Prognostic value of single nodal zone metastasis in non-small-cell lung cancer

Kim, M.S.,Lee, H.S.,Lee, J.M.,Zo, J.I.,Lee, G.K.,Nam, B.H. Springer International ; Springer-Verlag New York 2010 European journal of cardio-thoracic surgery Vol.38 No.4

Objective: Mediastinal nodal metastasis is related to poor prognosis in surgically resected non-small-cell lung cancer (NSCLC) and the prognosis becomes worse with an increasing number of nodal stations involved. However, intra-operative designation of each nodal station might be difficult and confusing because of the adjacency of the nodal stations, and this may cause inaccurate nodal staging. The new concept of a 'nodal zone' was proposed by the IASLC lung cancer staging project (IALC, International Association for the Study of Lung Cancer), and we investigated the impact of the 'nodal zone' on the survival of pathological N2 patients. Methods: From a total of 1186 patients with NSCLC, who underwent surgical resection with curative intent, we analysed the survival data of 217 patients with ipsilateral mediastinal metastasis retrospectively. Results: The operative mortality rate was 1.4% (three patients) and median follow-up period was 35.4 months. The 5-year overall survival rate was 36.5% (median: 39.3 months; confidence interval (CI): 32.05-46.62). Median disease-free survival was 17.4 months (CI: 13.84-21.03). Overall and disease-free survival were better in the single-zone metastasis group than in the multiple zone group (median: 48.5 vs 33.4 months, p=0.001, CI: 32.05-46.62, and 20.4 vs 10.6 months, p<0.001, CI: 13.84-21.03). Among those of the single nodal zone metastasis group, no differences were found between the single and multiple nodal station metastasis groups in overall and disease-free survival. Conclusions: Patients with single nodal zone metastasis showed favourable outcomes compared with the multiple zone metastasis group. Even though two or more nodal stations were involved, the outcome was favourable if the nodal stations involved were confined to a single nodal zone. In conclusion, patients with single nodal zone metastasis can benefit from surgical resection.

Prediction of cognitive dysfunction and patients' outcome following valvular heart surgery and the role of cerebral oximetry

Hong, S.W.,Shim, J.K.,Choi, Y.S.,Kim, D.H.,Chang, B.C.,Kwak, Y.L. Springer International ; Springer-Verlag New York 2008 European journal of cardio-thoracic surgery Vol.33 No.4

Objective: Postoperative cognitive dysfunction (POCD) commonly develops after cardiac surgery affecting patients' outcome. Cerebral oximetry noninvasively measures regional cerebral oxygen saturation (rSO<SUB>2</SUB>) and significant correlation has been reported between intraoperative cerebral desaturation and POCD, as well as patients' outcome following coronary artery bypass grafting. However, evidence is limited in valvular heart surgery (VHS). We investigated the relationship of intraoperative rSO<SUB>2</SUB> values with POCD and length of postoperative hospitalization in patients undergoing VHS. Methods: One hundred patients undergoing elective VHS were enrolled. Neurocognitive evaluation was performed with Mini-Mental State Examination, Trail-Making Test (Part A), and Grooved Pegboard Test at 1 day before and 7th day after surgery. During surgery, rSO<SUB>2</SUB> was continuously monitored and the incidence and duration of decrease in rSO<SUB>2</SUB> values for five consecutive minutes were recorded as follows; (1) decrease in absolute rSO<SUB>2</SUB> values to less than 50%, (2) 40%, and (3) a 20% decrease compared to baseline value. Results: Twenty-three patients (23%) demonstrated POCD. We could not observe any significant differences in either the incidence or duration of decrease in rSO<SUB>2</SUB> values between patients with and without POCD. Low education level and higher baseline temperature had significant correlation with POCD. Patients with cerebral desaturation required significantly longer postoperative hospitalization. Conclusion: In patients undergoing VHS, POCD could not be predicted with cerebral oximetry. However, patients with intraoperative cerebral desaturation required significantly longer postoperative hospitalization and cerebral oximetry appears to be promising in terms of monitoring the brain as the index organ for systemic perfusion and improving patients' outcome.

