Pub Date : 2024-11-01Epub Date: 2024-10-04DOI: 10.1007/s12055-024-01836-0
H Shafeeq Ahmed
Understanding research designs is crucial for cardiothoracic surgeons to enhance their clinical practice and decision-making. This article provides a comprehensive overview of different research study types, including observational and experimental studies, and their relevance to cardiothoracic surgery. Detailed explanations of cohort, case-control, and cross-sectional studies, as well as various types of randomized controlled trials, are presented. Key terms and concepts like bias, validity, and reliability are discussed. Practical case examples from the literature illustrate the application of these research designs, aiding clinicians in selecting the appropriate study design for their research questions.
{"title":"Research designs for cardiothoracic surgeons: part 1 - a primer for evidence-based practice.","authors":"H Shafeeq Ahmed","doi":"10.1007/s12055-024-01836-0","DOIUrl":"https://doi.org/10.1007/s12055-024-01836-0","url":null,"abstract":"<p><p>Understanding research designs is crucial for cardiothoracic surgeons to enhance their clinical practice and decision-making. This article provides a comprehensive overview of different research study types, including observational and experimental studies, and their relevance to cardiothoracic surgery. Detailed explanations of cohort, case-control, and cross-sectional studies, as well as various types of randomized controlled trials, are presented. Key terms and concepts like bias, validity, and reliability are discussed. Practical case examples from the literature illustrate the application of these research designs, aiding clinicians in selecting the appropriate study design for their research questions.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"40 6","pages":"737-751"},"PeriodicalIF":0.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-07-22DOI: 10.1007/s12055-024-01789-4
Sudipto Bhattacharya
{"title":"Looking ahead: Incorporation of objective assessment methods, surgical simulation and 3D-printed models to improve technical skills of a cardiac surgeon in training in the Indian context.","authors":"Sudipto Bhattacharya","doi":"10.1007/s12055-024-01789-4","DOIUrl":"https://doi.org/10.1007/s12055-024-01789-4","url":null,"abstract":"","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"40 6","pages":"755-756"},"PeriodicalIF":0.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-06-19DOI: 10.1007/s12055-024-01753-2
Anton Kazantsev, Alexander Korotkikh, Roman Leader, Sergey Artyukhov, Lyudmila Roshkovskaya, Vladimir Unguryan, Maxim Chernyavin, Belov Yury
Introduction: This is a retrospective analysis of the results of carotid endarterectomy (CEA) in different age groups.
Methods: This cohort, comparative, retrospective, open-label study for the period from 2008 to 2020 included 7248 patients with hemodynamically significant stenoses of the internal carotid artery (ICA), who underwent CEA. According to the classification of the World Health Organization, patients were divided into groups depending on age: up to 44 years-young age (n = 84); 45-60 years-middle age (n = 1635); 61-75-elderly age (n = 4817); over 75 years-senile age (n = 712).
Results: In terms of the frequency of hospital complications, the group of patients over 75 years of age experienced the largest number of cardiovascular events. One year after surgery, there were no significant differences in the incidence of complications between groups: death (group 1, 1.2%; group 2, 0.5%; group 3, 0.4%; group 4, 1%; p = 0.14), myocardial infarction (group 1, 1.2%; group 2, 0.3%; group 3, 0.14%; group 4, 0.3%; p = 0.12), stroke (group 1, 0%; group 2, 0.3%; group 3, 0.1%; group 4, 0.4%; p = 0.32).
Conclusion: The largest number of adverse cardiovascular events after CEA are observed among patients over 75 years of age, which is due to the high frequency of multivessel coronary lesions, atrial fibrillation, and the severity of the comorbidities. One year after surgery, there were no significant differences in the incidence of complications between groups.
