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Leonardi B, Natale G, Vicario G, Grande M, Fiorelli A, Di Tommaso L, Speranza V, Torella D, De Feo M, Torella M. Challenge of concomitant thymoma resection and myocardial revascularization: A Case Report. Thorac Cancer 2024; 15:1721-1724. [PMID: 39049202 PMCID: PMC11293930 DOI: 10.1111/1759-7714.15245] [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: 12/10/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 07/27/2024] Open
Abstract
Myocardial revascularization in patients presenting with an anterior mediastinal mass poses considerable challenges. In this report, we outline two cases involving patients with anterior mediastinal masses who underwent surgical resection alongside concurrent myocardial revascularization. One patient underwent coronary artery bypass graft surgery, while the other was treated by percutaneous coronary intervention with drug-eluting stent placement. Both patients fully recovered from the relative procedures and were discharged within two weeks post-surgery, ultimately diagnosed with thymoma. The concomitant intervention offered the advantage of promptly addressing both conditions, and it was performed safely through a collaborative multidisciplinary effort.
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Affiliation(s)
- Beatrice Leonardi
- Thoracic Surgery UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Giovanni Natale
- Thoracic Surgery UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Giuseppe Vicario
- Thoracic Surgery UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Mario Grande
- Thoracic Surgery UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Alfonso Fiorelli
- Thoracic Surgery UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | | | | | | | - Marisa De Feo
- Cardiac Surgery UnitUniversity of Campania “Luigi Vanvitelli” – Monaldi HospitalNaplesItaly
| | - Michele Torella
- Cardiac Surgery UnitUniversity of Campania “Luigi Vanvitelli” – Monaldi HospitalNaplesItaly
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Abdikarimov A, Bekenova A, Nurmakhan N, Shayakhmetov Y, Tuganbekov T. Simultaneous surgery for coexisting heart disease and non-cardiac malignancy: assessment of feasibility in case series. J Surg Case Rep 2024; 2024:rjae340. [PMID: 38817785 PMCID: PMC11138668 DOI: 10.1093/jscr/rjae340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
We present case series of simultaneous surgery for coexisting cardiac and non-cardiac pathologies to evaluate the feasibility of the treatment. The retrospective analysis included 27 patients aged between 28 and 74 years. The most often heart diseases were coronary arterial disease and valve defects, and the most often heart surgery was coronary artery bypass grafting. The non-cardiac diseases included neoplasms in the abdominal cavity, urinary system, and chest organs. The average duration of surgery was 277 ± 87 minutes, blood loss 285 ± 182 ml. The in-hospital mortality was 0%, with median stay of 2 and 12 days in the intensive care unit (ICU) and emergency room, respectively. The 1 and 5-year survival rates were 85.7% and 76.2%, respectively. Simultaneous surgeries can be a treatment of choice for patients with cardiac pathology and concomitant neoplasm in abdominal, thoracic, or urinary system. This is the first such study conducted in the Central-Asian region and, in particular, in Kazakhstan.
