Background:Paravalvular leak involving a prosthetic mitral valve (M-PVL) is a rare but serious complication after mitral valve replacement (MVR). This study evaluated contemporary outcomes after surgical correction of M-PVL and investigated factors associated with its recurrence. Methods:This retrospective study included 199 patients who underwent first-time surgical correction of M-PVL between 2002 and 2023 (mean age, 64.5±9.6 years; 55.8% female). Early and long-term outcomes, including all-cause mortality and recurrence, were analyzed using Cox proportional hazards and cause-specific hazards models. The median follow-up duration was 55.9 months (interquartile range, 30.3-96.4 months). Results:Seventy-two percent of the patients had undergone at least 2 previous open-heart operations. The most common concomitant procedures were tricuspid valve surgery (n=78; 39.2%) and aortic valve surgery (n=48; 24.1%). Leak site repair was performed in 81 patients (40.7%), and redo MVR was performed in 118 patients (59.3%). The overall operative mortality rate was 6.0% (n=12) and decreased over time from 12.5% to 2.5%. The 5- and 10-year all-cause mortality rates were 20.7% and 38.4%, respectively. Cox proportional hazards analysis identified several preoperative and operative factors, including the era of operation, that were associated with all-cause mortality. The cumulative incidence of recurrent M-PVL was 10.0% at 5 years and 36.2% at 10 years. Cause-specific hazards analysis identified no factors significantly associated with recurrent M-PVL. Outcomes did not differ significantly between leak site repair and redo MVR. Conclusion:Early outcomes after surgical correction of M-PVL improved over the study period. However, recurrence remained common regardless of operative technique.
Congenital lung malformations (CLMs) represent a heterogeneous group of developmental anomalies increasingly detected through prenatal imaging. The optimal management of asymptomatic patients remains controversial. This review summarizes current evidence regarding surgical indications, timing, techniques, and outcomes. Although some studies report low rates of symptom development, longer-term data suggest that many initially asymptomatic patients eventually become symptomatic and require surgery. Delayed intervention after infection is associated with increased operative difficulty and morbidity. Additionally, the potential risk of malignant transformation, though rare, supports consideration of early resection. Minimally invasive approaches, particularly thoracoscopic surgery, have demonstrated superior postoperative recovery, musculoskeletal outcomes, and pulmonary function compared with thoracotomy. While lung-sparing procedures are increasingly utilized, careful patient selection is essential to minimize residual disease. Overall, early elective resection using minimally invasive techniques appears safe and may optimize long-term outcomes in patients with CLMs.
Tracheoesophageal fistula (TEF) and trachea-conduit fistula (TCF) after esophagectomy are rare but life-threatening complications. Large or multiple fistulas are difficult to treat when standard resection and tracheal reconstruction are not feasible. A 70-year-old man developed an anastomotic stricture after Ivor-Lewis esophagectomy for squamous cell carcinoma and underwent repeated balloon dilatations and stent placement. Progressive tissue injury resulted in 1 TCF and 2 large TEFs. Salvage surgery included stent removal, distal conduit takedown, proximal conduit closure, substernal colon interposition, and esophagocolostomy. The esophagus-proximal gastric conduit segment containing the fistulas was preserved in situ as a neo-posterior tracheal wall. Oral intake was resumed after esophagography on postoperative day 6, and bronchoscopy confirmed a viable blind pouch. Preserving the esophagus-conduit segment in situ may provide effective airway-alimentary separation in selected patients with extensive multifocal TEF/TCF. In highly selected patients, this salvage option for airway-alimentary separation when standard resection and reconstruction carry prohibitive risk. Given the limited survival in this case, it is not intended as a definitive or broadly generalizable reconstruction.
Background:Persistent air leak (PAL) is a frequent and challenging complication of secondary spontaneous pneumothorax (SSP) and often prolongs hospitalization. We compared the efficacy and safety of autologous blood patch pleurodesis (ABPP) plus doxycycline with those of ABPP alone for managing PAL in patients with SSP who were considered unfit for surgery. Methods:This prospective, randomized controlled trial enrolled 121 patients with SSP and PAL lasting ≥7 days. Participants were randomized to receive ABPP alone (n=62) or ABPP plus intrapleural doxycycline (n=59). The primary outcome was time to air leak cessation. Secondary outcomes included the 7-day success rate, time to drain removal, length of hospital stay, pain score, complications, and recurrence at 1 and 3 months. Results:Kaplan-Meier analysis showed significantly faster air leak cessation in the ABPP plus doxycycline group than in the ABPP-alone group (median, 4 days vs. 6 days; log-rank p<0.001). This was accompanied by earlier intercostal drain removal (median, 5 days vs. 7 days; p<0.001) and a shorter hospital stay (median, 12 days vs. 14 days; p<0.001). The 7-day success rate was 81% in the combination group and 74% in the ABPP group (p=0.34). Post-procedural pain scores were higher in the combination group (p<0.001). However, overall complication rates (36% vs. 40%, p=0.6) and 3-month recurrence rates (3.8% vs. 7%, p=0.68) were statistically comparable between groups. Conclusion:Combining doxycycline with ABPP appears to be a safe and effective bedside intervention. Compared with ABPP alone, the combination significantly accelerated air leak cessation and shortened hospitalization, while achieving pleural symphysis without increasing major complications (trial registration number: Pan African Clinical Trials Registry, PACTR202505753650802).
Tracheoesophageal fistula (TEF) and trachea-conduit fistula (TCF) after esophagectomy are rare but life-threatening complications. Large or multiple fistulas are difficult to treat when standard resection and tracheal reconstruction are not feasible. A 70-year-old man developed an anastomotic stricture after Ivor-Lewis esophagectomy for squamous cell carcinoma and underwent repeated balloon dilatations and stent placement. Progressive tissue injury resulted in 1 TCF and 2 large TEFs. Salvage surgery included stent removal, distal conduit takedown, proximal conduit closure, substernal colon interposition, and esophagocolostomy. The esophagus-proximal gastric conduit segment containing the fistulas was preserved in situ as a neo-posterior tracheal wall. Oral intake was resumed after esophagography on postoperative day 6, and bronchoscopy confirmed a viable blind pouch. Preserving the esophagus-conduit segment in situ may provide effective airway-alimentary separation in selected patients with extensive multifocal TEF/TCF. In highly selected patients, this salvage option for airway-alimentary separation when standard resection and reconstruction carry prohibitive risk. Given the limited survival in this case, it is not intended as a definitive or broadly generalizable reconstruction.