{"title":"One year outcomes following of carotid endarterectomy in different age groups: Russian multicenter study.","authors":"Anton Kazantsev, Alexander Korotkikh, Roman Leader, Sergey Artyukhov, Lyudmila Roshkovskaya, Vladimir Unguryan, Maxim Chernyavin, Belov Yury","doi":"10.1007/s12055-024-01753-2","DOIUrl":"https://doi.org/10.1007/s12055-024-01753-2","url":null,"abstract":"<p><strong>Introduction: </strong>This is a retrospective analysis of the results of carotid endarterectomy (CEA) in different age groups.</p><p><strong>Methods: </strong>This cohort, comparative, retrospective, open-label study for the period from 2008 to 2020 included 7248 patients with hemodynamically significant stenoses of the internal carotid artery (ICA), who underwent CEA. According to the classification of the World Health Organization, patients were divided into groups depending on age: up to 44 years-young age (<i>n</i> = 84); 45-60 years-middle age (<i>n</i> = 1635); 61-75-elderly age (<i>n</i> = 4817); over 75 years-senile age (<i>n</i> = 712).</p><p><strong>Results: </strong>In terms of the frequency of hospital complications, the group of patients over 75 years of age experienced the largest number of cardiovascular events. One year after surgery, there were no significant differences in the incidence of complications between groups: death (group 1, 1.2%; group 2, 0.5%; group 3, 0.4%; group 4, 1%; <i>p</i> = 0.14), myocardial infarction (group 1, 1.2%; group 2, 0.3%; group 3, 0.14%; group 4, 0.3%; <i>p</i> = 0.12), stroke (group 1, 0%; group 2, 0.3%; group 3, 0.1%; group 4, 0.4%; <i>p</i> = 0.32).</p><p><strong>Conclusion: </strong>The largest number of adverse cardiovascular events after CEA are observed among patients over 75 years of age, which is due to the high frequency of multivessel coronary lesions, atrial fibrillation, and the severity of the comorbidities. One year after surgery, there were no significant differences in the incidence of complications between groups.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"40 6","pages":"675-683"},"PeriodicalIF":0.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-07-30DOI: 10.1007/s12055-024-01801-x
Abha Chandra
{"title":"Women in cardiothoracic surgery.","authors":"Abha Chandra","doi":"10.1007/s12055-024-01801-x","DOIUrl":"10.1007/s12055-024-01801-x","url":null,"abstract":"","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"40 5","pages":"532-535"},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11329431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A newly identified left atrial (LA) mass on a post-repair intraoperative transoesphageal echocardiogram (TEE), following a left ventricle (LV) thrombectomy, will make the surgical team wonder-whether a part of the thrombus has been dislodged into the LA or what else could it be? This report is about a 34-year-old male who underwent LV thrombectomy, for whom the post cardiopulmonary bypass intra-operative TEE showed a new LA mass that turned out to be an inverted left atrial appendage on exploration.
左心室(LV)血栓切除术后,术中经蝶窦超声心动图(TEE)新发现的左心房(LA)肿块会让手术团队感到疑惑--是否部分血栓移位到了LA,或者是其他什么原因?本报告涉及一名接受左心室血栓切除术的 34 岁男性,他在心肺旁路术后的术中 TEE 显示新的 LA 包块,探查后发现是左心房阑尾倒置。
{"title":"An inverted left atrial appendage-when it gives a surprise on the table.","authors":"Ancy Robinson, Thiruvenkitasamy Nareshkumar, Madhava Rao Bathala","doi":"10.1007/s12055-024-01726-5","DOIUrl":"10.1007/s12055-024-01726-5","url":null,"abstract":"<p><p>A newly identified left atrial (LA) mass on a post-repair intraoperative transoesphageal echocardiogram (TEE), following a left ventricle (LV) thrombectomy, will make the surgical team wonder-whether a part of the thrombus has been dislodged into the LA or what else could it be? This report is about a 34-year-old male who underwent LV thrombectomy, for whom the post cardiopulmonary bypass intra-operative TEE showed a new LA mass that turned out to be an inverted left atrial appendage on exploration.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"40 5","pages":"626-628"},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11329473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-05-29DOI: 10.1007/s12055-024-01754-1
Mehmet Ali Sahin, Erkan Kuralay
Objective: Antegrade cardioplegia may cause maldistribution in patients with multivessel coronary artery disease. Surgically bypassing large epicardial vessels before the cross-clamp and then administering cardioplegia from both the aortic root and the anastomosed grafts significantly prevent maldistribution and provide better cardiac protection.
