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Hanquiez P, Neuville P, Robin J, Ruffion A, Fiard G, Rossello N, Decaussin-Petrucci M, Paparel P. Outcomes after radical nephrectomy with vena cava thrombectomy using multidisciplinary approach: A single center experience. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102657. [PMID: 38821382 DOI: 10.1016/j.fjurol.2024.102657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 05/09/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION To describe the perioperative outcomes in patients treated with radical nephrectomy with cava thrombectomy at all thrombi levels using a multidisciplinary approach, with or without extracorporeal circulation (ECC), and to identify factors associated with perioperative morbidity. METHODS We retrospectively identified 42 patients who were diagnosed with renal cell carcinoma (RCC) and a vena cava thrombus and treated with radical nephrectomy and cava thrombectomy by a double surgical team at Lyon University Hospital from 2008 through 2021. The surgeons operated in the cardiothoracic operating theater to proceed with median sternotomy or ECC, if necessary. The primary endpoint of this study was perioperative morbidity and mortality assessed using the Clavien-Dindo scale. Complications were recorded until 90 days after surgery, and those classified as grade IIIa or higher were considered high-grade complications. RESULTS Overall, 32 (76%) patients required ECC. No intraoperative mortality occurred; however, two patients (5%) died within 30 days. Complications occurred within 30 days in 30 patients (72%), with severe complications observed in 10 patients (24%). No further complications occurred between 30 and 90 days. Multivariate analysis revealed that age, thrombus level, ECC, American Society of Anesthesiologists physical status, symptoms, and metastasis at presentation were not significantly associated with high-grade complications (P>0.05). CONCLUSIONS Multidisciplinary approach is essential and frequent use of ECC, when achieved by a trained team, may facilitate surgery, and is associated with low perioperative morbidity, especially for patients with high-level thrombi. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Paul Hanquiez
- Department of Urology, Lyon Sud Hospital, Lyon, France.
| | - Paul Neuville
- Department of Urology, Lyon Sud Hospital, Lyon, France; Claude-Bernard University Lyon 1, Lyon, France.
| | - Jacques Robin
- Claude-Bernard University Lyon 1, Lyon, France; Department of Cardiac Surgery, "Louis-Pradel" Cardiologic Hospital, Lyon, France.
| | - Alain Ruffion
- Department of Urology, Lyon Sud Hospital, Lyon, France; Claude-Bernard University Lyon 1, Lyon, France.
| | - Gaëlle Fiard
- Department of Urology, Grenoble University Hospital, Grenoble, France.
| | - Noémie Rossello
- Department of Public health, Edouard Herriot Hospital, Lyon, France.
| | - Myriam Decaussin-Petrucci
- Claude-Bernard University Lyon 1, Lyon, France; Department of Pathology, Lyon-Sud Hospital, Lyon, France.
| | - Philippe Paparel
- Department of Urology, Lyon Sud Hospital, Lyon, France; Claude-Bernard University Lyon 1, Lyon, France.
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2
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Matsumoto R, Fujiyoshi T, Kamiya K, Matsubayashi J, Fukuda S, Nishibe T, Ogino H. Complete Resection of a Cavoatrial Metastatic Liposarcoma under Hypothermic Circulatory Arrest. Ann Thorac Cardiovasc Surg 2023; 29:206-209. [PMID: 35095053 PMCID: PMC10466114 DOI: 10.5761/atcs.cr.21-00226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022] Open
Abstract
A patient underwent surgical resection twice for primary and metastatic dedifferentiated liposarcomas. Computed tomography revealed a tumor mass at the cavoatrial junction. Prompt surgical resection of the tumor with thrombectomy was successfully performed using cardiopulmonary bypass with hypothermic circulatory arrest. Despite the poor prognosis of metastatic or recurrent liposarcoma, the patient has survived for 8 years since the first tumor resection.
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Affiliation(s)
- Ryumon Matsumoto
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshiki Fujiyoshi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Shoji Fukuda
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
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3
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Scott Eldredge R, Russell KW. Pediatric surgical interventions on ECMO. Semin Pediatr Surg 2023; 32:151330. [PMID: 37931540 DOI: 10.1016/j.sempedsurg.2023.151330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Extra Corporeal Membrane Oxygenation (ECMO) has historically been reserved for refractory pulmonary and cardiac support in children and adult. Operative intervention on ECMO was traditionally contraindicated due to hemorrhagic complications exacerbated by critical illness and anticoagulation needs. With advancements in ECMO circuitry and anticoagulation strategies operative procedures during ECMO have become feasible with minimal hemorrhagic risks. Here we review anticoagulation and operative intervention considerations in the pediatric population during ECMO cannulation. Pediatric surgical interventions currently described in the literature while on ECMO support include thoracotomy/thoracoscopy, tracheostomy, laparotomy, and injury related procedures i.e. wound debridement. A patient should not be precluded from a surgical intervention while on ECMO, if the surgery is indicated.
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Affiliation(s)
- R Scott Eldredge
- Department of Surgery, Mayo Clinic, Phoenix, AZ, United States; Department of Pediatric Surgery, Phoenix Children's, Phoenix, AZ, United States
| | - Katie W Russell
- Department of Surgery, Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, United States.
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4
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Mangiameli G, Testori A, Cioffi U, Alloisio M, Cariboni U. Extracorporeal membrane oxygenation support in oncological thoracic surgery. Front Oncol 2022; 12:1005929. [PMID: 36505824 PMCID: PMC9732715 DOI: 10.3389/fonc.2022.1005929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022] Open
Abstract
The use of extracorporeal lung support (ECLS) during thoracic surgery is a recent concept that has been gaining increasing approval. Firstly introduced for lung transplantation, this technique is now increasingly adopted also in oncological thoracic surgical procedures. In this review, we focus on the cutting-edge application of extracorporeal membrane oxygenation (ECMO) during oncological thoracic surgery. Therefore, we report the most common surgical procedures in oncological thoracic surgery that can benefit from the use of ECMO. They will be classified and discussed according to the aim of ECMO application. In particular, the use of ECMO is usually limited to certain lung surgery procedures that can be resumed such as in procedures in which an adequate ventilation is not possible such as in single lung patients, procedures where conventional ventilation can cause conflict with the surgical field such as tracheal or carinal surgery, and conventional procedures requiring both ventilators and hemodynamic support. So far, all available evidence comes from centers with large experience in ECMO and major thoracic surgery procedures.