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Affiliation(s)
- Anuar Abdikarimov
- Department of General and Torasic Surgery, National Scientific Medical Center, 42 Abylai Khan ave., 010009, Astana, Kazakhstan
| | - Aigerim Bekenova
- School of Medicine, Nazarbayev University School of Medicine, 5/1 Kerey and Zhanibek Khandar str., 020000, Astana, Kazakhstan
| | - Nazerke Nurmakhan
- Astana Medical University, 49/A Beibitshilik str., 010000, Astana, Kazakhstan
| | - Yerzhan Shayakhmetov
- Tomotherapy Department, International Tomotherapy Center “UMIT”, 42/1 Abylai Khan ave., 010000, Astana, Kazakhstan
| | - Turlybek Tuganbekov
- Astana Medical University, 49/A Beibitshilik str., 010000, Astana, Kazakhstan
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Lianyong J, Pengkai G, Xuefeng Z, Fangbao D, Hao L. Simultaneous Minimally Invasive Coronary Artery Bypass Grafting and Lung Resection. Thorac Cardiovasc Surg 2023. [PMID: 37774755 DOI: 10.1055/a-2184-6624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND The best surgical treatment strategy for coexisting coronary artery disease (CAD) and lung cancer (LC) remains controversial. This study analyzed the safety and efficacy of a simultaneous minimally invasive procedure for patients with CAD and LC. METHODS Patients who underwent simultaneous minimally invasive off-pump coronary artery bypass grafting and lung resection from January 2016 to December 2021 were retrospectively analyzed. The procedure was performed in the fourth intercostal space through a small left anterolateral minithoracotomy. Harvesting of the left internal mammary artery (LIMA) and sewing of the anastomoses were performed under direct vision. Lung resections were performed with or without the assistance of a thoracoscope. RESULTS Sixteen patients were included with a mean age of 67.13 ± 10.61 years. Procedural success occurred in all patients with a mean operative time of 366.88 ± 94.48 minutes. All patients received at least one coronary artery bypass LIMA graft. Pneumonectomy, lobectomy, segment resection, and wedge resection were performed in one (6.25%), eight (50%), two (12.5%), and five (31.25%) patients, respectively. There were no perioperative deaths or new myocardial infarctions. Complications included one case of postoperative bleeding, two lung infections, two cases of atelectasis, one case of pleural effusion, and one case of cardiac arrhythmia. All the patients were followed up for 1 to 57 months, cancer recurrence occurred in two patients, and one patient died. The remaining patients showed no evidence of tumor recurrence or myocardial infarction. CONCLUSION This simultaneous minimally invasive procedure is safe and effective for selected patients with CAD and LC.
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Affiliation(s)
- Jiang Lianyong
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Gao Pengkai
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Zhang Xuefeng
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
- Department of Radiology, The First Affiliated Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Ding Fangbao
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Liu Hao
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Seyrek Y, Akkuş M. How to facilitate concurrent lower lobectomy after coronary artery bypass grafting via median sternotomy without adding anterolateral thoracotomy? ANZ J Surg 2023. [PMID: 37095071 DOI: 10.1111/ans.18494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/03/2023] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND AND AIM Median sternotomy is an unfavourable approach for performing lung resection and mediastinal lymphadenectomy. Some studies have speculated that concurrent pulmonary resections other than upper lobectomy, necessitate anterolateral thoracotomy in addition to sternotomy. In this study, we aimed to discuss the feasibility and advantages of concomitant video-thoracoscopy (VATS) assisted lower lobectomy after coronary artery bypass grafting (CABG). METHODS We analysed 21 patients who underwent a single combined procedure that includes CABG followed by anatomical pulmonary resection and divided them into two groups: patients who underwent upper lobectomy via median sternotomy incision (Group A, n = 12) and patients who underwent lower lobectomy with video-thoracoscopic assistance (VATS) next to sternotomy incision (Group B, n = 9). RESULTS There were no significant differences between the groups in age, sex, comorbidities, tumour side or size, tumour stage, tumour histopathology, number of dissected lymph node stations, N status, CABG type, number of grafts used, operative time, hospitalization and complication rates. CONCLUSION The feasibility of upper lobectomies via median sternotomy is clear; however, performing lower lobectomies is challenging. In our study, we concluded that the operative feasibility of concurrent lower lobectomy by VATS assistance showed no essential difference to that of concurrent upper lobectomy by presenting that there was no statistically significant difference between the groups in terms of any studied parameters. We can speculate that median sternotomy with VATS assistance should be especially considered instead of anterolateral thoracotomy for lower lobectomies at centres where VATS lobectomies are performed.