Methods: This study included 80 patients, all older than 70 years with an ejection fraction between 25 and 35%. Patients were equally divided into two groups. Distal anastomoses to some of large epicardial coronary arteries were performed before the cross-clamp was placed. Grafted veins were attached to multi-perfusion set ports. Then, cross-clamping was performed, and the multi-perfusion set was disconnected from the aortic cannula and attached to the cardioplegia route. Antegrade cardioplegia was administered to both the aortic root and saphenous vein grafts. After all distal anastomoses were completed, the cross-clamp was removed, and the multi-perfusion set was connected to the aortic cannula again. Conventional coronary bypass techniques were used in group 2 patients.
Results: Inotropic agents were administered in 12 patients in group 1 and 29 patients in group 2 (p < 0.001). The average troponin I value in coronary sinus blood was 1.05 ± 0.8 ng/mL in group 1 and 3.12 ± 0.7 ng/mL in group 2 (p < 0.001). The average lactate value in coronary sinus blood was 1.15 ± 0.55 mmol/L in group 1 and 3.7 ± 2.4 mmol/L in group 2 (p < 0.001). Six patients died in the early postoperative period in group 2 (p = 0.028).
Conclusion: The current technique considerably reduces cross-clamping time and allows better distribution of the cardioplegic solution, preserving myocardium. Reduced coronary sinus lactate and troponin I levels also indicate better myocardial protection.
目的:在多支血管冠状动脉疾病患者中,前向心脏麻痹可能会导致分布不良。在交叉钳夹前通过手术绕过大的心外膜血管,然后从主动脉根部和吻合移植物处给予心脏麻痹,可显著防止分布不良,并提供更好的心脏保护:这项研究包括 80 名患者,年龄均在 70 岁以上,射血分数在 25% 至 35% 之间。患者平均分为两组。在放置交叉钳之前,对一些大的心外膜冠状动脉进行远端吻合。移植的静脉连接到多灌注装置端口。然后,进行交叉钳夹,将多灌注装置与主动脉插管断开,并连接至心脏麻痹途径。对主动脉根部和隐静脉移植物进行前向心脏麻痹。完成所有远端吻合后,移除交叉夹钳,将多灌注装置再次连接到主动脉插管上。第二组患者采用常规冠状动脉搭桥技术:结果:第 1 组有 12 名患者使用了肌力药物,第 2 组有 29 名患者使用了肌力药物(P P P = 0.028):结论:目前的技术大大缩短了交叉钳夹时间,并能更好地分配心脏麻痹溶液,保护心肌。冠状窦乳酸和肌钙蛋白 I 水平的降低也表明心肌得到了更好的保护。
{"title":"Comparison of a coronary bypass surgery using a combination of both on-pump beating heart and cardioplegic arrest with conventional coronary bypass surgery using cardioplegic arrest on-pump.","authors":"Mehmet Ali Sahin, Erkan Kuralay","doi":"10.1007/s12055-024-01754-1","DOIUrl":"10.1007/s12055-024-01754-1","url":null,"abstract":"<p><strong>Objective: </strong>Antegrade cardioplegia may cause maldistribution in patients with multivessel coronary artery disease. Surgically bypassing large epicardial vessels before the cross-clamp and then administering cardioplegia from both the aortic root and the anastomosed grafts significantly prevent maldistribution and provide better cardiac protection.</p><p><strong>Methods: </strong>This study included 80 patients, all older than 70 years with an ejection fraction between 25 and 35%. Patients were equally divided into two groups. Distal anastomoses to some of large epicardial coronary arteries were performed before the cross-clamp was placed. Grafted veins were attached to multi-perfusion set ports. Then, cross-clamping was performed, and the multi-perfusion set was disconnected from the aortic cannula and attached to the cardioplegia route. Antegrade cardioplegia was administered to both the aortic root and saphenous vein grafts. After all distal anastomoses were completed, the cross-clamp was removed, and the multi-perfusion set was connected to the aortic cannula again. Conventional coronary bypass techniques were used in group 2 patients.</p><p><strong>Results: </strong>Inotropic agents were administered in 12 patients in group 1 and 29 patients in group 2 (<i>p</i> < 0.001). The average troponin I value in coronary sinus blood was 1.05 ± 0.8 ng/mL in group 1 and 3.12 ± 0.7 ng/mL in group 2 (<i>p</i> < 0.001). The average lactate value in coronary sinus blood was 1.15 ± 0.55 mmol/L in group 1 and 3.7 ± 2.4 mmol/L in group 2 (<i>p</i> < 0.001). Six patients died in the early postoperative period in group 2 (<i>p</i> = 0.028).