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,*Correspondence: Alberto Testori,
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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5
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Thomason N, Monlezun DJ, Javaid A, Filipescu A, Koutroumpakis E, Shobayo F, Kim P, Lopez-Mattei J, Cilingiroglu M, Iliescu G, Marmagkiolis K, Ramirez PT, Iliescu C. Percutaneous Coronary Intervention in Patients With Gynecological Cancer: Machine Learning-Augmented Propensity Score Mortality and Cost Analysis for 383,760 Patients. Front Cardiovasc Med 2022; 8:793877. [PMID: 35237670 PMCID: PMC8882615 DOI: 10.3389/fcvm.2021.793877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022] Open
Abstract
BackgroundDespite the growing number of patients with both coronary artery disease and gynecological cancer, there are no nationally representative studies of mortality and cost effectiveness for percutaneous coronary interventions (PCI) and this cancer type.MethodsBackward propagation neural network machine learning supported and propensity score adjusted multivariable regression was conducted for the above outcomes in this case-control study of the 2016 National Inpatient Sample (NIS), the United States' largest all-payer hospitalized dataset. Regression models were fully adjusted for age, race, income, geographic region, cancer metastases, mortality risk, and the likelihood of undergoing PCI (and also with length of stay [LOS] for cost). Analyses were also adjusted for the complex survey design to produce nationally representative estimates. Centers for Disease Control and Prevention (CDC)-based cost effectiveness ratio (CER) analysis was performed.ResultsOf the 30,195,722 hospitalized patients meeting criteria, 1.27% had gynecological cancer of whom 0.02% underwent PCI including 0.04% with metastases. In propensity score adjusted regression among all patients, the interaction of PCI and gynecological cancer (vs. not having PCI) significantly reduced mortality (OR 0.53, 95%CI 0.36–0.77; p = 0.001) while increasing LOS (Beta 1.16 days, 95%CI 0.57–1.75; p < 0.001) and total cost (Beta $31,035.46, 95%CI 26758.86–35312.06; p < 0.001). Among gynecological cancer patients, mortality was significantly reduced by PCI (OR 0.58, 95%CI 0.39–0.85; p = 0.006) and being in East North Central, West North Central, South Atlantic, and Mountain regions (all p < 0.03) compared to New England. PCI reduced mortality but not significantly for metastatic patients (OR 0.74, 95%CI 0.32–1.71; p = 0.481). Eighteen extra gynecological cancer patients' lives were saved with PCI for a net national cost of $3.18 billion and a CER of $176.50 million per averted death.ConclusionThis large propensity score analysis suggests that PCI may cost inefficiently reduce mortality for gynecological cancer patients, amid income and geographic disparities in outcomes.
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Affiliation(s)
- Nicole Thomason
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Dominique J. Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
- Center for Artificial Intelligence & Health Equities, Global System Analytics & Structures, New Orleans, LA, United States
| | - Awad Javaid
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, United States
| | - Alexandru Filipescu
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Fisayomi Shobayo
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Peter Kim
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mehmet Cilingiroglu
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, United States
| | - Gloria Iliescu
- Department of Internal Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Kostas Marmagkiolis
- Division of Cardiovascular Disease, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Pedro T. Ramirez
- Department of GynOnc and Reproductive Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Cezar Iliescu
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6
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Pořízka M, Michálek P, Votruba J, Abdelmalak BB. Extracorporeal Oxygenation Techniques in Adult Critical Airway Obstruction: A Review. Prague Med Rep 2021; 122:61-72. [PMID: 34137682 DOI: 10.14712/23362936.2021.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Extracorporeal life support has been increasingly utilized in different clinical settings to manage either critical respiratory or heart failure. Complex airway surgery with significant or even total perioperative airway obstruction represents an indication for this technique to prevent/overcome a critical period of severe hypoxaemia, hypoventilation, and/or apnea. This review summarizes the current published scientific evidence on the utility of extracorporeal respiratory support in airway obstruction associated with hypoxaemia, describes the available methods, their clinical indications, and possible limitations. Extracorporeal membrane oxygenation using veno-arterial or veno-venous mode is most commonly employed in such scenarios caused by endoluminal, external, or combined obstruction of the trachea and main bronchi.
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Affiliation(s)
- Michal Pořízka
- Department of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Pavel Michálek
- Department of Anaesthesia, Antrim Area Hospital, Antrim, United Kingdom.,Department of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jiří Votruba
- 1st Department of Tuberculosis and Respiratory Diseases, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Basem B Abdelmalak
- Departments of General Anesthesiology and Outcomes Research, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, USA
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7
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Suk P, Šrámek V, Čundrle I. Extracorporeal Membrane Oxygenation Use in Thoracic Surgery. MEMBRANES 2021; 11:membranes11060416. [PMID: 34072713 PMCID: PMC8227574 DOI: 10.3390/membranes11060416] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022]
Abstract
This narrative review is focused on the application of extracorporeal membrane oxygenation (ECMO) in thoracic surgery, exclusive of lung transplantation. Although the use of ECMO in this indication is still rare, it allows surgery to be performed in patients where conventional ventilation is not feasible-especially in single lung patients, sleeve lobectomy or pneumonectomy and tracheal or carinal reconstructions. Comparisons with other techniques, various ECMO configurations, the management of anticoagulation, anesthesia, hypoxemia during surgery and the use of ECMO in case of postoperative respiratory failure are reviewed and supported by two cases of perioperative ECMO use, and an overview of published case series.
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Affiliation(s)
- Pavel Suk
- International Clinical Research Center, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic
- Department of Anesthesiology and Intensive Care, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic;
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
- Correspondence: (P.S.); (I.Č.J.)
| | - Vladimír Šrámek
- Department of Anesthesiology and Intensive Care, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic;
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Ivan Čundrle
- International Clinical Research Center, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic
- Department of Anesthesiology and Intensive Care, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic;
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
- Correspondence: (P.S.); (I.Č.J.)
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8
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Siwik D, Gajewska M, Karoń K, Pluta K, Wondołkowski M, Wilimski R, Szarpak Ł, Filipiak KJ, Gąsecka A. Pleiotropic Effects of Acetylsalicylic Acid after Coronary Artery Bypass Grafting-Beyond Platelet Inhibition. J Clin Med 2021; 10:2317. [PMID: 34073241 PMCID: PMC8198192 DOI: 10.3390/jcm10112317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 01/05/2023] Open
Abstract
Acetylsalicylic acid (ASA) is one of the most frequently used medications worldwide. Yet, the main indications for ASA are the atherosclerosis-based cardiovascular diseases, including coronary artery disease (CAD). Despite the increasing number of percutaneous procedures to treat CAD, coronary artery bypass grafting (CABG) remains the treatment of choice in patients with multivessel CAD and intermediate or high anatomical lesion complexity. Taking into account that CABG is a potent activator of inflammation, ASA is an important part in the postoperative therapy, not only due to ASA antiplatelet action, but also as an anti-inflammatory agent. Additional benefits of ASA after CABG include anticancerogenic, hypotensive, antiproliferative, anti-osteoporotic, and neuroprotective effects, which are especially important in patients after CABG, prone to hypertension, graft occlusion, atherosclerosis progression, and cognitive impairment. Here, we discuss the pleiotropic effects of ASA after CABG and provide insights into the mechanisms underlying the benefits of treatment with ASA, beyond platelet inhibition. Since some of ASA pleiotropic effects seem to increase the risk of bleeding, it could be considered a starting point to investigate whether the increase of the intensity of the treatment with ASA after CABG is beneficial for the CABG group of patients.
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Affiliation(s)
- Dominika Siwik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (D.S.); (M.G.); (K.K.); (K.P.); (K.J.F.)
| | - Magdalena Gajewska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (D.S.); (M.G.); (K.K.); (K.P.); (K.J.F.)
| | - Katarzyna Karoń
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (D.S.); (M.G.); (K.K.); (K.P.); (K.J.F.)
| | - Kinga Pluta
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (D.S.); (M.G.); (K.K.); (K.P.); (K.J.F.)
| | - Mateusz Wondołkowski
- Department of Cardiac Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.W.); (R.W.)
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.W.); (R.W.)
| | - Łukasz Szarpak
- Bialystok Oncology Center, 15-027 Bialystok, Poland;
- Maria Sklodowska-Curie Medical Academy in Warsaw, 00-001 Warsaw, Poland
| | - Krzysztof J. Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (D.S.); (M.G.); (K.K.); (K.P.); (K.J.F.)
