Address for correspondence: Dr. Fotini Ampatzidou, Department of Cardiac Surgery, ICU, General Hospital “G. Papanikolaou”, Exohi, 57010, Thessaloniki, Greece, e-mail: fampatzidou@gmail.com Received: 27.12.2022, accepted: 17.03.2023. Pulmonary artery sarcoma (PAS) is an extremely rare neoplasm arising from mesenchymal cells of the pulmonary artery [1]. PAS was first described in 1923, its incidence is about 0.001% to 0.03% and it is characterized by a very poor prognosis [2]. Early and correct diagnosis is crucial. Unfortunately misdiagnosis is quite common due to overlapping clinical characteristics with pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension (CTEPH), leading not only to delayed therapeutic management but also to unnecessary (and associated with hemorrhagic risks) thrombolytic and anticoagulation therapy [3]. A 68-year-old woman was referred to our Cardiothoracic Department with a case of chronic pulmonary thromboembolic disease in order to undergo pulmonary endarterectomy. She had a history of dyspnea one year ago with gradual deterioration during the last 3 months. A few days before, she was admitted to the Pneumonology Department suffering from thoracic pain. D-dimer levels were mildly elevated. She underwent a chest computed tomography (CT) scan which revealed an inhomogeneous mass arising into the medial bronchopulmonary segment with irregular borders. Triplex vascular ultrasound was performed twice and was negative for deep venous thrombosis. CT pulmonary angiography was suggestive for pulmonary embolism based on the following signs: filling defects in right main bronchus expanded peripherally to medial and lower lobe. Ventilation/perfusion lung scan showed normal ventilation with complete absence of perfusion of the right lung. Dilated right ventricle and estimated systolic pulmonary artery of 39 mm Hg were the main echocardiographic findings. She underwent an elective cardiothoracic surgical procedure with the use of a cardiopulmonary bypass under deep hypothermia (lowest 19°C). Intraoperatively, material from the right pulmonary artery was obtained and examined in frozen sections (Figure 1). The main finding is a mass protruding in the lumen of the pulmonary artery and filling its branches in a mold-like manner (Figure 2). The frozen sections (Figure 3) demonstrated a malignant neoplasm with sarcomatous features. It consisted of highly pleomorphic cells with evident mitotic activity, in an edematous or slightly myxoid background. The cells were either spindle-shaped with enlarged, elongated nuclei, or round to oval-shaped with vesicular nuclei. There were also scattered multi-nucleated cells with lobular nuclei. Subsequently, a right pneumonectomy was performed. Duration of mechanical ventilation was 20 hours and ICU stay lasted 3 days. The patient was discharged on the 6th postoperative day without complications. She underwent chemotherapy and survived 11 months. Intimal sarcoma of the pulmonary artery was first described by Moritz Mandelstamm in 1923 [4]. The true incidence of pulmonary artery intimal sarcoma is unknown, because it is most often misdiagnosed. A high level of suspicion is required due to resemblance in clinical presentation to acute or chronic pulmonary embolism (dyspnea, chest pain, cough, hemoptysis). Hemodynamic instability is suggestive for PE while IPAS is characterized by more long standing symptoms. Diagnosis is based on contemPulmonary artery sarcoma presenting as chronic thromboembolic pulmonary hypertension (CTEPH)

BACKGROUND:The variable life-adjusted display (VLAD) method shows the difference between predicted and observed outcomes over time. Our study aims to implement routine in-house monitoring of risk-adjusted 30-day mortality and morbidity following cardiac surgery.METHODS:The Society of Thoracic Surgeons (STS) risk score was calculated for 249 isolated and combined coronary and aortic or mitral valve cases performed during a 6-month period. The nine predicted STS variables were operative mortality, permanent stroke, renal failure (RF), prolonged ventilation, deep sternal wound (DSW) infection, reoperation for any reason, short and long length of stay (LOS), and major morbidity or operative mortality. EuroSCORE II was also calculated for the study population. VLAD plots were generated for each variable indicating whether performance is better or worse than expected on the basis of predicted risk of failure.RESULTS:The mortality plot was fluctuating close to baseline risk. The prolonged ventilation, RF, reoperation, morbidity/mortality, and LOS plots were consistently positive, indicating favorable results. The stroke chart showed an upward trend for most of the period until two incidents toward last month led to a steep descent. The DSW infections plot though, indicated a worse-than-expected performance. The VLAD charts were shared in multidisciplinary meetings and clinicians were able to confront the performance with the population-specific expectancies and respond to adverse trends with further actions.CONCLUSION:Graphical tool monitoring of risk-adjusted 30-day mortality and morbidity following cardiac surgery is feasible and allows detection of underperformance and implementation of changes in clinical practice.

