Research

11 pages, 456 KiB

Open AccessFeature PaperArticle

Analysis of Pain Management after Anatomic VATS Resection in Austrian Thoracic Surgery Units

by Florian Ponholzer, Thomas Schweiger, Bahil Ghanim, Herbert Maier, Jörg Hutter, Florian Tomaselli, Axel Krause, Michael Müller, Jörg Lindenmann, Gero Spruk and Florian Augustin

J. Clin. Med. 2024, 13(1), 80; https://doi.org/10.3390/jcm13010080 - 22 Dec 2023

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Abstract

Background: Postoperative pain influences rehabilitation, postoperative complications and quality of life. Despite its impact, there are no uniform treatment guidelines. Different centers seem to use various strategies. This study aims to analyze pain management regimens used after anatomic VATS resections in Austrian thoracic [...] Read more.

Background: Postoperative pain influences rehabilitation, postoperative complications and quality of life. Despite its impact, there are no uniform treatment guidelines. Different centers seem to use various strategies. This study aims to analyze pain management regimens used after anatomic VATS resections in Austrian thoracic surgery units, with a special interest in opioid usage and strategies to avoid opioids. Methods: A questionnaire was designed to assess the use of regional anesthesia, postoperative pain medication and characteristics of individual pain management regimens. The questionnaire was sent to all thoracic surgery units in Austria, with nine out of twelve departments returning them. Results: All departments use regional anesthesia during the procedure. Four out of nine centers use epidural analgesia or an intercostal catheter for postoperative regional anesthesia in at least 50% of patients. Two departments follow an opioid restrictive regimen, five depend on the visual analogue scale (VAS) and two administer opioids on a fixed schedule. Three out of nine departments use NSAIDs on a fixed schedule. The most used medication is metamizole (eight out of nine centers; six on a fixed schedule, two depending on VAS) followed by piritramide (six out of nine centers; none as a fixed prescription). Conclusions: This study reflects the heterogeneity in postoperative pain treatment after VATS anatomic lung resections. All departments use some form of regional anesthesia in the perioperative period; prolonged regional anesthesia is not utilized uniformly to reduce opioid consumption, as suggested in enhanced recovery after surgery programs. More evidence is needed to optimize and standardize postoperative pain treatment. Full article

(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives—Part II)

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12 pages, 1116 KiB

Open AccessArticle

Creatinine Reduction Ratio Is a Prognostic Factor for Acute Kidney Injury following Cardiac Surgery with Cardiopulmonary Bypass: A Single-Center Retrospective Cohort Study

by Akiko Anzai, Shunsuke Takaki, Nobuyuki Yokoyama, Shizuka Kashiwagi, Masashi Yokose and Takahisa Goto

J. Clin. Med. 2024, 13(1), 9; https://doi.org/10.3390/jcm13010009 - 19 Dec 2023

Viewed by 745

Abstract

Acute kidney injury (AKI) after cardiac surgery is a common complication that can lead to death. We previously reported that the creatinine reduction ratio (CRR) serves as a useful prognostic factor for AKI. The primary objective of this study was to determine the [...] Read more.

Acute kidney injury (AKI) after cardiac surgery is a common complication that can lead to death. We previously reported that the creatinine reduction ratio (CRR) serves as a useful prognostic factor for AKI. The primary objective of this study was to determine the predictors of AKI after surgery. The secondary objective was to determine the reliability of the CRR for short- and long-term outcomes. We retrospectively collected information about cardiac surgery patients who underwent cardiopulmonary bypass. Patients were divided into AKI and non-AKI groups based on the AKIN and RIFLE criteria. We analyzed the two groups regarding the preoperative patient data and operative information. The CRR was calculated as follows: (preoperative creatinine—postoperative creatinine)/preoperative creatinine. The prognostic factors of AKI-CS were surgery time, CPB time, aorta clamp time, platelet transfusion, and CRR < 20%. In the multivariate logistical analysis, CRR was an independent predictor of AKI (adjusted odds ratio: 0.90 [0.87–0.93], p < 0.001). However, there were no significant differences in CRR in terms of the rate of new onset chronic kidney disease (CKD). After cardiac surgery with cardiopulmonary bypass, CRR has good diagnostic power for predicting perioperative AKI. However, we cannot use it as a prognostic factor over a long-term period. Full article