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (D.S.); (M.G.); (K.K.); (K.P.); (K.J.F.)
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9
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Jiang R, Xiao Z, Huang J, Sun X, Chu X, Wang F, Wang Y, Pang L, Luo F. Feasibility of radical gastrointestinal tumor resection with simultaneous off-pump coronary artery bypass surgery for patients with severe heart problems: A retrospective cohort study from a single institutional database. J Card Surg 2021; 36:2714-2721. [PMID: 34018259 DOI: 10.1111/jocs.15656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/07/2021] [Accepted: 03/24/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Clinical treatment of gastrointestinal neoplasms in patients with severe coronary stenosis is difficult, and it remains controversial to perform staged or simultaneous surgeries. The purpose of this study was to retrospectively analyze the feasibility and indications for simultaneous gastrointestinal tumor resection and off-pump coronary artery bypass (OPCAB) graft surgery. METHODS Data collected from a total of five patients, including three patients with gastric cancer and two patients with colorectal cancer, who underwent simultaneous radical cancer resection and OPCAB between September 2010 and October 2019, were retrospectively analyzed. Among these patients, one had an incomplete colonic obstruction. All patients had severe coronary stenosis, and one experienced acute heart failure before surgery. OPCAB was performed first, followed by the radical cancer resection. RESULTS All five patients were discharged from hospital without perioperative death, major cardiovascular events or anastomotic leakage. The mean postoperative hospital stay was 9.4 days. One patient experienced slight gastrointestinal bleeding after surgery, which improved with conservative treatment. After a mean follow-up of 39 months, two patients with gastric cancer died from tumor metastasis at 28 months and 37 months, while the remaining three patients did not have tumor recurrence or metastasis. None of the patients experienced myocardial ischemia. CONCLUSION It is safe and feasible to perform simultaneous OPCAB and gastrointestinal surgeries on the premise of strictly controlling the indications for patients with gastrointestinal tumors complicated with severe coronary artery stenosis.
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Affiliation(s)
- Rongrong Jiang
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, P.R., China
| | - Ziying Xiao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, P.R., China
| | - Jiechun Huang
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, P.R., China
| | - Xiaotian Sun
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, P.R., China
| | - Xianglin Chu
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, P.R., China
| | - Fangrui Wang
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, P.R., China
| | - Yiqing Wang
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, P.R., China
| | - LieWen Pang
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, P.R., China
| | - Fen Luo
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, P.R., China
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10
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Tricard J, Milad D, Chermat A, Simard S, Lacasse Y, Dagenais F, Conti M. Staged management of cardiac disease and concomitant early lung cancer: a 20-year single-center experience. Eur J Cardiothorac Surg 2021; 59:610-616. [PMID: 33210113 DOI: 10.1093/ejcts/ezaa360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/21/2020] [Accepted: 08/29/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The association of unstable heart disease and resectable lung cancer is rare. The impacts of staged management, cardiac surgery with cardiopulmonary bypass (CPB) versus angioplasty, on long-term survival and cancer recurrence remain debated. We report our experience using staged management. METHODS From 1997 to 2016, 107 patients were treated at the Quebec Heart and Lung Institute: 72 underwent cardiac surgery with CPB (group 1), 35 were treated with angioplasty (group 2), followed by oncological pulmonary resection. RESULTS Two postoperative deaths (3%) and 1 ischaemic heart complication (1%) were reported in group 1. One death (3%) was reported in group 2. Two-year overall survival was 82% (59/72) in group 1 and 80% (28/35) in group 2; 5-year overall survival was 62% (33/53) in group 1 and 63% (19/30) in group 2. Two-year disease-free survival in group 1 was 79% (57/72) and 77% (27/35) in group 2; 5-year disease-free survival was 58% (31/53) in group 1 and 60% (18/30) in group 2. The independent risk factors for death after thoracic surgery were transfusions (P = 0.004) and grade ≥3 complications (P = 0.034). Independent risk factors for recurrence included the cancer stage (P < 0.001) and, paradoxically, a shorter delay between cardiac and lung procedures (P = 0.031). CONCLUSIONS When a staged management remains feasible after cardiac procedure, oncological outcomes of patients with cardiopathy and lung cancer are satisfactory. CPB does not seem to be deleterious. The delay between procedures should intuitively be as small as possible but not at the expense of good recovery after the cardiac procedure.
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Affiliation(s)
- Jérémy Tricard
- Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada.,Cardiac Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada.,Thoracic and Cardiovascular Surgery Department, Limoges University Hospital Center, Limoges, France
| | - Daniel Milad
- Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada
| | - Anaëlle Chermat
- Thoracic and Cardiovascular Surgery Department, Limoges University Hospital Center, Limoges, France
| | - Serge Simard
- Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada.,Cardiac Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada
| | - Yves Lacasse
- Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada
| | - François Dagenais
- Cardiac Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada
| | - Massimo Conti
- Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada
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11
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Aittokallio J, Kauko A, Palmu J, Niiranen T. Predictors and Outcomes of Coronary Artery Bypass Grafting: A Systematic and Untargeted Analysis of More Than 120,000 Individuals and 1,300 Disease Traits. J Cardiothorac Vasc Anesth 2021; 35:3232-3240. [PMID: 33934986 DOI: 10.1053/j.jvca.2021.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To perform an untargeted data-driven analysis on the correlates and outcomes of coronary artery bypass grafting (CABG). DESIGN FinnGen cohort study. SETTING The authors collected information on up to 1,327 disease traits before and after CABG from nationwide healthcare registers. PARTICIPANTS A mixed population and patient sample of 127,911 individuals including 3,784 CABG patients. INTERVENTIONS The authors assessed the association between (1) traits and incident CABG and (2) CABG and incident traits using multivariate-adjusted Cox models. MAIN RESULTS Patients who underwent CABG and were in the fourth quartile of a risk score based on the top predictors of mortality had 12.2-fold increased risk of dying (95% confidence interval [CI], 10.3-14.5) compared with those in the first quartile. Cardiovascular disease (CVD) and CVD risk factors were most strongly associated with incident CABG. However, CABG was associated with death due to cardiac causes (hazard ratio [HR], 3.7; 95% CI, 3.5-4.0) or other causes (HR, 2.5; 95% CI, 2.4-2.7). CABG also was related to increased risk of several non-CVD traits, including anemia (HR, 3.4; 95% CI, 2.8-4.1), gastrointestinal disorders (HR, 2.2; 95% CI, 1.8-2.6), acute renal failure (HR, 4.2; 95% CI, 3.5-5.1), septicemia (HR, 3.6; 95% CI, 3.1-4.1), lung cancer (HR, 2.3; 95% CI, 1.9-2.8), Alzheimer's disease (HR, 2.5; 95% CI, 2.2-2.7), and chronic obstuctive pulmonary disease (HR, 2.5; 95% CI, 2.2-2.9). CONCLUSIONS Known CVD risk factors associate most strongly with incident CABG. However, CABG is associated with increased risk of several, somewhat unexpected, non-CVD traits. More detailed study of these links is warranted to establish potential causality and pathogenesis.