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Affiliation(s)
- Yunus Seyrek
- Department of Thoracic Surgery, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Akkuş
- Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Lv B, Deng L, Xie T, Wei X, Liu X, Tan W, Wang X, Gao X. Evaluation of the anti-inflammatory and antioxidant pharmcodynamic compoents of naoxintong capsules as a basis of broad spectrum effects. PHARMACEUTICAL BIOLOGY 2021; 59:242-251. [PMID: 33874833 PMCID: PMC8079059 DOI: 10.1080/13880209.2020.1870506] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/06/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
CONTEXT Naoxintong capsule (NXT) is one of the most prevalent Traditional Chinese Medicine formulations in the treatment of coronary heart disease (CHD), yet the action of pharmacodynamic components remains unclear. OBJECTIVE To determine the basis by which pharmacodynamic components of NXT may be effective in the treatment of CHD. MATERIALS AND METHODS The protective effect of NXT (0.01-100 μg/mL) on 293 T and hy926 cells was determined by MTT assay for 24 h. Afterwards, to investigate the pharmacodynamic material basis of NXT in anti-inflammatory and antioxidant effects, based on previous UPLC/Q-TOF analysis, 293 T and hy926 cells were divided into control (treated with solvent), model (incubated with TNF-α, LPS or H2O2), intervention (treated with UPLC components) and positive groups. After 24 h of treatment, all cells were tested to verify the screening results. MOE software was applied to dock bioactive compounds with phosphoinositide 3-kinase (PI3K), then the protein expression and phosphate levels were determined by western blotting. RESULTS NXT could significantly inhibit the expression of NF-κB, MMP-9 and NO in cells with IC50 values of 0.1178, 0.1182 and 0.1094 μg/mL. Based on the screening results, six components of NXT were identified (calycosin, ferulic acid, salvianolic acid B, ononin, salvianolic acid E, and salvianolic acid F) which can inhibit NF-κB, MMP-9, and NO simultaneously, while exerting cytoprotective effects by inhibiting the activation of the PI3K/AKT pathway under different conditions by virtue of their advantageous interaction with PI3K. CONCLUSIONS These ingredients have outstanding therapeutic potential and may provide a scientific basis for the future application and research of NXT.
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Affiliation(s)
- Bin Lv
- State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lina Deng
- State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tian Xie
- State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xing Wei
- State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiao Liu
- State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wangxiao Tan
- State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaoying Wang
- State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiumei Gao
- State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Cheng S, Jiang Y, Li X, Lu X, Zhang X, Sun D. Perioperative outcomes of combined heart surgery and lung tumor resection: a systematic review and meta-analysis. J Cardiothorac Surg 2021; 16:227. [PMID: 34372896 PMCID: PMC8351083 DOI: 10.1186/s13019-021-01607-7] [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: 09/28/2020] [Accepted: 08/02/2021] [Indexed: 11/10/2022] Open
Abstract
Objective The prevalence of patients with concomitant heart and lung lesions requiring surgical intervention is increasing. Simultaneous cardiac surgery and pulmonary resection avoids the need for a second operation. However, there are concerns regarding the potentially increased mortality and complication rates of simultaneous surgery and the adequacy of lung exposure during heart surgery. Therefore, we performed a meta-analysis to evaluate the perioperative mortality and complication rates of combined heart surgery and lung tumor resection. Methods A comprehensive literature search was performed in July 2020. The PubMed, Embase, and Web of Science databases were searched to identify studies that reported the perioperative outcomes of combined heart surgery and lung tumor resection. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias of included studies. Pooled proportions and 95% confidence intervals (95% CI) were calculated by R version 3.6.1 using the meta package. Results A total of 536 patients from 29 studies were included. Overall, the pooled proportion of operative mortality was 0.01 (95% CI: 0.00, 0.03) and the pooled proportion of postoperative complications was 0.40 (95% CI: 0.24, 0.57) for patients who underwent combined cardiothoracic surgery. Subgroup analysis by lung pathology revealed that, for patients with lung cancer, the pooled proportion of anatomical lung resection was 0.99 (95% CI: 0.95, 1.00) and the pooled proportion of systematic lymph node dissection or sampling was 1.00 (95% CI: 1.00, 1.00). Subgroup analysis by heart surgery procedure found that the pooled proportion of postoperative complications of patients who underwent coronary artery bypass grafting (CABG) patients using the off-pump method was 0.17 (95% CI: 0.01, 0.43), while the pooled proportion of complications after CABG using the on-pump method was 0.61 (95% CI: 0.38, 0.82). Conclusion Combined heart surgery and lung tumor resection had a low mortality rate and an acceptable complication rate. Subgroup analyses revealed that most patients with lung cancer underwent uncompromised anatomical resection and mediastinal lymph node sampling or dissection during combined cardiothoracic surgery, and showed off-pump CABG may reduce the complication rate compared with on-pump CABG. Further researches are still needed to verify these findings.
