the unavoidable imbalance of patient cohort to the control group (those who never had phrenic nerve palsy), their findings were quite interesting, and surprising: (1) nearly half of the patients with phrenic nerve palsy recovered diaphragmatic function and (2) despite worse restrictive ventilatory impairment, those with persistent diaphragmatic paralysis did not have deleterious hemodynamic outcomes or exercise capacity, even when compared with patients who never had diaphragm problems. These findings are of course contrary to what we have expected. Although it might not be surprising that half of the paralyzed diaphragms recovered, the discovery that Fontan patients with persistent phrenic nerve palsy have essentially equivalent hemodynamics and exercise tolerance (eg, anaerobic threshold and peak oxygen consumption) as those with normal diaphragm function went against conventional (and unsupported) supposition. One would expect that losing the valuable respiration driven flow benefits would significantly affect how they cope with the obligatory and unrelenting adversities of the Fontan physiology. Nonetheless, Komori and colleagues’ data2Komori M. Hoashi T. Shimada M. et al.Impact of phrenic nerve palsy on late Fontan circulation.Ann Thorac Surg. 2020; 109: 1897-1903Abstract Full Text Full Text PDF Scopus (1) Google Scholar suggest that they are indeed coping well. It is worth noting that instead of relying on one single test, such as spirometry alone, the authors were able to engender a more complete picture and gather accurate answers with concomitant cardiac catheterization and cardiopulmonary exercise testing. For complex physiologies such as the Fontan circulation, this study further validates the importance of multidisciplinary and multimodality follow-up. Impact of Phrenic Nerve Palsy on Late Fontan CirculationThe Annals of Thoracic SurgeryVol. 109Issue 6PreviewAlthough adverse effects of phrenic nerve palsy (PNP) on early Fontan circulation have been reported, detailed late impact remains unclear. Full-Text PDF

Tracheal Injury Complicating Mitral Valve Repair

TRACHEAL injuries complicating cardiac surgery are extremely rare. Therefore, no guidelines exist for the management of such injuries. Tracheal injuries present unique challenges, such as endotracheal tube (ETT) positioning, adequacy of ventilation if there is an air leak, and anesthetic delivery. Although tracheal injuries during cardiac surgery are rarely reported, there are many reports of tracheal injuries from trauma or tracheal intubation, with an incidence reported as high as 0.12% after intubation with a double-lumen tube. 1 Borasio P. Ardissone F. Chiampo G. Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg. 1997; 12: 98-100 Crossref PubMed Scopus (143) Google Scholar There are a variety of methods described in the literature for managing these injuries, including conservative management and surgical repair, both with excellent clinical outcomes. 2 Schneider T. Storz K. Dienemann H. et al. Management of iatrogenic tracheobronchial injuries: A retrospective analysis of 29 cases. Ann Thorac Surg. 2007; 83: 1960-1964 Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar Tracheal injury may be associated with significant morbidity and mortality because of increased risk of airway fire with the use of electrocautery and the risk of pneumothorax or pneumomediastinum causing cardiac tamponade or inadequate ventilation. There are special concerns regarding these injuries during cardiac surgery, including the increased risk of infection and mediastinitis secondary to contamination from tracheal secretions and bleeding from the repaired tracheal injury as a result of anticoagulation required for cardiopulmonary bypass. These complications must be weighed against the risks of delaying cardiac surgery.

E2F1/IGF-1R Loop Contributes to BRAF Inhibitor Resistance in Melanoma

E2F1/IGF-1R Loop Contributes to BRAF Inhibitor Resistance in Melanoma

Comparison of dynamic brain metabolism during antegrade cerebral perfusion versus deep hypothermic circulatory arrest using proton magnetic resonance spectroscopy

Comparison of dynamic brain metabolism during antegrade cerebral perfusion versus deep hypothermic circulatory arrest using proton magnetic resonance spectroscopy

