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Cardiothoracic Surgery: State of the Art and Future Perspectives
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Cardiothoracic Surgery: State of the Art and Future Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (20 August 2022) | Viewed by 19855

Special Issue Editor

Dr. Rajeev Dhupar

E-Mail Website
Guest Editor
1. Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Suite 715, Shadyside Medical Building, 5200 Centre Avenue, Pittsburgh, PA 15232, USA
2. Surgical Services Division, Veteran's Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
Interests: thoracic cancers; lung cancer immunotherapy; malignant pleural effusions; radiomics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cardiothoracic surgery deals with some of the most important disease states faced by humanity. The efforts to improve the longevity for those who suffer from coronary artery disease, aortic aneurysms, lung failure, lung cancer, and esophageal cancer have given surgeons the opportunity to be on the cutting edge of our greatest medical advances. The last three decades have seen the introduction and adoption of minimally invasive techniques, robotic-assisted procedures, artificial-intelligence-assisted diagnostics, immunotherapeutic treatments, and biomarker-based risk assessment, among others. The rate of advance is staggering, and the next decade will likely usher in the ability to drastically improve our diagnostic and therapeutic capabilities. This Special Issue of the Journal of Clinical Medicine, “Cardiothoracic Surgery: State of the Art and Future Perspectives”, highlights the most recent advances in the field as related to the diagnosis and treatment of disease states faced by cardiothoracic surgeons.

Prof. Dr. Rajeev Dhupar
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Cardiothoracic surgery advances
  • Minimally invasive surgery
  • Artificial intelligence
  • Immunotherapy in thoracic cancers
  • Lung transplant
  • Esophageal cancer
  • Lung cancer
  • Aortic aneurysm

Published Papers (7 papers)