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Affiliation(s)
- Shizhao Cheng
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, 300222, China
| | - Yiyao Jiang
- Department of Cardiac Surgery, Tianjin First Central Hospital, Tianjin, 300074, China
| | - Xin Li
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, 300222, China
| | - Xike Lu
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, 300222, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, 300222, China
| | - Daqiang Sun
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, 300222, China.
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Reshetov AV, Elkin AV, Nikolaev GV, Stepanov SS. Surgical treatment of lung cancer in patients with coronary artery surgery. GREKOV'S BULLETIN OF SURGERY 2021. [DOI: 10.24884/0042-4625-2021-180-1-60-64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objective was to improve the surgical treatment tactics in patients with non-small cell lung cancer (NSCLC) and coronary heart disease (CHD), requiring myocardial revascularization.Methods and materials. Two groups consisting of 24 patients operated on for NSCLC were examined. In one group, operations for NSCLC were performed in the second stage after coronary artery bypass grafting (CABG). Survival rates in both groups and factors influencing them were evaluated.Results. The number of postoperative complications in both groups was comparable: 20.8 % in patients with CABG and 16.6 % in the group operated only for NSCLC. Indicators of relapse-free and overall survival did not differ significantly from each other (p=0.90 and p=0.95). Only the stage of the disease (p=0.009) and the implementation of complex cancer treatment in case of its necessity (p=0.035) had a reliably impact on the long-term results of the operation. The first stage of myocardial revascularization surgery did not affect the results of treatment (p=0.94), as well as the age of patients, the volume of performed surgery, the morphological picture of the tumor.Conclusion. The staging approach to the treatment of patients with NSCLC and critical forms of CHD requiring myocardial revascularization is reliable, convenient and does not affect the long-term results of treatment.
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Affiliation(s)
- A. V. Reshetov
- North-Western State Medical University named after I.I. Mechnikov, Russia, St. Petersburg
| | - A. V. Elkin
- North-Western State Medical University named after I.I. Mechnikov, Russia, St. Petersburg
| | - G. V. Nikolaev
- National Medical Research Center named after V.A. Almazova, Russia, St. Petersburg
| | - S. S. Stepanov
- National Medical Research Center named after V.A. Almazova, Russia, St. Petersburg
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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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Dual-screening of anti-inflammatory and antioxidant active ingredients of shenxiang suhe pill and its potential multi-target therapy for coronary heart disease. Biomed Pharmacother 2020; 129:110283. [DOI: 10.1016/j.biopha.2020.110283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 02/08/2023] Open
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Yeginsu A, Vayvada M, Karademir BC, Erkılınç A, Tasci AE, Buyukbayrak F, Gurcu E, Kutlu CA. Combined Off-Pump Coronary Artery Bypass Grafting and Lung Resection in Patients with Lung Cancer Accompanied by Coronary Artery Disease. Braz J Cardiovasc Surg 2019; 33:483-489. [PMID: 30517257 PMCID: PMC6257540 DOI: 10.21470/1678-9741-2018-0126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/30/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Optimal surgical approach for the treatment of resectable lung cancer
accompanied by coronary artery disease (CAD) remains a contentious issue. In
this study, we present our cases that were operated simultaneously for
concurrent lung cancer and CAD. Methods Simultaneous off-pump coronary artery bypass surgery (OPCABG) and lung
resection were performed on 10 patients in our clinic due to lung cancer
accompanied by CAD. Demographic features of patients, operation data and
postoperative results were evaluated retrospectively. Results Mean patient age was 63.3 years (range 55-74). All patients were male. Six
cases of squamous cell carcinoma, three of adenocarcinoma and one case of
large cell carcinoma were diagnosed. Six patients had single-vessel CAD and
4 had two-vessel CAD. Three patients underwent OPCABG at first and then lung
resection. The types of resections were one right pneumonectomy, three right