MS06.05 Transcervical Lymphadenectomies

Introduction: The aim of his study is to analyze the issue of transcervical lympadenectomies for Non-Small-Cell Lung Cancer performed by the techniques of Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA) and Transcervical Extended Mediastinal Lymphadenectomy (TEMLA). Methods The Pubmed search was performed and there were 27 articles found on VAMLA and 33 articles on TEMLA. After further analysis there were 13 original article on VAMLA and 18 original articles on TEMLA. In the current paper all proven and possible advantages of transcervical lymphadenectomies represented by VAMLA and TEMLA are described. Results The proven advantages of VAMLA and TEMLA: 1. Superior diagnostic value in discovery of the metastatic mediastinal nodes for staging and restaging of NSCLC. 2. bilateral mediastinal lymphadenectomy, more extensive than the techniques of lymphadenectomy used during standard thoracotomy or Video-Assisted Thoracic Surgery (VATS) approaches. Possible advantages include: 1. Improved selection of patients for pulmonary resection for NSCLC 2. Combination of VAMLA/TEMLA with VATS pulmonary resection, 3. Combination of VAMLA/TEMLA with esophegeal resection, 4. Combination of TEMLA and Stereotactic Radiotherapy (SBRT) for advanced NSCLC 5. The use of TEMLA for preoperative staging of mesothelioma, 6. Combination of TEMLA and pulmonary lobectomy through a sole transcevical approach 7. Resection of various metastatic tumors, including thyroid cancer and metastatic mediastinal nodes. 8. Possible impact of VAMLA/TEMLA on improvement of survival for NSCLC patients, which is the most important issue. In case of VAMLA superior survival of patients operated on with the use pulmonary resection with VAMLA in comparison to the pulmonary resection with addition of standard mediastinoscopy. In case of TEMLA no reports on survival has been published, yet Disadvantages of VAMLA/TEMLA include 1. Possible complications, especially the left recurrent nerve palsy 2. Possible delay or elimination of some patients from pulmonary resection due to postoperative complication in case of negative result of VAMLA/TEMLA 3. Scar in the neck (cosmetic) 4. Demanding surgical technique Conclusions 1. Bilateral transcervical lymphadenectomies representd by VAMLA and TEMLA are more extensive than the techniques of lymphadenectomy used during standard thoracotomy or Video-Assisted Thoracic Surgery (VATS) approaches and superior to the other techniques of staging and restaging of NSCLC in regard to the diagnostic value. 2. There are several other possible advantages of TEMLA/VAMLA for the treatment of NSCLC, esophageal cancer, mediastinal tumors and malignant mesothelioma. 3. Possible impact of VAMLA/TEMLA on survival of NSCLC has not been proven, yet. References Hurtgen M, Friedel G, Toomes H et al: Radical video-assisted mediastinoscopic lymphadenectomy (VAMLA) – technique and first results. Eur J Cardiothorac Surg 2002;21:348-51 Zielinski M, Szlubowski A, Kołodziej M, Orzechowski S, Laczynska E, Pankowski J, Jakubiak M, Obrochta A. Comparison of endobronchial ultrasound and/or endoesophageal ultrasound with transcervical extended mediastinal lymphadenectomy for staging and restaging of non-small-cell lung cancer. J Thorac Oncol. 2013 May;8(5):630-6. Zielinski M, Hauer J, Hauer L, Pankowski J, Nabialek T, Szlubowski A. Staging algorithm for diffuse malignant pleural mesothelioma. Interact Cardiovasc Thorac Surg. 2010;10:185-9 Zieliński M, Pankowski J, Hauer L et al: The right upper lobe pulmonary resection performed through the transcervical approach. Eur J Cardiothorac Surg. 2007;32:766-769 Singh AK, Hennon M, Ma SJ, Demmy TL, Picone A, Dexter EU, Nwogu C, Attwood K, Tan W, Hermann GM, Fung-Kee-Fung S, Malhotra HK, Yendamuri S, Gomez-Suescun JA. A pilot study of stereotactic body radiation therapy (SBRT) after surgery for stage III non-small cell lung cancer. BMC Cancer. 2018 Nov 29;18(1):1183. https://doi.org/10.1186/s12885-018-5039-5. Turna A, Demirkaya A, Ozkul S, Oz B, Gurses A, Kaynak K. Video-assisted mediastinoscopic lymphadenectomy is associated with better survival than mediastinoscopy in patients with resected non-small cell lung cancer. J Thorac Cardiovasc Surg. 2013 Oct;146(4):774-80. https://doi.org/10.1016/j.jtcvs.2013.04.036. Epub 2013 Jun 15. Li X, Wang W, Zhou Y, Yang D, Wu J, Zhang B, Wu Z, Tang J. Efficacy comparison of transcervical video-assisted mediastinoscopic lymphadenectomy combined with left transthoracic esophagectomy versus right transthoracic esophagectomy for esophageal cancer treatment. World J Surg Oncol. 2018 Feb 9;16(1):25. https://doi.org/10.1186/s12957-017-1268-3. Call S, Obiols C, Rami-Porta R, Trujilo-Reyes JC, Iglesias M, Saumench R, Gonzalez-Pont G, Serra-Mitjans M, Belda-Sanchís J. Video-Assisted Mediastinoscopic Lymphadenectomy for Staging Non-Small Cell Lung Cancer. Ann Thorac Surg. 2016 Apr;101(4):1326-33. https://doi.org/10.1016/j.athoracsur.2015.10.073. Epub 2016 Jan 21. .Kim HJ, Kim YH, Choi SH, Kim HR, Kim DK, Park SI. Video-assisted mediastinoscopic lymphadenectomy combined with minimally invasive pulmonary resection for left-sided lung cancer: feasibility and clinical impacts on surgical outcomes†. Eur J Cardiothorac Surg. 2016 Jan;49(1):308-13. https://doi.org/10.1093/ejcts/ezv077. Epub 2015 Mar 11 Zielinski M. Transcervical Resection of the Mediastinal Tumors. In Zielinski M, Rami-Porta R (eds). Transcervical Approach in Thoracic Surgery. Springer 2014, pages 141-148.

