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BMC Anesthesiol. 2025 Jun 19;25(1):296. doi: 10.1186/s12871-025-03168-x.

ABSTRACT

BACKGROUND: The aim of this study was to develop a risk calculation model for peri-operative 30-day-mortality in preterm infants in non-cardiac surgery.

METHODS: Retrospective monocentric follow-up cohort-study of 27,453 pediatric anesthesias at a German university hospital and level one perinatal center between 2008 and 2021 for non-cardiac surgeries. Inclusion criteria were age < 37 post-menstrual weeks at the time of surgery. The primary endpoint was 30-day-mortality after surgery. For statistical analysis, stepwise backwards logistic regressions were performed to identify predictors for 30-day mortality after surgery.

RESULTS: Between 2007 and 2021, 278 preterm infants underwent surgery. The 30-day-mortality was 8.6% (24/278; CI95%:5.6–12.6). A preselection of potential risk factors was based primarily on prior knowledge available from the literature and the results of previously published studies. The final prediction model using a multivariable logistic regression revealed lower post-menstrual age (odds-ratio(OR): 0.67; CI95%: 0.54–0.83) and lower body weight at the time of surgery for extremely preterm infants (OR: 0.024; CI95%: 0.003–0.22), administration of dopamine or norepinephrine or epinephrine (OR: 11.6; CI95%: 3.58–37.7), and life-threatening emergencies between 10pm-7am (OR: 10.1; CI95%: 2.36–43.5) as significant independent risk factors for 30-day-mortality. The Area-Under-The-Receiver-Operating-Characteristic-Curve (0.90; CI95%: 0.85–0.96) showed a good discrimination of the final model. The investigation of the calibration curve (p = 0.99, Spiegelhalter test) and the goodness of fit test (p = 0.85, Hosmer-Lemeshow test) indicated no significant discrepancies between estimated and observed probabilities for the peri-operative 30-day mortality.

CONCLUSIONS: Peri-operative 30-day-mortality of preterm infants during non-cardiac surgery is high. The prediction model with easily ascertainable factors as described could be a valuable tool for estimating 30-day-mortality in preterm infants and should be validated in larger populations.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-025-03168-x.

PMID:40537757 | PMC:PMC12180206 | DOI:10.1186/s12871-025-03168-x

Am J Transl Res. 2025 May 15;17(5):3546-3553. doi: 10.62347/SMEE7102. eCollection 2025.

ABSTRACT

INTRODUCTION: Spinal meningoceles are congenital anomalies characterized by meningeal herniation through vertebral defects, most commonly occurring in the lumbosacral region. Intrathoracic meningoceles are rare and are typically associated with neurofibromatosis type 1 (NF-1). True anterior thoracic meningoceles unassociated with NF-1 represent exceptionally rare clinical entities.

CASE SUMMARY: This is a retrospective case report. We report a 15-year-old female with severe kyphoscoliosis and a non-NF-1-associated anterior thoracic meningocele who presented with progressive spastic paraparesis. Imaging examinations revealed thoracolumbar scoliosis with 100-degree kyphotic angulation, midline anterior spina bifida at T7, and a well-defined cystic structure exhibiting hypointense T1 and hyperintense T2 signals (measuring 5.7×4.5 cm) anterior to the T7-T8 vertebral bodies. Surgical intervention included posterior spinal laminar decompression, T7 vertebral osteotomy, microscopic dural sac reduction, and stabilization using a pedicle screw system with autologous bone grafting. The patient was discharged without any complications 12 days after surgery, and at the 12-month follow-up, the patient achieved ambulation with a walker and leg brace.

CONCLUSION: This case underscores the necessity of tailored surgical strategies for anterior thoracic meningoceles complicated by severe spinal deformities. The integration of microsurgical techniques and 3D-printed anatomical modeling may optimize procedural safety and functional outcomes.

PMID:40535678 | PMC:PMC12170365 | DOI:10.62347/SMEE7102

J Pediatr Surg Case Rep. 2025 May;116:102989. doi: 10.1016/j.epsc.2025.102989. Epub 2025 Mar 21.

ABSTRACT

INTRODUCTION: Lipomas are typically slow-growing tumors with the highest incidence in the fourth through sixth decades of life, less commonly occurring in pediatric patients, particularly extending across multiple body compartments. Excision is often reserved for cases that cause cosmetic or compressive symptoms and, due to the slow growth pattern, is less likely to be necessary in younger patients.

CASE PRESENTATION: A 2-year-old female with congenital albinism presented with a painless but visible 3 × 4 cm non-mobile left lateral neck mass that had been present for 2 months. MRI without contrast demonstrated a lobulated lesion in the left inferolateral supraclavicular region extending into the left thoracic inlet and thoracic apex. Due to concern for developing mass effect on carotid space structures, resection of the mass was performed. Complete excision was achieved through a single lower cervical incision, requiring dissection from the brachial plexus, carotid sheath, subclavian vessels, and extrapleural thoracic apex. Final pathology revealed an adipocytic neoplasm consistent with a lipoma with a total specimen size measuring 9 × 6.5 × 5 cm. The patient was discharged on postoperative day one and was healing well without complaint at the time of follow-up.