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Research

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9 pages, 1896 KiB  
Article
Prognostic Difference of Pleural versus Distant Metastasis after Surgery for Lung Cancer
by Kyla D. Joubert, Olugbenga T. Okusanya, Summer Mazur, John P. Ryan, Chigozirim N. Ekeke, Matthew J. Schuchert, Adam C. Soloff and Rajeev Dhupar
J. Clin. Med. 2021, 10(21), 4846; https://doi.org/10.3390/jcm10214846 - 22 Oct 2021
Cited by 3 | Viewed by 1817
Abstract
Background: Pleural metastasis in lung cancer found at diagnosis has a poor prognosis, with 5–11 months’ survival. We hypothesized that prognosis might be different for patients who have had curative-intent surgery and subsequent pleural recurrence and that survival might differ based on the [...] Read more.
Background: Pleural metastasis in lung cancer found at diagnosis has a poor prognosis, with 5–11 months’ survival. We hypothesized that prognosis might be different for patients who have had curative-intent surgery and subsequent pleural recurrence and that survival might differ based on the location of the first metastasis (distant versus pleural). This may clarify if pleural recurrence is a local event or due to systemic disease. Methods: A database of 5089 patients who underwent curative-intent surgery for lung cancer was queried, and 85 patients were found who had biopsy-proven pleural metastasis during surveillance. We examined survival based on pattern of metastasis (pleural first versus distant first/simultaneously). Results: Median survival was 34 months (range: 1–171) from the time of surgery and 13 months (range: 0–153) from the time of recurrence. The shortest median survival after recurrence was in patients with adenocarcinoma and pleural metastasis as the first site (6 months). For patients with pleural metastasis as the first site, those with adenocarcinoma had a significantly shorter post-recurrence survival when compared with squamous cell carcinoma (6 vs. 12 months; HR = 0.34) and a significantly shorter survival from the time of surgery when compared with distant metastases first/simultaneously (25 vs. 52 months; HR = 0.49). Conclusions: Patients who undergo curative-intent surgery for lung adenocarcinoma that have pleural recurrence as the first site have poor survival. This may indicate that pleural recurrence after lung surgery is not likely due to a localized event but rather indicates systemic disease; however, this would require further study. Full article
(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives)
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6 pages, 777 KiB  
Article
Lung Nodule Evaluation Using Robotic-Assisted Bronchoscopy at a Veteran’s Affairs Hospital
by Chigozirim N. Ekeke, Matthew Vercauteren, Smiljana Istvaniczdravkovic, Roy Semaan and Rajeev Dhupar
J. Clin. Med. 2021, 10(16), 3671; https://doi.org/10.3390/jcm10163671 - 19 Aug 2021
Cited by 16 | Viewed by 2811
Abstract
The incidence of lung nodules has increased with improved diagnostic imaging and screening protocols. Despite improvements for diagnosing pulmonary nodules with technologies such as electromagnetic navigational bronchoscopy (ENB), several limitations still exist including adequate visualization, localization, and diagnostic yield. Robotic-assisted bronchoscopy with ENB [...] Read more.
The incidence of lung nodules has increased with improved diagnostic imaging and screening protocols. Despite improvements for diagnosing pulmonary nodules with technologies such as electromagnetic navigational bronchoscopy (ENB), several limitations still exist including adequate visualization, localization, and diagnostic yield. Robotic-assisted bronchoscopy with ENB has been introduced as a method to overcome these shortcomings. We describe our initial experience in evaluating lung nodules with robotic assisted bronchoscopy. We retrospectively reviewed data on the first 25 patients that underwent robotic-assisted bronchoscopy and biopsy. We analyzed success with localization, diagnostic yield, and post procedural morbidity. Diagnostic yield was 96% (24/25) with no periprocedural morbidity. The majority of nodules were malignant or atypical (76%) and were located in the right upper lobe. Diameter ranged between 0.8–6.9 cm (median size 1–2 cm). Seventy-five percent of patients underwent subsequent treatment for cancer based on these results, with 25% having continued surveillance. Robotic assisted bronchoscopy is safe and accurate. Studies with larger numbers will allow better understanding of the diagnostic yield and clinical utility of this approach in comparison to other diagnostic tools for lung nodules. Full article
(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives)
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10 pages, 901 KiB  
Article
Changes in the Bronchial Cuff Pressure of Left-Sided Double-Lumen Endotracheal Tube by Lateral Positioning: A Prospective Observational Study
by Jong-Hae Kim, Eugene Kim, In-Young Kim, Eun-Joo Choi and Sung-Hye Byun
J. Clin. Med. 2021, 10(8), 1590; https://doi.org/10.3390/jcm10081590 - 9 Apr 2021
Cited by 5 | Viewed by 2093
Abstract
Proper bronchial cuff pressure (BCP) is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. As positional change during endotracheal tube placement could alter cuff pressure, we aim to evaluate the change in BCP of DLT from the supine to [...] Read more.
Proper bronchial cuff pressure (BCP) is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. As positional change during endotracheal tube placement could alter cuff pressure, we aim to evaluate the change in BCP of DLT from the supine to the lateral decubitus position during thoracic surgery. A total of 69 patients aged 18–70 years who underwent elective lung surgery were recruited. BCP was measured at a series of time points in the supine and lateral decubitus positions after confirming the DLT placement. The primary outcome was change in the initial established BCP (BCPi), which is the maximum pressure at which the BCP did not exceed 40 cmH2O without air leak in the supine position, after lateral decubitus positioning. As the primary outcome, the BCPi increased from 25.4 ± 9.0 cmH2O in the supine position to 29.1 ± 12.2 cmH2O in the lateral decubitus position (p < 0.001). Out of the 69 participants, 43 and 26 patients underwent surgery in the left-lateral decubitus position (LLD group) and the right-lateral decubitus position (RLD group) respectively. In the LLD group, the BCPi increased significantly (p < 0.001) after lateral positioning and the beginning of surgery and the difference value, ∆BCPi, from supine to lateral position was significantly higher in the LLD group than in the RLD group (p = 0.034). Positional change from supine to lateral decubitus could increase the BCPi of DLT and the increase was significantly greater in LLD that in RLD. Full article
(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives)
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Review