LUNG NODULE WITH PAPILLARY FEATURES ON BIOPSY: A DIAGNOSTIC DILEMMA

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Papillary adenocarcinoma (PA) is a rare sub type of adenocarcinoma of the lung. It can have histological and immunohistochemistry features like papillary thyroid carcinoma (PTC). We report a case of lung nodule found to have features suggestive of PTC on biopsy. CASE PRESENTATION: A 69-year-old female with a history of COPD and colon cancer presented to the pulmonologist for follow up of a solitary lung nodule in the right upper lobe, which was first diagnosed two years back. It had shown a recent increase in size from 8 mm to 12 mm, with spiculated pattern on imaging. Biopsy of the lung nodule was highly suspicious for PTC, with positive TTF1, papillary features, intranuclear cytoplasmic inclusions, nuclear grooves, negative CK20, CDX2 immunostain. She denied any symptoms of hypo/hyperthyroidism, weight loss, fatigue, cough, dyspnea, neck radiation exposure. She had a 37.5 pack-year smoking history. Family history was non-contributory. Vital signs and physical examination were unremarkable. Thyroid function tests including TSH, fT3, fT4 were within normal limits. With findings suggestive of PTC on biopsy, initial concern was for metastatic disease. Thyroid ultrasound showed 0.7cm cystic nodule in the right lobe, and two solid nodules of 0.9cm, 0.8cm on the left. FNAC of the nodules showed benign pathology. Tumour board was consulted, and they recommended MRI of the neck with contrast which revealed mildly enlarged thyroid with sub centimetric nodules, without lymphadenopathy, making our suspicion for metastatic PTC very low. Ectopic thyroid tissue carcinoma, PA of the lung were now being considered as differentials. Lung biopsy slides were sent to Mayo clinic for a second opinion, which revealed neoplastic cells with lining of papillary structures, with positive immunochemistry for napsin-A and TTF1, and negative for Pax-8, confirming the diagnosis of primary PA. DISCUSSION: PA accounts for 7-12% of lung adenocarcinomas, with a predilection for female smokers. It mimics PTC, as they can have similar histological features of pseudo-inclusions, intra-nuclear grooves. In such cases, immunohistochemistry aids in the diagnosis. Although, our patient had a nodule which morphologically resembled PTC, the history of solitary lung nodule, in the absence of significant findings on imaging and biopsy made the diagnosis of PTC unlikely. CONCLUSIONS: Most common etiology for lung nodule showing papillary features is metastatic disease. The combination of positive TTF1, napsin-A, and negative Pax-8 is a reliable tool to differentiate primary lung adenocarcinoma from metastatic tumors. Understanding the existence of papillary thyroid carcinoma-like primary pulmonary papillary adenocarcinoma will avoid misdiagnosis or unnecessary investigations. Reference #1: Zhu YZ, Li WP, Wang ZY, Yang HF, He QL, Zhu HG, Zheng GJ. Primary pulmonary adenocarcinoma mimicking papillary thyroid carcinoma. J Cardiothoracic Surg. 2013; 17; 8:131 Reference #2: El-Maqsoud NM, Tawfiek ER, Abdelmeged A, Rahman MF, Moustafa AA. The diagnostic utility of the triple markers Napsin A, TTF-1, and PAX8 in differentiating between primary and metastatic lung carcinomas. Tumour Biol. 2016; 37(3):3123-34 Reference #3: Karmakar S, Nath A, Neyaz Z, Agarwal V, Ahsan S. Primary papillary adenocarcinoma of lung: Report of two cases. Lung India. 2017; 34(3):299-302 DISCLOSURES: No relevant relationships by Shujaa Faryad, source=Web Response No relevant relationships by Pallavi Pradeep, source=Web Response

