Indian Journal of Thoracic and Cardiovascular Surgery最新文献

Purpose: This study aims to compare the effectiveness, safety, and outcomes of trans-axillary thoracotomy and full sternotomy for surgical repair of simple congenital cardiac anomalies in children.

Methods: A cross-sectional retrospective study was conducted on 90 paediatric patients (aged 2-11 years) treated at Assiut University Heart Hospital between 2010 and 2017. Patients were randomly distributed into trans-axillary thoracotomy and full sternotomy groups. Echocardiography and physical assessments were performed. Operative and postoperative metrics (surgical time, bypass time, intensive care unit (ICU) stay, complications, and analgesic requirements) were collected from medical records and analysed using independent t-tests with statistical significance set at p < 0.05.

Results: Full sternotomy exhibited a shorter operative, bypass, and ischaemic time compared to trans-axillary thoracotomy (p < 0.001). Despite these challenges, trans-axillary thoracotomy had a lower rate of wound complications (11.1% vs. 24.4%) (p = 0.022) and required less postoperative analgesia (p = 0.027), with better pain management and cosmetic results. Trans-axillary thoracotomy was associated with marginally longer ICU (1.40 vs. 1.16 days) and hospital (5.42 vs. 4.13 days) stays postoperatively.

Conclusion: Despite longer surgical times, trans-axillary thoracotomy is a safe and effective minimally invasive alternative to full sternotomy, providing significant cosmetic and recovery benefits. Its successful adoption depends on surgeon expertise and patient selection. Further research should also be aimed at improvements in trans-axillary thoracotomy techniques, leading to reductions in surgical times and longer-term clinical outcomes.

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Purpose: Transversus thoracic muscle plane block (TTPB) is an upcoming modality for analgesia post-sternotomy. We aimed to evaluate the effect of pre-operative TTPB on post-operative analgesia in cardiac surgical patients undergoing sternotomy.

Methods: Seventy patients (18-65 years) of either gender, posted for cardiac surgery needing midline sternotomy, were prospectively enrolled and block randomized into two groups of 35 each -group T (receiving TTPB) and group C (control). Post-operative analgesia was monitored using the Numerical Rating Scale (NRS) during rest, cough, and incentive spirometry. Diaphragmatic excursion and arterial blood gases (ABG) were used to measure post-operative respiratory function, along with total opioid consumption and the duration of post-operative mechanical ventilation.

Results: NRS at rest, during cough and spirometry was significantly lower in group T at 6, 12, and 24 h post-surgery (p < 0.0001). Bilateral diaphragmatic excursion (at rest and maximal inspiration) was reduced more in group C than group T (p < 0.0001 at 12 h and 24 h post-operatively). Mean opioid consumption in the first 24 h after surgery was much lesser in group T (232.29 µg vs 373 µg, p < 0.0001), along with a lesser need for rescue analgesia in the same group. The mean duration of mechanical ventilation was 9.31 h in group T and 11.53 h in group C (p < 0.0001).

Conclusion: Administering TTPB prior to midline sternotomy in cardiac surgeries is an effective way of providing post-operative analgesia. It also improves the diaphragmatic excursion, reduces opioid consumption, and aids in faster extubation.

Trial registration: The study has been registered with the Clinical Trials Registry of India prior to patient enrolment.(CTRI/2022/10/046536).Link to webpage- https://ctri.nic.in/Clinicaltrials/regtrial.php?trialid=75409&EncHid=13705.55824&modid=1&compid=19 Date of registration: 17/10/2022.Date of first patient enrollment: 21/10/2022.

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Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02015-5.

Tracheobronchial metastases from colorectal adenocarcinoma are rare but clinically significant, often with airway obstruction and severe respiratory symptoms. We report the management of a 63-year-old woman with a history of colorectal adenocarcinoma and recurrent metastatic disease, who developed a large endotracheobronchial mass with complete obstruction of the right main bronchus and partial obstruction of the left main bronchus. This case highlights the fundamental importance of a multidisciplinary approach involving interventional pulmonology, systemic therapy, and advanced thoracic surgery for the effective management of extensive respiratory metastases. Furthermore, it underscores the critical role of meticulous surgical planning and the application of innovative techniques in achieving optimal oncological control while preserving respiratory function.

Aim: To examine the risk factors for transfusion during isolated off-pump coronary artery bypass grafting (OPCAB) and investigate the differential characteristics among patients receiving single versus multiple blood transfusion units.

Methods: This retrospective cohort study evaluated patients undergoing isolated OPCAB at a tertiary care centre. Patients were grouped based on whether they received no transfusion, a single unit, or multiple units of blood. Clinical, demographic, and surgical variables were reviewed to assess associations with transfusion requirements. Predictive factors for single- and multiple-unit transfusion were identified through multivariable analysis.