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7 pages, 362 KiB  
Review
State of the Art in Lung Nodule Localization
by Evan T. Alicuben, Renee L. Levesque, Syed F. Ashraf, Neil A. Christie, Omar Awais, Inderpal S. Sarkaria and Rajeev Dhupar
J. Clin. Med. 2022, 11(21), 6317; https://doi.org/10.3390/jcm11216317 - 26 Oct 2022
Cited by 4 | Viewed by 1437
Abstract
Lung nodule and ground-glass opacity localization for diagnostic and therapeutic purposes is often a challenge for thoracic surgeons. While there are several adjuncts and techniques in the surgeon’s armamentarium that can be helpful, accurate localization persists as a problem without a perfect solution. [...] Read more.
Lung nodule and ground-glass opacity localization for diagnostic and therapeutic purposes is often a challenge for thoracic surgeons. While there are several adjuncts and techniques in the surgeon’s armamentarium that can be helpful, accurate localization persists as a problem without a perfect solution. The last several decades have seen tremendous improvement in our ability to perform major operations with minimally invasive procedures and resulting lower morbidity. However, technological advances have not been as widely realized for lung nodule localization to complement minimally invasive surgery. This review describes the latest advances in lung nodule localization technology while also demonstrating that more efforts in this area are needed. Full article
(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives)
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16 pages, 1125 KiB  
Review
Heart Donation and Preservation: Historical Perspectives, Current Technologies, and Future Directions
by Nicholas R. Hess, Luke A. Ziegler and David J. Kaczorowski
J. Clin. Med. 2022, 11(19), 5762; https://doi.org/10.3390/jcm11195762 - 28 Sep 2022
Cited by 10 | Viewed by 2791
Abstract
Heart transplantation has become the accepted treatment for advanced heart failure, with over 4000–5000 performed in the world annually. Although the number of yearly transplants performed has been increasing over the last decade, the number of candidates in need of transplantation continues to [...] Read more.
Heart transplantation has become the accepted treatment for advanced heart failure, with over 4000–5000 performed in the world annually. Although the number of yearly transplants performed has been increasing over the last decade, the number of candidates in need of transplantation continues to grow at an even faster rate. To distribute these scarce and precious resources equitably, donor heart placement is based on clinical need with priority given to those who are more critically ill. As a result, donors are matched with recipient candidates over increasingly farther distances, which may subject these organs to longer ischemic times. One of the mainstays of successful heart transplantation is successful organ preservation while the donor organ is ex vivo from the time of donor procurement to recipient implantation. In order to adapt to a new era of heart transplantation where organs are shared across wider ranges, preservation strategies must evolve to accommodate longer ischemia times while mitigating the harmful sequalae of ischemia-reperfusion injury. Additionally, in order to address the ever-growing supply demand mismatch of donor organs, evolving perfusion technologies may allow for further evaluation of donor grafts outside of conventional acceptance practices, thus enlarging the effective donor pool. Herein this review, we discuss the history of organ preservation, current strategies and modalities employed in current practice, along with developing technologies in preclinical stages. Lastly, we introduce the concept of donation after circulatory death (DCD), which has been until recently a largely unexplored avenue of heart donation that relies much on current preservation techniques. Full article
(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives)
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12 pages, 1713 KiB  
Review
Chest-Wall Tumors and Surgical Techniques: State-of-the-Art and Our Institutional Experience
by Alessandro Gonfiotti, Alberto Salvicchi and Luca Voltolini
J. Clin. Med. 2022, 11(19), 5516; https://doi.org/10.3390/jcm11195516 - 20 Sep 2022
Cited by 12 | Viewed by 4426
Abstract
The chest wall can be involved in both primary and secondary tumors, and even today, their management and treatment continue to be a challenge for surgeons. Primary chest-wall tumors are relatively rare and include a large group of neoplasms that can arise from [...] Read more.
The chest wall can be involved in both primary and secondary tumors, and even today, their management and treatment continue to be a challenge for surgeons. Primary chest-wall tumors are relatively rare and include a large group of neoplasms that can arise from not only bone or cartilage of the chest wall but also from associated subcutaneous tissue from muscle and blood vessels. Secondary tumors refer to a direct invasion of the chest wall by neoplasms located elsewhere in the body, mainly metastases from breast cancer and lung cancer. En-bloc surgical excision of the lesion should ensure adequate negative margins to avoid local recurrence, and a full thickness surgical resection is often required, and it can result in important chest-wall defects such as skeletal instability or impaired breathing dynamics. The reconstruction of large defects of the chest wall can be complex and often requires the use of prosthetic and biologic mesh materials. This article aims to review the literature on these tumor entities, focusing on the main surgical techniques and the most recent advances in chest-wall resection and reconstruction. We also report on the institutional experience our center. Full article
(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives)
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7 pages, 536 KiB  
Review
A Review of Robotic-Assisted Bronchoscopy Platforms in the Sampling of Peripheral Pulmonary Lesions
by Michael Lu, Sridesh Nath and Roy W. Semaan
J. Clin. Med. 2021, 10(23), 5678; https://doi.org/10.3390/jcm10235678 - 1 Dec 2021
Cited by 14 | Viewed by 3315
Abstract
Robotic-assisted bronchoscopy is one of the newest additions to clinicians’ armamentarium for the biopsy of peripheral pulmonary lesions in light of the suboptimal yields and sensitivities of conventional bronchoscopic platforms. In this article, we review the existing literature pertaining to the feasibility as [...] Read more.
Robotic-assisted bronchoscopy is one of the newest additions to clinicians’ armamentarium for the biopsy of peripheral pulmonary lesions in light of the suboptimal yields and sensitivities of conventional bronchoscopic platforms. In this article, we review the existing literature pertaining to the feasibility as well as sensitivity of available robotic-assisted bronchoscopic platforms. Full article
(This article belongs to the Special Issue Cardiothoracic Surgery: State of the Art and Future Perspectives)
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