IBS20.02 Airway Stenosis

Tracheal stenosis is suspected in individuals with risk factors presenting with signs and symptoms of airway narrowing. The condition may be suspected based on spirometry with a flow-volume loop and CT imaging of the neck and chest but fiberoptic bronchoscopy is required to confirm the presence and severity of tracheal stenosis. The symptoms of tracheal stenosis are similar to those of other conditions so it is important to carefully evaluate patients history. The symptoms of tracheal stenosis typically are wheezing, coughing or shortness of breath, cornage, upper respiratory infections, asthma that doesn’t respond to treatment. Benign tracheal stenoses are more commonly the result of an injury to the trachea due to prolonged intubation or tracheostomy but also Infections (tuberculosis), autoimmune disorders such as Granulomatosis with polyangiitisand amyloidosis or radiation therapy to the neck or chest. The morphological classification of airway stenosis includes granulomas, pseudoglottic stenosis, and “true stenosis” divided into web-like and complex stenoses. Web-like stenoses are circumferential strictures of the trachea involving the mucosa of a short segment (maximum 1 cm long)without any damage to the cartilages. Complex stenosesare sleeve strictures of the trachea more than 1 cm long, often associated with various degrees of cartilage involvement, malacia and inflammation. Several treatment options that can be used for tracheal stenosis depending on the cause, location and severity of the tracheal narrowing. Resection and anastomosis of the involved tract of the trachea is the gold standard treatment. Interventional Pulmonology (IP) offers minimally invasive techniques. Some IP treatment options can provide immediate relief but are considered temporary solutions, while others can provide a better long-term solution. Short-term treatment options for the condition include laser surgery and mechanical dilation with rigid scopes.Treatment options that are generally considered to work long term include stenting and tracheal reconstruction when only a short portion of the trachea is involved. Choice of procedure depends on the exact location and extent of the stenosis, but also on patient age and comorbidities.The most common treatment options for tracheal stenosis include: In 2007 Cavaliere et al. published the results of Laser Assisted Mechanical Dilation in 113 post-intubation tracheal stenosesTab 1Patient carachterstics Therapeutic bronchoscopies were performed using rigid bronchoscopes (Efer, Dumon-Harrel type; FR) and general anesthesia.Endoscopic treatment was based on the use of three main techniques: laser photo-resection (multiple radial incisions), gentle dilation and removable silicon stents.SexAge(Y)Cause of stenosisType of stenosisM 4750±21 (12-84)Intubation 38Tracheotomy 35Web-like 13Complex 60 Open table in a new tab View Large Image Figure ViewerDownload Hi-res image Download (PPT) Most web-like stenoses were successfully treated with Laser Assisted Mechanical Dilation (LAMD) alone; among complex stenoses LAMD was sufficient to treat 13 patients (22%), whereas 47 patients (78%) required stent placement: 22 had their stent removed after one year and did not require any further therapy, 13 inoperable patients required permanent stent and 12 were referred to surgery after failure of multiple endoscopic treatments. No permanent complications secondary to endoscopic treatment were observed. Forty-eight patients (66%) obtained a stable, good result with the endoscopic procedure, 13 (18%) required a permanent stent while 12 patients (16%) were referred to surgery. These authors indicate that bronchoscopic treatment of post-intubation tracheal stenoses can be considered a safe first-line therapy, leaving some selected cases and the relapsing stenosis for surgical resection. 1.Shapshay SM, Beamis JF, Jr, Hybels RL, Bohigian RK. Endoscopic treatment of subglottic and tracheal stenosis by radial laser incision and dilation. Ann Otol Rhinol Laryngol. 1987;96:661–664. 2. Bacon JL, Patterson CM, Madden BP. Indications and interventional options for non-resectable tracheal stenosis. J Thorac Dis. 2014;6:258–70. 3. Galluccio G, Lucantoni G, Battistoni P, Paone G, Batzella S, Lucifora V et al. Interventional endoscopy in the management of benign tracheal stenoses: definitive treatment at long-term follow-up. Eur J Cardiothorac Surg. 2009;35:429–33. 4. Murgu SD, Colt HG, Mukai D, Brenner M. Multimodal imaging guidance for laser ablation in tracheal stenosis. Laryngoscope. 2010;120:1840–6. 5. Cavaliere S, Bezzi M, Toninelli C, Foccoli P Management of post-intubation tracheal stenoses using the endoscopic approach. Follow-up of 73consecutive patients over a four-year period. Monaldi arch Chest Dis 2007 Jun; 67(2):73-80