</p><p><strong>Conclusion: </strong>The current technique considerably reduces cross-clamping time and allows better distribution of the cardioplegic solution, preserving myocardium. Reduced coronary sinus lactate and troponin I levels also indicate better myocardial protection.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"40 5","pages":"547-553"},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11329465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-08-05DOI: 10.1007/s12055-024-01809-3
Pradeep Narayan
The Nordic Aortic Valve Intervention-2 (NOTION-2) trial is the first randomized controlled trial to compare transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in low-risk patients, specifically focusing on relatively younger patients and those with bicuspid valves. It randomized 370 patients (mean age 71 years) to assess outcomes at 1 year. Results indicated a higher composite primary endpoint rate for TAVI (10.2%) compared to SAVR (7.1%) in the overall cohort, with even more pronounced differences in patients with bicuspid valves (14.3% for TAVI vs. 3.9% for SAVR). The risk of death or disabling stroke at 1 year was also three times higher with TAVI.
{"title":"Bicuspid Aortic Valve dilemma: TAVI or SAVR? Insights from the NOTION-2 trial.","authors":"Pradeep Narayan","doi":"10.1007/s12055-024-01809-3","DOIUrl":"10.1007/s12055-024-01809-3","url":null,"abstract":"<p><p>The Nordic Aortic Valve Intervention-2 (NOTION-2) trial is the first randomized controlled trial to compare transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in low-risk patients, specifically focusing on relatively younger patients and those with bicuspid valves. It randomized 370 patients (mean age 71 years) to assess outcomes at 1 year. Results indicated a higher composite primary endpoint rate for TAVI (10.2%) compared to SAVR (7.1%) in the overall cohort, with even more pronounced differences in patients with bicuspid valves (14.3% for TAVI vs. 3.9% for SAVR). The risk of death or disabling stroke at 1 year was also three times higher with TAVI.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"40 5","pages":"645-647"},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11329489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-05-31DOI: 10.1007/s12055-024-01752-3
Sivakumar Krishnasamy, Raja Amin Raja Mokhtar, Ahmad Farouk Musa, Xian Pei Cheong, Toh Yen Fa
Background: The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to reduce wound pain and infection, compared with open saphenous vein harvesting (OSVH) techniques. There are still controversies regarding this technique. The aim of our study is to investigate the endothelial preservation of saphenous vein (SV) grafts harvested by different techniques. Further observations were made for harvesting and closure time, incision length and effect of pressure distension of the veins to the vein endothelium.
Methods: Prospective observational study of sixty human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin-eosin and Cluster of Differentiation 31 (CD 31) staining. Saphenous vein was harvested endoscopically either by closed CO2 (carbon dioxide) ESVH, open CO2 ESVH or OSVH harvesting technique. Demographic data and intra-operative data were collected. Two saphenous vein samples were collected from each patient to compare differences before and after distension of the veins. Both haematoxylin-eosin and immunohistochemistry slides were imaged by a high-resolution slide scanning system.