upper lobectomies, one right lower lobectomy, three left upper lobectomies,
and two left lower lobectomies. Reoperation was performed in one patient due
to hemorrhage. One patient developed intraoperative contralateral tension
pneumothorax. One patient died due to acute respiratory distress syndrome at
the early postoperative period. Conclusion Simultaneous surgery is a safe and reliable option in the treatment of
selected patients with concurrent CAD and operable lung cancer.
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Affiliation(s)
- Ali Yeginsu
- Department of Thoracic Surgery, Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital, Kartal, Istanbul, Turkey
| | - Mustafa Vayvada
- Department of Thoracic Surgery, Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital, Kartal, Istanbul, Turkey
| | - Burcin C Karademir
- Department of Cardiovascular Surgery, Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey
| | - Atakan Erkılınç
- Department of Anesthesia and Reanimation, Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Erdal Tasci
- Department of Thoracic Surgery, Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital, Kartal, Istanbul, Turkey
| | - Fuat Buyukbayrak
- Department of Cardiovascular Surgery, Okan University School of Medicine, Istanbul, Turkey
| | - Emre Gurcu
- Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital, Department of Anesthesia and Reanimation, Istanbul, Turkey
| | - Cemal Asım Kutlu
- Yuzuncu Yil University School of Medicine Gaziosmanpasa Hospital, Department of Thoracic Surgery, Istanbul, Turkey
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Liu W, Huang Q, Lin D, Zhao L, Ma J. Effect of lung protective ventilation on coronary heart disease patients undergoing lung cancer resection. J Thorac Dis 2018; 10:2760-2770. [PMID: 29997938 DOI: 10.21037/jtd.2018.04.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Mechanical ventilation, especially large tidal volume (Vt) one-lung ventilation (OLV), can cause ventilator-induced lung injury (VILI) that can stimulate cytokines. Meanwhile, cytokines are considered very important factor influencing coronary heart disease (CHD) patient prognosis. So minimization of pulmonary inflammatory responses by reduction of cytokine levels for CHD undergoing lung resection during OLV should be a priority. Because previous studies have demonstrated that lung-protective ventilation (LPV) reduced lung inflammation, this ventilation approach was studied for CHD patients undergoing lung resection here to evaluate the effects of LPV on pulmonary inflammatory responses. Methods This is a single center, randomized controlled trial. Primary endpoint of the study are plasma concentrations of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-10 and C-reactive protein (CRP). Secondary endpoints include respiratory variables and hemodynamic variables. 60 CHD patients undergoing video-assisted thoracoscopic lung resection were randomly divided into conventional ventilation group [10 mL/kg Vt and 0 cmH2O positive end-expiratory pressure (PEEP), C group] and protective ventilation group (6 mL/kg Vt and 6 cmH2O PEEP, P group; 30 patients/group). Hemodynamic variables, peak inspiratory pressure (Ppeak), dynamic compliance (Cdyn), arterial oxygen tension (PaO2) and arterial carbon dioxide tension (PaCO2) were recorded as test data at three time points: T1-endotracheal intubation for two-lung ventilation (TLV) when breathing and hemodynamics were stable; T2-after TLV was substituted with OLV when breathing and hemodynamics were stable; T3-OLV was substituted with TLV at the end of surgery when breathing and hemodynamics were stable. The concentrations of TNF-α, IL-6, IL-10 and CRP in patients' blood in both groups at the very beginning of OLV (beginning of OLV) and the end moment of the surgery (end of surgery) were measured. Results The P group exhibited greater PaO2, higher Cdyn and lower Ppeak than the C group at T2, T3 (P<0.05). At the end moment of the surgery, although the P group tended to exhibit higher TNF-α and IL-10 values than the C group, the differences did not reach statistical significance(P=0.0817, P=0.0635). Compared with C group at the end moment of the surgery, IL-6 and CRP were lower in P group, the differences were statistically significant (P=0.0093, P=0.0005). There were no significant differences in hemodynamic variables between the two groups (P>0.05). Conclusions LPV can effectively reduce the airway pressure, improve Cdyn and PaO2, reduce concentrations of IL-6 and CRP during lung resection of CHD patients.Trial registration: The trial was registered in the Chinese Clinical Trial Registry.