AORTOBRONCHIAL FISTULA DUE TO GRAFT FAILURE: A RARE CAUSE OF HEMOPTYSIS

SESSION TITLE: Case Report Semifinalists 10 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Aortobronchial Fistula (ABF) is a rare etiology of hemoptysis, an otherwise common finding. ABF is a complication of aortic surgery and is fatal if untreated. Its high mortality rate along with unequivocal symptoms and imaging make it a challenging diagnosis. We present a case of a patient presenting with hemoptysis secondary to ABF from thoracic aortic graft failure that was first detected via bedside ultrasound CASE PRESENTATION: An 84-year-old female with history of hypertension, tracheostomy, CVA, aortic dissection with multiple surgical repairs and stents presents for hemoptysis and suspected sepsis from Nursing Home. Vital Signs showed Blood Pressure 142/116 mmHg, Pulse 133 BPM, Temperature 101.6 F. Patient was obtunded, and found to have copious intermittent bloody secretions from tracheostomy tube. Labs revealed WBC 30 K/mm3. Hemoglobin 10 mg/dL, lactate 5.5. Urinalysis was positive leukocyte esterase with elevated WBCs. Chest XR showed left sided opacity. She was admitted to ICU for Sepsis. Bedside ultrasound of thorax showed findings seen in Figure 1, raising suspicion of hematoma. Subsequent Chest CT Angiography (CTA) seen in Figure 2. Descending aorta showed separation of stent graft component, indicating graft failure, and extravasation of contrast adjacent to this site with the hematoma.Diagnosed with aortic graft failure with endoleak, she was transferred for emergent surgical repair. Surgery revealed endoleak in thoracic aorta forming aortobronchial fistula with pooling of blood in left lung. Blood was suctioned and surgical repair was performed. Patient was stable during monitoring and shortly returned to nursing home DISCUSSION: ABFs are a rare complication after TEVAR with a 100% mortality rate if untreated. Symptoms are nonspecific, with intermittent hemoptysis being the first and often, only sign. Imaging via CTA, x-rays and even bronchoscopy is vague, leading to missed diagnoses with more than 30% of cases diagnosed at autopsy. Early detection and prompt surgical repair require a strong index of suspicion. ABFs present chronically after surgery, due to formation of an endoleak due to graft failure leading to hematoma compressing on nearby bronchial tree. Treatment is emergent surgical repair. ABF has high risk of complications, leading to mortality of 71% despite treatment. In our patient, high clinical suspicion prompted early BUS of thorax, revealing a likely hematoma. Early detection led to a CTA confirming diagnosis of graft failure, and subsequent ABF during surgery CONCLUSIONS: With its reputation as a misdiagnosed and fatal complication, we hope to raise awareness of ABF in the differential of hemoptysis and encourage clinicians to consider a through bedside ultrasound of the thorax in high risk patients for graft failure Reference #1: Fontana M et al. An uncommon cause of hemoptysis: aortobronchial fistula. Multidiscip Respir Med. 2018 Reference #2: Czerny M, Reser D, Eggebrecht H, Janata K, Sodeck G, Etz C, Luehr M, Verzini F, Loschi D, Chiesa R, Melissano G, Kahlberg A, Amabile P, Harringer W, Janosi RA, Erbel R, Schmidli J, Tozzi P, Okita Y, Canaud L, Khoynezhad A, Maritati G, Cao P, Kölbel T, Trimarchi S. Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications. Eur J Cardiothorac Surg. 2015 Reference #3: 3. Youssef Touma, Pierre Demondion, Akhtar Rama, Pascal Leprince; Aortobronchial fistula in the presence of a midgraft hole after endovascular repair of thoracic aortic aneurysms, European Journal of Cardio-Thoracic Surgery, Volume 43, Issue 6, 1 June 2013, Pages 1259–1261 DISCLOSURES: No relevant relationships by Artur Alaverdian, source=Web Response No relevant relationships by Shiva Arjun, source=Web Response No relevant relationships by Javed Iqbal, source=Web Response No relevant relationships by Hyfaa Mashaal, source=Web Response