Results: Compared to patients who required no transfusion, those receiving a single or multiple units were progressively older (56.21 ± 9.1 vs. 58.23 ± 9.03 vs. 60.52 ± 11.67 years, p < 0.0001) and had a higher proportion of females (5.8% vs. 7.3% vs. 19.2%, p < 0.0001). Patients who required multiple transfusions underwent more extensive grafting, as reflected by a higher mean number of grafts (2.93 ± 0.91 vs. 3.07 ± 0.90 vs. 3.22 ± 0.85; p < 0.0001), greater drain outputs (604.26 ± 256.05 ml vs. 683.02 ± 328.25 ml vs. 840.47 ± 613.52 ml; p < 0.0001), and higher rates of re-exploration (0.1% vs. 0.6% vs. 5.4%; p < 0.0001). Multivariable analysis identified number of grafts (Odds ratio (OR) 1.58, 95% Confidence interval (CI) 1.45-1.72), female sex (OR 2.95, 95% CI 2.20-3.97), peripheral vascular disease (OR 1.74, 95% CI 1.10-2.74), elevated creatinine (OR 1.34, 95% CI 1.06-1.70), low preoperative haematocrit (OR 0.85, 95% CI 0.84-0.87), and low body mass index (OR 0.93, 95% CI 0.91-0.95) as significant predictors of multiple-unit transfusion. Similar trends were observed for single-unit transfusion, with number of grafts (OR 1.20, 95% CI 1.10-1.31), low haematocrit (OR 0.95, 95% CI 0.93-0.97), and peripheral vascular disease (OR 1.76, 95% CI 1.10-2.82) emerging as significant predictors, while associations with female sex and renal function were not statistically significant.

Conclusion: A higher number of grafts, low preoperative haematocrit, low body mass index, and peripheral vascular disease were common predictors of both single- and multiple-unit transfusion during OPCAB. In addition, female sex and elevated preoperative creatinine were independently associated with an increased risk of multiple-unit transfusion.

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Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02008-4.

Intracavitary (IC) coronary course is an anatomical variant in which a segment of the coronary artery passes inside a cardiac chamber by penetrating through the myocardium. The condition is still under-recognized by cardiac physicians and surgeons despite more frequent reporting. Although it is accidentally diagnosed, with symptoms always unrelated to the IC segment, the risk of complications during cardiac intervention is not uncommon. Percutaneous trans-catheter procedures involving the right side chambers may pose a risk of arterial injury, potentially leading to myocardial ischemia. Moreover, intra-operative dissection of the IC left anterior descending (LAD) artery may cause inadvertent right ventricular injury, with graft anastomosis being technically challenging. A systematic review of literature was conducted on case reports and case series reporting IC coronary course. A total of 200 patients were included, with the diagnosis made either by computed tomography, intraoperatively, or on autopsies. In this article, we aim to provide a structured review focusing on the role of different modalities in diagnosis, clinical hazards associated with interventions, precautions to be implemented, and the current gaps in evidence. In addition, we propose an algorithm for the surgical management of IC LAD requiring bypass graft.

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Tetralogy of Fallot with absent pulmonary valve syndrome (ToF-APVS) is a congenital heart disease with dilated pulmonary arteries causing varied degrees of bronchial compression. Double aortic arch is a complete vascular ring encasing the trachea and oesophagus causing early respiratory compromise. This unique case highlights the concurrence of double aortic arch in ToF-APVS causing respiratory compromise at the tracheal and bronchial levels detected on computed tomography angiography.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02036-0.

Dilated cardiomyopathy (DCMP), a non-ischaemic heart disease involving ventricular enlargement, is the second most common cause of heart failure, with a prevalence of 1:2500. Few studies document the use of paediatric ventricular assist devices (VADs) such as the Berlin Heart EXCOR (BHE) device in those with sepsis. We report an 18-month-old patient, diagnosed with DCMP-induced refractory heart failure, causing septicaemia and thrombocytopenia. Despite this, BHE implantation was used as a last resort bridge to heart transplantation. Our case highlights the importance of carefully managing BHE in high-risk, compassionate-use patients, challenging existing guidelines and encouraging individualised assessments in VAD application.

Pericardial foreign bodies (FB) are exceptionally rare. Complications of pericardial foreign bodies include infections, pericardial effusion, arrhythmias, myocardial perforation, and constrictive pericarditis leading to heart failure. We demonstrate a case in which a pigtail catheter, which was inserted for pericardial effusion, was not completely removed, resulting in retained FB. We retrieved the FB using uniportal video-assisted thoracic surgery (u-VATS) demonstrating its feasibility. The learning point from this case was that it should be confirmed that the whole pigtail catheter had been removed by post-removal chest radiograph and an echocardiogram.