Clinical outcomes of tricuspid valve repair accompanying left-sided heart disease.

AIM: To determine whether the need for additional tricuspid valve repair is an independent risk factor when surgery is required for a left-sided heart disease. METHODS: One hundred and eighty patients (68 ± 12 years, 79 males) underwent tricuspid annuoplasty. Cox proportional-hazards regression model for multivariate analysis was performed for variables found significant in univariate analyses. RESULTS: Tricuspid regurgitation etiology was functional in 154 cases (86%), organic in 16 cases (9%), and mixed in 10 cases (6%), respectively. Postoperative mortality at 30 days was 11.7%. Mean follow-up was 51.7 mo with survival at 5 years of 73.5%. Risk factors for mortality were acute endocarditis [hazard ratio (HR) = 9.22 (95%CI: 2.87-29.62), P < 0.001], ischemic heart disease requiring myocardial revascularization [HR = 2.79 (1.26-6.20), P = 0.012], and aortic valve stenosis [HR = 2.6 (1.15-5.85), P = 0.021]. Significant predictive factors from univariate analyses were double-valve replacement combined with tricuspid annuloplasty [HR = 2.21 (1.11-4.39), P = 0.003] and preoperatively impaired ejection fraction [HR = 1.98 (1.04-3.92), P = 0.044]. However, successful mitral valve repair showed a protective effect [HR = 0.32 (0.10-0.98), P = 0.046]. Additionally, in instances where tricuspid regurgitation required the need for concomitant tricuspid valve repair, mortality predictor scores such as Euroscore 2 could be shortened to a simple Euroscore-tricuspid comprised of only 7 inputs. The explanation may lie in the fact that significant tricuspid regurgitation following left-sided heart disease represents an independent risk factor encompassing several other factors such as pulmonary arterial hypertension and dyspnea. CONCLUSION: Tricuspid annuloplasty should be used more often as a concomitant procedure in the presence of relevant tricuspid regurgitation, although it usually reveals an overly delayed correction of a left-sided heart disease.

Diaphragmatic Herniation through Prosthetic Material after Extrapleural Pneumonectomy: Be Aware of Tumor Recurrence.

Extrapleural pneumonectomy (EPP) is indicated in selected group of patients with pleural mesothelioma. Diaphragmatic reconstruction represents a part of this complex operation. We present the case of a late diaphragmatic gastric herniation through prosthetic material after EPP.

Video-assisted mediastinoscopy in superior vena cava obstruction: to fear or not to fear?

INTRODUCTION: We investigate the safety and efficacy of video-assisted mediastinoscopy (VAM) used for diagnosis of the superior vena cava syndrome. METHODS: In a 7-year period, we have done 447 VAM for malignant causes. We have compared, in a retrospective study from a prospectively maintained database, the differences between the groups with (first group) or without (second group) superior vena cava syndrome in terms of operative time, preoperative and postoperative complications, and results of pathologic examination. Statistical differences between the groups were calculated by χ2 test. RESULTS: Mean operative time for first (31 patients) and second (416 patients) groups was 18 and 34 minutes, respectively (p < 0.00). Mean hospital stay was 1.2 days in both the groups. Mortality rates for the first and second groups were 0 and 0.5% (p = 0.31); major morbidity rates were 0 and 0.7% (p = 0.50); and minor morbidity rates were 6.4 and 1.7% (p = 0.27), respectively. In the superior vena cava syndrome group, most of the lymph nodes biopsied were in paratracheal superior sites (81%); histology showed small cell lung cancer in 51.6%, non-small cell lung cancer in 25.8%, and lymphoma in 22.6%. CONCLUSIONS: VAM represents an important diagnostic tool in superior vena cava syndrome. Once decided to be used, we think that video technique is a good option with high rate of efficacy and low rates of mortality and morbidity.

Lesson to be learned: beware of lusoria artery during transhiatal esophagectomy.

The presence of an aberrant right subclavian artery represents a potentially risky situation when high mediastinal surgery is planned. We report a case of a patient needing transhiatal esophagectomy for cancer; the presence of the abnormal anatomic arterial situation complicated the postoperative course, when a vascular- digestive fistula appears. We discuss the direct causes and consequences of a rare situation.

Bronchopleural fistula: the Damocles sword of all pneumonectomies.

The postpneumonectomy bronchopleural fistula (BPF) remains a difficult challenge for the thoracic surgeon. We report the case of a very late-onset (60 years) left BPF managed by video-assisted mediastinoscopy discussing the direct consequences of this complication in the postpneumonectomy period.

Skeletal muscle metastasis from non-small cell lung cancer.

PURPOSE: Skeletal muscle metastases (SMM) from non-small cell lung cancer (NSCLC) are rarely encountered in clinical practice. The prognosis and the adequate treatment are not known. The aim of the study was to report our experience and to make an extensive literature research concerning SMM. PATIENTS AND METHODS: In our unit, we identified 16 patients with SMM in a 10-year period. The source of our literature search (English and French language) was the international MEDLINE database, and it exhausted all cited publications. RESULTS: We found 114 cases in the international literature (follow-up period mentioned in 72 cases). Pain was the most frequent symptom (83%). A mass was palpable in 78% of cases. The diagnosis was obtained by either fine needle/surgical biopsy or wide exeresis. The 5-year survival time was 11.5% with a median survival of 6 months. The 5-year survival rates: number of SMM - single versus multiple (13.6% [67 patients] versus 0% [21 patients]; p = 0.0022); disease-free interval (DFI) >6 months versus DFI < or =6 months (16.9% [18 patients] versus 9.1% [70 patients ]; p = 0.0458). We built three groups of prognostic significance: group I: DFI >6 months and single metastasis; group II: DFI >6 months or single metastasis; and group III: DFI < or =6 months and multiple metastasis. The 5-year survival rates were: group I (14 patients): group II (57 patients):group III (17 patients) = 28%:6%:0% (p = 0.0000), and the median survival was 19:9:4 months. CONCLUSION: The presence of SMM suggests an aggressive disease. Selection of patients for a local treatment is an important factor that determines survival. The ideal patient had a unique metachronous metastasic deposit that can be treated by surgery.