Δευτέρα, 15 Απριλίου 2019

Cardiovascular & Thoracic Surgery

African-American surgeons: A legacy of excellence
Mark Walker

Nigerian Journal of Cardiovascular & Thoracic Surgery 2018 3(2):21-22



History of pioneer black surgeons in American medicine – Part 2
Arthur Brown Lee, Mark Walker, Jonathan Nwiloh

Nigerian Journal of Cardiovascular & Thoracic Surgery 2018 3(2):23-30

Little information was acknowledged by the American medical establishment on the contributions of Black Americans to medicine in the United States till after the civil rights revolution of the 1960s. This review is an attempt to recount some of the small corps of Black surgeons' trailblazers who helped establish the black identity in American surgery, thereby paving the way for succeeding generations. 


Pharmacologic management of chronic heart failure
Obiora Egbuche, Jo Ann Cross, Anekwe Onwuanyi

Nigerian Journal of Cardiovascular & Thoracic Surgery 2018 3(2):31-35

Heart failure (HF) is a complex progressive clinical syndrome that is associated with high morbidity and mortality. Although several pharmacologic therapy have become available for treatment of certain HF phenotypes, HF still is characterized by recurrent hospitalizations and need for advanced therapy resulting in huge economic burden. The optimal management of HF includes modifying risk factors, identifying and treating reversible causes, address socioeconomic barriers to care and instituting appropriate pharmacologic and device treatments. In this brief review, we summarize the pharmacologic treatment of chronic heart failure and highlight a few major landmark trials that provide the basis for specific therapy in clinical practice. 


Lung metastasectomy in renal cell carcinoma: Evaluation of 20 cases
Aynur Bas, Anil Gökçe, Merve Satir Turk, Muhammet Sayan, Ali Çelik, İsmail Cüneyt Kurul, Abdullah İrfan Taştepe

Nigerian Journal of Cardiovascular & Thoracic Surgery 2018 3(2):36-39

Aim: About 90% of kidney cancers are renal cell carcinoma (RCC), and one-third of them are metastatic at the time of diagnosis. Most RCC metastases are to the lung. In this article, we present the results of a series of pulmonary metastasectomies for RCC in our institute. Materials and Methods: Twenty cases who underwent pulmonary metastasectomy for RCC between 2007 and 2017 were retrospectively reviewed. Patients were classified according to the age, sex, smoking history, duration of disease-free survival, number of metastatic lesions, median survival time, survival time after metastasectomy, type of surgery, and whether they received immunotherapy. Results: Fifteen of the patients were male and five were female. The mean age was 60-year-old (range: 28–86-year-old). Nineteen of the 20 patients had a history of nephrectomy. The median disease-free survival time was found to be 16.5 months while the median survival time after nephrectomy was 43.3 months. The number of detected metastatic lesions ranged from one to eight, and the location of the majority of them was intraparenchymal. Survival time after metastasectomy was found to be 20.6 months. Surgical approaches included bilateral metastasectomy through median sternotomy, unilateral wedge resection, and lobectomy through video-assisted thoracoscopic surgery or thoracotomy. Conclusion: The results of a combination of pulmonary metastasectomy and immunotherapy treatment were found to be better than immunotherapy or surgery alone. However, further study is needed with a larger series to support this argument. 


Chronic mitral regurgitation: Does atrial fibrillation impact outcome in patients managed with medical therapy only?
Jonathan Nwiloh, Uzoma Okechukwu, Kenneth Adiele, Newton Orumwense, Uche Oriaku, Victor Ezenwajiaku

Nigerian Journal of Cardiovascular & Thoracic Surgery 2018 3(2):40-45

Background: The AHA/ACC guideline recommends surgery for symptomatic chronic severe mitral regurgitation or percutaneous mitral valve repair for high surgical risk or inoperable patients. Although atrial fibrillation (AF) is a known predictor of survival after either of these interventional procedures, its impact on the outcome of patients treated only medically is less well defined. Materials and Methods: This was a retrospective review of adult patients with chronic mitral regurgitation seen at our heart center from August 2014 to December 2017. Results: There were 102 patients, with a mean age of 58.4 ± 15.8 years and 51% were males. Major comorbidities were AF (58.8%), hypertension (HTN) (53.9%), pulmonary HTN (18.6%), and diabetes mellitus (10.8%). Sixty-seven (65.7%) patients had primary and 35 (34.3%) had secondary mitral regurgitation. Eighty-eight (86.3%) patients were in New York Heart Association Class 3/4, 92 (90.2%) in AHA/ACC Stages C/D, and 70 (68.6%) had left ventricular (LV) dysfunction with ejection fraction (EF) <60. Patients were subdivided into Group 1 – 60 (58.8%) patients with AF and Group 2 – 42 (41.2%) patients without AF. AF frequency was higher with primary or degenerative mitral regurgitation (PMR) versus secondary mitral regurgitation (SMR), 75% versus 25%, P = 0.031, whereas HTN was higher in SMR versus PMR, 77.1% versus 41.8%, P = 0.001. Four patients underwent mitral valve replacement and two patients implantable cardioverter defibrillator. All patients were treated with the AHA/ACC guideline-directed medical therapy (GDMT). All-cause mortality for Groups 1 and 2 was 25% and 14.3%, respectively, odds ratio was 2.0, and 95% confidence interval was 0.705–5.677, P = 0.285. Overall, Kaplan–Meier survival at 30 months was 63%, and log-rank analysis survival was 56% and 79% for Groups 1 and 2, respectively, P = 0.345. Conclusion: In a cohort of patients with chronic mitral regurgitation treated only medically with GDMT in a low-resource country, all-cause mortality and intermediate survival were comparable between AF and non AF patients. 


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