(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives—Part II)

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15 pages, 1481 KiB

Open AccessFeature PaperArticle

Lung Transplantation Outcomes in Recipients Aged 70 Years or Older and the Impact of Center Volume

by Nidhi Iyanna, Ernest G. Chan, John P. Ryan, Masashi Furukawa, Jenalee N. Coster, Chadi A. Hage and Pablo G. Sanchez

J. Clin. Med. 2023, 12(16), 5372; https://doi.org/10.3390/jcm12165372 - 18 Aug 2023

Cited by 1 | Viewed by 945

Abstract

Objective: To evaluate trends and outcomes of lung transplants (LTx) in recipients ≥ 70 years. Methods: We performed a retrospective analysis of the UNOS database identifying all patients undergoing LTx (May 2005–December 2022). Baseline characteristics and postoperative outcomes were compared by age (<70 [...] Read more.

Objective: To evaluate trends and outcomes of lung transplants (LTx) in recipients ≥ 70 years. Methods: We performed a retrospective analysis of the UNOS database identifying all patients undergoing LTx (May 2005–December 2022). Baseline characteristics and postoperative outcomes were compared by age (<70 years, ≥70 years) and center volume. Kaplan–Meier analyses were performed with pairwise comparisons between subgroups. Results: 34,957 patients underwent LTx, of which 3236 (9.3%) were ≥70 years. The rate of LTx in recipients ≥ 70 has increased over time, particularly in low-volume centers (LVCs); consequently, high-volume centers (HVCs) and LVCs perform similar rates of LTx for recipients ≥ 70. Recipients ≥ 70 had higher rates of receiving from donor after circulatory death lungs and of extended donor criteria. Recipients ≥ 70 were more likely to die of cardiovascular diseases or malignancy, while recipients < 70 of chronic primary graft failure. Survival time was shorter for recipients ≥ 70 compared to recipients < 70 old (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.28–1.44, p < 0.001). HVCs were associated with a survival advantage in recipients < 70 (HR: 0.91, 95% CI: 0.88–0.94, p < 0.001); however, in recipients ≥ 70, survival was similar between HVCs and LVCs (HR: 1.11, 95% CI: 0.99–1.25, p < 0.08). HVCs were more likely to perform a bilateral LTx (BLT) for obstructive lung diseases compared to LVCs, but there was no difference in BLT and single LTx likelihood for restrictive lung diseases. Conclusions: Careful consideration is needed for recipient ≥ 70 selection, donor assessment, and post-transplant care to improve outcomes. Further research should explore strategies that advance perioperative care in centers with low long-term survival for recipients ≥ 70. Full article

(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives—Part II)

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11 pages, 1625 KiB

Open AccessArticle

CT-Derived Body Composition Is a Predictor of Survival after Esophagectomy

by Kartik Iyer, Cameron A. Beeche, Naciye S. Gezer, Joseph K. Leader, Shangsi Ren, Rajeev Dhupar and Jiantao Pu

J. Clin. Med. 2023, 12(6), 2106; https://doi.org/10.3390/jcm12062106 - 08 Mar 2023

Cited by 3 | Viewed by 1612

Abstract

Background: Body composition can be accurately quantified based on computed tomography (CT) and typically reflects an individual’s overall health status. However, there is a dearth of research examining the relationship between body composition and survival following esophagectomy. Methods: We created a cohort consisting [...] Read more.

Background: Body composition can be accurately quantified based on computed tomography (CT) and typically reflects an individual’s overall health status. However, there is a dearth of research examining the relationship between body composition and survival following esophagectomy. Methods: We created a cohort consisting of 183 patients who underwent esophagectomy for esophageal cancer without neoadjuvant therapy. The cohort included preoperative PET-CT scans, along with pathologic and clinical data, which were collected prospectively. Radiomic, tumor, PET, and body composition features were automatically extracted from the images. Cox regression models were utilized to identify variables associated with survival. Logistic regression and machine learning models were developed to predict one-, three-, and five-year survival rates. Model performance was evaluated based on the area under the receiver operating characteristics curve (ROC/AUC). To test for the statistical significance of the impact of body composition on survival, body composition features were excluded for the best-performing models, and the DeLong test was used. Results: The one-year survival model contained 10 variables, including three body composition variables (bone mass, bone density, and visceral adipose tissue (VAT) density), and demonstrated an AUC of 0.817 (95% CI: 0.738–0.897). The three-year survival model incorporated 14 variables, including three body composition variables (intermuscular adipose tissue (IMAT) volume, IMAT mass, and bone mass), with an AUC of 0.693 (95% CI: 0.594–0.792). For the five-year survival model, 10 variables were included, of which two were body composition variables (intramuscular adipose tissue (IMAT) volume and visceral adipose tissue (VAT) mass), with an AUC of 0.861 (95% CI: 0.783–0.938). The one- and five-year survival models exhibited significantly inferior performance when body composition features were not incorporated. Conclusions: Body composition features derived from preoperative CT scans should be considered when predicting survival following esophagectomy. Full article