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Affiliation(s)
- Jenni Aittokallio
- Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland; Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
| | - Anni Kauko
- Department of Internal Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Joonatan Palmu
- Department of Internal Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Teemu Niiranen
- Department of Internal Medicine, Turku University Hospital and University of Turku, Turku, Finland; Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
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Frattini S, Troise G, Fucci C, Pressman GS, Faggiano P. Aortic valve stenosis and cancer: a common and complex association. Expert Rev Cardiovasc Ther 2021; 19:289-299. [PMID: 33688784 DOI: 10.1080/14779072.2021.1902306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction. The prevalence of aortic valve stenosis (AS) and malignancy are both high, especially in elderly people and in developed countries. These two conditions frequently coexist and share the same risk factors as atherosclerotic disease.Area covered. The progression of calcified AS may be accelerated by both cardiovascular risk factors and cancer treatments, such as radiotherapy. The standard treatment for symptomatic severe AS is surgical aortic valve replacement; however, in cancer patients, transcatheter implantation may be preferred as they are often at high-risk for cardiac surgery. In patients with AS and cancer, physicians may face difficult treatment decisions.To date, there is limited information on the impact of malignancy on outcomes in patients with severe AS; hence, there is no established treatment policy.Expert Opinion. Treating clinicians must integrate complex information about the severity of valve disease and expected cardiac outcomes with information regarding the cancer prognosis and the need for specific treatment, including surgery. Other comorbidities, age and frailty also contribute to decision-making about whether, when, and how to perform aortic valve replacement.
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Affiliation(s)
| | - Giovanni Troise
- Cardiac Surgery Division, Fondazione Poliambulanza, Brescia, Italy
| | - Carlo Fucci
- Cardiac Surgery Division, Spedali Civili, Brescia, Italy
| | - Gregg S Pressman
- Einstein Medical Center, Heart and Vascular Institute, Philadelphia, Pennsylvania, US
| | - Pompilio Faggiano
- , University of Brescia and Fondazione Poliambulanza, Brescia, Italy
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13
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Condello I, Santarpino G, Moscarelli M, Nasso G, Speziale G. Toward Minimally Invasive Extracorporeal Circulation in Oncologic Cardiac Surgery. Braz J Cardiovasc Surg 2021; 36:141-142. [PMID: 33577264 PMCID: PMC7918395 DOI: 10.21470/1678-9741-2020-0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ignazio Condello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy. E-mail:
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Paracelsus Medical University, Nuremberg, Germany.,Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, "Magna Graecia" University of Catanzaro, Italy
| | - Marco Moscarelli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
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14
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Imada R, Komakata T, Aryal B, Tada N, Nuruki K, Kataoka T, Hiramine K, Mukaihara K, Kinjo T. Pancreaticoduodenectomy after transcatheter aortic valve implantation in an elderly patient with severe aortic stenosis and pancreas cancer: A case report. Ann Med Surg (Lond) 2021; 62:207-210. [PMID: 33537131 PMCID: PMC7843360 DOI: 10.1016/j.amsu.2021.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction and importance Not only pancreatic cancer but also aortic stenosis (AS) is increasing with the aging population. There is no optimal strategy for elderly patients with both pancreatic cancer and AS. We report a case of pancreatic head cancer with severe AS undergoing pancreaticoduodenectomy (PD) after transcatheter aortic valve implantation (TAVI). Case presentation An 88-year-old woman was referred to our hospital because of severe AS with symptoms of heart failure. Preoperative examination revealed resectable pancreatic head cancer, so TAVI was performed before PD to reduce the perioperative risk. The patient underwent PD 34 days after TAVI, with no significant postoperative complications, and was transferred to the other hospital for rehabilitation on postoperative day 45. No recurrence was observed at more than 7 months without adjuvant therapy. Clinical discussion Aortic valve replacement (AVR) is recommended before non-cardiac surgery in patients with symptomatic severe AS. Surgical aortic valve replacement (SAVR) is the standard treatment. However, owing to the highly invasive procedure and increased perioperative risk, SAVR is usually avoided in elderly patients with malignancy and severe AS. We demonstrated that TAVI followed by PD could be safely performed in high-risk elderly patients presenting with both severe AS and pancreatic head cancer. To our knowledge, this is the first case report of PD after TAVI in a patient with severe AS. Conclusion We demonstrated that TAVI followed by PD could be safely performed in high-risk elderly patients presenting with severe AS and co-existing malignancy. Severe aortic stenosis (AS) is a risk factor for non-cardiac surgery. In some cases, prior treatment of AS is recommended. Minimally invasive transcatheter aortic valve implantation (TAVI) may be a treatment option for the elderly cancer patients. Preceding TAVI may be a useful therapeutic strategy for elderly cancer patients with severe AS.
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Affiliation(s)
- Ryo Imada
- Department of Surgery, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Teruo Komakata
- Department of Surgery, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Bibek Aryal
- Department of Surgery, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Nobuhiro Tada
- Department of Surgery, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Kensuke Nuruki
- Department of Surgery, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Tetsuro Kataoka
- Department of Cardiovascular Medicine, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Kiyohisa Hiramine
- Department of Cardiovascular Medicine, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Kosuke Mukaihara
- Department of Cardiovascular Surgery, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Tamahiro Kinjo
- Department of Cardiovascular Surgery, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
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15
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Redwan B, Freermann C, Akil A, Fischer S. [Extracorporeal Lung Support in Thoracic Surgery: Basics and Pathophysiology]. Pneumologie 2021; 75:60-66. [PMID: 33461235 DOI: 10.1055/a-1172-7202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Extracorporeal lung support (ECLS) is of increasing importance in general thoracic surgery. Different modes of ECLS may be applied in several situations throughout the perioperative phase and are adapted to the individual patient's needs and the planned surgical procedures. ECLS is not a static procedure and should be always evaluated according to the present condition of the patient. Therefore, it is essential to understand the pathophysiology of the disease and the different ECLS modes, as well as the different cannulation options, in order to be able to use the different escalation and de-escalation techniques in accordance with the clinical situation.
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Affiliation(s)
- B Redwan
- Sektion für Thoraxchirurgie, Universitätsklinik Münster, Deutschland
| | - C Freermann
- Klinik für Thoraxchirurgie und Lungenunterstützung, Klinikum Ibbenbüren, Deutschland
| | - A Akil
- Klinik für Thoraxchirurgie und Lungenunterstützung, Klinikum Ibbenbüren, Deutschland
| | - S Fischer
- Klinik für Thoraxchirurgie und Lungenunterstützung, Klinikum Ibbenbüren, Deutschland
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16
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Xu H, Tao T, Ma L, Li W, Ni Y. Concomitant surgery for aortic valve and lung cancer patients in an elder. J Cardiothorac Surg 2020; 15:257. [PMID: 32938498 PMCID: PMC7493905 DOI: 10.1186/s13019-020-01277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The treatment strategy for aortic valve and lung cancer patients includes concomitant or two-stage procedures. Conventional simultaneous operations are usually performed under the median sternotomy. CASE PRESENTATION A 72-year-old man was admitted to our hospital after experiencing chest tightness after activity for two months. Aortic valve regurgitation had been confirmed when squamous cell carcinoma of the lung was discovered. The therapeutic strategy for these patients is controversial. Considering the potential risk of tumour metastasis and the risk of cardiopulmonary bypass (CPB), we recommended concomitant transcatheter aortic valve implantation (TAVI) and a lobectomy. A trans-apical TAVI with left-sided intercostal thoracotomy was successfully performed, followed by an immediate video-assisted thoracoscopic surgery (VATS) lobectomy and selective lymph node dissection. CONCLUSIONS We suggest that a one-stage surgery of pulmonary resection following TAVI is an acceptable and safe choice after careful evaluation and should be performed as soon as possible in response to lung cancer in elderly patients with aortic valve disease.