Background/Aim Deep sternal wound infection (DSWI) after cardiac surgery, is a rare complication that can be fatal. Due to a lack of available data, we compared early in-hospital, 1-year and long-term mortality in patients with DSWI. Methods Patients undergoing any type of cardiac surgery, in the Cardiothoracic Surgery Department of G. Papanikolaou Hospital, between May 2012 and December 2016, were investigated. All patients who developed DWSI postoperatively, treated with negative pressure wound therapy (NPWT), were included in the group of cases. A random population from the rest of the patients was selected in a 1:2 ratio, representing controls. Results From a total of 2104 patients, 80 patients (3.8%) developed DSWI (cases group), whereas 180 patients were randomly selected as controls. Early (within 30 days) mortality was significantly higher in the DSWI group compared with controls (15% vs 3.9%, respectively; P = .002). Similarly, more deaths occurred in the cases group compared with controls during the follow-up (ie, 19 vs 12, respectively; P < .001); the majority of deaths (84.2%) occurred within the first year. Long-term survival did not differ between the two study groups during follow-up (median duration = 1072 vs 1022 days for cases and controls, respectively). Conclusions DSWI significantly increased early and 1-year mortality in poststernotomy patients treated with NPWT compared with those not developing this complication. However, long-term survival was similar between the two study groups, thus highlighting the beneficial effect of NPWT in terms of clinical outcomes in patients with DWSI.

Background: Most studies evaluating predictors of renal replacement therapy (RRT) following cardiac surgery use arbitrary defined limits of preoperative serum creatinine. The aim of this study was to evaluate the effect of preoperative renal function using either estimated-glomerular filtration rate (eGFR) derived using Chronic Kidney Disease-Epidemiology (CKD-EPI) or serum creatinine alone as a predictor for RRT after cardiac surgery. Methods: In this prospective cohort study, baseline, intraoperative, and postoperative data of all patients who underwent an elective, urgent, or emergency cardiac surgery between 2012 and 2016 in a single center were analyzed in order to identify multivariate parameters determining the need for RRT after surgery. For preoperative renal function, we used serum creatinine levels and eGFR-derived CKD-EPI equation. We also divided our cohort into eGFR groups following the thresholds of the currently proposed CKD classification. Results: From the 1,614 patients (mean age: 65.4 ± 10.6 years; male: 77.6%) that constituted the study population, 42 (2.6%) underwent RRT postoperatively. EUROSCORE II, cardiopulmonary bypass time, cross clamp time, red blood cell (RBC) units transfused, type and urgency of surgery, combined/non combined operation, peripheral vascular disease, heart failure, chronic obstructive pulmonary disease, dyslipidemia, and preoperative renal function were all univariately associated with RRT use. Multivariate regression with bootstrap utilization indicated that CKD-EPI eGFR (OR 0.979; 95% CI 0.956–0.998), heart failure with the New York Heart Association class ≥2 (OR 4.695; 95% CI 1.756–14.061) and RBC units transfused (OR 1.287; 95% CI 1.081–1.850) were independently associated with RRT need. When serum creatinine (OR 2.920, 95% CI1.056–8.074) was used in the model, the associations with RRT were also significant. Conclusion: Preoperative renal function, defined by serum creatinine or eGFR by CKD-EPI, NYHA class II–IV, and the number of blood units transfused were all independent predictors of RRT postoperatively.

Abdominal compartment syndrome is associated with severe dysfunction of intra-abdominal and intrathoracic organs. Medical therapy, with the goal of reducing intra-abdominal pressure, leads to improvement in organ perfusion.

Long-term exposure to inhaled silica dust induces pneumoconiosis, which remains a heavy burden in developing countries. Modern industry provides new resources of occupational SiO2 leading to artificial stone silicosis especially in developed countries. This study aimed to characterize the serum metabolic profile of pneumoconiosis and artificial stone silicosis patients. Our case-control study recruited 46 pairs of pneumoconiosis patients and dust-exposed workers. Nontargeted metabolomics and lipidomics by ultra-high-performance liquid chromatography-tandem mass spectrometry platform were conducted to characterize serum metabolic profile in propensity score-matched (PSM) pilot study. 54 differential metabolites were screened, 24 of which showed good screening efficiency through receiver operating characteristics (ROC) in pilot study and validation study (both AUC > 0.75). 4 of the 24 metabolites can predict pneumoconiosis stages, which are 1,2-dioctanoylthiophosphatidylcholine, phosphatidylcholine(O-18:1/20:1), indole-3-acetamide and l-homoarginine. Kynurenine, N-tetradecanoylsphingosine 1-phosphate, 5-methoxytryptophol and phosphatidylethanolamine(22:6/18:1) displayed the potential as specific biomarkers for artificial stone silicosis. Taken together, our results confirmed that tryptophan metabolism is closely related to pneumoconiosis and may be related to disease progression. Hopefully, our results could supplement the biomarkers of pneumoconiosis and provide evidence for the discovery of artificial stone silicosis-specific biomarkers.