Corrigendum to 'Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS)' [Eur J Cardiothorac Surg 2019;56:224-9

Corrigendum to 'Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS)' [Eur J Cardiothorac Surg 2019;56:224-9

Corrigendum to 'What counts more: the patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry' [Eur J Cardiothorac Surg 2019, doi:10.1093/ejcts/ezz187

Corrigendum to 'What counts more: the patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry' [Eur J Cardiothorac Surg 2019, doi:10.1093/ejcts/ezz187

Parasternal Pectoral Block for Right Anterior Minimally Invasive Thoracotomy in Cardiac Surgery

MINIMALLY invasive cardiac surgery (MICS) is being increasingly performed. 1 Gammie J.S. Zhao Y. Peterson E.D. et al. Less-invasive mitral valve operations: Trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2010; 90 (1401-10.e1) Abstract Full Text Full Text PDF Scopus (270) Google Scholar Several approaches are listed under the term MICS, such as ministernotomy for aortic valve replacement, left minithoracotomy for minimally invasive direct coronary artery bypass, and right anterior minimally invasive thoracotomy (RMIT) principally for mitral or aortic valve surgery. Minimally invasive thoracotomy is associated with intense and prolonged postsurgical pain, which can be equal to that occurring after conventional sternotomy. Pain after RMIT is caused by rib retraction, pectoralis and intercostal muscle dissection, and intercostal nerve lesions. Moreover, this pain is exacerbated by breathing movements, coughing, respiratory physiotherapy, and chest tubes. 2 Furrer M. Rechsteiner R. Eigenmann V. et al. Thoracotomy and thoracoscopy: Postoperative pulmonary function, pain and chest wall complaints. Eur J Cardiothorac Surg. 1997; 12: 82-87 Crossref PubMed Scopus (150) Google Scholar

Preoperative Evaluation of Patients With Interstitial Lung Disease

Preoperative Evaluation of Patients With Interstitial Lung Disease

AGA Clinical Practice Update on the Utility of Endoscopic Submucosal Dissection in T1b Esophageal Cancer: Expert Review

AGA Clinical Practice Update on the Utility of Endoscopic Submucosal Dissection in T1b Esophageal Cancer: Expert Review

Corrigendum to 'Free margin length and geometric height in aortic root dilatation and leaflet prolapse: implications for aortic valve repair surgery' [Eur J Cardiothoracic Surg 2020;57:124-132

