Soojin Lee, M.D., Jeong Su Cho, M.D., Eunsoo Kim, M.D., Yeongdae Kim, M.D., Jonggeun Lee, M.D.. J Chest Surg 2022;55:30-6. https://doi.org/10.5090/jcs.21.119

Soojin Lee, M.D., Jeong Su Cho, M.D., Hoseok I, M.D., Hyo Yeong Ahn, M.D., Yeong Dae Kim, M.D.. J Chest Surg 2021;54:224-7. https://doi.org/10.5090/jcs.20.065

Mil Hoo Kim, M.D., Soojin Lee, M.D., Juhyun Lee, M.D., Seohee Joo, M.D., You Kyeong Park, M.D., Kang Min Kim, M.D., Joon Chul Jung, M.D., Ph.D., Hyoung Woo Chang, M.D., Ph.D., Jae Hang Lee, M.D., Ph.D., Dong Jung Kim, M.D., Ph.D., Jun Sung Kim, M.D., Ph.D., Kay-Hyun Park, M.D., Ph.D., Cheong Lim, M.D., Ph.D.. J Chest Surg 2024;57:371-9. https://doi.org/10.5090/jcs.23.167

Background: Owing to the lack of understanding of the clinical significance of pericardial calcification during pericardiectomy, whether pericardial calcification should be considered when determining the optimal timing for pericardiectomy is debatable. We aimed to investigate the effect of pericardial calcification on early postoperative outcomes in patients who underwent pericardiectomy for constrictive pericarditis. Methods: Altogether, 44 patients who underwent pericardiectomy for constrictive pericarditis were enrolled. After excluding three patients who underwent concurrent surgeries, a total of 41 patients were categorized into two groups based on the presence of pericardial calcification as determined by preoperative computed tomography and pathological examination. Preoperative clinical and imaging characteristics, intraoperative data, and early postoperative outcomes were compared between the two groups. A multivariable analysis was performed to identify the factors associated with postoperative complications. Results: The group with and without PC comprised 21 and 20 patients, respectively. No significant differences were observed in 30-day mortality (n = 1 [5%]) in the group with pericardial calcification and no mortality in the group without pericardial calcification (p > 0.999). Other early postoperative outcome variables did not demonstrate any significant differences between the two groups. However, the use of cardiopulmonary bypass was associated with postoperative complications (p < 0.009, odds ratio: 63.5, 95% confidence interval: 5.13–3400). Conclusions: Pericardial calcification did not significantly affect the postoperative outcomes after pericardiectomy. Further comprehensive studies, including those with larger sample sizes and longitudinal designs, are necessary to determine whether pericardial calcification can significantly influence the timing of surgical intervention.

Background and Objectives: The estimation of lung function impairment after pulmonary lobectomy for primary non-small cell lung cancer (NSCLC) has been of great interest since the reduction of respiratory function might severely affect a patient’s quality of life. The perioperative factors that may have an influence on widening the gap between the postoperative measured lung function and predicted postoperative lung function were our greatest concern. We aimed to analyze the perioperative patient factors that may influence postoperative lung function in patients undergoing pulmonary lobectomy. Materials and Methods: A retrospective study was conducted using the medical records of 199 patients who underwent lobectomy for lung cancer between July 2017 and May 2020. After comparing the achieved postoperative forced expiratory volume in 1 s (FEV1) and predicted postoperative (ppo) FEV1, patients were divided into two groups: group A (n = 127), who had preserved pulmonary lung function; and group B (n = 72), who had decreased pulmonary lung function. Primary endpoints included location of pulmonary resection, preoperative performance status, body mass index (BMI) on admission, total muscle area, and muscle index. Results In group A, the proportion of normal weighted patients was significantly higher than that in group B (67.7% vs. 47.2%, p = 0.003). Conversely, the proportion of overweight patients was significantly higher in group B than in group A (47.2% vs. 28.3%, p = 0.003). Group B had a significantly high incidence of upper lobe resection (p = 0.012). The mean total muscle area in group A was higher than that in group B, but the difference was not statistically significant. Conclusions: A greater decrease in postoperative lung function than in ppo FEV1 was associated with BMI and the location of pulmonary resection in patients who underwent lobectomy. Postoperative physiologic changes due to high BMI and the resection of upper lobes need to be discussed to prevent postoperative morbidities.

Background: Tracheostomy complications (TCs) can result in severe outcomes such as mediastinitis, yet their significance is often underestimated due to their frequent presentation as minor local infections. In patients undergoing tracheostomy following cardiac surgery via sternotomy, the anatomical proximity between the tracheostoma and sternotomy wound, along with systemic inflammation from cardiopulmonary bypass, may increase the risk of complication. However, clinical outcome studies in this field remain limited. In this study, we aimed to investigate the outcomes of tracheostomy after cardiac surgery through median sternotomy and identify perioperative factors associated with TCs. Methods: In total, 1,689 patients underwent cardiac surgery between February 2014 and August 2024; among those patients, 85 (5%) required tracheostomy. After the exclusion of 21 patients who required thoracotomy or mini-thoracotomy, 64 patients (cardiac surgery through median sternotomy required tracheostomy) were ultimately enrolled and divided into TC (n=11) and no TC (N-TC; n=53) groups. Preoperative characteristics, intraoperative data, and early postoperative outcomes were compared between the groups. Multivariable analysis was performed to identify factors associated with TCs. Results: In total, 11 of 64 patients (17.2%) developed complications after tracheostomy, with an in-hospital mortality rate of 40.6% (26/64). A history of redo tracheostomy was significantly more prevalent (P=0.03) and the median units of packed red blood cells (pRBCs) transfused intraoperatively and on the day of cardiac surgery were significantly more in the TC group than in the N-TC group [12.0 (range, 6.0, 16.0) vs. 7.0 (range, 5.0, 9.0), P=0.042]. The intensive care unit stay was significantly longer in the TC group by 412 h (P=0.03). Use of the left internal mammary artery (odds ratio: 8.64, 95% confidence interval: 1.43–52.19, P=0.02) and the units of pRBCs transfused intraoperatively and on the day of cardiac surgery (odds ratio: 1.27, 95% confidence interval: 1.09–1.49, P=0.001) were significantly associated with TCs. Conclusions: Patients who underwent tracheostomy after cardiac surgery through median sternotomy showed high early mortality and morbidity rates. The incidence of TCs was also high, underscoring the need for close monitoring of the tracheostomy site. Further research is warranted to investigate the long-term effects of these complications on patient outcomes.