(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives—Part II)

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Review

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21 pages, 1718 KiB

Open AccessReview

Orchestrating Resilience: How Neuropilin-2 and Macrophages Contribute to Cardiothoracic Disease

by Rajeev Dhupar, Amy A. Powers, Seth H. Eisenberg, Robert M. Gemmill, Charles E. Bardawil, Hannah M. Udoh, Andrea Cubitt, Leslie A. Nangle and Adam C. Soloff

J. Clin. Med. 2024, 13(5), 1446; https://doi.org/10.3390/jcm13051446 - 01 Mar 2024

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Abstract

Immunity has evolved to balance the destructive nature of inflammation with wound healing to overcome trauma, infection, environmental insults, and rogue malignant cells. The inflammatory response is marked by overlapping phases of initiation, resolution, and post-resolution remodeling. However, the disruption of these events [...] Read more.

Immunity has evolved to balance the destructive nature of inflammation with wound healing to overcome trauma, infection, environmental insults, and rogue malignant cells. The inflammatory response is marked by overlapping phases of initiation, resolution, and post-resolution remodeling. However, the disruption of these events can lead to prolonged tissue damage and organ dysfunction, resulting long-term disease states. Macrophages are the archetypic phagocytes present within all tissues and are important contributors to these processes. Pleiotropic and highly plastic in their responses, macrophages support tissue homeostasis, repair, and regeneration, all while balancing immunologic self-tolerance with the clearance of noxious stimuli, pathogens, and malignant threats. Neuropilin-2 (Nrp2), a promiscuous co-receptor for growth factors, semaphorins, and integrins, has increasingly been recognized for its unique role in tissue homeostasis and immune regulation. Notably, recent studies have begun to elucidate the role of Nrp2 in both non-hematopoietic cells and macrophages with cardiothoracic disease. Herein, we describe the unique role of Nrp2 in diseases of the heart and lung, with an emphasis on Nrp2 in macrophages, and explore the potential to target Nrp2 as a therapeutic intervention. Full article

(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives—Part II)

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11 pages, 2295 KiB

Open AccessReview

A Review of Slipping Rib Syndrome: Diagnostic and Treatment Updates to a Rare and Challenging Problem

by Isheeta Madeka, Sneha Alaparthi, Marisa Moreta, Shawn Peterson, Jeffrey J. Mojica, Johanes Roedl and Olubenga Okusanya

J. Clin. Med. 2023, 12(24), 7671; https://doi.org/10.3390/jcm12247671 - 14 Dec 2023

Viewed by 2255

Abstract

Slipping rib syndrome (SRS) is a disorder that occurs when one or more of the eighth through tenth ribs become abnormally mobile. SRS is a poorly understood condition leading to a significant delay in diagnosis and therapeutic management. History and a physical exam [...] Read more.

Slipping rib syndrome (SRS) is a disorder that occurs when one or more of the eighth through tenth ribs become abnormally mobile. SRS is a poorly understood condition leading to a significant delay in diagnosis and therapeutic management. History and a physical exam are usually sufficient for a diagnosis of SRS. The utility of dynamic ultrasounds has also been studied as a useful diagnostic tool. Multiple surgical techniques for SRS have been described within the literature. Cartilage rib excision (CRE) has been the most common technique utilized. However, the literature has shown a high rate of recurrence and associated risks with the procedure. More recently, minimally invasive rib fixation and costal cartilage excision with vertical rib plating have been shown as successful and safe alternative techniques. This may be an effective, alternative approach to CRE in adult and pediatric populations with SRS. Full article