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Affiliation(s)
- Wenjun Liu
- Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Qian Huang
- Department of Respiratory Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Duomao Lin
- Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Liyun Zhao
- Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jun Ma
- Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Liu B, Chen C, Gu C, Li Q, Liu J, Pu Y, Lin Y, Wei Z, Li Z, Zhang Y. Combined Coronary Artery Bypass Graft (CABG) Surgery and Lung Resection for Lung Cancer in Patients More than 50 Years-of-Age. Med Sci Monit 2018; 24:3307-3314. [PMID: 29779035 PMCID: PMC5989628 DOI: 10.12659/msm.907545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The co-existence of coronary heart disease (CHD) and lung cancer is increasing in an increasingly aging population. The aim of this study was to evaluate patient outcome from combined off-pump coronary artery bypass graft (CABG) surgery and lung resection in patients more than 50 years-of-age. Material/Methods A retrospective clinical study of 23 patients with a mean age of 70.2±8.4 years (range, 51–86 years) included 18 men and five women with CHD and lung cancer who underwent a single operation with combined off-pump CABG surgery and lung resection, for non-small cell lung cancer (NSCLC) (n=22) and small cell lung cancer (n=1). Surgical approaches included: median sternotomy in six patients; left lateral thoracotomy in nine patients; a median sternotomy in three patients; median sternotomy combined with thoracoscopic lobectomy in five patients. Results In the retrospective study of 23 patients, there were no deaths and no new cases of myocardial infarction (MI) in the immediate perioperative period. During the follow-up period, six patients died from lung cancer metastasis or recurrence; one patient died of acute renal failure; and one patient died from the effects of chemotherapy. The remaining 15 patients underwent postoperative follow-up for between 3–79 months with no deaths and no new cases of MI. Conclusions For patients who are more than 50 years-of-age and who have CHD and lung cancer, a single combined operation that includes off-pump CABG and lung resection can be safe and effective.