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Affiliation(s)
- Hongfei Xu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University, Number 79 Qingchun Road, Hangzhou, China
| | - Tingting Tao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University, Number 79 Qingchun Road, Hangzhou, China
| | - Liang Ma
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University, Number 79 Qingchun Road, Hangzhou, China
| | - Weidong Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University, Number 79 Qingchun Road, Hangzhou, China.
| | - Yiming Ni
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University, Number 79 Qingchun Road, Hangzhou, China.
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17
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Mamas MA, Brown SA, Sun LY. Coronary Artery Disease in Patients With Cancer: It's Always the Small Pieces That Make the Bigger Picture. Mayo Clin Proc 2020; 95:1819-1821. [PMID: 32861320 DOI: 10.1016/j.mayocp.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Newcastle, United Kingdom.
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee
| | - Louise Y Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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18
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Kato T, Matayoshi A, Nakasone T. A case of oral cancer with preoperative transcatheter aortic valve implantation for aortic stenosis: A case report. Mol Clin Oncol 2020; 13:36. [PMID: 32802332 PMCID: PMC7412742 DOI: 10.3892/mco.2020.2106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/30/2020] [Indexed: 11/30/2022] Open
Abstract
Aortic valve stenosis [or aortic stenosis, (AS)] is a risk factor in non-cardiac surgery. Guidelines from the European Heart Association recommended that AS treatment should be applied prior to non-cardiac surgery. Transcatheter aortic valve implantation (TAVI) is a method of minimally invasive AS treatment. The present study reports a case of tongue excision and neck dissection after TAVI for a patient with tongue cancer and AS. A 79-year-old woman was diagnosed with AS following preoperative examination for tongue cancer. The patient was judged as a high-risk case for open-heart surgery after consultation with staff at the University Hospital of The Ryukyus. It was concluded that TAVI should be performed prior to cancer surgery. On day 21 following TAVI, cancer surgery was performed and the patient was discharged from hospital 22 days after tongue cancer surgery. To the best of our knowledge, there is no report of oral cancer surgery after TAVI. TAVI is generally used as a short-term treatment strategy for AS associated with head and neck cancer due to its minimally invasive nature. In the present case, oral cancer surgery was performed closely following TAVI without serious complications. The case demonstrated that TAVI might be useful for severe AS patients with high surgical risk prior to cancer resection surgery. However, further cases are required to confirm the safety and effectiveness of TAVI treatment strategies.
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Affiliation(s)
- Tomoki Kato
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan.,Department of Oral and Maxillofacial Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akira Matayoshi
- Department of Oral and Maxillofacial Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Toshiyuki Nakasone
- Department of Oral and Maxillofacial Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
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19
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Omoto T, Aoki A, Maruta K, Masuda T, Horikawa Y. Influence of transcatheter aortic valve replacement on patients with severe aortic stenosis undergoing non-cardiac surgery. J Cardiothorac Surg 2020; 15:198. [PMID: 32727528 PMCID: PMC7391702 DOI: 10.1186/s13019-020-01237-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives The purpose of this study was to clarify the influence of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis (AS) undergoing non-cardiac surgery. Methods Thirty-four patients with severe AS diagnosed by preoperative evaluation for non-cardiac surgery were reviewed and compared in two categories. First, patient profiles and surgical risk were compared before (pre-TAVR group; n = 10) and after (post-TAVR group; n = 24) the introduction of TAVR. Second, the completion rate of non-cardiac surgery and interval between the two cardiac and non-cardiac operations were compared between surgical aortic valve replacement (AVR) patients before the introduction of TAVR (pre-AVR group (n = 10)), in AVR patients after the introduction of TAVR (post-AVR (n = 12)), and in TAVR patients (TAVR group (n = 12)). Results Age and Japan score were higher in the post-TAVR group than in the pre-TAVR group. Malignancy was the most common non-cardiac disease (80%) in the pre-TAVR group, whereas orthopedic disease was the most common (50%) in the post-TAVR group. Completion rate of non-cardiac operation in the pre-AVR, post-AVR and TAVR groups was 70, 33, and 75% (post-AVR vs. TAVR: p = 0.010), and the interval between the two operations was 129 ± 98 days, 87 ± 40 days and 27 ± 15 days, respectively (pre AVR vs. TAVR: p = 0.034 and post AVR vs. TAVR: p = 0.025). In the post-TAVR group, AVR was selected because of a lack of fitness for TAVR in 5 of 12 patients. Conclusions After the introduction of TAVR, more senile and high-risk patients became candidates for a two-stage operation, and orthopedic conditions became the most common non-cardiac disease. Innovation in transcatheter valvular interventions and expansion of indications for patients currently evaluated as “unfit for TAVR” might be crucial issues for non-cardiac surgery with severe AS.
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Affiliation(s)
- Tadashi Omoto
- Department of Cardiovascular Surgery, Showa University, Hatanodai 1-5-8, Shinagawa-ku, Tokyo, 142-8666, Japan.
| | - Atsushi Aoki
- Department of Cardiovascular Surgery, Showa University, Hatanodai 1-5-8, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Kazuto Maruta
- Department of Cardiovascular Surgery, Showa University, Hatanodai 1-5-8, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Tomoaki Masuda
- Department of Cardiovascular Surgery, Showa University, Hatanodai 1-5-8, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Yui Horikawa
- Department of Cardiovascular Surgery, Showa University, Hatanodai 1-5-8, Shinagawa-ku, Tokyo, 142-8666, Japan
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20
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Watanabe A, Kato H, Mathis BJ, Matsubara M, Gomi S, Sakamoto H, Hiramatsu Y. Surgical Correction of Adult Unrepaired Tetralogy of Fallot to Facilitate Stage IIIA Uterine Cancer Treatment. World J Pediatr Congenit Heart Surg 2019; 10:796-798. [PMID: 31701837 DOI: 10.1177/2150135119872479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Unrepaired tetralogy of Fallot (TOF) in adults may compound cancer treatment difficulties, while strategies for adult unrepaired TOF combined with malignant neoplasms are scarce. Here, we report a case of adult unrepaired TOF with uterine cancer. A hybrid surgical strategy minimized invasiveness and the patient survived both cancer resection and adjuvant radiochemotherapy. The patient remains asymptomatic at 12 months of follow-up with no recurrence of malignancy or its markers.