(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives—Part II)

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12 pages, 1418 KiB

Open AccessReview

Robotic First Rib Resection in Thoracic Outlet Syndrome: A Systematic Review of Current Literature

by Maikerly Reyes, Sneha Alaparthi, Johannes B. Roedl, Marisa C. Moreta, Nathaniel R. Evans, Tyler Grenda and Olugbenga T. Okusanya

J. Clin. Med. 2023, 12(20), 6689; https://doi.org/10.3390/jcm12206689 - 23 Oct 2023

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Abstract

Thoracic outlet syndrome (TOS) involves the compression of neurovascular structures in the thoracic outlet. TOS subtypes, including neurogenic (nTOS), venous (vTOS), and arterial (aTOS) are characterized by distinct clinical presentations and diagnostic considerations. This review explores the incidence, diagnostic challenges, and management of [...] Read more.

Thoracic outlet syndrome (TOS) involves the compression of neurovascular structures in the thoracic outlet. TOS subtypes, including neurogenic (nTOS), venous (vTOS), and arterial (aTOS) are characterized by distinct clinical presentations and diagnostic considerations. This review explores the incidence, diagnostic challenges, and management of TOS with a focus on the innovative approach of Robotic First Rib Resection (R-FRR). Traditional management of TOS includes conservative measures and surgical interventions, with various open surgical approaches carrying risks of complications. R-FRR, a minimally invasive technique, offers advantages such as improved exposure, reduced injury risk to neurovascular structures, and shorter hospital stays. A comprehensive literature review was conducted to assess the outcomes of R-FRR for TOS. Data from 12 selected studies involving 397 patients with nTOS, vTOS, and aTOS were reviewed. The results indicate that R-FRR is associated with favorable intraoperative outcomes including minimal blood loss and low conversion rates to traditional approaches. Postoperatively, patients experienced decreased pain, improved function, and low complication rates. These findings support R-FRR as a safe and effective option for medically refractory TOS. Full article

(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives—Part II)

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Other

Jump to: Research, Review

10 pages, 5650 KiB

Open AccessSystematic Review

Immediate Postoperative COVID-19 Infection after Lung Transplantation: A Systematic Review and Case Series

by Jack K. Donohue, Eric J. Hyzny, Sarah Clifford, Ernest G. Chan, Jenalee Nicole Coster, Masashi Furukawa and Pablo G. Sanchez

J. Clin. Med. 2023, 12(22), 7028; https://doi.org/10.3390/jcm12227028 - 10 Nov 2023

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Abstract

Background: With new variants challenging the effectiveness of preventive measures, we are beginning to recognize the reality that COVID-19 will continue to pose an endemic threat. The manifestations of COVID-19 in lung transplant recipients during index admission are poorly understood with very few [...] Read more.

Background: With new variants challenging the effectiveness of preventive measures, we are beginning to recognize the reality that COVID-19 will continue to pose an endemic threat. The manifestations of COVID-19 in lung transplant recipients during index admission are poorly understood with very few cases reported in recent lung transplant recipients. Optimal management of immunosuppression and antiviral therapy in recent transplant recipients is challenging. Methods: We performed a retrospective analysis identifying lung transplant recipients at our institution who contracted COVID-19 in the immediate postoperative period (within index admission). In addition, we performed a systematic review from January 2020 to August 2023 identifying all publications on the PUBMED database regarding COVID-19 infection in lung transplant recipients during index admission. Results: We report four cases of COVID-19 pneumonia in lung transplant recipients in the immediate postoperative period and we describe the clinical course, treatment options, and immunosuppression changes to manage this unique clinical problem. All patients made a full recovery and were eventually discharged home. Within our review of the literature, the most prevalent presenting symptoms were cough, dyspnea, and fatigue. Six (75%) patients decreased or held their antimetabolite. The two most common treatments were monoclonal antibodies (38%) and remdesivir (63%). Conclusion: Although previous literature demonstrates that COVID-19 can be deadly in recent lung transplant recipients, rapid treatment with anti-viral therapy/immunotherapy, deescalating immunosuppression, and treatment of respiratory decompensation with Decadron was effective in our patients. Full article

(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives—Part II)

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