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Affiliation(s)
- Ban Liu
- Department of Cardiology, Shanghai Tenth Peoples' Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Chao Chen
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, Chile
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Qianfan Li
- Department of Cardiothoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jingjing Liu
- Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yiwei Pu
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Yu Lin
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zilun Wei
- The First Clinical Medical Department of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zhi Li
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Yangyang Zhang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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Zhao X, Li Y, Kong HY, Zhang L, Wen XH. Anesthetic management of off-pump simultaneous coronary artery bypass grafting and lobectomy: Case report and literature review. Medicine (Baltimore) 2017; 96:e8780. [PMID: 29390270 PMCID: PMC5815682 DOI: 10.1097/md.0000000000008780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Survey data show approximately 10% patients with lung cancer may present concomitant coronary heart disease. Simultaneous surgery is a challenge for anesthetist. We review our experience in the anesthesia with 5 patients who required simultaneous off-pump coronary artery bypass grafting (OPCABG) and pulmonary resection for lung cancer. PATIENT CONCERNS Between 2014 and 2016, 5 patients with ASA (American Society of Anesthesiologists) grade II or III, underwent combined OPCABG and lung resection in the first Affiliated Hospital, Zhejiang University School of Medicine. DIAGNOSES All five patients were diagnosed with coronary heart disease and peripheral pulmonary carcinoma INTERVENTIONS:: Five patients received general anesthesia with double-lumen endobronchial tube for lung separation. The anesthetics were used, which caused slight hemodynamic fluctuations during induction of anesthesia; while during the maintenance of anesthesia, supplemented by Dexmedetomidine, the drug doses were titrated according to the depth of anesthesia. Guided by cardiac index (CI), stroke volume variation (SVV) and oxygen delivery (DO2), different strategies were taken at the different stage of surgery, during lung resection, SVV was kept about 13% to 15%, and less than 10% during OPCABG. OUTCOMES Five patients were transferred to intensive care unit (ICU) with intubation after surgery, duration of ventilation was 10 to 18 hours, and length of ICU stay and hospital stay were 1.8 to 2.5 ds and 11 to 16 ds, respectively. All of patients were discharged with not any perioperative complication. LESSONS In summary, anesthetists should focus on the maintenance of the balance between oxygen supply and demanding, which was achieved by close monitoring, titration of anesthetics and goal-directed fluid therapy during surgical procedures.
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Affiliation(s)
- Xian Zhao
- Department of Anesthesiology, Zhejiang University International Hospital, Hangzhou
| | - Yuhong Li
- Department of Anesthesiology and Medical Research Center, Shaoxing People's Hospital, Shaoxing
| | - Hai-Ying Kong
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Zhang
- Department of Anesthesiology and Medical Research Center, Shaoxing People's Hospital, Shaoxing
| | - Xiao-Hong Wen
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Liu B, Gu C, Wang Y, Wang X, Ge W, Shan L, Wei Y, Xu X, Zhang Y. Feasibility and efficacy of simultaneous off-pump coronary artery bypass grafting and esophagectomy in elderly patients. Oncotarget 2017; 8:46498-46505. [PMID: 28148891 PMCID: PMC5542285 DOI: 10.18632/oncotarget.14824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/17/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION To analyze the outcomes of off-pump coronary artery bypass grafting (OPCABG) and esophagectomy simultaneously for patients with coronary artery disease (CAD) and coexisting esophageal cancer. METHODS Twenty-two patients with CAD and coexisting esophageal cancer underwent combined surgical interventions were subjected to the study. OPCABG was performed first, followed by esophagectomy. All the corresponding data including clinicopathological characteristics and postoperative outcomes were all investigated. RESULTS All the combined procedures were performed successfully. The average number of grafts was 2.36. Tumors were located at the middle third of the esophagus in 5 patients, at the lower third of the esophagus in 8 patients, at the esophageal gastric junction (EGJ) in 9 patients, respectively. The operations were carried out through a left lateral thoracotomy approach in 21 patients while a median sternotomy and left lateral thoracotomy approach was used in 1 patient for his condition rapidly worsened. Postoperatively, pneumonia occurred in 4 patients (18.2%). During the follow-up, three patients died of cancer metastasis /recurrence (6, 18, 37 months) and one died of pneumonia (1 month). The cumulative 5 years survival rate is 52.9%. CONCLUSIONS The combined procedure of OPCABG and esophagectomy is a safe and effective treatment option for patients with severe CAD and esophageal cancer.
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Affiliation(s)
- Ban Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuliang Wang
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiaowei Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Wen Ge
- Department of Cardiovascular Surgery, Shuguang Hospital, Affiliated to Shanghai University of TCM, Shanghai, China
| | - Lingtong Shan
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Yujian Wei
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Xiaohan Xu
- Department of Cardiovascular Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
- Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China
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