Results: Open CO2 ESVH group showed the highest number of endothelial detachments. Mean scoring of the immunohistochemistry method using the CD31 antibody was much lower in the open CO2 ESVH group (33.25% ± 28.71, P < 0.0003). This represents a more poorly preserved endothelial cells in the Open CO2 ESVH than the closed CO2 ESVH. Closure time and incision lengths were significantly shorter in both ESVH groups compared to the OSVH group. Significant low scores of immunohistochemistry for samples were seen in distended veins (39.0% ± 30.08, p = 0.004). The OSVH in random sample B, which represents the conduit that will be used, had a far better endothelium preservation and less endothelial detachment when compared to ESVH.
Conclusion: We observed more endothelial detachment in the open CO2 ESVH group, due to lack of subcutaneous tissue separation, poor visualization and traction stress across the wall of the saphenous vein. The closed CO2 ESVH group had more endothelial cells preserved, but the OSVH group fared the best with the least number of endothelial cell detachment and a higher score of CD31 antibody.
Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01752-3.
背景:据报道,与开放式大隐静脉采集(OSVH)技术相比,内窥镜大隐静脉采集(ESVH)可减少伤口疼痛和感染。但关于这项技术仍存在争议。我们的研究旨在调查通过不同技术采集的隐静脉(SV)移植物的内皮保存情况。我们还进一步观察了采集和闭合时间、切口长度以及静脉压力扩张对静脉内皮的影响:方法:对 60 例人体大隐静脉移植物进行前瞻性观察研究,通过血红素-伊红和分化簇 31(CD 31)染色评估内皮的保存情况。通过闭合式二氧化碳ESVH、开放式二氧化碳ESVH或OSVH采集技术在内窥镜下采集隐静脉。收集人口统计学数据和术中数据。为比较静脉扩张前后的差异,从每位患者身上采集了两份隐静脉样本。通过高分辨率玻片扫描系统对血红素-伊红和免疫组化玻片进行成像:结果:开放 CO2 ESVH 组的内皮脱落数量最多。使用 CD31 抗体的免疫组化法的平均评分在开放式 CO2 ESVH 组要低得多(33.25% ± 28.71,P 0.0003)。这表明开放式 CO2 ESVH 比闭合式 CO2 ESVH 的内皮细胞保存更差。与 OSVH 组相比,ESVH 两组的闭合时间和切口长度都明显较短。膨胀静脉样本的免疫组化得分明显偏低(39.0% ± 30.08,P = 0.004)。随机样本 B 中的 OSVH(代表将使用的导管)与 ESVH 相比,内皮保存更好,内皮脱落更少:我们在开放式二氧化碳 ESVH 组观察到更多的内皮脱落,这是由于皮下组织分离不足、可视性差以及大隐静脉壁上的牵引应力造成的。闭合式二氧化碳 ESVH 组保留了更多的内皮细胞,但 OSVH 组的情况最好,内皮细胞脱落最少,CD31 抗体得分更高:在线版本包含补充材料,可在 10.1007/s12055-024-01752-3上查阅。
{"title":"A histology and immunochemistry study comparing open versus close and open-method endoscopic saphenous vein harvesting.","authors":"Sivakumar Krishnasamy, Raja Amin Raja Mokhtar, Ahmad Farouk Musa, Xian Pei Cheong, Toh Yen Fa","doi":"10.1007/s12055-024-01752-3","DOIUrl":"10.1007/s12055-024-01752-3","url":null,"abstract":"<p><strong>Background: </strong>The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to reduce wound pain and infection, compared with open saphenous vein harvesting (OSVH) techniques. There are still controversies regarding this technique. The aim of our study is to investigate the endothelial preservation of saphenous vein (SV) grafts harvested by different techniques. Further observations were made for harvesting and closure time, incision length and effect of pressure distension of the veins to the vein endothelium.</p><p><strong>Methods: </strong>Prospective observational study of sixty human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin-eosin and Cluster of Differentiation 31 (CD 31) staining. Saphenous vein was harvested endoscopically either by closed CO<sub>2</sub> (carbon dioxide) ESVH, open CO<sub>2</sub> ESVH or OSVH harvesting technique. Demographic data and intra-operative data were collected. Two saphenous vein samples were collected from each patient to compare differences before and after distension of the veins. Both haematoxylin-eosin and immunohistochemistry slides were imaged by a high-resolution slide scanning system.