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Affiliation(s)
- Atsuyuki Watanabe
- Division of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideyuki Kato
- Division of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Bryan J Mathis
- Division of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Muneaki Matsubara
- Division of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Seigo Gomi
- Division of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroaki Sakamoto
- Division of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuji Hiramatsu
- Division of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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21
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The Onco-cardiologist Dilemma: to Implant, to Defer, or to Avoid Transcatheter Aortic Valve Replacement in Cancer Patients with Aortic Stenosis? Curr Cardiol Rep 2019; 21:83. [DOI: 10.1007/s11886-019-1166-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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22
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Tamai K, Okamura S, Kitahara T, Minoji T, Takabatake H, Watanabe N, Yamamura N, Fukuchi N, Ebisui C, Yokouchi H, Tsuda M, Mizote I, Kinuta M. Laparoscopic colectomy after transcatheter aortic valve implantation in an elderly patient with obstructive descending colon cancer and severe aortic stenosis: a case report. Surg Case Rep 2019; 5:102. [PMID: 31236739 PMCID: PMC6591332 DOI: 10.1186/s40792-019-0662-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The demand for laparoscopic colectomy is increasing due to greater number of elderly colon cancer patients, and it is important to evaluate existing comorbidities to ensure perioperative safety. Aortic stenosis (AS) is one of the most common heart diseases in the elderly, and elderly cancer patients with severe AS may be considered ineligible for optimal cancer treatment if they cannot endure surgical aortic valve replacement (SAVR). Recently, transcatheter aortic valve implantation (TAVI) has become a valid option in patients who are high risk for SAVR. We herein present the first case of an elderly cancer patient with severe AS who underwent laparoscopic colectomy after TAVI. CASE PRESENTATION An 87-year-old woman with a history of multiple cardiovascular diseases was diagnosed with obstructive descending colon cancer and initially underwent colonic stenting. However, as preoperative echocardiography revealed severe AS, she underwent TAVI prior to the colectomy to reduce perioperative risk. TAVI was chosen instead of SAVR due to high SAVR mortality risk, and laparoscopic colectomy was performed 22 days after TAVI. Her postoperative course was uneventful, and she was discharged 14 days later without any deterioration in general condition. No recurrence was observed at more than 1 year, even without adjuvant therapy. CONCLUSION TAVI facilitated subsequent laparoscopic colectomy in an elderly cancer patient with severe AS. Our case report shows that TAVI may enable further cancer treatment even in patients with severe AS, who may otherwise be considered not suitable for such treatments.
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Affiliation(s)
- Koki Tamai
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Shu Okamura
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan.
| | - Tomohiro Kitahara
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Takayuki Minoji
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Hiroyuki Takabatake
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Noriyuki Watanabe
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Noriyuki Yamamura
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Nariaki Fukuchi
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Chikara Ebisui
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Hideoki Yokouchi
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Masaki Tsuda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Masakatsu Kinuta
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
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Carinal surgery: A single-institution experience spanning 2 decades. J Thorac Cardiovasc Surg 2019; 157:2073-2083.e1. [DOI: 10.1016/j.jtcvs.2018.11.130] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/14/2018] [Accepted: 11/17/2018] [Indexed: 11/22/2022]
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24
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Okuno T, Yahagi K, Horiuchi Y, Sato Y, Tanaka T, Koseki K, Osanai A, Yokozuka M, Miura S, Tanabe K. The role of transcatheter aortic valve replacement in the patients with severe aortic stenosis requiring major non-cardiac surgery. Cardiovasc Interv Ther 2019; 34:345-351. [DOI: 10.1007/s12928-019-00575-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
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25
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Zahra A. Efficacy of on-pump versus off-pump coronary artery bypass grafting in early-stage renal impairment without dialysis therapy. JOURNAL OF MEDICINE IN SCIENTIFIC RESEARCH 2019. [DOI: 10.4103/jmisr.jmisr_18_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Braile DM, Évora PRB. Cardiopulmonary Bypass and Cancer Dissemination: A Logical But Unlikely Association. Braz J Cardiovasc Surg 2018; 33:I-II. [PMID: 29617496 PMCID: PMC5873772 DOI: 10.21470/1678-9741-2018-0600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Domingo M Braile
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil and Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Paulo Roberto B Évora
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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Évora PRB, Albuquerque AAS, Nadai TRD, Mente ED, Sankarankuty AK, Castro-E-Silva O. The cardiopulmonary bypass and cancer dissemination puzzle1. Acta Cir Bras 2018; 33:1037-1042. [PMID: 30517330 DOI: 10.1590/s0102-865020180110000010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/09/2018] [Indexed: 11/22/2022] Open
Abstract
Early cancer diagnosis, new therapies that increased survival of patients, besides the increasingly elderly population are some factors would be associated with possible cancer dissemination in patients under cardiopulmonary bypass (CPB) cardiac surgery. Also, the benefits, and risks, regarding long-term survival, have not yet been established. Therefore, cardiac surgery morbimortality may be superior in patients with cancer disease. Also, immunologic and inflammatory changes secondary to CPB can also increase tumor recurrence. After a brief introduction and CPB immunologic the two main topic subjects included: 1) Combined heart surgery and lung resection and; 2) Possible influence of neoplasia type. After observing the relative literature scarcity, we keep the opinion that "CPB has a modest association with cancer progression" and that "CPB and cancer dissemination should be a logical but unlikely association."
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Affiliation(s)
- Paulo Roberto Barbosa Évora
- PhD, Full Professor, Division of Thoracic and Cardiovascular Surgery, Department of Surgery and Anatomy, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (FMRP-USP), Ribeirao Preto-SP, Brazil. Conception and design of the study, manuscript writing, critical revision
| | - Agnes Afrodite Sumarelli Albuquerque
- Fellow Master degree, Experimental Medicine Program, Division of Thoracic and Cardiovascular Surgery, Department of Surgery and Anatomy, FMRP-USP, Ribeirao Preto-SP, Brazil. Acquisition of data
| | - Tales Rubens de Nadai
- Fellow PhD degree, Experimental Medicine Program, Division of Thoracic and Cardiovascular Surgery, Department of Surgery and Anatomy, FMRP-USP, Ribeirao Preto-SP, Brazil. Acquisition of data
| | - Enio David Mente
- PhD, Assistant Professor, Department of Surgery and Anatomy, Division of Digestive Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Acquisition of data
| | - Ajith Kumar Sankarankuty
- PhD, Assistant Professor, Department of Surgery and Anatomy, Division of Digestive Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Acquisition of data
| | - Orlando Castro-E-Silva
- Full Professor, Surgery and Anatomy Department, FMRP-USP, Ribeirao Preto-SP, and Department of Gastroenterology, Medical School, USP, Sao Paulo-SP, Brazil. Critical revision
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Extended pneumonectomy for advanced lung cancer with cardiovascular structural invasions. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:336-342. [PMID: 32082760 DOI: 10.5606/tgkdc.dergisi.2018.15059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/07/2017] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the predictive factors in relation to tumor stages, mediastinal involvements, perioperative adjuvant therapies and surgical techniques in advanced lung cancer patients who underwent extended pneumonectomy with cardiovascular structural resection. Methods A comprehensive literature review was performed for extended pneumonectomies with cardiovascular structural resections in the PubMed, Google Scholar and HighWire Press for the year range 2000-2016. Data were carefully extracted regarding details such as the study population, demographics, clinical features, types of lung cancer, pathologic stages, nodal involvement, extent of pneumonectomy, cardiovascular structural resections, use of cardiopulmonary bypass, completeness of resection, pre- and postoperative adjuvant therapies, 1-5-year survival, median survival duration, comorbidity and mortality. Results Patients undergoing extended pneumonectomy with cardiovascular structural resection were characterized more by squamous carcinomas, N0 or N1, T4, stage 3 and left atrial invasions. More patients received postoperative radiochemotherapy than radioor chemotherapy. The five-year survival rate was 30.5±11.5% and the median survival duration was 23.0±10.7 months. Level 1 left atrial, aortic adventitial, and partial superior vena cava resections could be performed without cardiopulmonary bypass, while levels 2 and 3 left atrial resections with aorta or superior/inferior vena cava replacement should be performed under cardiopulmonary bypass. Conclusion The advent of cardiopulmonary bypass facilitated complete resection of lung cancer, while leading to potential risks of metastasis and reoccurrence. Pathological status, surgical techniques and pre- and postoperative adjuvant therapies affect survival significantly. Surgical indications and negative predictive risk factors for patients' survival warrant further evaluations.