Coronary ostial stenosis after aortic valvuloplasty (comprehensive aortic root and valve repair)

Han, S.W.,Kim, H.J.,Kim, S.,Ryu, K.H. Springer International ; Springer-Verlag New York 2009 European journal of cardio-thoracic surgery Vol.35 No.6

Comprehensive aortic root and valve repair (CARVAR) surgery using specially designed aortic rings was introduced as a new surgical technique for aortic valve disease. We present five consecutive cases of iatrogenic coronary ostial stenosis after CARVAR surgery in patients with aortic stenosis. The preoperative coronary angiography confirmed that all the patients had normal coronary arteries. They underwent aortic valvuloplasty by aortic leaflet extension and insertion of specially designed inner and outer rings at the level of the sinotubular junction. Within 6 months after surgery, all the patients complained of resting chest pain and dyspnea with changes of electrocardiography. Repeated coronary angiography demonstrated right coronary artery (RCA) ostial stenosis in one patient and left main (LM) ostial stenosis in the other four patients. Intravascular ultrasonography demonstrated severe ostial stenosis and extensive echogenic tissue in the extravascular area. Four patients with LM ostial disease successfully underwent coronary bypass graft surgery, and percutaneous coronary intervention with stenting was performed in one case of RCA ostial stenosis. Because the mechanism of this complication is not fully confirmed, more clinical study is required to confirm the safety issues of CARVAR surgery.

Carbon dioxide embolism induced right coronary artery ischaemia during off-pump obtuse marginalis artery grafting

Shim, J.K.,Choi, Y.S.,Yoo, K.J.,Kwak, Y.L. Springer International ; Springer-Verlag New York 2009 European journal of cardio-thoracic surgery Vol.36 No.3

Although use of carbon dioxide (CO<SUB>2</SUB>) blower has been regarded safe during off-pump coronary bypass surgery (OPCAB), we experienced a case of right coronary artery ischaemia induced by retrograde CO<SUB>2</SUB> embolism originating from the opened obtuse marginalis artery during OPCAB. The spray pressure can exceed the diastolic pressure, especially during grafting at the lateral or posterior wall when haemodynamic compromise due to mechanical heart displacement is most severe. In this situation, CO<SUB>2</SUB> blowing at an incompletely slinged coronary arteriotomy site can result in retrograde migration of CO<SUB>2</SUB> into the ascending aorta causing coronary embolism of the right coronary artery. When signs of ischaemia on the right coronary artery are encountered during grafting of other coronary artery, although CO<SUB>2</SUB> blower has been used, gas embolism should also be considered as the cause and identified at the mid-oesophageal aortic valve long-axis view. When confirmed, the use of gas blower should immediately be discontinued and coronary perfusion pressure increased while allowing time for the CO<SUB>2</SUB> to be absorbed. In case of massive embolism, needle aspiration of the gas should also be considered.

Prognostic value of B-type natriuretic peptide in patients with chronic mitral regurgitation undergoing surgery: mid-term follow-up results.

Hwang, In-Chang,Kim, Yong-Jin,Kim, Kyung-Hee,Lee, Seung-Pyo,Kim, Hyung-Kwan,Sohn, Dae-Won,Oh, Byung-Hee,Park, Young-Bae Springer International ; Springer-Verlag New York 2013 European journal of cardio-thoracic surgery Vol.43 No.1

<P>The prognostic value of B-type natriuretic peptide (BNP) for surgical outcome in patients with mitral regurgitation (MR) has not been studied. The purpose of this study was to determine the prognostic value of BNP in patients with chronic severe MR, undergoing mitral valve surgery.</P>

High-concentration glutaraldehyde fixation of bovine pericardium in organic solvent and post-fixation glycine treatment: in vitro material assessment and in vivo anticalcification effect

Lee, C.,Kim, S.H.,Choi, S.H.,Kim, Y.J. Springer International ; Springer-Verlag New York 2011 European journal of cardio-thoracic surgery Vol.39 No.3

Objective: Glutaraldehdye (GA)-fixed xenografts are widely used in cardiovascular surgery. The objective of this study was to evaluate the anticalcification effect of glycine treatment and high-concentration GA fixation in organic solvent on GA-fixed bovine pericardium, and to evaluate the possible synergistic effect of combined treatment. Methods: Bovine pericardial tissues were divided into four groups according to the methods of treatment. Group 1 consisted of tissues fixed with 0.5% GA (control), group 2 fixed with 0.5% GA and post-treated with glycine, group 3 fixed with 2% GA in organic solvent (65% ethanol+5% octanol), and group 4 fixed with 2% GA in organic solvent and post-treated with glycine. The material characteristics of the treated tissues were assessed by amino acid analysis, thermal stability test, uniaxial mechanical test and light microscopy. The tissues were subcutaneously implanted into 4-week-old rats for 8 weeks, and the calcium contents of the explanted tissues were measured. Results: Differently treated tissues resulted in no significant alterations in material characteristics and morphology as assessed by amino acid analysis, thermal stability test, uniaxial mechanical test, and light microscopy. Median calcium contents of groups 1, 2, 3, and 4 were 80.5μgmg<SUP>-1</SUP>, 1.0μgmg<SUP>-1</SUP>, 0.5μgmg<SUP>-1</SUP> and 1.7μgmg<SUP>-1</SUP>, respectively. The calcium contents of groups 2, 3 and 4 were all significantly lower than that of group 1 (p<0.05). Conclusions: Post-fixation treatment with glycine, high-concentration GA fixation in organic solvent and combined treatment of these all strongly prevented calcification of GA-fixed bovine pericardium in rat subcutaneous implantation model.