Corrigendum to 'Free margin length and geometric height in aortic root dilatation and leaflet prolapse: implications for aortic valve repair surgery' [Eur J Cardiothoracic Surg 2020;57:124-132

Corrigendum to 'Simplified frozen elephant trunk technique for combined open and endovascular treatment of extensive aortic diseases' [Eur J Cardiothoracic Surg 2019; doi:10.1093/ejcts/ezz082

Corrigendum to 'Simplified frozen elephant trunk technique for combined open and endovascular treatment of extensive aortic diseases' [Eur J Cardiothoracic Surg 2019; doi:10.1093/ejcts/ezz082

Corrigendum to: 'Sutured and sutureless repair of postinfarction left ventricular free-wall rupture: a systematic review' [Eur J Cardiothorac Surg; doi:10.1093/ejcts/ezz101

Corrigendum to: 'Sutured and sutureless repair of postinfarction left ventricular free-wall rupture: a systematic review' [Eur J Cardiothorac Surg; doi:10.1093/ejcts/ezz101

Retraction to 'A novel approach for the treatment of dysphagia lusoria' [Eur J Cardiothorac Surg 2013;43:434-6

Retraction to 'A novel approach for the treatment of dysphagia lusoria' [Eur J Cardiothorac Surg 2013;43:434-6

Retraction to 'The influence of acute preoperative plasmapheresis on coagulation tests, fibrinolysis, blood loss and transfusion requirements in cardiac surgery' [Eur J Cardiothorac Surg 1997;11:557-563

Retraction to 'The influence of acute preoperative plasmapheresis on coagulation tests, fibrinolysis, blood loss and transfusion requirements in cardiac surgery' [Eur J Cardiothorac Surg 1997;11:557-563

Hydrogen-Rich Preservation Solution Attenuates Lung Ischemia-Reperfusion Injury after Prolonged Cold Ischemia in a Canine Left Lung Transplant Model

Purpose Molecular hydrogen (H2) has been reported as having protective effects on ischemia-reperfusion injury (IRI) in various organs. However, most of the reports are on inhalation of H2. Our group has previously reported the protective effects of H2-rich solution on lung IRI in a rat hilar-clamp model (Takahashi M, et al. Eur J Cardiothorac Surg 2017; 51: 442-448.) and the protective effects of hydrogen-rich preservation solution on lung preservation in a rat left lung transplant (LTx) model (Saito M, et al. J Heart Lung Transplant 2018; 37: S226). In this study, we examined the protective effects of hydrogen-rich preservation solution on lung preservation in a canine left LTx model. Methods TOYO beagles underwent orthotopic left LTx after cold ischemia followed by reperfusion (RP) for 4 hours. Forty-five minutes after RP, the right main pulmonary artery was clamped for evaluating the implanted graft function. Beagles were divided into two groups: control group (CON, n=4) and hydrogen group (H2, n=4). In the CON groups, donor lungs were flushed and immersed for 23 hours cold preservation at 4 °C by the preservation solution (ET-Kyoto Solution). In the H2 groups, donor lungs were flushed and immersed by the hydrogen-rich ET-Kyoto Solution. Arterial blood gas analysis, lung mechanics, and pulmonary vascular resistance (PVR) were evaluated during RP. After RP, wet-to-dry ratio (W/D) was evaluated. Results Compared with the CON group, significantly higher partial pressure of arterial oxygen (Figure A) and significantly lower partial pressure of carbon dioxide in the H2 group was observed 4 hours after RP. Although not statistically significant, dynamic lung compliance was better and PVR was lower in the H2 group than in the CON group (Figure B, C). Furthermore, W/D in the H2 group was significantly lower than that in the CON group (Figure D). Conclusion Our results indicated that hydrogen-rich preservation solution attenuated IRI in a canine left LTx model.

Corrigendum to: 'An early European experience with transapical off-pump mitral valve repair with NeoChord implantation [Eur J Cardiothorac Surg 2018;54:460-6

Corrigendum to: 'An early European experience with transapical off-pump mitral valve repair with NeoChord implantation [Eur J Cardiothorac Surg 2018;54:460-6