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Komatsu H, Izumi N, Tsukioka T, Chung K, Toda M, Hara K, Nishiyama N. Pulmonary Resection for Lung Cancer Following Transcatheter Aortic Valve Implantation for Severe Aortic Valve Stenosis: A Case Report. Ann Thorac Cardiovasc Surg 2018; 26:220-223. [PMID: 29695653 PMCID: PMC7435133 DOI: 10.5761/atcs.cr.18-00028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An 82-year-old woman was referred to our hospital because of dyspnea on effort. Echocardiography revealed severe aortic valve stenosis (AS). Simultaneously, chest computed tomography (CT) revealed a 19-mm nodule in the lower lobe of the right lung, and bronchoscopic biopsy revealed adenocarcinoma. She underwent transcatheter aortic valve implantation (TAVI) for severe AS. Three weeks later, she underwent lower lobectomy of the right lung and mediastinal dissection for the lung cancer. Her postoperative course was good, and she was discharged 8 days postoperatively. In conclusion, we encountered a patient who successfully underwent pulmonary resection for lung cancer following TAVI for severe AS. We suggest that pulmonary resection following TAVI is an acceptable choice for lung cancer in patients with severe AS because of the lack of a need for cardiopulmonary bypass, the high safety and efficacy of two-stage therapy, and the short period between the two therapies.
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Affiliation(s)
- Hiroaki Komatsu
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Nobuhiro Izumi
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Takuma Tsukioka
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Kyukwang Chung
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Michihito Toda
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Kantaro Hara
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Noritoshi Nishiyama
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
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Hawranek M, Zembala MO, Gasior M, Hrapkowicz T, Pyka Ł, Cieśla D, Zembala M. Comparison of coronary artery bypass grafting and percutaneous coronary intervention in patients with heart failure with reduced ejection fraction and multivessel coronary artery disease. Oncotarget 2018; 9:21201-21210. [PMID: 29765531 PMCID: PMC5940397 DOI: 10.18632/oncotarget.25006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/01/2018] [Indexed: 01/06/2023] Open
Abstract
AIMS To compare coronary artery bypass grafting (CABG) with percutaneous coronary interventions (PCI) in patients with heart failure with reduced ejection fraction (HFrEF) and multivessel coronary artery disease. METHODS 1213 patients were selected from institutional databases, 761 and 452 in CABG and PCI group respectively. Only the subjects with left ventricle ejection fraction ≤ 35% and multivessel coronary artery disease were included to the study. The primary outcome measure was long-term all-cause death, the secondary outcomes were recurrent myocardial infarction, urgent repeat revascularization and stroke. Propensity Score-Based Adjusted Survival Curves were used for revascularization methods comparison. RESULTS Survival rates were similar in both groups (HR, 0.91; 95% CI, 0.65-1.28; p=0.59). Recurrent myocardial infarction was observed significantly less often in the CABG group (HR, 0.44; 95% CI, 0.26-0.74; p=0.002). Repeat urgent revascularization was less frequent in the CABG group (HR, 0.50; 95% CI, 0.30-0.84; p=0.008). The rate of stroke did not differ between the groups (HR, 1.17; 95% CI, 0.62-2.22; p=0.62). CONCLUSIONS In patients with HFrEF and multivessel CAD revascularization both with CABG and PCI resulted in similar survival rates. PCI is associated with increased risk of recurrent MI and urgent repeat revascularization, whereas the risk of stroke is similar in both methods.
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Affiliation(s)
- Michał Hawranek
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease, Zabrze, Poland
| | - Michal O. Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Mariusz Gasior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease, Zabrze, Poland
| | - Tomasz Hrapkowicz
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Łukasz Pyka
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease, Zabrze, Poland
| | - Daniel Cieśla
- Department of Science, Biostatistics and New Technologies, Silesian Centre for Heart Disease, Zabrze, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
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31
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Transcatheter aortic valve implantation: a safe and efficient procedure to treat an aortic valve stenosis before lung cancer resection. Gen Thorac Cardiovasc Surg 2018; 67:321-323. [PMID: 29492835 DOI: 10.1007/s11748-018-0901-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/18/2018] [Indexed: 10/17/2022]
Abstract
A 75 year old man presented with left upper lobe squamous cell carcinoma. Severe aortic stenosis has been discovered during preoperative assessment. In this situation, two therapeutic strategies are described: concomitant or two-staged procedures. The debate has not yet led to the conclusion on whether preferably performing one or the other. Furthermore, in an oncologic context, using cardiopulmonary bypass is still controversial. So, thoracic and cardiac surgeons jointly proposed to the patient a transcatheter aortic valve implantation followed, 72 h later, by lung cancer resection. This case report describes a way to treat both diseases avoiding cardiopulmonary bypass adverse effects and without delaying lung cancer treatment.
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32
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Lorusso R, Vizzardi E, Johnson DM, Mariscalco G, Sciatti E, Maessen J, Bidar E, Gelsomino S. Cardiac surgery in adult patients with remitted or active malignancies: a review of preoperative screening, surgical management and short- and long-term postoperative results. Eur J Cardiothorac Surg 2018; 54:10-18. [DOI: 10.1093/ejcts/ezy019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/04/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Enrico Vizzardi
- Department of Experimental and Applied Medicine, Cardiology Unit, University of Brescia, Brescia, Italy
| | - Daniel M Johnson
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Edoardo Sciatti
- Department of Experimental and Applied Medicine, Cardiology Unit, University of Brescia, Brescia, Italy
| | - Jos Maessen
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
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Iannaccone M, D'Ascenzo F, Vadalà P, Wilton SB, Noussan P, Colombo F, Raposeiras Roubín S, Abu Assi E, González-Juanatey JR, Simao Henriques JP, Saucedo J, Kikkert WJ, Nuñez-Gil I, Ariza-Sole A, Song XT, Alexopoulos D, Liebetrau C, Kawaji T, Moretti C, Garbo R, Huczek Z, Nie SP, Fujii T, Correia LC, Kawashiri MA, García Acuña JM, Southern D, Alfonso E, Terol B, Garay A, Zhang D, Chen Y, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Giordana F, Kowara M, Filipiak K, Wang X, Yan Y, Fan JY, Ikari Y, Nakahashi T, Sakata K, Gaita F, Yamagishi M, Kalpak O, Kedev S. Prevalence and outcome of patients with cancer and acute coronary syndrome undergoing percutaneous coronary intervention: a BleeMACS substudy. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:631-638. [PMID: 28593789 DOI: 10.1177/2048872617706501] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence and outcome of patients with cancer that experience acute coronary syndrome (ACS) have to be determined. METHODS AND RESULTS The BleeMACS project is a multicentre observational registry enrolling patients with acute coronary syndrome undergoing percutaneous coronary intervention worldwide in 15 hospitals. The primary endpoint was a composite event of death and re-infarction after one year of follow-up. Bleedings were the secondary endpoint. 15,401 patients were enrolled, 926 (6.4%) in the cancer group and 14,475 (93.6%) in the group of patients without cancer. Patients with cancer were older (70.8±10.3 vs. 62.8±12.1 years, P<0.001) with more severe comorbidities and presented more frequently with non-ST-segment elevation myocardial infarction compared with patients without cancer. After one year, patients with cancer more often experienced the composite endpoint (15.2% vs. 5.3%, P<0.001) and bleedings (6.5% vs. 3%, P<0.001). At multiple regression analysis the presence of cancer was the strongest independent predictor for the primary endpoint (hazard ratio (HR) 2.1, 1.8-2.5, P<0.001) and bleedings (HR 1.5, 1.1-2.1, P=0.015). Despite patients with cancer generally being undertreated, beta-blockers (relative risk (RR) 0.6, 0.4-0.9, P=0.05), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (RR 0.5, 0.3-0.8, P=0.02), statins (RR 0.3, 0.2-0.5, P<0.001) and dual antiplatelet therapy (RR 0.5, 0.3-0.9, P=0.05) were shown to be protective factors, while proton pump inhibitors (RR 1, 0.6-1.5, P=0.9) were neutral. CONCLUSION Cancer has a non-negligible prevalence in patients with acute coronary syndrome undergoing percutaneous coronary intervention, with a major risk of cardiovascular events and bleedings. Moreover, these patients are often undertreated from clinical despite medical therapy seems to be protective. Registration:The BleeMACS project (NCT02466854).