Results of an extracardiac pericardial-flap lateral tunnel Fontan operation

Park, H.K.,Youn, Y.N.,Yang, H.S.,Yoo, B.W.,Choi, J.Y.,Park, Y.H. Springer International ; Springer-Verlag New York 2008 European journal of cardio-thoracic surgery Vol.34 No.3

Objective: Extracardiac pericardial-flap lateral tunnel Fontan operation has the theoretical advantage of growth potentiality of the extracardiac tunnels. The mid-term results of this technique and morphologic change of the lateral tunnel were studied. Methods: Clinical data were reviewed in 42 patients who underwent extracardiac pericardial-flap lateral tunnel Fontan operation between November 1993 and December 2004. The age was 2.8+/-1.5 years and the body weight was 12.3+/-3.2kg. Extracardiac tunnel was constructed using the pedicled pericardium with the base undetached. By reviewing the follow-up cardiac angiograms (2.3+/-1.4 years postoperatively), ratios of diameter and cross-sectional area of the lateral tunnel to those of inferior vena cava were obtained. Results: There were 4 surgical mortalities (10%). Postoperative morbidity included prolonged pleural effusion in 5 patients and heart block in 1 patient. Follow-up was possible in 37 patients and the follow up duration was 3.8+/-2.2 years. There were two late deaths due to ventricular dysfunction and sudden death of unknown causes. Two patients required reoperation due to subaortic stenosis and stenosis between inferior vena cava and lateral tunnel. In one patient, bradyarrhythmia was observed but there was no thromboembolic complication. Follow-up anteroposterior and lateral diameter ratio were 1.1+/-0.5 and 1.2+/-0.5. The cross-sectional area ratio was 2.6+/-2.3. In 5 patients, fusiform dilatation of the lateral tunnel was observed, but in the remaining patients, the lateral tunnel preserved tubular morphology with good hemodynamics. Conclusions: Extracardiac pericardial-flap lateral tunnel Fontan operation is relatively simple and feasible even in patients with previous median sternotomies. The mid-term results were acceptable, and the lateral tunnel demonstrated a tendency to preserve its tubular shape. However in some patients, dilatation of the pericardial-flap tunnel was observed during follow up. Longer follow-up is required to determine the morphologic changes of the lateral tunnel and the value of this technique.

Therapeutic angiogenesis using naked DNA expressing two isoforms of the hepatocyte growth factor in a porcine acute myocardial infarction model

Cho, K.R.,Choi, J.S.,Hahn, W.,Kim, D.S.,Park, J.S.,Lee, D.S.,Kim, K.B. Springer International ; Springer-Verlag New York 2008 European journal of cardio-thoracic surgery Vol.34 No.4

Objective: We evaluated the potency of therapeutic angiogenesis using intramyocardial injection of naked DNA expressing two isoforms of hepatocyte growth factor (pCK-HGF-X7) in a porcine myocardial infarction model. Methods: Four weeks after left anterior descending coronary artery ligation, 14 pigs were allocated to pCK-Null (negative control, n=7) or pCK-HGF-X7 (n=7) treatment groups. Gated myocardial single photon emission computed tomography was performed 4 and 8 weeks following coronary ligation. The effect of pCK-HGF-X7 on capillary density in the gene-injected myocardium was examined by histological analysis using alkaline phosphatase staining. Results: Segmental myocardial perfusion of the underperfused area (@?70%) from coronary ligation increased in the pCK-HGF-X7 group (p=0.051), without significant differences in changes over time between the two groups (p=0.54). Systolic wall thickening (p=0.001), left ventricular end-diastolic (p=0.045) and end-systolic volumes (p=0.009), and left ventricular ejection fraction (p=0.041) changed in both groups without significant differences in changes over time between the two groups. The increase in the left stoke volume was higher in the pCK-HGF-X7 group than in the pCK-Null group (p=0.008). Histological analysis showed that capillary density was significantly higher in the pCK-HGF-X7 group than the pCK-Null group (p<0.001). Conclusion: Intramyocardial injection of pCK-HGF-X7 induced significant angiogenesis at infarct-border zone, and increased the left ventricular stroke volume probably caused by reverse remodeling process.