Background: To investigate whether obesity impairs the duration of mechanical ventilation in postoperative cardiac surgery patients. Methods: A total of 1,739 patients who underwent elective cardiac surgery procedures under the use of cardiopulmonary bypass from May 2012 to September 2016 were retrospectively analyzed. Body mass index (BMI) was used to classify patients in categories (WHO classification). The total hours of postoperative mechanical ventilation have been correlated with the 3 obesity stages (obese class I, II, III). The non-parametric test of Kruskal-Wallis was used for the statistical analysis Also, obesity in all stages has been correlated with prolonged mechanical ventilation defined as ventilation of more than >24 h by the use of chi-square test Results: Analysis revealed statistical significant correlation between prolonged ventilation (>24 hours) and all stages of obesity (χ2=8,311, P<0.05). After Kruskal-Wallis analysis between hours of mechanical ventilation and each stage of obesity no correlation was found Conclusions: Duration in hours of postoperative mechanical ventilation has no correlation with any obesity stage. The incidence of prolonged mechanical ventilation (>24 hours) is higher in obese patients.

Background: To present the early postoperative and the long-term results of simultaneous or staged surgical management of lung tumor resection and coronary artery disease.

Background/IntroductionPostoperative acute kidney injury (AKI) has negative impact on patient's outcome after cardiac surgical procedures.Reported incidence of AKI requiring renal replacement therapy is approximately 1-3% of cardiac surgical patients and is characterized by extremely high morbidity and mortality rates.

Background Noninvasive Ventilation (ΝΙV) is an important therapeutic choice in case of acute respiratory failure after cardiac surgery with cardiopulmonary bypass. Aim of our retrospective study is to investigate factors associated with ΝΙV failure resulting in re-intubation.

Objective Aim of our retrospective study is to investigate the impact of smoking status on preoperative profile and on postoperative outcome.

The aim of our study was to investigate perioperative risk factors associated with deep sternal wound infections in complicated cardiac surgery.

Innominate artery cannulation is indicated in operations for acute and chronic aortic disease and also in case of porcelain aorta or reoperations. We routinely used innominate artery cannulation in 81 elective operations which included ascending aorta replacement.

Background: Cardiothoracic surgery sternal infections are difficult to treat situations. Until now there are no clear guidelines which or if an antibiotic could be used as prophylactic treatment.Patients and methods: We collected retrospectively data from 535 patients from our hospital which underwent cardiothoracic surgery and recorded several biological parameters and technical aspects of the surgery.Results: It was observed that patients to whom vancomycin was administered had less post surgery infection than those to whom begalin was administered. Male who were treated with vancomycin it was observed that they had 1.67 chances to be treated properly than female. Patients which were hospitalized for more than 7 days before surgery had 62.6% higher chances for post surgery infection.Conclusions: It was observed that vancomycin can be used as a prophylactic treatment for cardiothoracic surgeries acting efficiently against sternal wounds.

Synovial sarcomas are rare tumors accounting for approximately 1% from all cardiac neoplasms and present with a variety of symptoms depending on their location and size.

Pneumothorax can occur in several situations such as; chronic obstructive pulmonary disease (COPD) where emphysema is observed or due to a biopsy for malignancy suspicion. In any case it is a dangerous situation that requires immediate attention and treatment. Pneumothorax can be divided in primary and secondary. Staging of pneumothorax is also very important. In our current editorial we summarize etiology and treatment of pneumothorax from a panel of pulmonary physicians, oncologists and thoracic surgeons.

Acute respiratory distress syndrome (ARDS) can occur during the treatment of several diseases and in several interventional procedures as a complication. It is a difficult situation to handle and special care should be applied to the patients. Mechanical ventilation is used for these patients and several parameters are changed constantly until compliance is achieved. However, a complication that is observed during the application of positive airway pressure is pneumothorax. In our current work we will present definition and causes of pneumothorax in the setting of intensive care unit (ICU). We will identify differences and similarities of this situation and present treatment options.