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Affiliation(s)
- Mario Iannaccone
- 1 San Giovanni Bosco Hospital, Turin, Italy.,2 Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Italy
| | - Fabrizio D'Ascenzo
- 2 Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Italy
| | - Paolo Vadalà
- 2 Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Italy
| | | | | | | | | | - Emad Abu Assi
- 4 University Clinical Hospital, Santiago de Compostela, Spain
| | | | | | | | - Wouter J Kikkert
- 5 University Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - Xian-Tao Song
- 9 Beijing Anzhen Hospital, Capital Medical University, China
| | | | | | | | - Claudio Moretti
- 2 Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Italy
| | | | | | - Shao-Ping Nie
- 14 Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | | | | | - Masa-Aki Kawashiri
- 17 Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | | | | | | | - Belén Terol
- 17 Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | | | - Dongfeng Zhang
- 9 Beijing Anzhen Hospital, Capital Medical University, China
| | - Yalei Chen
- 9 Beijing Anzhen Hospital, Capital Medical University, China
| | | | - Neriman Osman
- 11 Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | | | | | - Francesca Giordana
- 2 Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Italy
| | | | | | - Xiao Wang
- 14 Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yan Yan
- 14 Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Jing-Yao Fan
- 14 Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yuji Ikari
- 15 Tokai University School of Medicine, Tokyo, Japan
| | - Takuya Nakahashi
- 17 Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenji Sakata
- 17 Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Fiorenzo Gaita
- 2 Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Italy
| | - Masakazu Yamagishi
- 17 Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Oliver Kalpak
- 18 University Clinic of Cardiology, Skopje, Macedonia
| | - Sasko Kedev
- 18 University Clinic of Cardiology, Skopje, Macedonia
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Hashimoto M, Okumura Y, Tanaka F, Yoneda K, Takuwa T, Kondo N, Hasegawa S. Circulating Tumor Cell Count Can Be a Useful Prognostic Factor in Lung Resection via Cardiopulmonary Bypass. Case Rep Oncol 2017; 10:169-174. [PMID: 28413393 PMCID: PMC5346945 DOI: 10.1159/000457116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 11/28/2022] Open
Abstract
Tumor resection with cardiopulmonary bypass (CPB) remains controversial in the field of oncology. Here, we present a 57-year-old male patient with locally advanced squamous cell carcinoma. The tumor was located in the left hilum and invaded the left atrium. Complete resection, left pneumonectomy combined with partial left atrium resection, was achieved using CPB. We evaluated the circulating tumor cell (CTC) counts, as a surrogate for micrometastasis, in peripheral blood and the CPB circuit. Both CTC counts were 0, which could indicate local disease without micrometastasis. CTC count may be a useful indicator for tumor resection with CPB in lung cancer.
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Affiliation(s)
- Masaki Hashimoto
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Fumihiro Tanaka
- Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazue Yoneda
- Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Teruhisa Takuwa
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nobuyuki Kondo
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Kataoka S, Otsuka M, Goto M, Kahata M, Kumagai A, Inoue K, Koganei H, Enta K, Ishii Y. Primary Multiple Cardiac Myxomas in a Patient without the Carney Complex. J Cardiovasc Ultrasound 2016; 24:71-4. [PMID: 27081449 PMCID: PMC4828420 DOI: 10.4250/jcu.2016.24.1.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 01/04/2016] [Accepted: 02/01/2016] [Indexed: 12/03/2022] Open
Abstract
Cardiac tumors are rare, and multiple myxomas are even rarer. The latter phenomenon is mostly associated with the Carney complex, a dominantly inherited disease characterized by multiple primary cardiac myxomas, endocrinopathy, and spotty pigmentation of the skin. We report the rare case of a patient who did not have the Carney complex but had multiple primary cardiac tumors. A 78-year-old woman with a past history of breast cancer was referred to our hospital for further examination of multiple cardiac tumors. Echocardiography showed 4 tumors in the left atrium and left ventricle. We could not diagnose them preoperatively and decided to resect them surgically because they were mobile and could have caused embolism and obstruction. The postoperative pathological findings of all 4 tumors were myxomas, although the patient did not meet the diagnostic criteria of the Carney complex. Therefore, a rare case of multiple primary cardiac myxomas was diagnosed.
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Affiliation(s)
- Shohei Kataoka
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Masato Otsuka
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Masayuki Goto
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Mitsuru Kahata
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Asako Kumagai
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Koji Inoue
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Hiroshi Koganei
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Kenji Enta
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Yasuhiro Ishii
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
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Rosskopfova P, Perentes JY, Ris HB, Gronchi F, Krueger T, Gonzalez M. Extracorporeal support for pulmonary resection: current indications and results. World J Surg Oncol 2016; 14:25. [PMID: 26837543 PMCID: PMC4736123 DOI: 10.1186/s12957-016-0781-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/26/2016] [Indexed: 12/21/2022] Open
Abstract
Extracorporeal assistances are exponentially used for patients, with acute severe but reversible heart or lung failure, to provide more prolonged support to bridge patients to heart and/or lung transplantation. However, experience of use of extracorporeal assistance for pulmonary resection is limited outside lung transplantation. Airways management with standard mechanical ventilation system may be challenging particularly in case of anatomical reasons (single lung), presence of respiratory failure (ARDS), or complex tracheo-bronchial resection and reconstruction. Based on the growing experience during lung transplantation, more and more surgeons are now using such devices to achieve good oxygenation and hemodynamic support during such challenging cases. We review the different extracorporeal device and attempt to clarify the current practice and indications of extracorporeal support during pulmonary resection.
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Affiliation(s)
- Petra Rosskopfova
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hans-Beat Ris
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Fabrizio Gronchi
- Division of Thoracic Anesthesiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thorsten Krueger
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Lang G, Ghanim B, Hötzenecker K, Klikovits T, Matilla JR, Aigner C, Taghavi S, Klepetko W. Extracorporeal membrane oxygenation support for complex tracheo-bronchial procedures†. Eur J Cardiothorac Surg 2014; 47:250-5; discussion 256. [DOI: 10.1093/ejcts/ezu162] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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