CONCLUSION: Despite their benign nature, cases such as the one presented here demonstrate the capability of lipomas to adhere to and involve surrounding critical structures, particularly when located in the cervicothoracic region and occurring in younger patients. However, with careful surgical planning involving cross-sectional imaging, such lesions can successfully be completely resected through a single cervical incision without morbidity.

PMID:40535308 | PMC:PMC12176381 | DOI:10.1016/j.epsc.2025.102989

Indian J Thorac Cardiovasc Surg. 2025 Jul;41(7):852-862. doi: 10.1007/s12055-025-01907-w. Epub 2025 Mar 6.

ABSTRACT

BACKGROUND: The efficacy and safety of off-pump relative to on-pump coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD) remain unclear.

OBJECTIVES: Conduct a meta-analysis assessing the outcomes following CABG comparing off-pump CABG vs. on-pump CABG.

METHODS: MEDLINE, Cochrane, and Embase were examined for randomized controlled trials (RCTs) and observational studies that communicated outcomes after off-pump vs. on-pump CABG in patients with LMCAD. Odds ratios (OR) with 95% confidence intervals (CI) were pooled with a random-effects model. Cochrane recommendations for quality assessment and risk of bias were performed. This study was registered in the PROSPERO platform, ID: CRD42023451467.

RESULTS: One RCT and 17 observational studies with 16,848 patients were included, 6735 (40.0%) of whom underwent off-pump CABG. In patients with LMCAD undergoing CABG, off-pump CABG was associated with a lower incidence of all-cause mortality (OR 0.52, 95% CI 0.38-0.71; p < 0.001), acute renal dysfunction (OR 0.40; 95% CI 0.27-0.59; p < 0.001), postoperative use of intra-aortic balloon pump (IABP) (OR 0.38; 95% CI 0.22-0.64; p < 0.01), and wound infection (OR 0.66; 95% CI 0.48-0.9; p = 0.01). There was no difference between the groups for myocardial infarction (OR 0.81; 95% CI 0.59-1.11; p = 0.193), stroke, or transitional ischemic attack (TIA) (OR 0.64; 95% CI 0.38-1.06; p = 0.085). The number of grafts per patient was also lower in the off-pump CABG group (mean deviation (MD) -0.32; 95% CI -0.50 to -0.14; p < 0.001). After a mean follow-up of 38.1 months, no significant difference in all-cause mortality incidence was observed between the two techniques (OR 0.72; 95% CI 0.30-1.74; p = 0.47). This underscores that the reduction in mortality rates was primarily driven by short-term outcomes.

CONCLUSION: In this meta-analysis with 16,848 patients with LMCAD undergoing CABG, off-pump CABG was associated with lower rates of all-cause mortality, acute renal dysfunction, IABP use, and wound infection compared with on-pump CABG.

GRAPHICAL ABSTRACT: On-pump versus off-pump CABG in patients with LMCAD.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-025-01907-w.

PMID:40535226 | PMC:PMC12170468 | DOI:10.1007/s12055-025-01907-w

Eur J Cardiothorac Surg. 2025 Jun 3;67(6):ezaf135. doi: 10.1093/ejcts/ezaf135.

ABSTRACT

OBJECTIVES: In the last decades, minimally invasive cardiac surgery has emerged as an alternative approach to conventional median sternotomy. However, some reports state an increased risk of iatrogenic acute aortic dissection. Evidence remains limited regarding preoperative diagnostics for risk reduction and the appropriate adjustment of surgical procedures if acute aortic dissection is detected intraoperatively.

METHODS: In this retrospective single-centre observational study, we analysed 1065 patients who underwent minimally invasive cardiac surgery via right anterolateral thoracotomy for atrioventricular valves and atrial structures with femoral cannulation for cardiopulmonary bypass from August 2009 to June 2021. Occurrence of iatrogenic acute aortic dissection was evaluated, along with patient profiles and the primary composite outcome of major adverse cardiovascular events (non-fatal stroke, myocardial infarction or cardiovascular death). An optimal perioperative strategy was subsequently described.

RESULTS: Intraoperative iatrogenic acute aortic dissection was observed in 8 patients (0.75%). It was identified at the start of cardiopulmonary bypass in 4 patients (50.0%). All patients underwent conversion to full sternotomy; 7 patients underwent additional aortic surgery with circulatory arrest thereafter. In-hospital mortality was 37.5% (n = 3), including 1 intraoperative death. Non-fatal stroke was observed in 12.5% (n = 1). A preoperative computed tomography scan was missing in 3 patients with aortic calcification (n = 1) and hostile peripheral arteries (n = 2).

CONCLUSIONS: Intraoperative aortic dissection in minimally invasive cardiac surgery remains a rare complication. Frequent major adverse cardiovascular events highlight the importance of preoperative imaging based procedure planning. Intraoperatively, early diagnosis with standardized monitoring and time- and location-specific surgical adaptations might increase safety and outcomes.

PMID:40534225 | PMC:PMC12199776 | DOI:10.1093/ejcts/ezaf135