</p><p><strong>Results: </strong>Open CO<sub>2</sub> ESVH group showed the highest number of endothelial detachments. Mean scoring of the immunohistochemistry method using the CD31 antibody was much lower in the open CO<sub>2</sub> ESVH group (33.25% ± 28.71, <i>P</i> < <i>0.0003</i>). This represents a more poorly preserved endothelial cells in the Open CO<sub>2</sub> ESVH than the closed CO<sub>2</sub> ESVH. Closure time and incision lengths were significantly shorter in both ESVH groups compared to the OSVH group. Significant low scores of immunohistochemistry for samples were seen in distended veins (39.0% ± 30.08, <i>p</i> = <i>0.004</i>). The OSVH in random sample B, which represents the conduit that will be used, had a far better endothelium preservation and less endothelial detachment when compared to ESVH.</p><p><strong>Conclusion: </strong>We observed more endothelial detachment in the open CO<sub>2</sub> ESVH group, due to lack of subcutaneous tissue separation, poor visualization and traction stress across the wall of the saphenous vein. The closed CO<sub>2</sub> ESVH group had more endothelial cells preserved, but the OSVH group fared the best with the least number of endothelial cell detachment and a higher score of CD31 antibody.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-024-01752-3.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"40 5","pages":"554-563"},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11329470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Left ventricular (LV) pseudoaneurysms are uncommon, with traumatic cases being particularly rare. We present a case of a 26-year-old male with a delayed presentation of a traumatic LV pseudoaneurysm, 2 years post-blunt chest trauma. The patient experienced New York Heart Association (NYHA) grade 2 dyspnea, which prompted the investigation. Imaging studies, including X-ray, echocardiogram, and cardiac computed tomography (CT), revealed a large pseudoaneurysm arising from the LV apex, containing intramural thrombus. The surgical intervention involved the closure of the communicating orifice and on-lay pericardial patch placement. This case emphasizes the diagnostic challenges and successful management of traumatic LV pseudoaneurysms. Early detection through imaging and prompt surgical intervention led to a favorable outcome. This report contributes to understanding post-traumatic pseudoaneurysms and underscores the importance of a multidisciplinary approach in their management. Further studies are needed to refine diagnostic and treatment strategies for this rare condition.
{"title":"Delayed traumatic left ventricular pseudoaneurysm: diagnostic challenges and surgical management.","authors":"Rahul Bhushan, Arun Kengalapura Ramesh, Vijay Grover","doi":"10.1007/s12055-024-01729-2","DOIUrl":"10.1007/s12055-024-01729-2","url":null,"abstract":"<p><p>Left ventricular (LV) pseudoaneurysms are uncommon, with traumatic cases being particularly rare. We present a case of a 26-year-old male with a delayed presentation of a traumatic LV pseudoaneurysm, 2 years post-blunt chest trauma. The patient experienced New York Heart Association (NYHA) grade 2 dyspnea, which prompted the investigation. Imaging studies, including X-ray, echocardiogram, and cardiac computed tomography (CT), revealed a large pseudoaneurysm arising from the LV apex, containing intramural thrombus. The surgical intervention involved the closure of the communicating orifice and on-lay pericardial patch placement. This case emphasizes the diagnostic challenges and successful management of traumatic LV pseudoaneurysms. Early detection through imaging and prompt surgical intervention led to a favorable outcome. This report contributes to understanding post-traumatic pseudoaneurysms and underscores the importance of a multidisciplinary approach in their management. Further studies are needed to refine diagnostic and treatment strategies for this rare condition.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"40 5","pages":"621-625"},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11329469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}